Plantar Fasciitis.

Plantar fasciitis is one of the most aggravating and common foot ailments, accounting for around a quarter of all injuries suffered by runners.

The foot is a remarkable mechanism that can be flexible enough to adjust to the surface on which it is walking or running, and then become a stiff weight-bearing structure that propels the body ahead efficiently. The foot can generate a lot of force, but it also has to absorb a lot of it, making it subject to overuse and injury. Walking may put up to 2.5 times our body weight through the foot and ankle, and running can put up to 5 times our body weight through the foot and ankle. When you add jumping to the equation, your foot has to take up to 20 times its own weight!

 

 

Function and Anatomy

The foot is made up of 26 bones that form 34 joints, as well as 20 muscles and tendons that regulate it. The plantar fascia is a large ligament-like structure that runs from the heel bone (calcaneus) to the base of your toes (metatarsal heads) on the bottom of your foot, providing support and shock absorption to the longitudinal arch of your foot. During push off, it also turns potential energy into kinetic energy, resulting in increased foot acceleration.

 

Plantar Fasciitis

 

Symptoms

The pain is commonly felt near the bottom of the heel or in the middle of the arch of the foot, and it is worse in the morning and gets better after a few minutes of walking. Plantar fascia discomfort may be noticed in the initial few minutes of activity, then ease or disappear once you’ve warmed up, and then again after you’ve finished. Walking barefoot on hard surfaces is normally difficult (and not recommended), but it is less painful if you wear supportive shoes with enough cushion. It’s crucial to remember that, as with any injury, the more intense and frequent the pain, the more severe the injury is likely to be. If you have pain that lasts more than a few days, you should always seek medical care.

 

 

Causes

Plantar fasciitis is a common overuse condition that causes inflammation and pain due to the accumulation of micro-trauma. Training errors, inadequate footwear, and tight and weak muscles of the foot, calf, thigh, and hip are all common causes of plantar fasciitis. Any mechanism or action that generates excessive pronation (flattening of the arch of the foot) increases tension within the plantar fascia, and any mechanism or activity that causes excessive pronation has the potential to cause damage.

 

Training errors are mainly caused by doing too much too soon and can affect the frequency, length, or intensity of training or exercise (or any combination of these factors). Too much stress combined with insufficient rest will strain the plantar fascia beyond the body’s ability to repair it, resulting in damage. Proper footwear that is intended to match the unique demands of an activity is essential for support and shock absorption in order to prevent excessive pronation. The mechanics of the foot are influenced by several muscles in the foot, ankle, thigh, and hip, which, if tight and/or weak, can induce excessive pronation. Overweight, high arches (pes cavus), flat feet (pes planus), and leg length disparities are also risk factors.

 

 

Prevention and Treatment

Treatment begins with activity modification or total rest and ice, as with any musculoskeletal or soft tissue injury. Consult a doctor if the discomfort persists for longer than a few days. The first step in treating plantar fasciitis is to protect the foot as much as possible. This involves always wearing supportive and cushioned footwear and avoiding going barefoot, wearing sandals, or flip-flops, as these typically provide little to no support or cushion.

 

Self-massage with a tennis ball and taping might also be beneficial. Ice can assist relieve inflammation and pain, and a night splint may be necessary. Our feet usually assume a pointed (plantar flexed) posture as we sleep, which causes the plantar fascia to shrink. When the alarm goes off and we get out of bed, we immediately stretch the plantar fascia by flexing the foot in the opposite way (dorsiflexion). Night splints keep the plantar fascia from being overworked when you get out of bed by maintaining the dorsiflexed posture.

 

When you are able to resume training, review your program to identify and correct any training flaws that may have contributed to your situation. Identify and treat any muscle weaknesses or inflexibilities that may contribute to excessive pronation and poor mechanics. Because excessive hip adduction and internal rotation of the thigh lead to excessive pronation of the foot, this includes local foot and ankle muscles as well as those of the thigh and hip.

 

Do not pick up where you left off with your training. Depending on how much time you missed, you may need to begin at 25%–50% of your normal program and gradually increase by 10% or so each week, or as directed by your physical therapist, doctor, or coach. For best support and cushioning, replace worn shoes and consider replacing insoles in ALL of your shoes.

 

The greatest preventive advice, as with most injuries, may be summarized in what I call the PETR Principles, which comprise adequate Preparation, Equipment, Technique, and Recovery.

 

A conditioning program that includes a proper warm-up, flexibility, strength, endurance, and balance training is referred to as preparation. Conditioning is essential for everybody who participates in any sport or activity on a regular basis because it not only enhances performance but also helps to prevent injury by raising our physiological tolerance. The gastroc-soleus complex, posterior tibialis, and peroneal muscles of the calf are flexible and strong in plantar fasciitis because they assist control the rate and amplitude of pronation. The hip adductors, abductors, and external rotators are significant because they control internal rotation of the femur (thigh) and shin (tibia) bones, which affects foot pronation.

 

Using the appropriate activity-specific equipment, such as good footwear for running or hiking, bike fit for cycling, racquet and golf club fit, and so on, is essential. Plantar fasciitis-specific equipment comprises footwear that provides enough activity-specific support and cushioning. Replacement insoles can help with support and shock absorption while also increasing the area of contact between the foot and the shoe. A bespoke orthotic may be required in the case of severely flat feet, arched feet, or leg length disparities.

 

When performing an activity or sport, technique refers to proper form and/or body mechanics. Runners are more likely to use ‘technique’ when it comes to plantar fasciitis. Proper cadence, posture, and leg movement are all crucial factors that, when used appropriately, can reduce pronation, reduce stress, and increase overall efficiency. Cadence refers to the number of steps done in a certain amount of time, usually one minute, with a greater cadence being preferred.

 

Recreational runners have a lower cadence of 165 steps per minute than more experienced runners who have a cadence of 180-192. Shorten your stride and increase your cadence if you’re on the lower end of the cadence scale. Consider having a gait study performed by an experienced physical therapist, coach, or running shoe salesperson to discover your ideal cadence. Technique is important in any action or sport, and it can be learned.

 

Within a training program, recovery includes enough rest so that the body may replenish, adapt, and get stronger. Depending on the intensity of an activity or exercise, rest and recuperation can take many various forms. The more severe the workout, the longer it will take to recuperate. Complete rest, such as sleep or days off, or “relative rest,” such as an easy training day, are examples of recovery. However, without appropriate rest, sleep, or healing time, the body becomes weary and more prone to injury.

 

Coaching
Whether you are a leisure or professional athlete, you should consider hiring a coach regardless of how serious you are about a particular sport. Not only can a little knowledge help you improve your performance, but it can also help you avoid injury.

 

Conclusion

Plantar fasciitis is manageable, while painful and annoying, and the sooner it is correctly recognized and treated, the faster it will heal. If you are already involved in or considering beginning a new training program, make sure to follow the PETR Principles of preparation, equipment, technique, and recovery to avoid many additional overuse injuries.

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