Plantar Fasciitis in Runners Over Explained

Have you ever hopped out of bed, only to wince in pain with your first step? That sharp heel pain might be more than just a fluke—it could be plantar fasciitis, a common issue that sidelines runners of all levels. But don't worry, you're in the right place.

This guide will break down what plantar fasciitis is, why it happens, and most importantly, what you can do to treat and prevent it. Let's get you back on your feet—literally!

Plantar Fasciitis is pretty popular among runners. Unfortunately, around 10-19% of runners will deal with plantar fasciitis during their running lifetime, making it the third most frequent running injury. [1]

Fortunately, most cases of plantar fasciitis resolve without the need for surgery—only about 5-10% of individuals require surgical intervention [2]. However, the recovery process can be lengthy; research indicates that it can take up to 18 months to fully heal.

This may seem like a considerable amount of time, and understandably so. The encouraging news is that once you begin appropriate treatment, you should start to notice improvements within about three weeks.

In my experience complete recovery typically occurs within 2 to 6 months, depending on the severity of the plantar fasciitis. Generally, the longer the plantar fasciitis has been present, the longer the healing process may take.

Understanding the condition is key to effective treatment. In this article, my goal is to explain what plantar fasciitis is, explore the anatomy and function of the plantar fascia, discuss how it becomes injured, and provide some research-backed strategies for treatment and prevention.

What Is Plantar Fasciitis?

So what is plantar fasciitis?

We'll grab the definition from the Mayoclinic website: 

"Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of each foot and connects the heel bone to the toes (plantar fascia)."

While this is a widely accepted definition, the emphasis on inflammation may not fully capture the condition's nature. Recent studies suggest that plantar fasciitis involves more degeneration of the tissue rather than inflammation [3]. This has led some experts to refer to it as plantar fasciosis. This distinction is important because it may explain why anti-inflammatory medications are sometimes ineffective in providing relief.

Plantar Fasciitis Anatomy: Understanding Your Foot's Unsung Hero

To truly grasp plantar fasciitis, I need you to know a little bit about the intricate architecture of your foot. At the heart of this condition lies a remarkable structure: the plantar fascia. Let's explore this crucial component of your foot's anatomy and why it plays such a pivotal role in your every step.

The Plantar Fascia: Your Foot's Natural Shock Absorber

Imagine a thick, band stretching along the bottom of your foot, anchoring your heel bone to your toes. This is your plantar fascia, a marvel of biological engineering that acts as your foot's built-in arch support system. It's not just a simple strap, though. The plantar fascia is a complex structure composed of three distinct bands, each with its own role to play: [4]

1. The Medial Band: Running along the inside of your foot, this band provides support to the inner arch.
2. The Central Band: This is the star of the show. As the thickest and strongest of the three, the central band bears the brunt of the work in maintaining your foot's arch.
3. The Lateral Band: Situated on the outside of your foot, this band completes the trio, offering balance and stability to the outer edge of your foot.

Together, these bands form a dynamic support system that flexes and tenses with each step, helping to distribute the forces of your body weight and movement across your foot.

Functions of the Plantar Fascia and the Windlass Mechanism

When you walk, run, or even stand, your foot performs an intricate dance of biomechanics. At the heart of this performance is the plantar fascia and a process known as the windlass mechanism. Understanding these elements not only gives us insight into the complexity of human movement but also helps us appreciate how to maintain foot health and prevent conditions like plantar fasciitis.

The Plantar Fascia: Your Foot's Multitasking Marvel

So we've identified where the plantar fascia is and some of its unique characteristics, but how exactly does it function to help us?

Let's explore its two primary functions:

1. Arch Support for Propulsion
   
   Imagine your foot as a bow, with the plantar fascia as the bowstring. As you move, particularly during the push-off phase of walking or running, your toes naturally flex upward. This action pulls on the plantar fascia, causing it to tighten. Like drawing back a bowstring, this tightening elevates your foot's arch, transforming your foot into a rigid lever. This rigidity is crucial for efficient movement, allowing you to propel yourself forward with each step.
2. Shock Absorber
   
   When your foot strikes the ground, especially during high-impact activities like running, it needs to absorb a significant amount of force.  As your foot lands, the arch slightly flattens, and the plantar fascia stretches to accommodate this movement. This stretching action works like a natural shock absorber, helping to dissipate impact forces and protect the bones and joints of your foot from excessive stress.

