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Sports Medicine
Sports Medicine: Plantar Fasciitis
By Mark Cucuzella, MD, FAAFP
July/August 2011
Plantar Fasciitis is the common term for what should be more accurately termed Plantar Fasciosis.
itis = an acute inflammation caused by a trauma or infection.
osis = chronic degenerative condition.
No evidence exists for an ideal treatment of this condition without identifying and treating the causes, which can be many. Since we have no literature to guide us, this advice comes from seeing hundreds of runners and guiding them in self-corrections.
What is the Plantar Fascia?
The plantar fascia (PF) is a strong ligament that runs from the heel to the metatarsal heads in the front of your foot. This ligament helps absorb the shock that occurs when your foot contacts the ground. It has function in the windlass mechanism recreating the arch on takeoff.
What is the Cause of Plantar Fasciitis?
The PF is designed to manage a relatively small amount of stress. The intrinsic and extrinsic muscles of the foot are designed to receive signals from the fascia and in turn manage the majority of the load. When those muscles are dysfunctional the load gets transferred to the PF, which in turn is unable to handle the load and thus causes tears or plantar fasciitis.
You can repair these tears by using palliative methods, but as soon as you hit it again you will have to go through the same process. The only way that you can actually fix plantar fasciitis is to address the root cause---weak foot muscles.
Structural causes that can contribute to the problem include:
* Weak intrinsic muscles of the foot
* A misaligned and weak first toe
* Tight shortened calf muscles
* Tight plantar fascia
Other important contributors:
* Increased mechanical stress from the amount of running or activity
* Obesity
* Adapting too fast from supportive footwear, which inhibits intrinsic muscles, to flat shoes or barefoot (e.g., in the summertime this can happen if you are going quickly into flip flops or barefoot)
* Poor walking and running mechanics
* Overly supportive footwear leading to instability. This is a paradox as shoes that over support will weaken the foot, which, in turn, leads to the foot’s instability.
What Can You Do to Correct Plantar Fasciitis?
Below are a few basic principles to help correct PF, but they will vary depending on the cause:
1) Any support from an orthotic, arch support, or taping should be a temporary modality while you strengthen and lengthen the tissues. Using one of these forever is akin to breaking your arm and leaving the cast on forever (e.g., in one week muscles begin to atrophy from disuse).
2) Doing eccentric drop down exercises from a stair can help. Place your foot on one step and drop your heels down. It is OK to have a little pain doing this as long as it is getting progressively better.
3) Dorsiflex the big toe to lengthen the PF if it is tight.
4) Get out of heels, gradually and in all activities.
5) Work on foot intrinsics---pick things up with your foot and walk barefoot.
6) Practice a technique of running that encourages more natural form, lighter ground contact and loading rates, and more proprioceptive cueing.
(For more information: check out ChiRunning by Danny Dreyer, Natural Running by Danny Abshire, Evolution Running by Ken Mierke, and the excellent teaching of Lee Saxby of Terra Plana VIVOBAREFOOT).
7) Strengthen your big toe by pushing it into the ground as often as you can whenever you are standing throughout the day. This will wake up the foot muscles and help recreate the arch.
8) If your first toe is bent in, consider a product to straighten it like Correct Toes from Dr. Ray McClanahan.
(For more information: nwfootankle.com).
9) Use the principle of gradual progression and body sensing when making any changes.
10) Avoid NSAIDS (Nonsteroidal anti-inflammatory drugs) like Motrin, ibuprofen, etc. These drugs interfere with natural healthy healing processes.
11) See a good health provider who understands natural running and walking.
Mark Cucuzella is a Family Physician at Harper’s Ferry Family Medicine and an Associate Professor at West Virginia University School of Medicine. As a Lieutenant Colonel in the Air Force Reserves, he is coach and captain of their marathon team. He has a marathon PR of 2:24 and is race director for Freedom’s Run to be held on October 1, 2011. For more information, go to Two Rivers Treads (www.trtreads.org).
(Ed Note: This article is adapted from an article on the Web site www.toesalad.com.)