Plantar Fasciitis & Achilles Tendonitis: Why they should be easy to get better – PART 1

Plantar Fasciitis and Achilles Tendonitis would have to be two of the more common ailments I have seen in runners during my relatively short time as a coach. These conditions can often last for 6, 12, 18 or even up to 24 months, and as a runner I know what you’re thinking “that is far too long to be away from running”. If you are like me, you want to get back out there ASAP, which is why I like the iMove Physiotherapy team and their dedication to keeping you running through conditions such as these wherever possible. You want to be able to notice significant improvement on a weekly basis in the first 6-12 weeks – and you should if you get the right advice. There really is no excuse for these types of conditions to be hampering your running for 6 – 12 months, or longer!!

The iMove Physio team take a multi-modal approach by attacking these conditions from several angles which Co-Owner Michael Rizk has outlined for us in this article. Common points in rehab AND where people go wrong in regards to treating Plantar Fasciitis and Achilles Tendinitis will also be covered in follow up blogs.

Phase I – The multi-modal approach to treatment (AKA – Attacking it from all angles)

The people that come and see us at iMove Physio for ongoing Plantar Fascia issues and Achilles tendonitis have usually tried 1 or 2 things but haven’t ‘gone hard’ early to really settle the symptoms down. Trying several of the following at the same time is crucial.

  1. Reducing load – Initially I will start by asking a patient to reduce running load by 50% depending on how bad symptoms are. Even if it’s mild I might still suggest 50%. It also doesn’t matter if they are running 15km per week or 60km per week. We need to pull load right back and see if we get a change in symptoms. If this crucial first step is missed, where we can settle the symptoms down to a 2-3 out of 10 in pain, then there is no base to work from. In fact, the most common mistake we see people make, who’ve had issues for up to 3 months, is a failure to aggressively reduce their load in the first 2 weeks. The beauty of being so strict in the first 2 weeks is to get a rapid change and for people to know that symptoms are changeable.
  2. Monitor the pain – This is also crucial as too often it is hard to recall exactly what triggered the symptoms, or on the flip side, what made them feel better. A simple spreadsheet, diary or A4 sheet of paper on the fridge to record a score out of 10 in the morning, during exercise and at night is ideal. We can’t change what we don’t measure and too often people with symptoms for up to 3 months have never been measuring these symptoms. This makes it extremely difficult to know what is helping and what is hindering.
  3. Shoes: Finding the right pair + using multiple – In your first 2 weeks it is a great idea to trial 2-3 different pairs of shoes and see which ones have you feeling better or worse. Again, symptoms that are changing are a great sign and often, even a shoe that makes you worse is a good clue. Once you find the shoe that has you feeling 1-2 points better we might stick with this for a week. There is also a good argument to rotate your shoes once your symptoms are settling. Every shoe will load your structures in a different way and it is this variability that can help settle your Achilles or plantar fascia down. If you’re struggling, the general advice I will give is to have a shoe with a higher heel to toe drop, i.e. a traditional running shoe usually has a 12mm heel. This can take the strain or stretch out of your Achilles and plantar fascia and can really help in that opening 2 weeks. For people who are really struggling or are still hovering around the 6-8 out of 10 pain a shoe with a ‘rocker’ bottom can really help (e.g. Hoka). The idea is that, the sole of the shoe does the work for you and propels you forward, thus resting your irritated structures.
  4. Taping – Taping the foot is an amazing short-term strategy to reduce symptoms and often will have our patients walking out 30-50% better. Whilst we know that taping doesn’t hold for very long it does seem to do enough to change the way we use our foot, and again this variability is what really helps an irritated Achilles or plantar fascia. I will often tape someone 2 days on and 1 day off to keep it nice and strong and avoid skin irritation.
  5. Rolling – You’ve all seen it, you’ve all done it – get on the ball 3-5 times a day for 1 minute. As with taping, it also provides some great short-term relief. Rolling may change the way we load our foot which all helps. If your Achilles is struggling, roll both your foot and your calf.
  6. Isometrics – The research has shown us that just holding a static muscle contraction (isometric) can have a great pain-relieving effect on our tissues. This has been comparable to paracetamol for pain! Like the rolling, we need to do this more often – 2 sets of 40 seconds, 3-5 times a day, or whenever you’re feeling symptoms is perfect. As well as being pain relieving, this gives us a great base to go towards our more traditional exercises that get the muscles and tendons of the foot stronger in the long term and therefore prevent plantar fascia and Achilles issues returning.
  7. Ankle biomechanics – We often see people with ongoing plantar fascia and Achilles pain who have significant difference in their ankle mobility or stability. When we identify and work on these areas, we increase the proprioception at the joint and again, this causes some movement variability which will help offload the irritated structures. Don’t forgot to check your ankle with a simple knee to wall test and remember, it is common that the side your symptoms are on is usually a bit stiffer.

Stay tuned for Part II of this article in which Michael will cover common points in rehab AND where people go wrong in regards to treating Plantar Fasciitis and Achilles Tendinitis.

If you suffer either of these conditions and need help with treatment so you can get back out on the road, contact iMove Physio located in Miranda, Panania and Rozelle, Sydney –

About Rachel Allworth (113 Articles)
Owner & Coach - Rachel's Runners

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  1. Plantar Fasciitis & Achilles Tendonitis: Why they should be easy to get better – PART 2 – Rachel's Runners

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