Plantar Fasciitis is an overuse condition which results in inflammation of the Plantar Fascia, a long ligament covering most of the bottom of your foot, under the skin. We’ll take a look at Plantar Fasciitis treatment for runners and ways to minimise the risk of getting it in the first place.
Table of contents:
- What is Plantar Fasciitis?
- Why does Plantar Fasciitis happen to runners?
- How to avoid Plantar Fasciitis?
- How to recover if you have Plantar Fasciitis?
- How soon can I run after Plantar Fasciitis?
What is Plantar Fasciitis?
The Plantar Fascia connects the heel to the toes / front of your foot, splaying out along each toe, and maintains shape in the arch of your foot while landing on the floor. Plantar Fasciitis pain symptoms are usually felt in the heel and / or along the sole of the foot, as demonstrated between the fingers in the image below, although pain in these areas can be caused by other issues, so see a physician to be sure. Plantar Fasciitis is characterised by often being worse in the mornings / when you first wake up and step out of bed, and pain that lessens with activity. Does this sound familiar? If so, maybe this article will help you.
Why does Plantar Fasciitis happen to runners?
- Over use, under recovery
- Rapid change – zero to hero
- Hard, flat running surfaces
- Change of footwear
- Short and tight calf muscles
1. Over-use, under-recovery
As with most things related to running, the body is excellent at adapting to what you ask it to do, as long as it’s given enough recovery and rest. If you don’t get enough rest after each session, eventually something won’t be able to keep up with the effort it’s being asked to perform. It could be the plantar fascia that gives up first.
There’s a temptation to blame it on “that run I did where I ran fast up that hill” or similar. However, you rarely get injured from one particular session and are far more likely to injured from repeated sessions without enough recovery until the final run where the injury actually happens. It could even be a super easy run, if there hasn’t been enough rest beforehand.
2. Rapid change – zero to hero
Linked to under-recovery, overly rapid change is the enemy when it comes to avoiding running injuries like Plantar Fasciitis. The body takes time to adapt to change and if a change is introduced too rapidly, it won’t be able to adapt quickly enough and will fail somewhere.
3. Hard, flat running surfaces
If you always run on the same flat running surface (road / pavement), your feet don’t get used to their full range of motion. So if you suddenly decide to do a week of hills, where the plantar is put under more load than normal, or some trail routes where you encounter cambers that require the plantar to do more lateral stabilisation, you may find the plantar starts complaining.
4. Change of footwear
If you change the type of footwear you are using, your plantar might need some time to adapt. For example if you go from a very high heel drop shoe to a flatter trail shoe, you may find the extra angle the heel sits in will pull on the plantar more and require some gradual introduction to your running shoe rotation.
Or perhaps you have just started running and spent all your life in work shoes with a firm “supportive” shape under the arch and are now exposed to a soft running shoe, most of which have nothing under the arch. Even pronation control support shoes normally provide this via a post in the outsole or guide rails down the sides of the shoe, rather than putting anything under the arch. Suddenly the arch is required to flex and work more, so the plantar is put under more load than it is used to.
5. Short and tight calf muscles
Your body adapts to endurance running by becoming stronger, but less flexible, to store energy. If you have tight calf muscles, you should work on this, especially if you are thinking of increasing your weekly running duration. Or if you do a lot of squats / lifts, they shorten the calf muscles. Tighter, shorter calf muscles pull more on the plantar, preventing the plantar loosening off at the right moment when you push off the ground during running. This means the foot looses mobility to move the heel back inwards after pronation. Moving the heel in locks the bones in the top of the foot to give a solid platform for propulsion (the heel was out during pronation to let the foot adapt to the surface and absorb impact). If the heel can’t move in, the bones can’t lock and suddenly the plantar is taking the strain instead of the foot bones. Continued stress of the plantar like this leads to plantar fasciitis.
How to avoid Plantar Fasciitis?
To minimise your risk of getting Plantar Fasciitis, make sure you have a well thought out running plan that gives muscles and tissues lots of time to adapt to, and recover from, any increases in intensity, duration or surfaces / gradients. If you don’t have a plan, consider a running coach. It should avoid overly rapid change and provide proper rest. Remember, recovery is the most important session!
Use regular massage to improve blood flow and recovery in between exercise sessions and assist with any calf muscle restrictions if need be. This will maintain suppleness of the soft tissues and optimise range of motion in the ankle joint. At first port of call, this can be self-massage, using a foot roller / golf ball / fingers, and improved by seeing a clinical massage therapist for a more professional result.
If you always wear shoes at home, try walking around the house barefoot a little. This will get the plantar used to a greater range of motion and doing more work. Just a few minutes at a time to start with if it’s new to you – suddenly taking up barefoot walking might itself lead to Plantar Fasciitis unless approached gradually, just like any other change to your regime.
Eccentric Heel Drops are a great exercise for all runners. “Eccentric” exercises are those that load a muscle while it gets longer. Squats and lifts and heel raises make the calves and hamstrings stronger, but shorter. To balance these out, perform Eccentric Heel Drops:
Eccentric Heel Drops: Stand on a step on tip-toes, take one foot off the step and lower the other heel down slowly over a few seconds and hold for a second at the bottom, before putting the hovering foot back on the step and raising back on to tip-toes. Do a few and repeat for the other foot. In this way, it’s easy on the way up and under double the load on the way down, while the calf is being loaded eccentrically. This will strengthen the calves while making them longer. Do this a few days a week, gradually building up the amount of drops. If you already have Plantar Fasciitis, try doing these while leaning the leg over towards the outside of the foot so that the bones in the foot are locked – lean a bit to the left if standing on the left foot, or to the right on the right foot.
