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Posted: February 27, 2013  :

(IAWR) Athletics: Plantar Fasciitis - Misunderstandings Corrected

Bennett just finished reading the recent New York Times article "No Consensus on a Common Cause of Foot Pain" by Gretchen Reynolds. Although plantar fasciitis has afflicted runners for decades and sidelines up to 10% of runners, there is a surprising lack of agreement in the sportsmedicine community regarding the injury and its treatment.

Reynolds provides a new insight as to the origin and progression of plantar fasciitis. Conventional understanding was that the injury was an acute inflammation of the plantar fascia.

However, something did not fit. Acute inflammations usually subside after a few days of rest and then disappear.

Not so with plantar fasciitis. Many plantar fasciitis sufferers develop chronic cases of the injury, often lasting months and resisting treatment.

Reynolds quotes Dr. Terrence M. Philbin plantar fascia specialist at the Orthopedic Foot and Ankle Centre in Westerville, Ohio: "….. when scientists actually biopsied fascia tissue from people with chronic plantar fasciitis, they did not find much if any inflammation".

Most specialists now believe that plantar fasciitis is caused by the weakening and degeneration of the plantar fascia, rather than acute inflammation. During training, the plantar fascia (and other tissue) sustain microscopic tears. The body repairs and strengthens the tissue during rest and recovery. The "new you" is now able to tolerate progressively higher levels of training.

In plantar fasciitis "the ongoing tissue damage overwhelms the body's capacity to respond. The small tears don't heal. They accumulate. The tissue begins subtly to degenerate, even to shred. It hurts".

This new understanding of plantar fasciitis is enlightening. Unfortunately, the same cannot be said about the plantar fasciitis treatments recommended by the doctors quoted in the article. They rely on the same old methods that reflect neither the new insights into plantar fasciitis nor the causes of plantar fasciitis. They recommend 1) cortisone injections 2) stretching exercises.

Cortisone is a powerful pain reliever and anti-inflammatory. Reduction in pain is certainly welcomed by plantar fasciitis sufferers. But if we now understand that chronic plantar fasciitis shows little if any inflammation, why inject an anti-inflammatory drug? It's not addressing the root cause of the injury -- the weakening and degeneration of the plantar fascia.

The same goes for the stretching exercises suggested by Dr. Philbin. Nowhere is lack of flexibility mentioned among the root causes of plantar fasciitis. Why rely on stretching for treatment? It does not make sense.

There is an obvious disconnect between the causes and the suggested treatments. If plantar fasciitis is caused by weakening and degeneration of the plantar fascia doesn't it make sense to strengthen the plantar fascia in a running-specific way? Of course it does!

How to strengthen your plantar fascia to recover from/prevent plantar fasciitis?

One of the most effective strengthening exercises for plantar fasciitis sufferers is Toe Grasping (taken from Injury-Free Running for Women Over 40).

Stand barefoot with straight posture, your feet hip width apart. Alternate curling the toes of your right foot and then your left foot down and under. Pretend you are grabbing an object with the toes of each foot.

Repeat this movement (right foot then left foot) 50 times with each foot. Aim to "walk" a distance of 1-2 yards (meters).

Progressions: Increase sets.

This is one of Bennett`s favourite exercises he uses to ward off plantar fasciitis.

For other effective exercises to treat and avoid plantar fasciitis and other injuries, check out Injury-Free Running for Women Over 40. It's an inexpensive way to prevent injury from ruining your training and racing plans!

© 2012 Savvy Runner Inc.

Bennett Cohen and Gail Gould are the Founders and Presidents of the International Association of Women Runners. For access to resources to help you reach your goals for running and racing, visit

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