For those people who train in repetitive actions of running or speed training, debilitating conditions in the lower legs can render you unable to train consistently and with confidence. Overuse injuries are common and can frustratingly bring a halt to your sport or daily fitness routines.
Plantar Fasciitis is the most common of injuries in people who run and jump. Court sports persons and runners in general suffer from this condition which is an inflammation of the connective tissue that covers the underside of the foot. The condition is usually diagnosed by intense pain upon placing your foot down on the floor when you first wake up in the morning. Slight limping until the fascia warms up and becomes malleable is a certain indicator and it can leave you unable to walk for a brief time in the morning hours. Continuing to ignore this condition can result in a tear which will leave you unable to place any weight on the foot without intense pain.
Being a volleyball player, I am constantly running, jumping, changing direction with powerful and explosive force. I am susceptible to this type of injury. Indeed a year or so ago, whilst training heavily for an international competition, I felt a 'twang' go around my L ankle whilst doing some skipping training. I didn't realise it at the time, but this was my plantar fascia tearing. Unfortunately I suffer from an 'athlete's focus' and threw myself back into playing and training too early into the recovery phase to understand that the fascia was not sufficiently repaired. Turning to run for a wayward ball, that same 'twang' came back and I was unable to walk for some time. It's kind of a challenge to keep treating and be hopping around a massage table! As the competition loomed closer and I pushed myself back onto the court again, to have the injury tear AGAIN, I was getting desperate. A decent rest was all I could do, along with some good Acupuncture, PRP Injections and eccentric strengthening, which saw me able to compete in my tournament in New Zealand without issue.
The plantar fascia is a band of connective tissue that runs from the medial arch of the foot, spreading out over the entire sole of the foot (plantar surface) and helps to support the transverse (crossways) arch of the foot and assist with flexion and extension of the ankle. It is also vital in assisting the action of plantar flexion (pointing the foot downwards) as in a jump or taking off in a sprint.
The inflammation that occurs in this fascia is a result of overuse and tightening of the plantar flexors, which run lengthways up the inside of the tibia or shin bone. Initial signs are a discomfort in the arch of the foot, pain in the medial (inside) heel bone and a tentativeness in putting the foot down first thing in the morning. The condition gradually worsens to the point where walking is difficult and running illicits a sharp pain in the ankle. Going downhill, sprinting or jumping is more acute and you begin to limp orcompromise running technique to compensate which can lead to further issues in the hips and lower back.
Two important factors will help alleviate this painful condition. Reduction of the inflammation and stretching/conditioning of the plantar flexors to allow the muscles to complete the movement and not the fascia. In any case of 'itis' it is the inflammation that is primary to eradicate. Rest is primary, followed by ice (though this can be over-administered). In more acute cases, acupuncture or corticosteroid injections can assist with reducing the inflammation. My experience with acupuncture was very effective, albeit painful. Particular techniques by a knowledgable Chinese Medicine Practitioner (such as our own Tina Camilleri) may involve moxibustion as part of the acupuncture process. In some drastic cases corticosteroid injections may be administered or, an alternative technique - Platelet Rich Plasma (PRP) Injection.
Conditioning the Plantar Flexors is primary to minimising the impact of the injury and also preventing it from returning. General tightening in the lower leg (calves) is a good starting point. Many people have set stretches for this anatomy which involves stretching on a straight knee. The lower leg needs two variations in every stretch to target both the superficial and underlying deep muscles. The Gastrocnemius gives the shape of the calf and is active during knee extension as it crosses the posterior knee joint. The Soleus, lies deep to the gastrocnemius and is active when the knee is flexed as its origin does not cross the knee joint. Both these muscles must be lengthened to maintain the all important achilles length. (it's common tendon of insertion). As these muscles are the primary movers of the action, the athlete should focus on the gross motor movers as well as the smaller muscles.
The smaller plantar flexors are the main issue in Plantar Fasciitis. The 'eccentric' strength of the plantar flexors is important to relieve the immediate pain and contributing factor. Activation of these small muscles makes all the difference to this conditon. Sitting on the floor and pulling the big toe back towards you in a 'pistol grip' with the knee both flexed and extended is a good way to stretch the flexors. There is a yoga posture called "the toe cruncher" which actively stretches the plantar foot and fascia. However with any inflammation you should be careful of 'over stretching' an already inflammed tendon.
Too much stretching too early in the rehabilitation will only pull on the tendons and result in further aggravation. Let pain be your guide, if it hurts - STOP. Stretching is a maintenance factor. That is, if you are acutely injured, then now is not the time to start stretching enthusiastically. Flexibility should be part of your weekly training to alleviate conditions. It is not as effective in the acute recovery phase.
Conditioning is perhaps the most vital of techniques. There is a simple 'stair exercise' that is most beneficial in developing the necessary eccentric strength or 'landing strength' to alleviate the condition. Standing on a step with the ball of your foot on the edge and your heels balancing off the end in full dorsi flexion (ankle extension). Rise up on your toes on both feet (this is important for the concentric phase of the exercise) til you are balanced on the toes. Transfer your weight to the affected foot and slowly over 5 counts, descend with a straight leg until the heel is at the original position, extended below the step line. Repeat 10 times over 3 sets. This develops the strength in the muscles so that the fascia does not have to contract to perform the action of plantar flexion. Be sure to keep the knees fully straightened throughout the exercise to target the eccentric nature of the exercise. Over 2-3 weeks, this should help alleviate the tension and with correct rest and considered stretching, the condition should begin to be noticeably reduced.
After recovery, it would be suggested to look at your technique in running or jumping and identify any imperfections that may be contributing to the condition (such as pronation). Worn out shoes or unforgiving surfaces can also be a contributor and a knowledgable trainer or instructor will be able to pick up on these technical aspects and identify bio-mechanical issues. This will ensure you are able to train consistently and confidently without fear of injury or risk.
*Flexor Hallucis Longus can also be included in this group
