Running & Plantar Fasciitis

June 4, 2020

By Melisa Abesa PT, DPT, OCS

As we discussed in our last blog, running injuries are unfortunately common – impacting up to 80% of participants. Lower leg injuries are among the most popular when it comes to running, and include shin splints, Achilles tendinopathy, and plantar fasciitis. Let’s dive into the relationship between running and plantar fasciitis.

What is it?

The plantar fascia is a thick layer of connective tissue that runs along the underside of the foot, from the heel to the base of the toes. It is considered an aponeurosis, or long broad sheet of tendon. It is not muscular or contractile in nature. The plantar fascia plays a large role in foot stability and arch support. It is stretched taut with toe extension, or pushing off the ground. 

Plantar fasciitis is the irritation or inflammation of the plantar fascia and typically presents as pain along the bottom of the foot, especially near the heel. Pain is typically the worst with initial loading – first thing in the morning or after sustained sitting.

How does this injury occur? 

Injury often occurs due to repeated stresses or trauma. This can be with repetitive impact like running, or due to sustained standing. Pain is typically triggered due to poor loading tolerance of the tissue from limited shock absorption, limited mobility, poor muscular control, or a combination of these factors. 

Who does it impact?

Plantar fasciitis occurs more often with repetitive loads or sudden changes in loading volume. Individuals with jobs requiring sustained standing or those with recent changes in activity level may be more susceptible. This injury also occurs more often in older individuals (> 40 years old) and those with an elevated BMI (body mass index). Foot posture may also play a role, targeting both higher stiffer arches and flat feet with excessive pronation. Limited flexibility, especially ankle flexion, may also play a role.

How do you treat it?

Treatment for plantar fasciitis is multifactorial and specific to each individual. It should include a combination of offloading structures, addressing mobility and strength deficits, modifying walking or running mechanics if appropriate, and potentially modifying footwear. A physical therapist will create a customized plan to fit your individual needs.

What should I expect at Physical Therapy?

A thorough subjective examination or discussion of your symptoms including:
  • Description of symptoms including severity, chronicity, and triggers
  • Running history – including training volume, terrain, intensity, and any pending races or events
  • Footwear (for running and daily use)
  • General activity including work duties and sustained positions
  • History of prior injury especially of the lower extremity
A physical examination to help identify what structures or movement patterns are contributing to your pain including:
  • Assessment of foot, ankle, knee, and hip range of motion and strength
  • Assessment of lumbar spine and pelvic range of motion and strength
  • Gait assessment
  • Running analysis, including high-speed video analysis
  • Testing of dynamic stability, lumbopelvic stability, and single leg strength
  • Footwear assessment
Appropriate treatment and patient education which may include:
  • Manual therapy including mobilization of muscles and joints for improved range of motion, decreased pain, and improved mechanics
  • Exercises specific to your impairments – targeting flexibility, strength, stability, or motor control/coordination
  • Modifications to walking and running mechanics, which may include changes in cadence, stride length, or positioning
  • Behavior modifications for symptom management, which may include short-term offloading of the foot through activity modification, change in running volume, taping or orthotics, or change in footwear
  • Long term management with home program to further progress strength and mobility, and help mitigate future injury

For a thorough evaluation and individualized treatment, contact us at Evolve Physical Therapy today!

Melisa Abesa is a California transplant who has come to love the Pacific Northwest. Since graduating with her Doctorate of Physical Therapy from the University of Southern California in 2014, she has practiced in the Portland/Salem area. She is a huge advocate for patient empowerment, individualized care, and a holistic approach to health and wellness.

As a board-certified clinical specialist in orthopedic physical therapy, she enjoys working with a large variety of orthopedic and sports related conditions, with special interests including runners, headache treatments, post-operative care, and adolescent athletes.

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