The Windlass Mechanism: Your Foot's Built-in Pulley System

Now, let's take a look at how your plantar fascia achieves this.

Introducing the windlass mechanism.

The term "windlass" comes from nautical vocabulary, referring to a device used to wind up a rope or cable, creating tension. (I know nothing about boats, I am a Physical Therapist, this is just what I am told.)

How the Windlass Mechanism Works:

1. The Setup: The plantar fascia originates at your heel bone, runs along the bottom of your foot, and attaches to the base of your toes.
2. The Action: As your toes lift upward (extend), particularly during the push-off phase of walking or running, the plantar fascia wraps around the metatarsal heads (the bones at the base of your toes).
3. The Effect: This wrapping action is like winding a rope around a winch. It tightens the plantar fascia, elevating your arch and stabilizing your foot for the push-off.
4.  The Force Absorber: When your foot lands and your toes return to a flat position, the fascia relaxes, allowing your arch to flatten slightly and absorb forces when your foot lands. 

This mechanism is crucial for efficient walking and running. It allows your foot to alternate between being a flexible shock absorber when it first hits the ground and a rigid lever for push-off.

Understanding the windlass mechanism sheds light on why plantar fasciitis develops and how to prevent it. If this mechanism doesn't function properly, it can place undue strain on the plantar fascia. Several factors can disrupt this delicate system:

• Tight calf muscles can restrict the movement needed for the windlass mechanism to work effectively.
• Poor footwear might not allow your toes to move naturally, interfering with the mechanism.
• Abnormal mechanics, such as overpronation, weak foot muscles, and weak hips, can alter how the windlass mechanism functions. 

Over time, these disruptions can lead to micro-tears and degeneration in the plantar fascia, resulting in plantar fasciitis.

How Plantar Fasciitis Develops in Runners

Plantar fasciitis develops through a combination of repetitive stress and the unique biomechanics of running. By understanding this process, runners can better prevent and treat this painful condition.

The Impact of Every Step

When you run, your feet bear the brunt of tremendous forces. With each footfall, your body weight is multiplied two to three times, creating a significant impact that needs to be absorbed through your foot structure. The plantar fascia, a tough band of tissue running along the bottom of your foot, bears much of this task.

As your foot strikes the ground, it rapidly flattens, forcing the plantar fascia to stretch and try to absorb the force. However, like we talked about, this tissue isn't very elastic. This lack of elasticity means that instead of stretching smoothly, the plantar fascia experiences increased tension, particularly at its attachment point on the heel bone (calcaneus).

The Toll of Repetitive Stress

Over time, this repeated stretching and tension can lead to micro-tears in the plantar fascia. These tiny injuries, while not immediately debilitating, can accumulate and cause persistent irritation. The heel, where the plantar fascia attaches to the bone, becomes a focal point for this strain and resulting pain.

The Challenge of Healing

What makes plantar fasciitis particularly tricky is the limited blood supply to the affected area. The attachment point of the plantar fascia to the heel doesn't receive a lot of circulation, which means fewer nutrients and healing factors can reach the injured tissue. This poor blood supply significantly slows down the healing process.

As a result, the micro-tears and irritation in the plantar fascia often struggle to heal completely between running sessions. Continued stress on this already compromised tissue compounds and leads to further damage and delayed recovery. Over time, this ongoing irritation can evolve into chronic pain.

By recognizing how each step contributes to the development of plantar fasciitis, runners can take proactive steps to protect their feet. 

Progression of Plantar Fasciitis Symptoms

For runners developing plantar fasciitis, the journey from initial discomfort to chronic pain often follows a predictable path. Understanding this progression can help you identify the problem early and take appropriate action.

The First Warning Signs

The earliest symptoms of plantar fasciitis are often subtle and easily dismissed. You might notice a sharp pain in your heel when you take your first steps in the morning or after sitting for extended periods. This pain, sometimes described as feeling like a stone bruise on your heel, is caused by the sudden stretching of the irritated plantar fascia.

