This is part two of "Plantar Fasciitis and Marathon Training'. In part one I provided a brief background on my history with plantar fasciitis. I also explained what the plantar fascia is and described the symptoms of plantar fasciitis itself.In part two, I want to look at the possible causes of plantar fasciitis, treatment, rehabilitation exercises and avoidance strategies to keep your marathon goals alive.
Causes of Plantar Fasciitis
Normally, the plantar fascia acts like a shock absorber that supports the arch of the foot. Inflammation can occur when the plantar fascia is overused or overstretched. It is thought that micro-tears and degeneration of the plantar fascia from overloads on the foot are the cause of this inflammation. When the fascia becomes inflamed, pain results.Risk Factors:
Age - plantar fasciitis is more likely to develop with age (typically between 40 and 60)
Women are more likely to develop plantar fasciitis
Being overweight or sudden weight gain
Exercises that place stress on the heel, such as long-distance running
Tight calf muscles
Occupations that require lots of standing (e.g. teacher, waitress)
Poor foot mechanics - abnormal weight distribution from flat feet or a relatively high foot arch can place significant stress on the plantar fascia
Sudden changes to training methods (e.g. significant increase in running mileage).
When you think about it a bit more, the demands and forces placed upon the foot are massive and it's amazing that we do not injure our feet more often. Forces equal to almost three times our body weight pass through the foot with each step. An elite level athlete has a stride rate of approximately 90 strides per minute. That equates to forces three-times his or her body weight on each foot, 90 times per minute!
Plantar Fasciitis Treatment
When I was first diagnosed with plantar fasciitis by physiotherapist, I thought my marathon dreams were doomed. How was I going to maintain my marathon training schedule with this nasty condition? Well truthfully, I did not maintain my marathon program; I had to tone it down to let my plantar fasciitis heal. All you marathoners know that 'rest' or 'reduce your training' are the last words you want to hear from your doctor or physiotherapist in the midst of your marathon training. Take my advice, listen to them, but find other ways to maintain your fitness levels (e.g. swimming, biking, strength training).Aside from rest, the initial treatment for plantar fasciitis is:
Ice - go for 3-4 sessions of 15 minutes per day. I like putting my foot into a bucket of ice water, that way you are ensuring that the entire foot is covered.
Anti-inflammatory medication such as ibuprofen or aspirin to help reduce pain and inflammation.
Night splints - some physiotherapists may recommend that you wear a night splint, which essentially holds the plantar fascia in a lengthened position through the night. On two occasions, my physiotherapist used athletic tape to create the same effect. I must admit, when I woke up in the morning and took those first few steps of the day, the pain was much less prominent.
Night Splint for Plantar Fasciitis
Rehabilitation Exercises for Plantar Fasciitis
1. Tennis Ball Arch Rolls
Place one foot on tennis ball
Roll arch back and forth over tennis ball
2. Towel Crunches
While barefoot, sit down placing your foot on top of a towel. Use your toes to crunch up the towel towards your body. Start with ten crunches and then reverse (un-crunch the towel away from your body) for ten more repetitions.
3. Calf StretchesAs mentioned above, tight calf muscles are associated with developing plantar fasciitis. This is a well known stretch, but it is important to perform it regularly. Be sure to keep your back foot straight4. Toe Pick-UpsPlace a small objects such as marbles or golf tees into a pile. Now see how many objects you can move into another pile using your toes to pick them up one at a time.
One important point I have not yet mentioned is that I purchased new running shoes at the beginning of my 4-month marathon training program. I thought I was being proactive as I got set to pound the pavement for many, many miles over the coming weeks.
My mistake however, was that I purchased a brand / model of running shoe that I had never worn before (it felt great when I tested in the store). If it aint broke, don't fix it! If you have a running shoe that you like and has not given you problems in the past, stick with it.Lastly, if you need to take some time away from running during your marathon training, look for ways to maintain your cardiovascular fitness and leg strength. Swimming and biking are great options.Related Posts: Plantar Fasciitis and Marathon Training – Part 1