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Injury prevention and performance.

Plantar Fasciitis  - Running Injury Prevention and Treatment
Plantar Fasciitis – Running Injury Prevention and Treatment

American marathoner Ryan Hall and I have something in common. Oh, I know what you’re thinking: but I have yet to run that 59-minute half-marathon or qualify for the Olympics. Rather, within the last year both Hall and I have suffered from plantar fasciitis, an inflammation and painful injury to the underside of the foot.

In early March of last year, Hall tweeted that he was getting an MRI done early that morning. Later he followed that tweet with a second, commenting that the image looked good and that he was checking on the plantar fasciitis he’d had for the last four months. Publicly, it was the first time Hall had mentioned the injury and, as it turned out, while suffering through the foot problem, he’d not only trained, but qualified for the marathon at the London 2012 Olympic Games.

Pain tolerance is one of many qualities separating ordinary runners from elites like Hall. While running on my injured foot, I found that every footfall brought an intense stabbing pain. Already injured for several weeks, I pulled out at 16K on what should have been a 22K run and was immediately off my feet for six days after. Hall told the media that his treatment included the painkiller Aleve, a splint, ice, rolling it out with a golf ball, strengthening and stretching, and shockwave therapy. He also took three weeks off. Like many injuries, plantar fasciitis responds well to rest.

Plantar fasciitis impacts the thick band of connective tissue running along the bottom of the foot. The main function of the plantar fascia is to help provide arch support during weight-bearing exercise, according to Maura Connolly-Wiezoreck, owner of Halifax-based Bluenose Physiotherapy and a sub-three-hour marathoner. Connolly-Wiezoreck describes the injury as typically resulting from too much of a load placed on that connective tissue, which then leads to microtears resulting in inflammation. Training errors such as adding too much volume too soon can trigger the injury, as can changes in running surfaces or hills – placing undue stress on the connective tissue in the feet. “Recently an increase in the barefoot and minimalist running phenomenon has brought in more runners with plantar fasciitis due to improper transition from their former thick- cushioned shoes,” Connolly-Wiezoreck says.

While the pain is most often felt in the heel, it may extend the length of the band of tissue. It’s common for it to be worse first thing in the morning but eases up shortly after. With an acute case, it may be uncomfortable merely to stand barefoot on hard surfaces. The pain may be intense for two to three weeks, with up to 12 weeks needed for healing. It may linger much longer unless you take proper precautions.

Hall’s program sums up what you should do if you have plantar fasciitis. First, take some time off. Consider adding non-weight-bearing exercises to your routine. Pool running is ideal as it helps maintain aerobic fitness. Cycling is another good substitute. A frozen water bottle also works wonders: take it and roll your foot out five or six times a day.

It’s likely your physiotherapist will proscribe a series of exercises, ranging from small movements such as scrunching a towel up with your toes to larger motions such as calf stretches. You might get your foot taped, although some people find that option uncomfortable. Aggressively combining all of these measures will help you get back to running sooner than later.

-Charles Mandel

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