Patients were scattered in the cool, wet grassy area just outside the classroom. Half the students pretend to be wounded, complete with fake blood and bruising, while the other students exercise their newly learned wilderness first aid skills. I was casually roaming between medical catastrophes answering questions and asking in return, “Are you going to touch that patient without your gloves?”
This was the day I felt the short-lived, but unmistakable, sharp pain on top of my right foot – it had stress fracture written all over it.
If I know how to react to anything in life, I know how to react to that sharp, little pain on the top of my foot. Action, or reaction, is swift and aggressive: a continuous dose of herbs, the offending area is taped, and extra days of rest added to the schedule. Preventative measures escalate every few days until the issue is resolved; my focus so intense on this little pain that I totally ignored the soreness in the arch of the same foot.
After several weeks of denial, I announced to my husband, “Its plantar fasciitis.” Swift and aggressive reaction finally began.
Last June, Dr. Thomas Michaud wrote an article, New Techniques for Treating Plantar Fasciitis, and updated it this month, as if on cue for me to discover it on running.competitor.com this week – just in time research.
Predicting Plantar Fasciitis
The plantar fascia, connective tissue that runs from the heel to the base of the toes, stabilizes the inner forefoot as forces peak during pushoff (runners expose the plantar fascia to up to 7x their body weight during the pushoff phase). The plantar fascia passively stores and returns energy, while another lesser known, small muscle that goes to the toes (the flexor digitorum brevis muscle – FDB) plays a more dynamic role in variable load sharing.
When tension in the plantar fascia gets too high, the FDB muscle tenses to distribute pressure away from the overworked plantar fascia. Latest research confirms the best predictor of the development of plantar fasciitis is not actually the height of the arch (specialists have commonly believed most plantar fasciitis cases are due to excessive lowering of the arch), but rather the speed in which the toes move upward during the propulsive period (which occurs when the FDB is weak).
There are several tests that can be performed to confirm you have plantar fasciitis (and not heel spurs), but the most common indicator is a sharp stab or deep ache in the middle of the heel or along the arch – worst during the first few steps of the morning or after sitting for awhile.
Injuries in general will almost always respond well to stretching, massage, or both. For example, it is my experience that IT Band Syndrome (ITBS) responds best to massage, especially the jiggling motion favored by a good massage therapist. Stretching does little, if anything, to resolve ITBS.
Plantar Fasciitis responds well to stretching. Pull your big toe back for 10 seconds, repeated 30 times per day. It has proven effective in relieving the pain in my heel after only a few days of consistent stretching – no heel lifts, no night brace, not even massage.
Aside from the fact that athletes often do really stupid things when it comes to training and recovery, there are lessons we can all take away.
When I finally owned up to my injury, my husband reminded me I have been on the verge of plantar fasciitis many times. For years I maintained a stash of tennis and golf balls to massage the arch when I felt that tinge of tightness. At one point, he went so far as to buy the night brace for me, which I hated.
Every athlete’s body has certain weaknesses. Mine happens to be my feet – possibly because of my Morton’s Toe, which makes me susceptible to stress fractures, tight calves and apparently plantar fasciitis. Your issues may be with your knees, hips or lower back. We should pay attention when our body speaks, and become well versed on how to resolve the issues specific to our body. Better yet, be diligent with injury prevention that is especially specific to your issues.
Resolve issues with a swift and aggressive reaction. Think of the days of pain I could have avoided had I not remained in denial.
Recovery, after all, can only begin when we acknowledge the problem.
Do’s and Don’ts for Plantar Fasciitis
- Avoid a mid- or forefoot strike pattern in favor of a heel-first strike, and don’t run hills until the injury is resolved..
- Reduce stride length and increase cadence.
- Build up gradually to minimalist shoes, especially for runners with tight calves.
- Avoid corticosteroid injections; surgical intervention should be a last resort.
- Use trigger point massage.
- Consider taping the arch for support (visit kttape.com for one method)
- Pick things up with your toes / strengthen the FDB muscle (see article below)
- Maintain calf flexibility
- Pull your big toe back for 10 seconds 30x/day