Plantar Fascitis: Causes and Cure
Runners, particularly distance runners, commonly suffer from Plantar Fascitis, an inflammation of the plantar fascia of the foot. The function of the plantar fascia is to help hold up the arch along the inside of the foot. When running, we strike the ground with two to five times body weight at approximately 1500 foot falls per mile. With every foot strike the arch drops (pronates) to unlock the foot for impact absorption. As the arch drops the plantar fascia is stretched, repeated stretching of the fascia can cause irritation and inflammation. The hallmark symptom of plantar fascitis is sharp pain underneath the heel, especially during the first 10-20 steps out of bed in the morning.
Plantar fascitis may have intrinsic and extrinsic causes, or a combination of both. Both causes result in increased stress on the fascia.
EXTRINSIC CAUSES:
Extrinsic causes are due to training errors that increase the stress on the plantar fascia beyond the body's ability to adapt. Too great an increase in run frequency or duration produces too many repetitions. Increased pounding causes an increase in the amount of force created at each heel strike, this occurs during speed works or on harder running surfaces.
INTRINSIC CAUSES:
Intrinsic causes of plantar fascitis are related to faulty foot biomechanics,
which result in overpronation (flat feet). The quicker and farther your arch
tends to drop while running, the more likely it is for those extrinsic factors
to produce irritation. Weakness of other supporting structures designed to
assist the plantar fascia places more stress on the plantar fascia. As we move
forward over our planted foot, the front of our foot and toes move closer to our
shins. This is called dorsiflexion. At least 10 degrees of dorsiflexion is
necessary for good running form and may be restricted by a tight heel cord (calf
muscles). The body compensates for this by increasing pronation.
A WORD ABOUT HEEL SPURS:
Heel spurs are created as the body combats chronic irritation to the plantar fascia by depositing the hardest substance it can to protect the area. This substance is bone, and spur formation occurs at the origin of the plantar fascia under the heel. Since this is the site of pain, it is often pointed to as the cause. This is not usually true, as it is a reaction to the cause - faulty mechanics. While removal of the spur occasionally decreases the pain, if the faulty mechanics are not corrected, pain and spur formation may recur.
WHAT YOU CAN DO:
Symptom relief is beneficial for your recovery, but the cause must be addressed or recurrence is likely.
Symptom Relief: the following should alleviate pain and inflammation.
1. Icing the painful area will reduce inflammation more efficiently than oral anti-inflammatories:
a. Ice packs - 20 minutes on, 40 minutes off. Repeat 3-5 times a day.
b. Ice massage - fill a paper cup with water and freeze it. Peel back the cup and massage the ice directly on your skin for 8-10 minutes, again off for 40 minutes. Repeat 3-5 times a day.
2. Ice should always be applied after a run while tissues are recovering.
3. Compression Massage: rolling your foot back and forth over an object like a golf or tennis ball helps break up adhesions and disburse swelling. The best approach is to use an empty glass coke bottle, stick it in the freezer (there's that cold thing again) and use for massage as necessary. This should be performed several times a day for 5-10 minutes.
4. 90° Night Splint: Our bodies do most of their healing at night while sleeping. Sleeping on our stomachs, for example, causes our toes to point down, shortening our plantar fascia. This causes scar tissue to lie down in a shortened format. The first few steps in the morning stretches the fascia, tearing the newly formed scar tissue and producing intense pain during the first few steps in the morning. Splinting the ankle at 90° while sleeping keeps the fascia from healing in a shortened position at night and has proven to decrease healing time.
CORRECTING THE CAUSE:
Extrinsic Causes: Address errors in your training program.
1. Active Rest - Cross training will allow you to train while taking the pounding stress off your injured fascia. It will also enable you maintain your aerobic base and prevent you from driving your significant other crazy with your grumpiness! Swimming, cycling, or using cross country ski machines and elliptical machines available at your local health clubs are great sources of aerobic exercise with differing amounts of pressure on the plantar fascia.