This initial pain may subside after a few minutes of movement. As you walk around and the fascia warms up, it becomes more pliable, temporarily alleviating the discomfort. This misleading relief can often lead runners to ignore the early warning signs and continue their regular training routines.

The Danger of Ignoring Symptoms

If left untreated, what starts as occasional discomfort can quickly escalate. Continuing to run without addressing the underlying issue puts further stress on the already inflamed plantar fascia. As a result, the pain may become more persistent, occurring not just during those first morning steps, but throughout your daily activities.

Over time, you might find that the pain no longer subsides with movement. Instead, it can become more constant, making its presence felt whether you're walking, standing, or even resting. At this stage, the plantar fascia may have developed more significant damage, making recovery more challenging and time-consuming.

For runners, this progression can be particularly frustrating. You may find yourself unable to maintain your usual training schedule or participate in planned races. The pain might force you to cut runs short or avoid running altogether, impacting not just your physical fitness but also the mental and emotional benefits you derive from your running.

By recognizing these stages of progression, you can take action at the first signs of plantar fasciitis. Early intervention, whether through rest, proper rehab, or seeking professional help, can prevent the condition from advancing to more severe stages and help you return to pain-free running sooner.

Symptoms of Plantar Fasciitis

Okay so you understand all there is to know about plantar fasciitis but how do you know if you have it?

This is where I'm going to say consulting a healthcare professional for an accurate diagnosis is important.

That being said I am aware nobody likes going to the doctor and being aware of the signs can help you understand when to seek medical advice.

The main symptoms you need to be looking for: [8]

Heel Pain During First Steps:

• Sharp pain in the heel or bottom of your foot when taking your first steps in the morning or after prolonged periods of sitting.

Pain Pulling Your Big Toe Up (the windlass test):

• If pulling your big toe upward hurts your heel or arch, it could be a sign.

• Press on the center of your heel - does it feel tender?

Risk Factors For Developing Plantar Fasciitis

Okay so let's say plantar fasciitis is something you are suffering from, understanding why you might be experiencing plantar fasciitis can be crucial in both prevention and treatment. Let's explore the various factors that can increase your risk of developing this painful condition.

Your Unique Foot Structure

Your foot type plays a significant role in your susceptibility to plantar fasciitis. If you have flat feet, your arches may collapse too much when you walk or run, a condition known as overpronation. This excessive inward rolling of the foot can put extra strain on your plantar fascia.

On the other hand, high arches can be equally problematic. While they might look impressive, high arches can prevent your feet from effectively absorbing shock, transferring more stress to the plantar fascia.

Age and Weight Considerations

As we age, our bodies naturally experience wear and tear. Individuals between 40 and 60 years old are at higher risk of developing plantar fasciitis due to the bodies delayed healing abilities. 

Carrying excess weight can also significantly impact your feet. Every extra pound adds pressure to your plantar fascia, increasing the likelihood of irritation and pain.

Muscle Tightness and Weakness

Tight calf muscles might seem unrelated to foot pain, but they can be a major contributor to plantar fasciitis. When your calf muscles are tight, they limit your ankle's range of motion. This restriction forces your foot to compensate by flattening more with each step, increasing tension on the plantar fascia.

Weak foot muscles can also play a role. The intrinsic muscles of your feet are designed to support your arch and lend a hand to your plantar fasciitis. When these muscles are weak, your arch loses its natural support system, putting more stress on the plantar fascia.

Looking up the chain weak hips have been linked to causing flat feet. As we talked about flat feet causes the plantar fascia to stretch straining its attachment point on your heel. 

External Factors

Several external factors can contribute to the development of plantar fasciitis:

1. Physical Activity: High-impact sports like running (hello readers) involve repetitive stress on your feet. In addition suddenly increasing your activity level without proper conditioning can overload and cumulatively overstress your plantar fascia.
2. Occupational Hazards: Jobs that require long periods of standing or walking, especially on hard surfaces, can contribute to plantar fasciitis.
3. Footwear Choices: Shoes lacking proper arch support or with very thin soles can alter your foot mechanics and increase stress on the plantar fascia. High heels are particularly problematic. In addition shoes that are worn out.

