Plantar Fasciitis

Plantar Fasciitis is a condition causing tissue damage and pain at the attachment of the plantar fascia to the underside of the calcaneus (heel bone).plantar 1

Anatomy
Plantar Fasciitis is the Latin term for “inflammation of the plantar fascia”. The plantar fascia is a thick, fibrous ligament that runs under the foot from the heel bone to the toes. It forms the arch of the foot and functions as our natural shock-absorbing mechanism. Unlike muscle tissue, the plantar fascia is not very elastic and therefore is very limited in its capacity to stretch or elongate. Herein lies the problem: when too much traction is placed on the plantar fascia (for various reasons) micro-tearing will occur, resulting in irritation, inflammation and pain.

In many cases, plantar fasciitis is associated with a heel spur. Surprisingly, the spur itself does not cause pain, and may often be found in the other foot without symptoms.

What is a Heel Spur?heel spur
A heel spur is a bony growth at the front/underside of the heel bone. This type of calcification is also referred to “calcaneal spur” (calcaneus is Latin for heel bone). The reason for the development of a spur is that the body ‘responds’ to the constant traction and pulling from the plantar fascia ligament away from the heel bone. The ligament itself cannot become any longer, so instead the bone will ‘assist’ the ligament and grow.

A heel spur will show clearly on an X-Ray of your foot. After diagnosis of the Plantar Fasciitis, some doctors will recommend you have X-Rays taken. However, it should be noted that calcaneal spurs are not painful. They are not the problem. Pain is only caused because of inflammation of the tissue surrounding the heel spur.

It is interesting to note that most people suffering from Plantar Fasciitis pain do not have a heel spur! And vice-versa, there are people with a spur under one or both heels, but they have never experienced any foot pain. Spurs take many years to develop, they can also be found at the back of the heel (near the Achilles Tendon) or in other parts of the body.

Risk Factors for Plantar Fasciitis

  • Certain sports:  Activities that place a lot of stress on the heel bone and attached tissue, i.e. running, dance and aerobics.
  • Flat-feet or high arches:  People with flat feet may have reduced shock absorption, increasing strain on the plantar fascia. High arched feet have tighter plantar tissue, leading to similar effects.
  • Middle-aged or older: Heel pain tends to be more common with ageing as muscles supporting the arch of the foot become weaker, putting stress on the plantar fascia.
  • Overweight:  Weight places a greater mechanical load on the plantar fascia. There is evidence that overweight and inactivity lead to chemical damage to the plantar fascia, with a worsening of pain.
  • Pregnancy:  Weight gain, swelling and hormonal changes that accompany pregnancy may lead to mechanical overload of the plantar fascia.
  • Being on your feet:  People with occupations that require a lot of walking or standing on hard surfaces may suffer plantar fascia pain.
  • Wearing shoes with poor arch support or stiff soles:  Poorly designed shoes may contribute to problems.

Prevention

  • Maintaining a healthy weight to minimise the stress on the plantar fascia.
  • Choosing supportive shoes. Avoiding stiletto heels and shoes with excessively low heels like ballet flats. Buying shoes with a low to moderate heel, good arch support and shock absorption. Reducing your time barefoot, especially on hard surfaces.
  • Not wearing worn-out runners. Replacing old runners before they stop supporting and cushioning the feet.  If a sport involves a lot of running, replacing shoes after about 650 kilometres of use.
  • Starting activity slowly. Warming up before starting any activity or sport, and starting a new exercise program slowly.
  • Undertaking training prior to competition to ensure readiness to play.
  • Allowing adequate recovery time between workouts or training sessions.
  • Drinking water before, during and after play.
  • Avoiding activities that cause pain.

What are the symptoms, why is the pain worse in the morning or after sitting?
Heel pain is in most cases experienced in the centre of the underside of the heel, or at the front or sides of the underside of the heel. The pain is more intense with your first steps out of bed in the morning or after sitting for a while. The reason for this is that during rest our muscles and ligaments tend to shorten and tighten up. The tightening of the plantar fascia means more traction on the ligament making the tissue even more sensitive. With sudden weight-bearing the tissue is being traumatised, resulting in a stabbing pain.

After walking around for a while the ligament warms up, becomes a little bit more flexible and adapts itself, making the pain go way entirely or becoming more of a dull ache. However, after walking a long distance or standing for hours the pain will come back again.

To prevent the sudden sharp pain in the morning or after sitting, it is important to give the feet a little warm-up first with some simple exercises. Also, any barefoot walking should be avoided, especially first thing in the morning, as this will damage to the plantar fascia tissue.

Apart from pain in the heel or symptoms may include a mild swelling under the heel. In addition, heel pain is often associated with tightness in the calf muscles. Tight calf muscles are a major contributing factor to Plantar Fasciitis.

