Common Foot Injuries
Plantar Fasciitis is an inflammation of the foot, specifically at the heel and arch areas. This is often referred to as 'Policeman's heel.' Before discussing Plantar Fasciitis, it is important to know some of the basic anatomy of the foot. The plantar fascia, also known as the plantar aponeurosis, is a thick, strong fibrous band of tendon-like tissue that runs along the plantar (bottom surface or sole) aspect of the foot. The plantar fascia has a number of important roles; however, its most important roles are to support the longitudinal arch of the foot and to assist in shock attenuation during foot strike. So what exactly is Plantar Fasciitis? As the name suggests, Plantar Fasciitis is an inflammation of the plantar fascia. Most commonly and more specifically, Plantar Fasciitis is the inflammation of the plantar fascia at its attachment to the medial calcaneal tubercle, although the inflammation can occur along any part of the plantar fascia. Plantar Fasciitis affects approximately 10% of the general population and makes up 10-15% of all foot problems needed medical care. Thus as you can see it is a very common condition. In the athletic population Plantar Fasciitis is just as prevalent and can cause ongoing, chronic problems. Plantar Fasciitis is most commonly seen in runners, however, it can affect athletes that play any sports that require increased amounts of running and jumping. Dancers and gymnasts are also commonly affected by Plantar Fasciitis. This is because they are required to fully extend onto their toes regularly, which places increased stress on the plantar fascia, eventually causing micro-tears and inflammation.
Plantar Fasciitis or Fasciosis
Recently there has been increased debate as to the nature of Plantar Fasciitis. Recent studies have suggested that rather there being an inflammation of the plantar fascia occurring, it is a degeneration of the plantar fascia without an inflammatory response. While this may seem irrelevant to the individual suffering with the condition, it is on the contrary very important. Without proper knowledge of the exact nature of the condition, proper and effective treatments will not be able to be developed.
Symptoms of Plantar Fasciitis in Strength Athletes
Some of the common symptoms of Plantar Fasciitis include:
- Insidious onset of pain
- Pain in the sole of the foot
- Pain is at its most intense after periods of non-activity e.g. after waking from sleep and taking your first few steps. This is known as “first step pain’ and is characteristic of Plantar Fasciitis. The pain will then usually get better throughout the day as walking increases.
- Pain may or may not improve with exercise. Pain is also usually intense after the activity or exercise has ceased.
- Plantar Fasciitis usually affects only once foot but both feet can be affected
- A limp may or may not be present due to the pain
- Burning, aching or a sharp type of pain is often described
- Warmth and swelling on and around the painful area
Causes of Plantar Fasciitis in Bodybuilders
There has been and still is much debate and research underway into the exact causes of Planatar Fasciitis. Many theories have been put forward but most of the evidence remains anecdotal. The more commonly identified factors in the typical presentation of Plantar Fasciitis include:
- Overuse: exercising too often, exercising above ones capabilities, decreased rest time between activity or a sudden increase in activity compared to normal levels are some factors that can result in the development of Plantar Fasciitis. This is especially the case in runners, especially when you consider the fact that the plantar fascia is partly responsible for attenuation shock through the foot and that forces through the foot during running can reach 2-3 times and individuals body weight!
- Poor biomechanical alignment: this includes lower limb muscle weaknesses, tightness or imbalances, excessively flat-feet or conversely high-arched feet and also ligament laxity.
- Footwear: poor footwear, or footwear not complementary to the individual’s foot type, is a major factor in the development of Plantar Fasciitis. Wearing the wrong type of shoe or wearing excessively worn shoes is often the instigating factor in the development of symptoms. Wearing high heels excessively is also a major contributor due to the tension it places on the plantar fascia. This is especially the case when wearing high heels all day and then swapping shoes and going for a run in your flat sneakers at the end of the day.
- Surfaces: activity, especially running and jumping, on hard and/or uneven surfaces, especially on a regular and high intensity basis can result in the development of Plantar Fasciitis. This is often overlooked as a contributing factor but is very vital factor that needs to be addressed when treating this condition.
- Prolonged standing – especially when combined with some other factors such as poor foot posture and poor footwear.
- Increased body weight or rapid weight gain – again this can exacerbate other known factors in the development of the condition.
- Tight calf muscles – this is another common sign seen with individuals suffering with Plantar Fasciitis and is often thought to be a contributing factor to its development. Tight calf muscles result in a change in gait which can place increased and abnormal tension stress on the plantar fascia via an increase in the ‘heel raise’ phase of gait.
Plantar Fasciitis Diagnosis
Plantar Fasciitis is almost always diagnosed clinically. In other words, by using the patient’s presenting history and their clinical presentation. In some cases ultrasound may be used as well and in very rare cases MRI’s can be used. X-rays cannot be used as the plantar fascia is fibrous in structure.
Plantar Fasciitis Treatment
As a general rule, the longer you have Plantar Fasciitis, the harder it is to treat. The following is a list of common, mostly conservative treatments of Plantar Fasciitis:
- Rest or activity modification
- Icing of the painful area (using a frozen water bottle and rolling your foot over it is often very effective)
- Compression and elevation if there is swelling in the area
- Pain management medication
- Footwear change
- Foot orthoses, both custom made and off the shelf devices
- Strapping of the foot
- Heel lifts to take the strain off tight calf muscles and therefore also the plantar fascia
- Muscle stretches for tight musculature and to increase flexibility
- Muscle strengthening to correct imbalances
- Weight management
- Corticosteroid injections (often only done as a last resort)
- A gradual return to activity
Plantar Fasciitis Prevention
A number of measures can be put in place to help reduce and improve the symptoms of Plantar Fasciitis or in some cases to completely eradicate them. These include:
- Undertaking adequate warm-up and warm down, including adequate stretching of lower limb muscles
- Strengthening the muscles in your legs
- Strapping of the foot
- Choosing even, flat, softer surfaces to run/play sports on
- Weight management
- Reduce the intensity or time of activit
- Increase rest between exercise sessions
- Purchasing proper athletic sneakers to support your foot
Seeking Medical Attention for Plantar Fasciitis
Plantar Fasciitis is a very common complaint amongst athletes, whether they are at the amateur or elite level. Medical attention should be sought if pain levels are not improving despite resting and other treatments or if pain levels are worsening. If the area becomes especially tender to touch. If there is any deformity present. Lastly, if there is pain experienced during night time or that wakes you from your sleep.E Medicine 2008, ‘Plantar Fasciitis’, viewed 2nd April 2011, <http://emedicine.medscape.com/article/86143-overview#a0101>.
Sports Injury Clinic 2011, ‘What is Plantar Fasciitis?’, viewed 29th March 2011, <http://www.sportsinjuryclinic.net/cybertherapist/front/foot/plantarfaciitis.htm>.
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