Archive: Mar 2013

  1. Rock in your Shoe?

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    More likely Plantar Fasciitis, the most common cause of Heel Pain. Don’t let the signs go unnoticed!

    I visit many races in the area and I try to observe runners as much as I can to help me more deeply understand the mechanisms of common running injuries. I inevitably see a runner start off well, perhaps a little fast in the start, and then their gait begins to change. This is never a good sign. The runner suddenly grimaces, hobbles over to a bench, and loosens their shoe. That’s it! That has shut down that runner for this race. What a sad way to end their hard work and training! They slowly, as if walking with a rock in their shoe, make their way over to my table or to their cars to head home. The pain and discomfort in their heel and arch of their foot is unbearable and worse with every step. He/She also feels like their calf muscles may be slightly tight and grabbing as well. Most of the time these patients go home, they eventually feel somewhat better later in the day and go about their lives as usual. The next morning they rise to get out of bed, put their bare feet on the floor and the first step is painful again, just like in the race. They can barely make it to the washroom first thing in the morning. As they move their foot loosens up slightly with a few more steps, put on their work heels, and head off without another worry. The next thing you know they are at their Monday night running group and 5K is the distance. They have all their athletic clothes on, sneakers, and head out on the run for the night. This is the time when the light bulb should go on for this runner! About 2-3 miles in the pain is back and the rock is still in my shoe! The runner then thinks, “Ugh! What could this be and should I seek treatment?” Duh, of course you should! The answer to the question is yes. Diagnosis of this condition is usually made by clinical examination alone. The runner has Plantar Fasciitis. Plantar fasciitis has been reported to affect 2 million Americans a year. The runner should seek treatment right away with a trained professional with background with runners who can address several facets of care for them. The runner must understand the cause of their injury, how to treat it, and what to do to prevent this from keeping them from their love of running! The plantar fascia is the thick connective tissue that supports the arch of the bottom of the foot running from the heel to the metatarsal heads of the metatarsal bones. The plantar fascia is made up of longitudinally oriented connective tissue. Plantar fasciitis in a runner is usually an overuse type injury. These can occur in any tissue in the body.


    Injury Over use type injuries occur from too much wear and tear for the body to heal and repair itself adequately and quickly. This creates a cumulative injury cycle. During this cycle the plantar fascia becomes weak and tight throughout the arch and where it attaches to the heel. There is increased tension, irritation, and pressure from running that occurs over and over with the pounding of landing, and especially in runners with a heavy heel strike. Whenever a body’s tissue is under these circumstances there is decreased oxygen and circulation to the area causing inflammation and scar tissue adhesions. These scar tissue adhesions may feel like small marbles in the heel of the foot or make the runners arch feel bubbly as they run their finger over it. There are four ways to address this issue, and consistency is key to resolving plantar fasciitis, which can become a chronic problem. Addressing this issue. Graston Technique® The first thing to due is break up the built up scar tissue within the plantar fascia and allow the fibers to stretch out more easily. Graston Technique® is a technique using patented stainless steel tools which a trained clinician moves over the affected area in a very specific way. Each tool has been specifically weighted to affect the area being treated. During the treatment the runner will feel the tool move over the bumpy areas that are the scar tissue adhesions until the bumps reduce and the feel of the smoother fascia is released. This frees the plantar fascia and allows the arch to have more pain free range of motion. Olympic athletes such as gold medalist swimmer Michael Phelps have triumphed Graston Technique® in helping him stay in top form for his races. ART® or Active Release Technique The second thing to do to treat plantar fasciitis is address the muscles that lead to the foot and plantar fascia. ART® or Active Release Technique is used to address the gastrocnemius and soleous muscles that make up the calf which leads into the achilles tendon and the heel and foot. ART® is a movement based sports massage technique that similar to Graston which releases soft-tissue restrictions only using motion and the clinicians’ hands. This keeps the cumulative injury cycle from perpetuating. When the tissues can move freely they receive adequate oxygen, and circulation, which prevents scar tissue from forming.


    No treatment plan is complete without a component to strengthen the plantar fascia. Many runners deal with overpronation where the arch falls down or weakens and there is not adequate shock absorption. This is one of the other common causes of plantar fascitis. Rehabilitation of the arch and the muscles of the foot must be done. Common exercises are marble grabs and short foot exercises. Swimming is also a great way to induce motion into the small muscles of the foot. Trained sports physicians whom have worked with runners will be able to give a protocol to strengthen the arch. Change Your Habits The last thing to do to resolve plantar fasciitis is change your habits. If you are a woman wearing high heels to work and running later in the day, look for an alternative shoe that supports your arch during the day. Men can also look for a more supportive work shoe or dress shoe to reduce overpronation. Stretching is key before and after a run. Failing to do a dynamic warm up of your tissues before a run, and post run cool down stretch can set a pattern of injury in motion. Also not going bare-feet can prevent plantar fascitis. Wearing supportive slippers around the house is better than walking in bare-feet. Solving plantar fasciitis and preventing its return can be a difficult task, however knowing and addressing the issue as soon as you notice symptoms is important. Should you the reader have symptoms/pain which you notice more than once associated with an activity like running you should consider seeking a diagnosis and treatment. Seek a physician with experience with runners who understand the common issues you face. This can prevent you from having to drop a race at the last minute, or stop during an event.