Plantar fasciitis (PF) is a common condition found in runners and can significantly impact running ability and performance. In the past PF was defined as a chronic inflammatory pathology which prompted a treatment approach designed to reduce inflammation with things like rest and anti-inflammatory medication. Currently, however, PF is considered to be more similar to a tendinopathy where inflammation is only a small component of the problem and inappropriate load on the soft tissues is the primary issue. Therefore, just resting may not cut it. The good news is that just like tendinopathies, PF can be improved with the help of physical therapy so you can get back to training and setting new PRs ASAP!
In general, the plantar fascia can become a source of pain when it is stressed beyond its loading capacity. Everyone’s loading capacity is different and may change with training (or detraining). A marathon runner will have a different capacity than someone who runs 2-3 miles on the weekend. A good rule of thumb with overuse injuries is “most injuries happen from doing too much too fast after doing too little for too long”. Other factors such as muscle flexibility, range of motion, and foot muscle weakness can contribute as well.
Physical Therapy Evaluation
Your physical therapist will consider your chief complaints, as well as your current performance, goals, and training regimen, and will take you through a thorough assessment and running gait analysis.
Goals of the Evaluation
- Determine what elements are contributing to potential excessive loading/stress of the plantar fascia.
- Diminish loading forces, in order to alleviate symptoms, allow healing of the soft tissue, while also avoiding a complete stop in training!
- Consider foot strike patterns. This is an important element because different foot strike patterns place different demands on your feet and load the plantar fascia differently. When running with a forefoot strike the load on the PF is increased compared to a rearfoot strike. This is not a bad thing as the PF can adapt and get stronger to handle this. However, if not given adequate time to adapt, this may contribute to development of PF. As part of rehabilitation, if appropriate, your physical therapist may change your foot strike pattern and cadence to offload the PF and decrease your symptoms and then gradually return you to running even better than before!
- Can include a change in distance, intensity, duration or frequency of your runs.
- Implementation of a strength training program can be helpful and will be tailored to your specific needs and impairments.
- Manual therapy to promote proper joint mechanics and soft tissue length and tension.
- Improve muscle flexibility and endurance, especially of the calf and foot intrinsic muscles. This will increase the resilience of your feet and legs and get you setting new PRs in no time!
- Modalities to control inflammation as needed
If you’d like to make an appointment to be evaluated by one of our skilled Orthopedic Physical Therapists, please call (212) 353-8693 or email schedule@zionpt.com.
Cristina Sabbadin DPT
References:1. Petraglia F, Ramazzina I, Costantino C. Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscles Ligaments Tendons J. 2017;7(1):107–118.2. Chen TL, Agresta CE et al. Ultrasound elastographic assessment of plantar fascia in runners using rearfoot strike and forefoot strike. J Biomech. 2019 May 24; 89:65-71.
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