A very valuable assessment, which I will follow up. I feel more confident about increasing my cycling mileage after making the recommended changes.
Sam, Maidenhead

Plantarfaciitis


JANUARY is that time of year when New Years’ fitness resolutions are put into action and those athletes amongst us pick up where we left off pre-Christmas. All good for you, right? Yes, but any sudden increase in activity levels without sufficient build up or reconditioning can lead to overuse or overload injuries. So if we are not careful, come March, we may fall foul of this blight.

 

Plantarfasciitis is amongst one of the most common and presents with foot and/or heel pain. As symptoms develop they may include:

  • Sharp pain through the inside aspect of the sole of the foot or heel.
  • Pain worse first thing in the morning with stiffness when taking your first few steps of the day.
  • Heel pain during and/or after exercise and on standing from prolonged sitting.

The plantarfascia is a thick band of strong connective tissue running from the heel to the ball of the foot and its primary purpose in life is to provide dynamic support to the medial arch of the foot and assist with shock absorbency. Pain is often a secondary effect of local inflammation caused by overloading and repetitive stretching of the plantarfascia.

Every step you take causes a stretching force to be placed on the plantarfascia, it is even on stretch when we stand still. Add to this the loading forces associated with running and physical activity and is it any wonder these tissues get a bit fed up? As mentioned earlier a sudden increase in activity levels or inadequate recovery time between sessions can predispose the plantarfascia to overload. Other risk factors include:

  • Altered foot biomechanics e.g. a low or high arched foot.
  • Global muscle imbalance – specific weakness and/or tightness that results in poor movement patterns.
  • Age – increased incidence in the 40+ age group.
  • Weight – the heavier you are the greater the mechanical load through the plantarfascia.
  • Poor footwear – ill-fitting or worn-out running trainers and flat shoes such as ballet pumps, flip-flops and Converse are the plantarfascia’s nemesis.

So now you know why it is sore, what can you do to settle the symptoms and address the cause?

  • DELOAD: It is important to first settle any acute inflammation and so taking a break from activities that aggravate pain is a must. These activities need to be re-introduced gradually!
  • FOOTWEAR: Avoid wearing flat shoes that provide little or no support and walking barefoot. It may be worth reviewing the trainers that you are currently wearing. Have they seen better days? Are they suitable for your specific foot type?
  • SUPPORT: Often strapping the foot to provide support to the plantarfascia can provide symptom relief. Furthermore, orthotics can provide support on a temporary or permanent basis, but be cautious with off-the-shelf products; every foot is different and so ‘one size fits all’ is not always the case.
  • EXERCISES: It is important to ensure sufficient mobility through the ankle and flexibility through the entire posterior chain. Here are a couple of exercises that you may find useful. In addition, it may be worthwhile incorporating these into your training program to prevent against further exacerbations.

 

Self-Myofascial Release (SMR) with ball into Plantarfascia

PF Ball Release

  • Place a tennis ball beneath the sole of the foot and apply pressure using bodyweight (can be done in sitting or standing).
  • Roll the ball through the area of soft tissue between the
  • heel and the balls of the foot (plantafascia region).
  • Concentrate on areas that feel tight and ‘sore’.
  • Continue for approx 5 minutes.

 

Self-myofascial release with the GRID into calf complex

PF Calf Roller

  • Place calf on foam roller and reinforce with other leg.
  • Lift up onto hands to put weight through lower body.
  • Sequence: Roll up for 2” and back down for 1” – Repeat x4, foot slaps x2, foot circles clockwise x2 / anticlockwise x2.
  • Repeat sequence all the way up the calf to just below the knee.
  • Complete at the centre, inside and outside of the calf.

 

Self-myofascial release with ball into the gluteal complex

PF Glute Ball Release

  • Place tennis ball underneath buttock muscles (in front and to the side of sitting bone).
  • Ensure both buttocks remain off the floor.
  • Sequence: lift and externally rotate leg x4, clamshells open x2, clamshells closed x2, pivot on the ball clockwise x2 / anticlockwise x2.
  • Repeat sequence at 4 points throughout the buttock.
  • Complete at the centre, inside and outside of the calf.

 

Downward Dog Fascial Stretch

PF Start DD PF Mid DD PF Up DD

  • Begin in lying with hands placed beneath shoulders and toes turned under.
  • Push up into a plank position – maintaining a strong core and foot/hand position.
  • Transfer body weight backwards into the lower body pushing your heels down towards the floor.
  • Be strong through the upper body but ensure you remain relaxed through the head, neck and shoulders.
  • It is important to maintain a neutral spinal position and so you may need to bend the knees to offload through the hamstrings if your lower back in rounding too much.
  • Hold for 30secs – 1minute and repeat up to 3 times.

 

 

Ankle Mobility Drills

PF Start Hip Mob PF Toe Tap End

  • In standing ensure left foot is facing forwards.
  • Bend the left knee and gently touch the heel of the right foot on the floor.
  • Ensure that the medial arch of the left foot is maintained and that the knee does not drift inwards – it must move towards the 2nd toe.
  • Return to the start position.
  • Repeat x10 on both the right and left leg.

PF Start Hip Mob PF T Step End

  • Adopt the same starting position as above.
  • Bring the right foot in front of the left creating a T shape with the feet.
  • Ensure that both knees face in the same direction as their respective foot and the medial arch of the foot is maintained.
  • Return to the start position.
  • Repeat x10 on both the right and left leg.

 

Often there is an underlying biomechanical or movement dysfunction that can predispose to plantarfasciitis. If you think this is the case for you, then you may benefit from the in-depth gait and movement analysis that we offer at the Drummond Clinic.

 

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