Plantar Fasciitis or Plantar Tendinopathy: How To Treat This Nasty Injury

What the hell is a Plantar and whats Fasciitis got to do with it?

The Plantar fascia is the connective tissue on the sole of the foot which runs from heel bone (calcaneus) all the way to toes. It's basically supports arch of foot and assists with propulsion; the push off or toe off when you walk or run.

Faciistics basically means inflammation- and is the common way to explain all injuries affecting this area. In common Running parlance, instances where you have had a stabbing pain on the sole of your feet near the heel, which is usually at its the worst with the first few steps after awakening or after long periods of standing or rising from sitting are referred to as Plantar Fasciitis.

More recently there has been debate out there about whether inflammation is the primary pain driver in the condition given that it goes on for an awful long time- longer than it takes for the inflammation to resolve. The injury is more in common with tendinopathy- as tissue (collagen) starts to break down, and new blood vessels and nerve endings grow, making it incredible painful and sensitive to loading.

What causes Plantar Tendinopathy?

Plantar Tendinopathy (PT) tends to be a facet of an increase in speed work or dynamic training. Typically you might suffer some discomfort when you put on your spikes for the first time in a while or a try and run some faster sessions on the track or hills in a low profile racing flat. You might wake up in the morning and feet feel a little bit sore. Often that sort of discomfort is ok- but you need to ease back and make training adjustments. If you don’t, the pain tends to gets worse, or it takes longer to settle down  and starts to affect your ability to run at speed.

The main problem will the injury is people don't tend to report it, and continue to run (and more importantly, they continue to run fast!) until it gets to a chronic, persistent, degenerative phase which is incredibly difficult to treat.

There is quite a thin line between niggle and injury and therefore pain in the foot should be treated with real caution, particularly when its not responding to adjustments in your training. If you ease back on the faster running and go back to a slightly more built up shoe your morning pain and stiffness should ease. But when it does not respond you need to get along to a physio and have it assessed and diagnosed. There are a number of conditions which manifest themselves in the same way so it's important to get it diagnosed and receive guidance back to an appropriate level of activity

How to treat Plantar injuries

  1. Monitor your training. This is more difficult if you don’t have a coach, but, as plantar is often caused by sudden increases in faster and more dynamic running- monitoring and reducing this where appropriate should be the first port of call. Having a real understanding of the training pathway and looking for spikes in loading of the muscles is really important.

  2. Look at other non-loading factors that could affect propensity to pick up injury. Could it be that your tired, ill and had other injuries that could affect your gait.

  3. Reduce loading. In the acute phases, running isn’t possible, so priority is getting load away from the irritated fascia. A physio will look at applying traditional manual therapy to sole of foot- we find that because of pain, joints of the mid and rear foot have locked up a little which is further contributed to the stresses. Orthotics can be helpful in short-term and taping can be useful in some instances.

  4. Other methods of treatment such as Shockwave and dry needling have shown good results.

However unfortunately there's no one answer. The most important factor is understanding how much you can run, who often and and what intensity. You also need to address any strength deficits which could be impacting your gait.

We need to work out how tolerant the fascia is. Stopping running and hoping the injury goes away will not solve the problem. Physios will try, unless the pain is 9 out of 10, to get patients doing something and monitor their reaction. The pain during training is not a great gauge- it's how they feel 24 hours afterwards that is the key. The aim is to get to a point where symptoms settle within 24 hours- so if a 5 mile run @ 7min mile pace leads to 4 days of pain you need to strip things back, run more slowly and see how things feels.

That's what runners struggle with, having that patience and discipline. Plantar tendinopathy can drag on for months and months and working out load tolerance can be a difficult process.  Just remember - patience is a virtue!

Are there factors, such as technique, which could reduce the likelihood of picking up this injury?

Suggestions are that high levels of vertical loading -ie runner who have very bouncy strides, are more likely to experience plantar issues. Although there is not a huge amount of research, if you're that type of runner increasing your cadence by roughly 10% can reduce vertical bounce and stress that goes through the feet at impact.