2. Frequency - Recovery time naturally increases with age, so you may need to take more days off than you used to. Proper nutrition also becomes more important with age, to provide the body with the building blocks to repair itself.
3. Intensity - Try not to follow a speed session day with a run course with long or steep downhills.
4. Duration - A general rule is not to increase your long slow run by 1-2 miles per week, or your total weekly mileage by more than 10% per week.
5. Type - Softer surfaces like packed dirt are a good alternative. Running on packed dirt trails is the best, let's give it a factor of 1, asphalt would have a factor of 2, concrete a 3. That's how much harder concrete is than asphalt. However, training for a marathon on dirt and running it on the streets will predispose you to injury because your body will not be prepared for the increased pounding.
Intrinsic Causes: Intrinsic causes are due to problems with biomechanics and require some form of functional correction. These conditions tend to recur even after prolonged rest.
1. Stretch!!: I've been treating runners for over 13 years now and I have yet to meet a runner that says "I think I stretch too much." Stretching your calf muscles should always follow your runs, but as the most dense muscle tissue in your body, and should be stretched frequently throughout the day. One calf muscle crosses the knee joint (gastrocnemius) and one does not (soleus), so they must be stretched separately. All stretches should be held for 30 seconds and performed throughout the day. Face a wall to lean into and place your right foot back in a lunge position, toes facing straight ahead or slightly inward (pigeon toed). Press your right heel into the floor, keep your knee straight, and lean your upper body towards the wall. Be sure to keep your heel down on the floor. Keeping your knee straight will stretch the gastrocnemius, which should be felt behind and below the knee. To stretch the soleus, bring your torso away from the wall and bend your right knee. Bring your torso forward again, keeping the back knee bent, heel pressed to the floor. You should now feel the stretch closer to your heel.
2. Strengthen: Heel raises are the only exercises that have been shown to strengthen the structures that support the arch. Like the stretches, they should be performed with the knee straight and the knee bent. I recommend doing single leg heel raises off the edge of a step to take the muscle through a full range of motion. Performing them in a doorway without holding on will build balance and coordination through a limited range of motion. And performing skipping drills when tolerated by the injury will incorporate them at a speed similar to running.
3. Proper Footwear: Overpronation can often be corrected by changing to a "motion control" or "stability" shoe. Every shoe company makes them, most commonly by incorporating a "dual density midsole" into their shoes. The sole will have cushioning along the medial side (inside) and under the arch of the shoe that is stiffer than the cushioning towards the lateral (outside) of the foot. These densities are usually different colors and easy to spot, but I would recommend going to a specialty running store for advice.
4. Orthotics: Orthotics are foot beds placed in the shoe that are designed to reduce or eliminate overpronation and the stretch it places on the fascia. These can vary in price from $15.00 to $500.00 and can be bought generically over the counter or made completely custom for the individual. As a provider of custom orthotics, I've compared a lot of companies and approaches to orthotic prescription. Here's what I recommend:
a. Not everyone needs orthotics! Try to find someone who can objectively evaluate your needs (not an orthotic store owner). In our clinic we send patients out for new shoes and try to get the correction there. We then tape our patient's arches to discern whether it reduces the pain. This indicates if orthotics will help.
b. All orthotics are not the same. Over the counter ones are not always cheaper than custom sets, and custom does not mean completely custom. Some companies claim to provide custom orthotics, when in reality they pull from ready-made forms, which most closely match the patient's needs.
c. Your orthotics are only as good as the casting procedure used. Ask the benefits of the procedure used by your orthotic provider over other casting procedures.
d. Last but not least, if you have a pair of orthotics, custom or otherwise, if they make enough of a difference to help overpronation, it should hurt to only wear them running. If you continue to experience pain despite your orthotics, they may not be providing enough of a correction.
Plantar fascitis can be a complex problem not often resolved simply by rest. Early evaluation and proper treatment are beneficial, while prevention through stretching and strengthening are invaluable.
