Plantar fasciitis is a painful foot condition caused by overstretching and degenerative tears of the plantar fascia – the long arch tendon which runs from the heel to the forefoot and supports the arch of the foot.
It is a fairly common condition which develops gradually through overuse, especially in runners and walkers / hikers. Pain tends to start under the heel and often radiates into the arch of the foot, being worst first thing in the morning.
There is plenty of advice out there on how to treat plantar fasciitis which centres on rest, cold therapy, massage, stretches, electrotherapy, acupuncture and orthotic insoles. Generally this is a slow but successful treatment regimen.
But what is rarely covered, is how to prevent this condition coming back, in the same foot, or in the case of NBA player Joakim Noah, in the other foot! Chicago Bulls Center Noah is suffering with the condition now in his right foot, after missing 18 games in the 09/10 season with the same problem in his left foot! Noah has learnt from his first experience of the condition where he tried to continue playing and says:
“I think the difference was last time I just tried to keep fighting through it and fighting through it, and (this time) I’m just trying to be smart about it.”
That’s good advice for all plantar fasciitis sufferers out there! Don’t try to carry on. The more you push through the pain, the more damage you are doing and the longer it will take to recover.
How Can Plantar Fasciitis Switch Feet?
Joakim Noah’s case is not that uncommon. Often plantar fasciitis will start off in one foot and then develop in the other foot, either within a few days or weeks, or some time later, after the initial injury has healed.
The cause of this is usually biomechanical – do to with the way we walk or run. At the time of injury, when weight bearing on one foot is causing us pain, we tend to (knowingly or subconsciously) change our gait to reduce the pressure on the painful area. This often means putting more pressure on the other foot and stressing the fascia on that side, resulting in a bilateral case of plantar fasciitis.
As in Noah’s case, the pain can develop much later, when the original injury is all but forgotten. In these circumstances, the cause is likely to be due to muscle imbalances which were probably worsened during the first bout of injury.
Whilst walking with a painful foot we tend to shorten our stride, especially when the affected foot is behind. This means that the hip flexor muscles are not stretched and the Glute muscles are not required to extend the leg back as far, which over a long period and if untrained in other ways, can cause weakness.
To compensate for these imbalances, the heel of the trail leg lifts up prematurely, which reduces the eccentric loading of the calf muscles. This means the force used to propel the rear leg forwards in reduced. This forward swinging is really important as it helps to supinate the opposite foot ready for push-off. Reduced supination means an increase in overpronation which stretches the fascia with every step, eventually leading to PF in the opposite foot to where it started!
This combination of tight hip flexors and weak gluts also causes an anterior pelvic tilt, which shifts our body weight forwards, onto the forefoot. In order to counteract that and prevent us falling flat on our faces, the calf muscles contract, resulting in tight calf muscles and another major cause of plantar fasciitis which further increases overpronation to compensate for reduced ankle motion.
How Do I Stop That Happening?
There are a several things you should be doing to prevent an injury returning or indeed becoming a bilateral issue:
- Firstly, address both sides from the onset. You are likely doing exercises for the painful foot to increase calf muscle flexibility and intrinsic foot muscle strength, so take a few more minutes to do them on both legs.
- Try not to alter your gait cycle. Rest as much as possible and try not to walk around more than absolutely necessary. The more you walk, the more pain you feel and the more you alter your gait, placing extra stress on the other foot.
- Look at the other causes. Do you have tight hip muscles? – Probably if you are sat down all day. Are your glutes firing strongly and in conjunction with your hamstrings? Address these problems to stop the condition jumping to the other foot!
- Continue with your exercises beyond the painful stage. Don’t be fooled into thinking that the pain has gone so you can stop stretching your calves and hip flexors and stop strengthening your glutes and foot muscles. Keep going to maintain your improved foot function.
- Consider your footwear on an ongoing basis. Try to wear good supportive shoes at all times, especially when you know you will be doing a lot of walking. Continue wearing insoles if these were prescribed for you and change running shoes regularly.
- Consider losing weight if you are over your recommended weight as this will reduce the stress on the fascia.
- If you are a runner / walker or play any sport, make sure you return gradually and don’t rush back. This is a sure fire way of the condition returning.
- Have a regular sports massage to maintain the condition of the calf and hip flexor muscle in particular.
- Rest and ice at the slightest onset of pain.
Having suffered with plantar fasciitis once, it is something that you need to consider for the rest of your life. A sufferer will always be prone to the condition, but following the steps above and being aware of the stresses you are placing on your feet and how you can reduce them can go a long way to preventing the injury coming back.