Immediate Management
Initial treatment includes offloading the area, wearing supportive cushioned footwear with a slight raise at the heel and avoiding flip flops, ballet flats and un-supportive stiff soled shoes. By booking an appointment with your podiatrist as soon as possible they will be able to assess your foot and the causative factors. They are able to apply a specific taping technique to your foot to rest the plantar fascia long enough for it to heal and for you to continue walking. They will then guide you with appropriate home exercises including important and specific stretching and strengthening of the lower leg and foot. They may also prescribe a heel lift and advice on appropriate footwear and may look at other modalities if required. A reduction in weight is also beneficial in assisting healing if you have increased body weight recently.

Treatment – Ongoing if required

  • Night splints/Strassburg Sock:  Your podiatrist may recommend wearing a splint or sock fitted to the calf and foot while sleeping. This holds the plantar fascia and Achilles tendon in a lengthened position overnight.
  • Orthotics.  A Podiatrist is the most specifically trained health professional to assess your biomechanics and may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to the feet more evenly, and to stimulate the small foot muscles.
  • Physiotherapy.  A physiotherapist can give instruction on a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilises the ankle and heel. A physiotherapist may also instruct how to apply athletic taping to support the bottom of the foot. Your podiatrist will refer you for this should you need it.
  • Other Modalities – for the chronic case which can be discussed with your podiatrist are Acupuncture, Trigger point massage, ESWT (shock wave therapy), Cortisone Injections, Medication. These measures are for the most persistent cases, and do not replace the need for the treatment methods detailed above.
  • Surgery – is the last resort once all of the above conservative treatment options have been exhausted.

Rehabilitation and return to play

Aims of rehabilitation

  • Decrease initial pain and inflammation.
  • Identify biomechanical dysfunction.
  • Improve flexibility.
  • Strengthen the plantar fascia, intrinsic foot muscles and lower limb
  • Return to full fitness.
  • Injury prevention.

Reducing pain and inflammation

  • Reduce activities that cause pain.
  • Maintain fitness by swimming or cycling. Take the opportunity to work on upper body strength.
  • Taping gives excellent support while allowing the foot to heal.
  • If taping is effective then it is likely that orthotics will also be effective in correcting foot biomechanics and helping to prevent the injury returning once normal training has resumed.
  • Apply cold therapy.  Ice massage for 10 minutes to the site of pain – several times a day if possible. A frozen drink bottle used like a rolling pin is an easy way of performing ice massage.

Return to play

  • Follow the advice given by a sports medicine professional.
  • After a week of no pain running can be started again.
  • This should be a gradual process. If pain is felt at any time then go back a step.
  • Running time should be gradually increased.
  • Apply tape to the foot to support it for the first few runs, especially if orthotics are not being worn.
  • Ensure the correct shoes for your type of running style or sport are worn. See our podiatrists for a personalised Footwear Assessment to determine the correct shoe.
  • After every training session apply ice for about 10 minutes.
  • Stretch properly before each training session and after.  Hold stretches for about 30 seconds and repeat five times.

Always Consult a Trained Professional

The information above is general in nature and is only intended to provide a summary of the subject matter covered. It is not a substitute for medical advice and you should always consult a trained professional practising in the area of sports medicine in relation to any injury. You use or rely on the information above at your own risk and no party involved in the production of this resource accepts any responsibility for the information contained within it or your use of that information.

Phil’s Shoe Review

Our Podiatrist, and resident shoe guru Phil reviews the Mizuno Wave Ride 19

BRAND: MizunoMizuno rider
STYLE: Rider 19
CATEGORY: Neutral firm high mileage running shoe
RRP: $220
SIZES:  Men’s 7-14 in D and 2E width, Women’s 6-12 in B and D width
WEIGHT: 270g
HEEL PITCH: 12mm

UPPER:
 Mizuno has used a new mesh with very little stitching or overlays to improve the fit of the shoe. The toe box has no restricting overlays, which dramatically reduces pressure over joint prominences and improves upper flexibility. The firm heel counter is padded but not excessively with thick memory foams as seen in other brands

MIDSOLE: A neutral wave plate finishing at the midfoot, provides equal amounts of medial and lateral support. The U4ic midsole that has been supplemented with the SRtouch cushioning compound in the heel gives this generation one of the softest rides of any Rider.

OUTSOLE: In areas of high wear the designers have utilised Mizuno’s X10 carbon rubber, this dramatically improves durability whilst not hindering grip. To reduce weight and improve grip the rest of the outsole is made up of G3 rubber.