Illiotibial Band Friction Syndrome: by Dr. Josh Laughlin
ITB friction syndrome or runner’s knee is a painful condition where the distal aspect of the band crosses the knee. As the knee is extended, the ITB rubs on the lateral femoral epicondyle (the bump on the outside of your knee). This usually occurs in people with tight IT bands and excessive pronation of their feet. To prevent this condition, get fitted with the right shoes, and stretch your IT bands. If you are experiencing knee pain, be sure to have an evaluation by your doctor or physical therapist, to rule out other potential injuries. It is best to take care of the problem early to avoid unnecessary pain and extended layoffs from your sport.
Josh Laughlin DPT, ATC
Clinical Director
Briargate Physiotherapy Associates
Stopping Chronic Ankle Sprains: by Dr. Josh Laughlin
Do you suffer from chronic ankle sprains? Have you skipped out on therapy to get on to your next race? Many people who chronically sprain their ankles have poor proprioception and balance on the involved leg.
Proprioception is the awareness of your body’s position in space. In other words, if your big toe is pointing up, you know this without looking at it because the proprioceptors in the joints signal your brain of your toes position.
After injuring your ankle, your ligaments and tendons are often overstretched, giving you a false sense of your ankle position. With balance and reaction exercises, you should be able to decrease your risk of having recurrent sprains. As always, check with your doctor or physical therapist after injury for proper evaluation.
Josh Laughlin DPT, ATC
Clinical Director
Briargate Physiotherapy Associates
Stress Fractures: by Dr. Lee Fleming
Running, as you well know is an excellent way of getting in shape, but like any sport, it requires a lot of effort. If you don’t believe that, just remember back to your first week of running. You were probably anaerobic (without oxygen) after five minutes, had accumulated enough lactic acid to fill a five-gallon milk pail, and were wondering if all of those runners you saw in the gym and on trails were a little psychotic. In spite of that, you have made it to the level that you’re at right now by either sheer luck or just plain perseverance. Hopefully you haven’t been injured along the way.
Anytime you’re involved in a sport that requires running, jumping, lurching, or squatting, your feet and legs absorb a great deal of shock. The body adapts well to these stresses if given enough time. However, if you’re a little overweight, exercise on a very hard surface, wear the wrong kind of shoes, or no shoes at all, or accelerate your pace too fast, you may be in trouble.
One of the most common weight bearing injuries associated with improper shock absorption are stress fractures. These fractures are actually micro breaks in the long bones of the feet and legs that are extremely painful and make even walking a chore. The pain is dull to sharp, localized over the area of the break and exaggerated by walking, running, or jumping. The area over the fracture is many times swollen, red, and painful to touch. The pain may continue even after exercise has ceased and has been known to interrupt sleep. The injury is caused by simply not allowing the body enough time to build up its bone structure enough to resist the stresses it is called upon to withstand.
If you’re having these symptoms you would do well to see a sports medicine podiatrist, for a definitive diagnosis. X-rays will be taken and the injured part will be immobilized until healing takes place. Never “work through the pain”. That is a sure-fire way of turning a four week injury into a four month injury.
Lee Fleming, DPM
Colorado Springs Foot and Ankle Clinic
3100 N. Academy Blvd. #115
Colorado Springs, CO 80917
Send questions or comments to Dr. Fleming at flemfam@hotmail.com.
Is your hip causing your knee, back, and/or ankle pain?: by Dr. Josh Laughlin
Hip musculature strength and activation are often overlooked when assessing athletic injuries. Weakness in the hip often leads to problems throughout the lower extremities. For instance, weak hip external rotators and abductors often lead to early pronation of the foot. When the foot hits the ground the weak rotators are unable to adequately decelerate the femur (thigh bone) causing the knee to turn in and the longitudinal arch of the foot to drop early. This my cause pain in the anterior aspect of the knee and along the posterior tibialis (the muscle along the medial side of the shin) which supports the arch. The IT band may also become aggravated as it shortens and rubs over the greater trochanter of the hip (the bump on the side of your hip where muscles attach) or at the distal portion where it crosses the knee. The lumbar region (low back) becomes irritated when the hip rotation decreases resulting in excessive rotation at the spine.
