Most runners can spout anecdotal advice regarding their experience with plantar fasciitis. Runners go to extreme lengths to resolve the foot pain that occurs first thing in the morning or with the first steps of their run. Once one has experienced the nagging pain that often lasts for months, one will do whatever it takes to achieve resolution and will remember the specific combination of interventions that allowed the return to pain-free running.
Plantar fasciitis is an inflammation of the fascia on the bottom inside portion of your foot that connects your heel bone to your toes. You may have pain near the heel or closer to your toes. Factors that contribute to irritation of the fascia include: weight gain, unsupportive footwear like flip flops, footwear that does not support the demand of your activity (like dancing at a wedding in three-inch heels), foot muscle weakness that can occur following the use of a “walking boot,” calf tightness in one or both calf muscles (gastroc or soleus), hip weakness, surgery, or prolonged inability to bear weight on your leg.
Here are a few things you can do to help reduce the irritation in your fascia and resolve your pain:
- Wear a splint on your foot at night to allow the fascia to heal in the appropriate position. Our feet naturally point downward at night, which allows the fascia to heal in a shortened position.
- Before putting weight through your foot first thing in the morning, stretch both muscles in your calf. Take a strap, belt, dog leash, etc. and position it around the ball of your foot. With you knee straight, gently pull your foot back until a moderate stretch is felt. Then, with your knee bent and heel resting on the bed, gently pull your foot back until a moderate stretch is felt. Hold each position for 30 seconds and perform 2-3 times on each side.
- Hip strengthening: There are six motions at the hip. Most of us need to increase our hip external rotation strength. To increase hip external rotation strength, lie on your side with your knees bent. Keep your ankles together and separate your knees like a clam. Stop separating your legs when your knee is in line with your hip, then return back to your starting point. Start with three sets of ten repetitions and progress until you are able to perform 3 sets of 15 repetitions. Keep your muscles in balance by performing these movements on both sides of your body, not just on the side that hurts.
- Stretch the muscle that bends your big toe downward. Your flexor hallicus longus (FHL) tendon, which bends your big toe downward, can get intertwined in the plantar fascia, causing irritation. The optimal time to stretch the FHL tendon is before your foot hits the ground in the morning. To stretch your FHL, bend your knee and set your heel on your bed. Grasp your big toe near the tip and gently pull back until you feel a moderate stretch. Hold 30 seconds and perform 2-3 times.
- Dry needling: Deep trigger points in your hip, calf, and foot muscles may be referring pain or be causing continued pain. Dry needling can eliminate the muscle tightness that may be causing tendon or fascial irritation.
As with any injury, seek the care of a health professional to ensure that you are receiving the appropriate treatment and interventions. While you can find accurate and self-guiding information on the internet, it’s the experience and specificity of treatment a physical therapist can offer that can return you to pain-free running.
Bethany Harry Fields
Twin City Track Club Member
Licensed Massage and Bodywork Therapist
Complete Motion Therapy