Plantar Fasciitis

You step out of bed to make it to the 5:30am class and heel pain stops you dead in your tracks. That first step is excruciating, but by the time you’ve finished the warm up, the pain is alleviating. You go about your day, only to experience the same thing the next morning. Sound familiar?

plantar-fasciitis

Symptoms of plantar fasciitis:

  • Stiffness/pain in the morning starting at your heel and radiating to your toes
  • Pain that gets worse when you climb stairs, stand on your toes, or wear heels
  • Pain after you stand for long periods
  • Pain at the beginning of exercise that gets better or goes away as exercise continues, but returns when exercise is completed

Plantar fasciitis can be an acute or chronic condition. It results from trauma to the thick, fibrous, connective tissue (plantar fascia) on the bottom of your foot. The fascia is fan shaped and connects your heel to your toes, traveling along the arch of your foot. When the tissue is under tension (i.e. Dorsifexion, e.g. the push off during walking, running or jumping) it can tear a little. Over time, the quality of the tissue degrades and becomes so irritated that just walking can be painful.

So what can you do about it? TONS!

Fortunately, plantar fasciitis responds well to conservative treatments that you can do on your own. The key is to be consistent and try different approachesto find what is right for you. Here are three foundational methods to get your started:

(1)
Relative REST.  CrossFitters notoriously love intensity. When the programming is good, it’s difficult to say “no” to WODing that day…and you don’t have to. Relative rest means scaling activities that are going to flare up your irritation.

If this hurts –>Try this.
Running –> Rowing
Double Under –> Air squats
 Box Jumps –> Kettlebell Swings

Avoid any explosive, repetitive foot motions & speak with your coach about what movements are more appropriate for you.

Don’t forget your footwear! If you’ve been wearing extremely minimalist shoes, the muscles on the bottom of your feet are working overtime. Try a shoe with more cushion and support, at least until you feel 100%. Outside of the box, opt for supportive, flats shoes. Ladies, this means no heels until you are symptom free.

Promote recovery while you sleep by wearing a night splint. You can pick one up at most medical supply stores, or fashion one yourself out of an ace bandage, or long sock. The goal here is to avoid plantar flexion (pointing your toe down) while you sleep. It’s not sexy, but it can help.


(2)
Increase MOBILITY and TISSUE QUALITY. In the CrossFit world, we have a love/hate relationship with mobility, but it’s key in maintaining muscle balance and quality. The musculature of the foot and ankle are both implicated in contributing to plantar fasciitis. From a flexibility standpoint, start with the bigger muscles (gastrocnemius and soleus) and work to the smaller (peroneals and foot flexors). Check out episodes 25 and 237 on Mobility WOD for some dedicated ankle mobility work.

More specifically for the plantar fascia, try rolling the bottom of your foot on a lacrosse or golf ball. You may also introduce ice therapy by rolling on a frozen water bottle. Prolonged eccentric stretch of the plantar fascia by lowering your heel off the back of a step has produced marked results for many suffering with the condition. Lower down slowly then hold for at least 30 seconds. Lastly, don’t be afraid to dig in there and massage (or convince someone else to).

plantar-fascia

(3)
BuildSTRENGTH. There’s more on the bottom of your foot than meets the eye. Underneath the plantar fascia are many small muscles called the foot intrinsics. Developing strength and control of these muscles is common in barefoot training. When these muscles are performing properly, the forces on the connective tissue are lessened. If you are pain free, try a variety of balance exercises in bare feet or pick up and move small objects with your toes while watching reruns of last year’s games on TV.

Plantar fasciitis can be a bigger beast to battle than Rich Froning, Jason Khalipa, and Matt Chan combined. Keep the following points in mind for happy, healthy feet:

  • Take care to note symptoms when they begin and be aggressive with your “pre-hab”
  • Maintain open lines of communication with your coach and listen to your body to scale/edit your movements appropriately
  • If you have prolonged or worsening pain after trying the aforementioned exercises,
    seek the advice of a medical professional who understands your training

Written By Liz Caruso

6 Comments

  1. Nice one Dr. Rocket. Like the alternative movements.

  2. Thanks for the great info Sean!
    Concerning PF what’s your take on the roll a persons diet plays especially the avoidance of grains considering their pro-inflammatory effect on the body?
    Tom

  3. I’m honored that you choice to include this piece on the website! I hope your readers find it useful.

    • Very useful – thanks Liz. I have had PF once (4 weeks prior to the Marine Corps Marathon) I hope I never have it again.

  4. Thank you very much. I will try all of these for my right foot

  5. The images and descriptions of this post helped me fashion an ace bandage splint to stop my ankle from passive plantar flexion while I lie supine in bed. Here’s what I did:

    1.) wrap around distal aspect of foot twice
    2.) wrap once around leg superiorly
    3.) wrap twice around leg just inferior to knee
    4.) bring ace wrap back down under the heel, across the plantar surface of foot and underneath the first two wraps
    5.) bring ace warp back up over the toes, putting some tension on the band to passively hold ankle at a 90 degree angle
    6.) tuck ace wrap underneath layers already flush to skin of leg
    7.) wrap excess wrap over the layers from step 3, place clips.

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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