Watch yourself in the mirror when you step down or a stair. Does your knee turn in? Does your waist line drop on the side you are stepping down with? Does your arch collapse? If any of the above occur, you may need to focus on strengthening your hips.
Josh Laughlin DPT, ATC
Clinical Director
Briargate Physiotherapy Associates
If the Shoe Fits, Check It Out Even Further: by Dr. Lee Fleming
Chances are you’ve had a difficult time in the past deciding which model of running shoe is best for you. You’ve probably seen the ads for some shoes and wonder if dual density EVA, external heel stabilizers and leather foxing on a semi curved combination last are really right for you. It’s almost like buying a car.
If you are in the market for a new pair of running shoes, there are several pointers you should keep in mind. Since there really aren’t any major expenses in running, you ought to be willing to spend a few dollars on some good shoes. Every once in a while, you can find a great pair on sale, but most of the bargain-basement varieties are not built well enough to provide adequate shock absorption and control of excessive foot and leg motion.
After all, the first thing to hit the ground when you run is the foot. If the shoe doesn’t provide adequate stability to the foot, unnecessary torque and strain will be transmitted to the ankle, knee and hip, causing all kinds of aches and pains.
The following tips may be helpful when shopping for shoes:
1. Never buy court or basketball shoes to run in. The heel is not elevated as in running shoes, which may cause excessive stretching of the Achilles tendon.
2. Purchase your shoes from people that understand running. Don’t be afraid to ask your salesman if he or she runs or has experience with runners.
3. The shoe should be constructed with leather reinforcements. Shoes made entirely of leather are too heavy and lose their supportive shape readily.
4. The heel counter is the part of the shoe that surrounds your heel. It should be rigid, firmly attached to the sole and perpendicular to the supporting surface. If the counter is not glued on to the sole properly, it may tilt, which lessens its stability.
5. The sole (outsole and midsole) should provide adequate shock absorption yet be firm enough to prevent side-to-side motion. If you can sink your thumbnail into the midsole and leave a deep impression, it’s probably too soft.
6. Combination lasting is usually the best. The last is the mold that the shoe is formed around. After the material is stretched around the mold, a board (actually dense cardboard) is glued to the bottom, which then adheres to the sole. The front part of the shoe doesn’t have this board but is glued directly to the sole. This combination provides stability in the rearfoot and increased motion and comfort in the forefoot.
7. Sizing is important. Fit yourself in the afternoon when the feet are swollen and allow at least one thumb’s width longer than your longest toe. Some people’s second or third toes are longest. Try on both shoes. If you’re right-handed, generally the left foot is longer.
8. Avoid shopping by mail order. You don’t know what you’re getting and the sizing may be wrong.
Remember, shoes are the most important piece of running equipment that you will ever own. Select good ones, replace them when worn and save them for running only. Many injuries can be prevented by following theses simple rules.
Lee Fleming, DPM
Colorado Springs Foot and Ankle Clinic
New Year’s Resolutions: by Dr. Grove Higgins
Well, the title is a little misleading. My resolution is to write more often. Aside from that, I want to encourage you to make a resolution of your own. Make a plan. Running is great, but do you have a goal? Now is the time to look ahead and plan out your race season. If you are not interested in racing, then perhaps you run for weight loss, personal health, or stress relief. In order to get the most out of your running, you need to have specific goals in mind. Don’t get frustrated over not losing the weight you want or miss peaking for your big race.
Here are three quick principals for setting goals to help you achieve the results you want:
Make reasonable goals, which can be completed in a realistic amount of time. A good example of this would be planning to run a 5K race in four months, when you already have a decent aerobic base; while a marathon in four months would be unreasonable without previous conditioning. Another example would be the goal of losing 10lbs in two months, whereas 2 weeks would mean certain failure.