Why Understanding Risk Factors Matters

By recognizing which factors apply to you, you can make informed decisions about your footwear, exercise routines, and daily habits.

For those already experiencing plantar fasciitis, understanding these risk factors can help healthcare professionals tailor more effective treatment strategies. It might involve choosing specific stretches, recommending particular shoes, or suggesting lifestyle adjustments to alleviate stress on your plantar fascia.

Remember, while some risk factors like age or foot structure can't be changed, many others are within your control. By addressing these modifiable factors, you can significantly reduce your risk of developing plantar fasciitis or help manage existing symptoms more effectively.

Treating Plantar Fasciitis for Runners

Okay so heres the best part and what you all have been waiting for, how to treat plantar fasciitis. Unfortunately its not easy, and just because a treatment choice works for one person doesn't mean it will work for you.

Treating plantar fasciitis effectively requires a multifaceted approach tailored to your specific needs and running habits.

Understanding Your Plantar Fasciitis is Unique Situation

The first step in treating plantar fasciitis is to identify the specific factors contributing to your condition. Use what we talked about in the risk factors and see if you qualify for them.

Do you have flat feet or high arches? Are your running shoes worn out? Did you recently start a new training program? 

Adjusting Your Training Regimen

One of the most crucial steps for runners with plantar fasciitis is modifying the training routine:

1. Gradual Progression: Avoid sudden increases in your running distance or intensity. Remember, your body needs time to adapt to new stresses.
2. Cross-Training: Incorporate low-impact activities like swimming or cycling into your routine. This maintains your fitness while giving your feet a much-needed break from the repetitive impact of running.
3. Recovery Time: Ensure you're allowing adequate rest between runs. Your plantar fascia needs time to heal and strengthen

Stretching and Strengthening Exercises

For runners, a rehab program using a combination of stretching and strengthening exercises can be particularly beneficial: 

1. Plantar Fascia Stretches: Gently stretch your arch by pulling your toes towards your shin. This is especially helpful for runners with high arches. [10]
2. Calf Muscle Stretches: Tight calves can exacerbate plantar fasciitis. Regular stretching of both the gastrocnemius and soleus muscles can provide relief. [10]
3. Foot Intrinsic Muscle Strengthening: Exercises like towel curls and marble pick-ups can help support your arch and reduce strain on the plantar fascia. [11]
4. Hip Strengthening: Don't neglect your hips! Strong gluteal muscles can improve your overall running mechanics and reduce stress on your feet. [12]

Supportive Gear for Runners

The right equipment can make a significant difference in managing plantar fasciitis:

Recovery Tools

Incorporate these recovery methods into your routine:

1. • Heel Pads: Heel pads can alleviate pressure on the sensitive heel, providing short-term pain relief. However, they won't address underlying issues. [13]
   • Taping: Anti-pronation taping can provide immediate pain reduction by unloading the plantar fascia. [14]
   • Foot Orthosis: Either over-the-counter or custom foot orthotics can support the arch and cushion the heel, reducing pain and improving function. [15]
   • Night Splints: Wearing night splints can be effective, especially for those with morning pain. [16]

   You can explore more tools and resources for recovery here: Plantar Fasciitis Tools for Recovery.

Patience and Consistency

Remember, treating plantar fasciitis is often a gradual process. Consistency with your treatment plan is key. While it might be tempting to jump back into your full running schedule as soon as you feel better, resist this urge. A gradual return to running, combined with ongoing preventive measures, will help ensure a lasting recovery.

By combining these treatment strategies and tailoring them to your specific needs as a runner, you can overcome plantar fasciitis and return to pain-free running. If your symptoms persist despite these measures, don't hesitate to consult a sports medicine professional or podiatrist for more specialized care.

Final Thoughts

I hope this guide has provided valuable insights into understanding and treating plantar fasciitis. By taking proactive steps and utilizing the strategies outlined, you can alleviate pain and return to your running routine.

Until next time,

Joe

Note: Always consult a healthcare professional before starting any new treatment regimen to ensure it's appropriate for your individual circumstances.