In part two, I want to look at the possible causes of plantar fasciitis, treatment, rehabilitation exercises and avoidance strategies to keep your marathon goals alive.

Causes of Plantar Fasciitis

Normally, the plantar fascia acts like a shock absorber that supports the arch of the foot. Inflammation can occur when the plantar fascia is overused or overstretched. It is thought that micro-tears and degeneration of the plantar fascia from overloads on the foot are the cause of this inflammation. When the fascia becomes inflamed, pain results.

Risk Factors:

• Age – plantar fasciitis is more likely to develop with age (typically between 40 and 60)
• Women are more likely to develop plantar fasciitis
• Being overweight or sudden weight gain
• Exercises that place stress on the heel, such as long-distance running
• Tight calf muscles
• Occupations that require lots of standing (e.g. teacher, waitress)
• Poor foot mechanics - abnormal weight distribution from flat feet or a relatively high foot arch can place significant stress on the plantar fascia
• Sudden changes to training methods (e.g. significant increase in running mileage).

When you think about it a bit more, the demands and forces placed upon the foot are massive and it’s amazing that we do not injure our feet more often. Forces equal to almost three times our body weight pass through the foot with each step. An elite level athlete has a stride rate of approximately 90 strides per minute. That equates to forces three-times his or her body weight on each foot, 90 times per minute!

Plantar Fasciitis Treatment

When I was first diagnosed with plantar fasciitis by physiotherapist, I thought my marathon dreams were doomed. How was I going to maintain my marathon training schedule with this nasty condition? Well truthfully, I did not maintain my marathon program; I had to tone it down to let my plantar fasciitis heal. All you marathoners know that ‘rest’ or ‘reduce your training’ are the last words you want to hear from your doctor or physiotherapist in the midst of your marathon training. Take my advice, listen to them, but find other ways to maintain your fitness levels (e.g. swimming, biking, strength training).

Aside from rest, the initial treatment for plantar fasciitis is:

• Ice - go for 3-4 sessions of 15 minutes per day. I like putting my foot into a bucket of ice water, that way you are ensuring that the entire foot is covered.
• Anti-inflammatory medication such as ibuprofen or aspirin to help reduce pain and inflammation.
• Night splints – some physiotherapists may recommend that you wear a night splint, which essentially holds the plantar fascia in a lengthened position through the night. On two occasions, my physiotherapist used athletic tape to create the same effect. I must admit, when I woke up in the morning and took those first few steps of the day, the pain was much less prominent.

Night Splint for Plantar Fasciitis

Rehabilitation Exercises for Plantar Fasciitis

1. Tennis Ball Arch Rolls

• Place one foot on tennis ball
• Roll arch back and forth over tennis ball

2. Towel Crunches

While barefoot, sit down placing your foot on top of a towel. Use your toes to crunch up the towel towards your body. Start with ten crunches and then reverse (un-crunch the towel away from your body) for ten more repetitions.

3. Calf Stretches

As mentioned above, tight calf muscles are associated with developing plantar fasciitis. This is a well known stretch, but it is important to perform it regularly. Be sure to keep your back foot straight

calf stretch

4. Toe Pick-Ups

Place a small objects such as marbles or golf tees into a pile. Now see how many objects you can move into another pile using your toes to pick them up one at a time.

Final Thoughts

One important point I have not yet mentioned is that I purchased new running shoes at the beginning of my 4-month marathon training program. I thought I was being proactive as I got set to pound the pavement for many, many miles over the coming weeks.

My mistake however, was that I purchased a brand / model of running shoe that I had never worn before (it felt great when I tested in the store). If it aint broke, don’t fix it! If you have a running shoe that you like and has not given you problems in the past, stick with it.Lastly, if you need to take some time away from running during your marathon training, look for ways to maintain your cardiovascular fitness and leg strength. Swimming and biking are great options.

Related Posts: Plantar Fasciitis and Marathon Training – Part 1

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Me in the Dublin Marathon

Anyway, I heard of plantar fasciitis before, but when I started having pain in the arch of my right foot, just in front of my heel bone, I did not put two and two together. I visited my physiotherapist a couple of days after my 2.5-hour run where I initially noticed the pain in my foot. It was any easy diagnosis for him; I had all the classic signs of plantar fasciitis.

The real kicker however, was that he also diagnosed me with IT band syndrome at the same time (I wrote about that in a previous post). I was a mess and still had many miles of training to fit in before I lined up at the start line for the Dublin Marathon.

Image source: Spectrum Wellness

What is the plantar fascia?

The plantar fascia is a fibrous tissue that runs along the bottom of the foot and connects the heel bone to the toes. In short, the plantar fascia is responsible for creating the arch of the foot. During walking and running, the plantar fascia is responsible for:

• stabilizing the bones within the foot when it makes contact with the ground;
• assists in absorbing shock for the leg; and
• helps lift the arch of the foot in the gait cycle.

What is plantar fasciitis?