Set a timeline so you can check your progress. Make your expectations a reality one step at a time, by setting intermediate goals.
Reward yourself when you hit your goals—intermediate as well as end goals. Go out to dinner, throw a party, or go buy yourself that super GPS running chronometer. You are worth it and now you have proven it to yourself!
Lastly, prepare yourself so that you are ready to pursue your goals now! Get yourself a good pair of running shoes and any other equipment you need. If you have any medical or physical problems, get them addressed before they become an injury that keeps you from running and from your goals. Also, get your biomechanics checked out so that you are able to run more efficiently and with fewer problems.
In the future months I hope to cover a broad range of subjects: nutrition, innovative products, specific injuries, and anything that you, as readers, want to know about. Also, my offer stands—if you give me a topic that I write on, you will receive a BRC running shirt as a prize. So, don’t let this opportunity pass you by.
Finally, I want to announce that I have changed my practice location. As of this month, I am part of Champion Health. I can now offer you 4 doctors, more than 4000sq feet of advanced exercise-based rehab and performance enhancement services, laser therapy, electrotherapies, and the most innovative health care environment for athletes as well as non-athlete available. I hope to see you there!
Champion Health Associates, LLC
175 S. Union Boulevard, Suite 230
Colorado Springs, CO 80910
Ph 473-7000
Helpful Hints to Avoid Shin Splints: by Dr. Lee Fleming
Ever tried telling your three-year old no? I did just last week and found out why my wife wants to freeze dry him until he’s 21. First came the look of indignation and then the four-minute temper tantrum complete with facial frenzy and high-pitched alien noises. I caved in. “Go ahead and have your chocolate chip cookies for breakfast, see if I care!”
Why am I mentioning this in a running article? To tell you the truth, I’ve gotten the same exact response from runners when I tell them they can’t run for a few weeks due to a stress fracture, shin splints or some other injury.
To help avoid these outbreaks of grief, I’m going to try to give you some helpful hints on how to guard against many of these debilitating injuries. This month – shin splints.
Shin splints hurt. The most common variety occurs in the inner leg (or shin) and most frequently in the unconditioned beginner due to overexertion or in the conditioned athlete attempting to increase his workload too fast. There’s also a higher incidence in overweight females and those with bow legs and flat feet. Probably as many as half of all runners have experienced the discomforts that could be considered shin splints.
Several factors that can precipitate symptoms of shin splints are running on hard terrain such as cement, poor biomechanics of running as in chronic pronation (flattening of the feet), improper shock absorption in footwear and running downhill or the same direction around circular tracks.
The most frequent location for shin splints is the inner and lower one-third of the leg. Pain occurring here is the result of musculotendinous inflammation of the tibialis posterior muscle. This is one of the major muscles holding up the arch of the foot. When a person flattens his foot excessively, this muscle is stretched beyond its elastic limits and may be partially separated from its insertion higher in the leg. This results in inflammation and big-time pain.
Shin splints also describe several other problems in the leg – mainly stress fractures and compartment syndrome.
Stress fractures are the result of chronic overload applied to the bones in the legs and feet. The bone responds by breaking down and forming a hairline fracture that usually cannot be seen even by x-ray at first.
Compartment syndrome, on the other hand, results from overuse of the muscles that raise the foot to clear the ground.
Treatment of the musculotendinous or garden-variety type of shin splints is aimed at decreasing the overuse of the muscle involved.
The following may help:
· Ice massage the entire front and inside of the leg before and after a workout.
· Use of anti-inflammatory medication (aspirin or other stronger medication that must be prescribed by your doctor).
· Orthotics – specially built arch supports that decrease pronation.
· Taping and padding of the long arch of the foot.
· Gradual strengthening of the muscle group involved through a series of isometric and isotonic exercises.
· Change to shoes that don’t allow pronation.
· Avoid downhill running. If you must then do so slowly. Don’t ever try to make up lost time by running downhill fast.
