Who the (explicit word of choice) left glass on the floor!?

Plantar Fasciopathy

Who the (explicit word of choice) left the glass on the floor?! If you have ever mumbled these words in the morning, odds are you have dealt with plantar fasciopathy. Cross your leg, pull your toes up and feel the arch of your foot. Do you feel that thick band of tissue? That is your plantar fascia. You also engaged your Windlass Mechanism - this will come into play later. The plantar fascia is the tissue that helps support the arch of your foot. The plantar fascia also helps to provide shock absorption with running and walking. Thus, why plantar fasicopathy may account for up to 8% of all running-related injuries (RRIs) (Lemont et al. 2003). Plantar fasciopathy is due to degeneration of the tissues that help support the foot. This condition can be set in motion by many different events. Examples include a rapid increase in running mileage or a return to activity following an extended period of rest.

Plantar Fasciopathy vs. Fasciitis

At this point, you may be asking why I keep saying fasciopathy instead of plantar fasciitis. While these terms seem to be interchangeable, there are key differences. Traditional thought is that the heel pain you experience is secondary to inflammation of the plantar fascia. New research has pointed to the belief that this condition can occur with an absence of inflammatory cells (Lemont et al. 2003)

This has opened up the possibility of new treatment options beyond ice. This is important in understanding the most current research to treat this condition.

Treating Plantar Fasciopathy

A quick google search for "plantar fasciitis" will lead you to a myriad of treatment options. These treatment options may include ice, stretching, splints, etc. A study by Rathleff et al. in 2015 set out to assess strength training for plantar fasciopathy. The study compared a high-load strengthening program vs. a stretching program. The study included a simple progressive strengthening program (outlined below). At 3-months, participants were able to report improved outcomes vs. the stretching program. A key component to the strengthening program involved the Windlass Mechanism. Remember when you pulled your toes back and caused your plantar fascia to become taught? That is the Windlass mechanism. This allows for a more direct load to the plantar fascia during strengthening. As you will see below, we will use a towel to do this.

Strengthening Protocol

- Roll up a towel and place under your toes

- Perform every other day - IMPORTANT! You need to allow time for the tissues to recover and adapt.

- If you are unable to perform on a single leg, perform using both legs until you are able to perform on one leg.

- Each rep consists of three phases: 3s up, hold at the top for 2s, and lower for 3s. You can also use a metronome at 30 bpm as this will help with control.

- How much weight should I use? You should be able to complete each set with good form and control but feel as though you only had 1-2 reps left in the tank.





Use the following sets and reps:

- Weeks 1-2: 3x12

- Week 3-4: 4x10; add a backpack with books

- Week 5-6: 5x8

Consistency and patience are key! Tissues take time to adapt. If you feel like you aren't ready for the next phase, don't be afraid to add an extra week at your current phase. Use this protocol to sweep the glass off of your bedroom floor!

References:


1. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–7.

2. Rathleff, M. S. et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports, 2015: 25, e292-e300.

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