by Supna Reilly DPM AACFAS and Julia Sinclair DPM AACFAS
As we gear up for the unofficial start of the running season (was there ever a time to stop?) we want to address issues that our athletes commonly run into (no pun intended) when it comes to training. In our office, we always joke that in our field, if our patients have adequate hip strength, and good calf flexibility, that we would be out of a job. While this is a bit of an exaggeration, it is certainly true that a lot of prevention can be done with adequate strengthening and conditioning.
Plantar Fasciitis and Achilles Tendonitis are by far the top two issues we see at Performance Podiatry Partners. In the early onset of plantar fasciitis and Achilles tendinitis, patients often complain about pain first thing in the morning, or after sitting for a long period and then going to stand. The reason this happens has less to do with your foot, and more to do with strength and flexibility up the leg. Activities like running and biking use our muscles in one direction- moving forward. Without doing a lot of activity to strengthen the muscles that stabilize our hips (exercises that move in a side to side direction), we end up under developing the gluteus medius muscle. This is the one that stabilizes your hips. With any weakness to this structure, the angle of the upper leg actually changes as the knee tends to dive in at single-leg-stance. This inadvertently changes the tension on the large muscles at the back of our calf, the gastrocnemius, and the soleus muscles. These muscles give rise to the Achilles tendon, which inserts on the back of the heel, and blends with the fibers of the plantar fascia. The reason there is more pain after a period of rest has to do with the fact that during rest, there is no utilization of these muscles. So you are effectively asking muscles and tendons that have been at rest to start functioning to support your body. After walking or running a bit, these muscles warm up and relax. The fact that the pain goes away with activity is one of the main reasons patients ignore the early onset of plantar fasciitis or Achilles tendinitis. Please don’t make this mistake! The early stage of these ailments is the most treatable. With a well-curated home exercise program to get your gluteus firing and your calf flexibility where it needs to be, a lot of symptoms can be treated at home. If the issue happens to be more mechanical due to having high arches or flat feet, a custom molded orthotic in conjunction with home exercises usually does the trick.
Moderate to Severe plantar fasciitis and Achilles tendonitis often present with pain after rest, as well as pain during or after activity. This is usually the point that patients are coming into our office- after having ignored symptoms for weeks to months. The issue with ignoring symptoms like early pain is that the tissue tends to turn into scar tissue, and can even tear or rupture without appropriate treatment. Treatment can be as simple as physical therapy or as complicated as surgery depending on the scenario. At Performance Podiatry, we do our best to leave surgery as a last resort and often recommend simple in-office procedures.
Radial shockwave is an excellent way to deal with plantar fasciitis and Achilles tendinitis with success rates as high as 80% according to the Journal of the American Podiatric Medical Association. Using a high powered sound wave, the tissue is actually physically impacted in order to stimulate blood to go to the injured tissue to heal and repair. The treatment is repeated twice a week for a duration of three weeks. By stimulating blood to get to the injured tissue, the body is laying down new growth factors over the area of injury, thereby allowing the tissue to heal.
Laser therapy is another in-office procedure that can reduce pain and acute flare-ups of more chronic injuries. This is a simple procedure where warm light is placed over the area of greatest discomfort. The tissue absorbs that light, and increases the rate of cellular turnover, thereby flushing away any inflammatory cells. This not only mediates pain but also helps to create a favorable environment for the tendons and ligaments.
Above all else, it is crucial to listen to your body. Remember, pain is your body’s way of telling you that something is wrong. If the pain is bad enough to alter your gait or stop you from meeting your goals, we always suggest seeking medical attention. Chances are, small changes in your routine will pay of big when it comes to training.