· Avoid hard unforgiving surfaces such as asphalt or cement. Dirt roads are best.
· Change directions when running around circular tracks.
Shin splints are divided into four grades of severity:
Grade 1 – pain after athletic activity.
Grade 2 – pain before and after athletic activity, does not affect performance.
Grade 3 – pain before, during and after athletic activity.
Grade 4 – pain so severe the athlete in unable to be competitive.
Remember, long-term shin splints can be as painful as listening to your three-year old complain in the morning. So be smart and avoid them.
Lee Fleming, DPM
Colorado Springs Foot and Ankle Clinic
Rules for Snow and Ice: by Dr. Lee Fleming
Today we devote our article to those hearty souls that find themselves trudging around in snow and ice this winter. There are two simple rules:
Don’t fall.
If you break rule number one, get help.
As you know, when the snow and ice accumulates, walking and/or running sometimes become treacherous (mind you I don’t advocate staying indoors all winter). There are some simple guidelines that you can do to avoid nasty spills. First and foremost, wear the right shoes. Icy sidewalks and high heels simply do not mix. Wear shoes that have as much contact with the ground as possible. Also, find shoes that have textured soles as opposed to smooth manmade or leather soles. If the soles on all your shoes are presently smooth, take them to your shoe repairman and have him add a thin textured outsole. This is not very expensive and it really helps you grip the road.
Overshoes are also important to keep shoes dry during inclimate weather. It is important, however, to inspect the tread on older overshoes. Sometimes the textured areas provided for friction have been worn down and are now smooth. This means it is time for a new pair. Needless to say, avoid overshoes that re smooth to begin with..
If the unavoidable does happen and you do take a spill, it is important that proper care is taken to insure a speedy recovery. The first rule is to never underestimate the severity of an injury. What many self diagnose as a simple, sprained ankle, for instance, may in fact turn out to be ruptured or severely sprained ligaments, or even bony fractures that require immobilization or even surgery for complete correction. Many runners that have suffered such a sprained ankle hobble around on it for years before healing finally takes place. Then they are left with an ankle that is not quite as strong or stable as it could have been had proper treatment been rendered.
I would urge that if you do take a spill this winter that the following rules be observed:
Call for help; do not try and ambulate on a sore foot, ankle or leg. Have someone assist you.
When in doubt, ice elevation and compression are the best rules.
Seek professional help. You are simply not qualified to determine the extent of your injuries. Much disability and suffering can be avoided with prompt and effective treatment.
In any event, I hope you have a wonderful holiday season and stay healthy by exercising daily, maintaining a good diet and avoiding those nasty spills that can disrupt all your fun.
Lee Fleming, DPM
Colorado Springs Foot and Ankle Clinic
Stretching for Success
By Dr. Grove Higgins
In previous articles, we have described athleticism as a mixture of skills and traits. These include flexibility, balance, agility, strength, endurance, speed, and power (more or less in that order). Flexibility is one of the most important, since it is the base of the other skills, and also one of the most misunderstood aspects. Most athletes don’t do an adequate job in developing it or they choose to not bother with it at all. Let’s fix this mistake.
Most athletics do not require great extents of flexibility; this is especially true of running. Yet there is a healthy amount that will enhance your performance. As running is largely reflex, it does not require a great deal of flexibility. However, improving your flexibility allows you to improve those reflexes and become more efficient. Stretching is one of the easiest ways to work on your flexibility.
There are many types of stretching. Two major categories are passive and active stretching. Passive (i.e. bending over to touch your toes) uses gravity or another force outside the body to elicit a stretch. This allows you to pull connective tissue to its elastic end and create more length in the muscle. This is great if you have a true muscle shortening and need to create length. However, the bad part is that time dedicated to warm up is time that you are not running. Worse, passive stretching can cause small (and sometimes large) amounts of damage and leads to a reduction in muscle force production. If you have ever stretched strongly, or “overstretched”, you most likely recall feeling slow and sluggish when you started your run.