FIT:

  • Forefoot: The open toe box and slight splay to the midsole creates a visual perception of width. The visual perception is matched when trialling the shoe as even in standard D width the Rider feels wider than comparable shoes.
  • Midfoot: In comparison to the forefoot the midfoot fit is snug and secure. The minimally supported mesh wraps around the foot and any sense of width in the forefoot is forgotten with a secure feel through the shank of the shoe.
  • Heel Counter: The firm heel counter and foam cushioning is a little harsher than other brands but therefore doesn’t choke the ankle. Overall it helps the streamline feeling of the shoe.
  • Orthotics: This shoe has been well loved by podiatrists in the past and the current generation is no different. The firm heel counter, neutral wave plate and firm ride works well with any device.

RIDE: This is not Mizuno’s softest neutral shoe and therefore the ride is on the firm side. Therefore for runners who like a plush ride they are better suited to the Enigma 5. However the Rider does give a firm and responsive ride that is comparable to high mileage training shoes, high praise for a much more supportive shoe

CONCLUSION: The Mizuno Rider 19 continues a tradition built up my its predecessor for a shoe that functions like a heavy neutral running shoe but feels and performs like a lightweight racing flat. It works well for the runner with a neutral to mildly pronating foot or those with orthoses. Its ideal for the runner who wants a lighter shoe but requires more stability than the performance biased options.

RECOMMENDED FOR:

  • Runners with a reasonably neutral foot type
  • Runners with orthoses
  • Runners requiring support but looking for a lighter weight option

Sponsor Athlete: Natalie van den Adel

Nat shooting NatA native from the Netherlands Natalie van den Adel has joined the McKinnon Cougars State Championship Team. At 25 Natalie has already had a spectacular career.
Natalie started playing basketball at the age of 8,after winning back to back National Championships and receiving MVP honors at 17 for her hometown club, she left to play for Colorado State University, USA where she would stay for 2 years.

In 2012 & 2013 Natalie returned to her hometown club in the Netherlands, playing for the Senior Womens Team (highest level in the Netherlands), winning back to back Final Four Gold Medals and an MVP award.

After a season in France, one of the best leagues in Europe, Natalie moved to play in the Liga Femenina, the highest division in Spain. Finishing her second season with C.D. Zamarat in Zamora would lead her to Australia, where she is now a member of the McKinnon Cougars State Championship Team.

Since she was 15 Natalie has been a member of the National Team of the Netherlands. She has played 6 youth European Championships, winning a Gold medal with her U20 team. At the age of 20, Natalie made her debut in the Senior National Team and she has been a member since.

It is great to have Natalie here in Australia, she is a very welcome addition to the Cougars Championship team. We look forward to continuing working with Natalie and the rest of the team for the rest of the season.

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Asics GT2000 Update

This is a warning for those runners who have been loyal to the Asics GT2000 model and have updated their shoes. The Asics GT2000-3 is significantly different to the Asics GT2000-2 and all previous GT2000 models.  Asics have re-engineered the GT2000 a shoe that has been consistent for years.  Similar stories can be read about the Kayano and Nimbus models. Continue reading “Asics GT2000 Update”

ITB FRICTION SYNDROME

ITB Friction Syndrome is a common overuse injury that involves pain being produced on the outside of the knee. It is usually associated with activities that involve repetitive bending and straightening of the knee, such as running and cycling.

The Iliotibial band is a thick band of fascia that runs from the top of the thigh and attaches into the kneecap and tibia (leg bone). As you bend and straighten the knee, the ITB passes over a bony prominence on the outside of the leg which causes a friction irritation and thus causes pain and inflammation.There are numerous reasons as to why the ITB may shorten and tighten.

  • Poor biomechanics – cycling/running technique
  • Muscle weakness/imbalance – weak gluteals or quads
  • Unsuitable footwear
  • Change in training frequency/distance/surface
  • Leg length discrepancy
  • Poor foot biomechanics

In order to treat ITB syndrome, rest from the aggravating activity is usually recommended, as well as ice over the outside of the knee to reduce inflammation.  Using a foam roller to roll up and down the ITB can be an effective home exercise to restore and maintain length of the fascial band. A Physiotherapist can utilise myofascial release, dry needling and trigger point therapy to release tight muscles and decrease pain.

It is also very important to address the biomechanical issues that may be causing the pain and irritation. At Physiosports, we use running and cycling video assessment as a great tool to gather information on biomechanics and any muscle weaknesses or imbalances that may be occurring. In turn, a thorough and specific rehabilitation program can be designed to address any issues found and when resolved, a gradual return to the pre-injury frequency and intensity of the activity may occur.

CROSSFIT with ALISON MURDOCH

Crossfit2
Ali and the Schwartz Crossfit Melbourne team won the Pacific Regional’s 2015

APA Sports Physiotherapist Alison Murdoch has competed internationally at the Crossfit Games;  read on about Crossfit, Ali, and her teams achievements. 

