Plantar Fasciitis

Hey! This week we'll be starting a series of common injuries that occur in triathletes, how you can spot them, and what you can do for them! To kick it off I figured we'd start from the bottom then end up... Here? Anyways, this week, we're going over...

Plantar Fasciitis

What is plantar fasciitis?

To make it simple, plantar fasciitis is an irritation of the connective tissue that connects your foot bones to your heel bones. The presentation for this is usually described as significant pain within the first 5 steps of the day (around the area pictured to the left) that dissipates to some level with continued walking.

Where things can get confusing is when words like inflammation, degeneration, heel spur, etc. come into play.

These things can sometimes play a part in the symptoms of plantar fasciitis but they are often not the root cause, which we'll discuss next. 

Root Cause of Plantar Fasciitis

The root cause of plantar fasciitis can be boiled down to something called neuromuscular inhibition.

In other words, certain muscles have stopped working to their normal and necessary capacity. 

And for plantar fasciitis, it is often not the muscles on the bottom of the foot that are inhibited!

Instead, we will be focusing on muscles in the front of the shin as the culprits!

The reason for this is something called reciprocal inhibition (more fancy words). This basically states that opposite muscles talk and work with each other.

But! When one muscle is inhibited, it doesn't take its fair share of the workload, and the opposite muscle (in this case, the muscles on the bottom of your foot) end up taking on more than they can handle.

What To Do About It

So, we've established that plantar fasciitis stems from certain muscles not doing their part, how can we make them... do their part?

First, we need to confirm what you're experiencing actually is plantar fasciitis and if there are any additional factors contributing to pain. Unfortunately, a lot of things, such as Achilles tendinosis, posterior tibialis tendinitis, and so on, all get lumped in as the same plantar fasciitis diagnosis. In reality those diagnoses have different muscles not working in different ways to cause the issue.

The best way to do this would be in the clinic where I could assess you myself but if that isn't an option right now here are a few things you can quickly check to see if your pain fits in the right box of plantar fasciitis.

• Pain on the bottom of your foot at the front of your heel (possibly into the arch)

• Symptoms come on in the first 5 steps of the day or whenever initiating walking after a prolonged period of sitting/lying down

• Pain may decrease with walking for a few minutes but generally cannot tolerate more stress such as running (this may get worse if you have been dealing with it for a long time)

• Difficulty/tightness felt doing this heel walk test. This may or may not be painful

If you fit those criteria the next, most important step is to cut out the crap!

Static stretching, foam rolling, massage gunning, scraping, shoe orthotics, and rolling on an ice bottle/lacrosse ball on the bottom of your foot lead to more neuromuscular inhibition. Although this time around you've shut down the signal from the muscles on the bottom of the foot leaving both sides of your leg weak and dysfunctional. That is, until your pain comes back and you have to repeat the cycle.

Those things may provide temporary relief (which is why it may be difficult to let go of them) but they don't solve the long term problem.

So, what do I recommend instead?

Start with this simple 3-way ankle raise exercise. Do 5 reps in each direction holding 5 seconds each time. This is the first step in reversing the inhibition of your shin muscles. 

Then follow it up with 5 crossover lunges and forward lunges (with a twist) on each leg.

Try to do these exercise 5x per day in the early stages (especially the ankles raises right when you wake up). Then go about your day with as little support in your shoes as possible (exceptions below). If you are in a situation where going barefoot or having minimal support shoes for most of the day isn't an option try to go barefoot at home as much as possible.

Exceptions: If the heel walk test gave you pain (in the heel) it is OK to walk with some cushioned shoes until pain decreases. This can be a sign of a heel spur causing irritation which can improve with time but just needs some short term relief in the beginning.

If you have diabetes continue to wear your orthotics as prescribed (if you have them). 

P.S. These tips will be more successful for you depending on how recently this problem has started, how closely you fit the diagnostic criteria above, and how closely you follow the exercise/activity prescription. If you are still experiencing problems you can book an appointment with us at ReTri Performance by calling/texting (312)857-6300 or emailing Cganzer@retriperformance.com