Active stretching (straight leg toe touch/kick) requires a coordinated effort between the stretching muscle (antagonist) and the shortening muscle (agonist) to cause a stretch. You contract the agonist, which causes the antagonist to relax and “give up” its flexibility. The benefit to this type is that you are warming up at the same time you are stretching and so are better prepared for your run. But don’t go too fast or too hard, as you can do yourself some damage.
So here are some rules for successful stretching. Always warm up. Get your heart rate up a little and maybe even break a little sweat before you stretch. A hundred yard jog or two may do the trick.
Easy-does-it. “No pain, no gain” generally does not apply here. Never stretch past the point of pain. Listen to your body.
If you have injured a muscle or tendon, stretch lightly and pain free until you are sure it is completely healed.
Stretch lightly before activity. This is where active stretches are best!
Save heavier stretches until after activity when your workout is over and you are good and warm. Always remember to do a good cool down after a workout (reduce heart rate) before plunking down to stretch.
Finally, I would like to open up this space to answering your questions about running, athletic performance, injuries, or general health. Please email me at grove@activerelease.com. If your question is used in an article, you will receive a Boulder Running Company logo running shirt as our “Thank you” for a great question.
Happy Running!
The Running Problem Worse than Mountain Lions: by Dr. Lee Fleming
What do April 15th, an unexpected visit from your mother-in-law, and the 2006 Denver Bronco-Pittsburg Steeler playoff game have in common? They’re painful experiences.
Another painful experience is being chased by a mountain lion during your morning run. No, this hasn’t happened to me personally, but given the fact that mountain lion sightings in residential areas have increased dramatically in the recent past, it’s surprising that more of us haven’t become “fast food” – pun intended. According to the Colorado Department of Wildlife, there are approximately 5,000 mountain lions in the state with only two confirmed deaths from attacks in the last two decades. So rest easy - the odds are that it won’t be a mountain lion that causes a painful disruption of your running routine. But plantar fasciitis may.
Plantar fasciitis, however obscure the name, is one of the most common of all running injuries. This malady, along with heel spurs and heel bursitis can cause an inordinate amount of pain and discomfort for both runners and non-runners alike. The first symptom of plantar fasciitis is intense pain in the heel when your foot first hits the floor in the morning. It may take as long as 10 to 30 minutes of weight bearing before you’re finally able to touch your heel to the floor. The same discomfort can reappear during heightened weight-bearing activities such as running, jumping or even walking.
The pain is usually dull to sharp and localized right under or just in front of the prominence of the heel. It usually occurs in one foot, but may occur in both. Oddly enough, relief can sometimes be obtained by simply changing from a low heel to a high heel shoe such as a cowboy boot. Anti-inflammatories, ice and rest are also helpful but unless the biomechanical problem is corrected, chances are that the pain associated with the plantar fasciitis will reoccur.
You see, the real cause of this type of heel pain is biomechanical one. On the bottom of everyone’s foot is a band of tissue called fascia. This band extends from the toes to the heel where it inserts. Normally this band of tissue isn’t tight, however, as the foot flattens (as in pronation) the fascia becomes taut like a well-strung bow. Add to this two to three times your body-weight, which is the equivalent of the weight transmitted through your feet as you run, and you can imagine the stress that this band of tissue must absorb. Something has to give; so the fascia starts pulling away from its insertion in the heel. As it pulls loose, the area becomes inflamed and the painful cycle begins.
If you are suffering from plantar fasciitis - don’t despair, there are several good methods of treating the problem. These include modified rest (cycling and swimming), ice massage, special taping of the long arch of the foot, ultrasound, and anti-inflammatory medication. Another mainstay of treatment includes orthotics, which are specialized arch supports worn in your shoes to help decrease pronation or the flattening of the foot. A more stable shoe can also help decrease pronation.
There are some resistant cases of plantar fasciitis that don’t respond to conservative therapy. In these cases, the fascia must be released surgically to exact a permanent cure. There are very few cases, however, that cannot be treated conservatively - so be of good cheer.