For a video to demonstrate this and more information about this specific exercise, press here to see how to do Eccentric Heel Drops. (It opens in a new tab, so this article will stay here for you to finish reading).
Look out for any change in your running or lifestyle. Will you need any more sleep or rest days to go with each change?
How to recover if have Plantar Fasciitis?
When it comes to Plantar Fasciitis treatment for runners, there are a few angles to approach it from, including sufficient rest to start with, plus understanding why it happened in the first place, so that you can put measures in place so it doesn’t reoccur once you get back to running.
Initially you need to rest. It’s rare you will meet anyone that successfully “ran through” Plantar Fasciitis and of those, once you dig deeper, most will say they are “managing it”. Beware of the “last thing I tried” fallacy; if you hear someone say “I tried everything, but eventually rubbed pizza topping on it and the next day it was cured”, it’s far more likely that it was just “time” that healed it. Can you stand on one foot on tiptoe for a few seconds without pain? If not, you need more rest.
Rest doesn’t always mean doing nothing. Rest means only doing activities that do not cause any pain. If you go for a walk and it starts hurting after 30 minutes, you know it’s doing more damage and your healing process is going backwards. If you go for a walk and it’s 100% perfect until 20 minutes, then aim to be back at home after 15 minutes. At that point rest does mean doing nothing. If you spend the afternoon walking around the shops, or doing the gardening, you are adding to the load.
The reason you should not rest completely and still aim to do easy activities is that for optimum healing, you need blood flow, so sitting with your foot elevated while doing nothing is going to slow healing down. Doing activity increases blood flow. The foot is a low blood flow area at the best of times. Keep it warm for extra blood flow – wear socks in bed while growth hormones produced during sleeping are busy doing their thing.
Don’t stretch initially – let it recover first. If it’s already damaged from being stretched too far by running over-use, stretching it more isn’t going to help and might hinder.
Meanwhile, work out why you got Plantar Fasciitis in the first place and change your running plan to avoid the same mistakes. Be brutally honest with yourself. It probably wasn’t that one speed session you did. That session would just have been the final culmination of a period of change that you weren’t ready for.
Self massage areas nearby. This would be the muscles on the side of the foot and on the muscles that cover the plantar in the middle of the arch. It would also be beneficial to massage the muscles around the Achilles and calf. Remember to do both legs, because often the non-affected foot / leg is at risk of over-compensating while you try to avoid pain in the affected foot.
The self-remedy of rubbing a golf ball into the painful area is often recommended for some reason, but there’s little basis in science. The Plantar Fascia is REALLY strong – it has to cope with flexing with your bodyweight every single step, so rolling your foot around on a golf ball isn’t going to do much. It might help massage the muscles around it though, to promote circulation and blood flow, so go ahead and do that, but there’s little evidence jamming the a golf ball into the most painful spot will help you.
Applying Ice once to the foot won’t help it recover and will just reduce blood flow. Instead, if the pain is flaring up, try Contrast Bathing where you are applying cold and then heat alternately for an extended period. Submerge the foot in cold water for 1 minute and then warm water for 3 minutes and repeat for at least 20 minutes, flushing blood in and out of the area each time. However, if you are able without pain, going for a walk for half an hour is a better use of your time and will keep you fitter. If you have time for both, then that’s great.
Once you are able to stand on tip-toe on one foot for a moment without issue, get started on the Eccentric Heel Drop exercises described above.
How soon can I run after Plantar Fasciitis?
Has the pain gone from the Plantar area? If so, can you stand on one foot on tiptoe for a few seconds with no pain? Then you are ready to try exercise again, but not necessarily run. Before leaping back into running, try other more gentle activities! Patience is key.
Walk for an hour. If you can’t walk for an hour non-stop at a brisk pace without any issues, there’s no point in trying running.
You may also find that cycling is pain-free, especially if you are using rigid soled SPD/Clipless shoes that don’t let the shoe bend around the pedals when pressed. If you don’t have access to clipless pedals and shoes, then choose the firmest trainers you have.
Another great exercise to keep you fit without aggravating the Plantar is Front Crawl swimming with a pull buoy. This figure-of-eight float sits between your legs so you don’t have to use them and just use the arms to get the heart rate up. This avoids the flapping motion in the feet and strenuous leg movement during breast-stroke should be avoided too during recovery for the same reason.
Once you can walk for an hour non-stop without issues, start running again. Rather than going straight out for a 5K run, pretend you are a beginner again. Do a minute run with a couple of minutes walk and repeat for 30 minutes. If this is fine, build up super-gradually from there. If you are finding this slow-build mentally challenging, remind yourself how grumpy you were when you couldn’t run at all and how rubbish it will be if suddenly you go back to square one!
Get proper massage for the calf, sole and hamstrings. This will alleviate trigger points and any restrictions caused by tight muscles that may have got tighter during the rest phase.
Strength exercise where possible. Runners are notorious for avoiding non-running exercises, so if you had to pick just two so that it’s easy to keep going with, start with the Eccentric Heel Drops described above. Secondly, consider balancing for as long as possible on a single leg, barefoot, with eyes shut, which will improve your proprioception (ability to detect what’s happening on the ground and react) and let you understand if there’s much difference in strength between the affected foot and the non-affected foot. Can you last thirty seconds? Is the time equal on both legs?
Summary – Plantar Fasciitis Treatment For Runners
Plantar Fasciitis happens due to lack of recovery and over-use.
You can minimise the risk of getting Plantar Fasciitis by using a running plan that is sensible, with gradual changes, and getting regular massage.
If you get Plantar Fasciitis, stay active in ways that are not painful and once you are able to walk for 60 minutes without any issues, consider coming back to running.
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