Plantar fasciopathy, often referred to as plantar fasciitis, is an overuse injury affecting the plantar fascia, which is a thick band of tissue running along the bottom of your foot, connecting the heel bone to the toes.

This condition is characterised by pain and inflammation, usually felt in the heel and arch area, making every step a painful endeavour. For runners, this can be particularly debilitating, potentially sidelining them for weeks or even months.

In this blog, we'll delve into the causes, symptoms, and treatment options for plantar fasciopathy, providing you with the knowledge to both prevent and manage this common running injury.

Plantar fasciopathy is often the result of a combination of factors that place excessive strain on the plantar fascia. Understanding these causes can help runners take preventive measures to avoid this painful condition. Here are some common causes:

Rapid Increases in Training Load: Abruptly increasing your training volume or intensity can put undue stress on the plantar fascia. For instance, significantly boosting your weekly mileage or adding intense speed sessions without adequate progression can overwhelm the tissues, leading to inflammation and microtears.

Volume and Pace: High-mileage weeks, especially when combined with faster running paces, can exacerbate the strain on the plantar fascia. This is particularly true if there isn’t enough recovery time between sessions, causing cumulative stress and overuse injuries.

Changes in Footwear: Switching to new running shoes, particularly those with a different heel drop, arch support, or cushioning, can alter your foot mechanics. If your feet are not accustomed to these changes, the plantar fascia may be forced to adapt too quickly, leading to injury.

Stride Mechanics: Overstriding, where your foot lands too far in front of your body, can increase impact forces on the heel and consequently on the plantar fascia. Proper stride mechanics and an efficient cadence, can help mitigate this risk.

Muscle Weaknesses: Calf weakness contributes to plantar fasciopathy due to the interconnected nature of the plantar fascia, Achilles tendon, and calf muscles. Weak calves fail

to absorb shock effectively, increasing the load on the plantar fascia and altering foot mechanics, which leads to additional stress and potential injury.

Runners can perform a few simple tests at home to help diagnose plantar fasciopathy. These include self-palpation, single leg hop tests, and single leg heel raise tests for symptom reproduction and asymmetries.

Heel Pain and stiffness: The hallmark symptom is pain in the heel, especially near the attachment of the plantar fascia to the heel bone. Pain and stiffness is typically worse in the morning, after prolonged rest or after activity.

Self-Palpation: Use your fingers to press along the bottom of your foot, specifically at the point where the arch meets the heel bone (the origin of the plantar fascia). If you feel tenderness or pain in this area, it may indicate plantar fasciopathy.

Single Leg Hop Test: Stand on one leg and perform a few gentle hops. If hopping on one foot reproduces pain in the heel or arch, it could be a sign of plantar fasciopathy. Test both legs to compare and identify any asymmetries or pain differences.

Single Leg Heel Raise Test: Stand on one leg and slowly raise your heel off the ground, balancing on the ball of your foot. Perform this movement several times. If this exercise causes pain in the heel or arch area, or if you notice significant difficulty or asymmetry between legs, it may suggest plantar fasciopathy.

It is essential that you seek a medical opinion on the diagnosis and management of your heel pain to ensure you’re on the right track.

Runners can effectively manage plantar fasciopathy at home through a combination of targeted treatments, load management, and strengthening exercises. Here are some key strategies:

Iced Foam Roller: Freeze a water bottle and use it as a rolling device under your foot. Gently roll your foot over the bottle for 10-15 minutes to reduce inflammation and soothe pain. This acts like an iced foam roller, providing both cooling relief and massage to the plantar fascia.

Load Management: Instead of complete rest, which can lead to stiffness and weakness, practice relative rest by reducing your running load. Cut back on both volume and pace to lower the strain on your plantar fascia. Gradually reintroduce activity as your symptoms improve, ensuring that you increase the load slowly to avoid re-injury.

Response to Load: Plantar fasciopathy responds well to controlled loading. Incorporate low-impact activities like swimming or cycling to maintain fitness without overstressing your feet.

Strengthening Exercises: Engage in heavy strength training exercises to build resilience in your lower legs and feet. Focus on calf raises with your toes extended to preload the plantar fascia. Exercises targeting the intrinsic foot muscles such as toe curls and splaying movements are helpful. Once your symptoms have calmed down significantly, look to incorporate plyometric exercises such as POGO hops to help develop stiffness and power in the plantar fascia. As you phase in running, look to reduce but not remove your exercise programme. For those running 4-5 times a week, 2 exercise sessions per week is an ideal recommendation.

Supportive Devices: Orthotics can provide additional support and alleviate symptoms. However, they should be considered a secondary treatment. First, focus on modifying your training and establishing a robust strengthening programme. Orthotics can be a helpful adjunct but should not replace foundational treatments.

Running Form: Overstriding, where your foot lands too far in front of your body, increases impact forces on the heel and plantar fascia. Work on shortening your stride and increasing your cadence to promote a more efficient running form that reduces stress on the plantar fascia.

Achieving optimal rehabilitation requires careful implementation of all the factors mentioned above, all working in harmony with each other.Remember, Gluteal tendinopathies don’t always play by the rules. Listen to your body, always seek professional guidance, and prioritise your rehabilitation.

For expert help and management please feel free to contact my team at The Running Room (www.therunningroom.net)