As treatment progresses, you should feel less and less pain in your heels in the morning and during long runs. After a while, you may even forget that your heels hurt. Then you can think about more important things, like how to avoid becoming breakfast for a mountain lion.
Lee T. Fleming, DPM
Colorado Springs Foot and Ankle Clinic
3100 N. Academy Blvd, #115
Colorado Springs, CO 80917
(719)574-9800
Send correspondence to flemfam@hotmail.com
Brief Bio:
Dr. Fleming is a surgically trained foot and ankle podiatrist.
Importance of Cross Training In Endurance Sports: by Dr. Grove Higgins
So, you want to increase your speed, increase your endurance, and at the same time you improve your hill climbing ability? Good goals, but how do you reach them? You could do speed workouts and sacrifice a day of distance running, or you could do your endurance run and include some hill work—but who has that kind of time? If you want a good return on your investment of time, sweat, and money……CROSSTRAIN!
Now don’t imagining that your choices are confined to the gym or swimming laps in a pool. While gyms and pools can be great assets, most cross training can be done at home, with very little equipment. Cross training can help prevent injuries, keep the body from adapting to exercises and plateauing, can help stave off boredom, and improve all aspects of performance.
Performance is more than just running fast or long. In fact, it includes components like flexibility, balance, agility, strength, power, speed, and endurance. These are each a necessary component to becoming a healthy, well-balanced athlete.
· Flexibility: Dynamic flexibility allows you to best use full ranges of motion of your joints. While you may not be able to do the splits, you run with good full strides.
· Balance: Good balance keeps you upright and allows you to put your power through to the ground. Good balance also helps in prevention of injuries such as sprains and strains.
· Agility: Accurateness of intended movements.
· Strength: The amount of weight you can lift over a distance. Can you lift your own body weight doing a squat (with one leg)?
· Power: How much weight you can lift in a short period of time. Examples of when you would need a lot of power is in a standing broad jump or at the start of a sprint.
· Speed: How far you can move in a given period of time: 10 minute miles or 5 minute miles.
· Endurance: The ability to do a certain amount of work at a given rate in a period of time. How long can you maintain a 6 minute/mile phase?
If you have not figured it out yet, each aspect of performance is dependent on the one before, as outline above. You can’t build speed without first improving your power, strength, agility, balance, and flexibility. So, while you need to train them all, you can develop them together with good cross training.
So to prepare, get (or find) yourself a few devices that might be helpful:
· Get on the ball…an exercise ball, that is! A ball is an unstable platform that allows you to develop balance and muscular control while doing flexibility or strength exercises. It is especially good for training core muscles (abdominals and back). A ball is like having an inexpensive, all-in-one universal gym. This is an essential for everyone, athlete or not!
· The foam roller is a great devise that allows you to stretch, work on balance, and also treat yourself to prevent muscular and fascial injuries, resulting from repetitive use of your body.
· Steps are useful in developing leg strength and speed by running and jumping on them. You can also work your upper body by doing dips, pushups, and bridges on them.
· Rubber bands, like theraband/tube are portable tools to do exercises wherever you are. Use these to work on strength and flexibility.
· Weights are the quintessential tool for building strength. There are as many different exercises for weights as you can dream up. When used right, machines, bar bells, dumbbells, and (my personal favorite) kettlebells, are all effective for building strength, power, and stability.
· Exercise classes, like yoga, kickboxing, karate, spinning, water classes… etc.
· Other sports.
These are only some ideas and modalities to get you a start into cross training. Remember, keep exercise interesting but also keep it safe. If you need a kick start or just some guidance, get a trainer or coach to help. Cross training is essential for you as a runner, walker, cyclist, or whatever your sport, is to be a well-rounded athlete and to prevent potential injury.
Dr. Higgins is a regular fixture at BRC. He does clinics most Saturdays from 10-2:00 to evaluate injuries you may have and answer any training questions you might have. Stop by and make an appointment or call him at 268-9500.