Now that you know what the plantar fascia is, what does it actually mean to have plantar fasciitis? When the plantar fascia becomes irritated and inflamed, pain will result. This inflammatory process is called plantar fasciitis.

Symptoms

Plantar fasciitis can be identified by a few distinctive symptoms:

• Sharp pain in the heel that develops gradually
• The pain is most intense with the first few steps out of bed in the morning, but slowly subsides throughout the day
• During exercise the pain may subside slightly, but the heel becomes more painful after exercise
• It usually affects only one foot, but does occasionally affect both

The above symptoms were right on the money for my bout with plantar fasciitis. Before taking off into the streets for my morning marathon training runs, the pain in my right heel was very sharp. I would describe the pain like someone is taking a sharp peg and is digging it into the spot between the middle of the arch of the foot and the heel bone.

After about ten minutes of running, the pain slowly subsided to a point where I did not even notice it. The mornings were the worst. I literally hobbled into the bathroom in the morning to shower. From some of my own research, I discovered that the plantar fascia actually shortens when you sleep as your feet are typically in a pointed position. This means that the plantar fascia is contracted while you sleep, but when you take those first steps of the day and stretch the plantar fascia out again, the pain can be excruciating.

More to come!

Stay tuned for Part 2 where I will take a look at causes, treatment, rehabilitation exercises and avoidance strategies for plantar fasciitis.

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I did not have any iliotibial band problems until I significantly bumped up the duration of my long Sunday training runs.  I ran for 2 hours for the first time without any problems, yet the following week when my goal was to run for 2 hours and 20 minutes, I was forced to stop at just over an hour.  The pain on the outside of my right knee started as a slight burning sensation and progressively worsened and eventually, I was forced to stop.  I was gutted.  What was the problem….I have a marathon to run in three months!  I had never had knee problems in the past so this was quite worrisome.  If I can’t run for over two hours and lack the running talent of Haile Gebrselassie (the current world record holder in the marathon with a ridiculous time of two hours, four minutes and 26 seconds), how I am I going to run a marathon!

Image source

Be Proactive When Training for a Marathon

At the onset of my marathon training I made a decision to book weekly physiotherapy appointments for two reasons (for any first time marathoners I highly recommend you do the same).  Firstly, I wanted to approach my marathon training with a proactive mindset in order to address such things as muscle imbalances, tight muscles, improper shoes and running biomechanics from the onset of my marathon training.  Secondly, for any injuries that did develop I wanted to address them as soon as possible so not to interrupt my training program.

When I explained to my physiotherapist what my symptoms were, he was very quick to point to my iliotibial band as the problem. The iliotibial band is a thick band of tissue that runs down the outside of the thigh and plays an integral part of stabilizing the knee when running.  What many runners do not realize however, is that the iliotibial band inserts just below the outside of the knee, exactly where my pain was.  When running, there is constant rubbing of the iliotibial band over the bones on the outside of the knee which can cause inflammation in the area and thus it becomes painful.

Iliotibial Band Syndrome Guidance From My Physiotherapist

“Where did I go wrong and how do I get rid of this”, I said to my physiotherapist.  While there are many potential causes of iliotibial band syndrome, I ran too far, too soon.  Some say that the hardest part of running a marathon is not the marathon itself, it’s the training. Pounding the pavement hard for 12 weeks takes its toll on the body.  You have to respect the distance and the volume of training that is required.

How did I get rid of this incredibly annoying running injury?  First and foremost, I had to cut back my training until I had the iliotibial band syndrome under control.  Secondly, I needed to increase the strength of my hip abductors (the muscles that help keep the legs out, away from the body) when walking or running.  Hip abductors are typically weak in long distance runners.  When they are weak, the iliotibial band gets overworked when the hip is abducting.  It is therefore, vital that these muscles (and other stabilizing muscles) are strengthened to an adequate level to take the burden off the iliotibial band.  One of my favorite exercises to do this is the side plank (see the photo below).  Try holding this position for 20-30 seconds on each side, while trying not to let your hips sag towards the floor.

Lastly, I regularly used a foam roller and The Stick (I purchased for traveling as it easily fits in a backpack) to break up any myofascial adhesions and generally loosen my iliotibial bands.  Using either are simple and effective ways to increase flexibility and loosen tight muscles.

Within a couple of weeks, I was back running up to two hours with no knee pain!  I continued to use the foam roller and was vigilant about regularly performing my hip abductor exercises for the remainder of my marathon-training program.  The result was not a pain-free marathon (does that exist?), but an iliotibial band pain-free marathon!

How do you prevent Iliotibial Band Syndrome?

1. ensure a proper warm-up before runs – this may include walking for five minutes before starting your run
2. replace your worn-out running shoes
3. be proactive – stretch and use a foam roller regularly (see video below)
4. build up your mileage slowly
5. perform exercises such as the side plank and side-lying hip abduction (see video below) to increase the strength of your hip abductors

Foam Roller Exercise

Sidelying Hip Abduction Exercise

Foam rollers are available at Foot Forward Training and Amazon.

Other resources: Foam roller exercises for tight muscles