CrossFit is a training program that builds strength and conditioning through extremely varied and challenging workouts including an assortment of standard weightlifting and gymnastics movements.  Each day the workout will test a different part of your functional strength or conditioning, not specializing in one particular thing, but rather with the goal of building a body that’s capable of practically anything and everything.
 
Ali has more than a passing interest in Crossfit and helping athletes return back to Crossfit following an injury; having competed at every Australian/NZ Regional Competition since 2011, four times on the team and once as an individual competitor last year, finishing 15th

Ali recently competed in the Pacific Regionals in Wollongong, the team won and have now qualified for the Crossfit Games in Los Angeles in July. This will be the third time Ali and the team have made it to the World Crossfit games

Good Luck Ali and the team!

FIFA 11 + – A COMPLETE WARM UP AND INJURY PREVENTION PROGRAM

Football fever continues with Germany just winning the Brazil 2014 World Cup Final.

The Socceroos World Cup preparation was riddled by injury, with big names  Tom Rogic (groin), Josh Kennedy (back), Mile Jedinak (groin) being affected. Away from the 2014 World Cup, the Matilda’s squad also suffered an influx of knee injuries .

The call for preventative measures toward the high incidence of lower limb injuries in football players has not fallen on deaf ears.

In 2008, International governing body FIFA (Fédération Internationale de Football Association) funded a research project looking at whether lower limb injuries could be prevented through the implementation of a structured warm up routine – The FIFA 11+. The results were astounding.

The study was huge, performed on almost 2500 Norweigan amateur female football players between 13 and 17 years old.

Almost 1900 players were part of the intervention group, and 600 in the control group which performed warm up as usual. The intervention  involved participating in a comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements. The program was performed during one season, and injuries were tracked throughout.

fifa

When performed only twice a week, the intervention group had 37% less injuries at training, and 29% fewer match injuries. Severe injuries (at least 28 days to return to play) reduced by almost 50%, the incidence of acute, overuse, ankle and knee injuries also reduced significantly (see Table below).

This is a scientifically proven, injury prevention warm up program that has been designed to be easily implemented by coaches.

FIFA have kindly attributed a website to the FIFA 11+ program, with all relevant resources(research articles, posters, manuals)  to be found there.

http://f-marc.com/11plus/home/

Phil’s Footy Boot Review- Nike Mercurial Vapor

Our Podiatrist Phil Trump reviews the new shoes available on the market

BRAND: Nike
STYLE: Mercurial Vapor
CATEGORY:Football
RRP:$350
SIZES:Men’s 7-13.5
WEIGHT: 230g

UPPER: The upper of the Nike Mercurial Vapor is a teijin synthetic upper.  It is ultra lightweight and moulds to the shape of the foot.  The lace cover on the previous models has been removed to reveal a traditional central lacing position.  This makes the shoe easier to adjust and allows the laces to be replaced.

MIDSOLE: As with all other Nike football boots there is no midsole or heel lift.

OUTSOLE: Unlike carbon fiber, which is found in the vapor’s more expensive brother, this model has a tepex glass fiber chassis.  Compared to traditional plastic, the glass fiber improves support and stiffness of the outsole, but reduces weight and thickness, bringing the foot closer to the ground.

Direct injected dual density TPU studs are cored out to further reduce weight.  The forefoot zonal spikes, which are based on a sprinting design, give the perfect balance of excellent straight-line force transfer and lateral grip.

FIT:

  • Forefoot:The one-piece teijin upper is extremely comfortable at the forefoot and due to its sprint spike like design, it has a glove like fit allowing the upper to mould to the foot.
  • Midfoot:The vapor does not have the flywire found in the Superfly, although, the fit across the midfoot remains firm without being tight.
  • Heel Counter:The heel has minimal padding to reduce weight, however, as the shoe moulds to your foot, there is no rubbing and the heel counter isn’t felt.
  • Orthotics:The tepex outsole gives provides an ideal base for orthoses to sit on, although, due to the minimalistic design of the boot, there is no room for bulky orthoses.

RIDE:The ride is similar to most football boots.  The tepex outsole distributes the pressure evenly from each stud allowing for little to no stud pressure.  The Nike Mercurial Vapor is noticeably more lightweight and comfortable when compared with other traditional leather boots.

CONCLUSION: The Nike Mercurial Vapor is a further improvement to an already impressive vapor range and religious followers of this boot will not be disappointed.  The Vapor’s upper has the best leather-like feel of any synthetic boot and is available in a range of exciting colours that fans of this shoe will appreciate.

RECOMMENDED FOR:

  • Players with a narrow to normal neutral foot type and lighter build
  • Players who are quick and agile and looking for a competitive advantage
  • Players who like colorful boots