|
|
Plantar Fascitis - Causes and Treatment
Plantar fasciitis is not uncommon among
runners. The causes are subject to debate as is the treatment. It is most
commonly seen in the athlete with a medium to high arch, and those who supinate
(turn inward) the forefoot during activity. However, any foot type can have
plantar fasciitis.
Common historical points include recent
increases in running mileage without a proper build-up, the "weekend
warrior" syndrome (inactivity followed by sporadic bouts of activity),
tight hamstrings and calf musculature. The athlete may have been improperly fit
with a motion-control shoe designed for a runner who pronates (turns outward)
the foot.
Potential Causes:
- Weak internal foot muscles
- Tight calf muscles with decreased
dorsiflexion (lifting the foot upward with the heel down)
- Tight hamstrings
- Overly flat or high arches
- Sudden increase in activity level
- Poor shoe support or wrong shoes in terms
of design
- Sudden increase in body weight
Elements of Treatment:
- Hamstring, calf and foot muscle
stretching
- Orthotics
- Taping for plantar support on a regular
basis
- Reduced running activity; avoid all
training on hard surfaces. Also stay out of soft sand and soft gravel.
- No bare feet, even at home. Wear shoes
whenever you are standing up.
- Use of shoes with a stiff shank and
inflexible sole except during athletic activity. Dansko brand is
particularly good.
- Strengthening internal foot muscles
- Appropriate running shoes
- Weight loss, if appropriate
- Patience, since successful treatment can
take months
- Local application of anti-inflammatory
creams
- NSAIDs- Ibuprofen, Motrin, Advil, Aleve
(if you have difficulty tolerating these, you will need to take Pepcid to
prevent stomach problems.)
- Night splint use on a consistent basis
Plantar Fasciitis Taping Technique:
This taping technique has been very
successful in treating plantar fasciitis if used consistently. You will need
to re-tape every 2-3 days, or more often if the tape were to loosen. You can
shower, for the tape to last. The skin of the foot will need a rest break, and
the best strategy is to remove one tape job, bathe, apply a vitamin E
containing cream, let you feet rest overnight. In the morning then wash with
soap and water, dry your feet, and after ensuring they are completely dry for
10-15 minutes, apply a new tape to the foot. It requires the use of Leuko tape,
a two part taping system. Regular white cloth tape will not stick to the skin
well enough to be satisfactory for this purpose. This tape is available through
us if you are a client. It is also available through medical supply companies
online.
 |
Assemble taping materials, talcum powder, and scissors. Conventional white adhesive will not stick well enough to be useful. Our instructions apply only to the two part tape system called Leukotape. The person being taped skin should be clean, without lotion or creams on skin of the foot. |
 |
Position the foot in the neutral position. It is important that the person being taped keep the foot relaxed but with the ankle at 90 degrees. It is also important that the foot not be turned inward or outward(pronated or supinated ).
First a apply skin protectant/adhesive to the skin on the tape path such as Benzoin, Tuffskin, Mastisol. |
 |
Measure and cut two pieces of the cover tape (white tape) long enough to encircle the ball of the foot and overlap by one inch.
|
 |
Measure and cut two pieces of brown Leukotape long enough to pass from the ball of the foot around the heel and back to the ball of the foot almost to the toes. Take care as the adhesive side of the tape readily picks up lint, and dirt, rapidly losing its adhesive quality. |
 |
Wrap the white tape around the ball of the foot, without making the band tight. Take care to avoid wrinkling the skin on the sole, as that will cause immediate pain with walking. Overlap the tape, be sure to start on the top of the foot. |
|
 |
Stick one end of the brown tape on the ball of the foot,under the big toe, wrapping around the heel, returning to overlap the white tape near the little toe. Take care to apply tension to the sole, without causing skin wrinkles. Make sure the tape is smooth over the sole of the foot. Pull the edges of the tape to lay it smoothly over the skin. |
|
 |
Trim the brown tape so that it ends on the white cover tape. Repeat with the second brown tape strip, starting near the little toe, proceeding this time in the opposite direction, passing across the sole inside the heel, then around, returning to near the big toe. |
|
 |
Next, cover the trimmed ends of the brown tape with the second strip of white cover tape, again taking care not to get the wrap too tight. Start and finish on the top of the foot Avoid wrinkles on the sole of the foot. |
|
 |
Trim any corners of the white tape that protrude from the circumferential wrap as they will tend to catch on shoes and socks. Massage the whole tape job into the skin. Apply talcum powder to cover the skin, tape, & adhesive. Also, powder the inside of your shoes to allow you to slide in more easily and prevent dirt from sticking to the tape. |
|
 |
Gastrocnemius stretch.
Place the foot that is to be stretched behind the other in a "stride." The knee of the back leg should be straight, heel on the floor and the toes facing forward. Lean forward, pushing your hip forward.
Feel the stretch in the calf of the back leg. Hold 30 seconds. Relax, Repeat 3x.
Reverse legs and repeat. |
 |
Soleus stretch.
Begin with the same position as the gastrocnemius stretch, but move the back leg toward the other leg about6 inches. Keep the heel on the ground, toes forward, bend the knee and lean forward.
Feel the stretch in the calf of the back leg, in a slightly different place than with the gastrocnemius stretch. Hold 30 seconds. Relax. Repeat 3x.
Reverse legs and repeat. |
 |
Plantar fascia stretch.
Position yourself near a wall. Place the legs in a "stride" position, with the foot to be stretched in front. Place the ball of your foot on the floor close enough to the wall so the toes lie flat on the wall. Lean forward onto the front foot. bending the front knee.
Feel this stretch in the sole of the foot and underneath the toes. |
|
|
|
Post exertional fainting
H2-receptor-mediated vasodilation contributes to postexercise hypotension
Jennifer L. McCord, Julie M. Beasley, and John R. Halliwill
Department of Human Physiology, University of Oregon, Eugene, Oregon
Submitted 5 August 2005 ; accepted in final form 25 August 2005.
The early ( 30 min) postexercise hypotension response after a session of aerobic exercise is due in part to H1-receptor-mediated vasodilation. The purpose of this study was to determine the potential contribution of H2-receptor-mediated vasodilation to postexercise hypotension. We studied 10 healthy normotensive men and women (ages 23.7 ± 3.4 yr) before and through 90 min after a 60-min bout of cycling at 60% peak O2 uptake on randomized control and H2-receptor antagonist days (300 mg oral ranitidine). Arterial pressure (automated auscultation), cardiac output (acetylene washin) and femoral blood flow (Doppler ultrasound) were measured. Vascular conductance was calculated as flow/mean arterial pressure. Sixty minutes postexercise on the control day, femoral ( 62.3 ± 15.6%, where is change; P < 0.01) and systemic ( 13.8 ± 5.3%; P = 0.01) vascular conductances were increased, whereas mean arterial pressure was reduced ( -6.7 ± 1.1 mmHg; P < 0.01). Conversely, 60 min postexercise with ranitidine, femoral ( 9.4 ± 9.2%; P = 0.34) and systemic ( -2.8 ± 4.8%; P = 0.35) vascular conductances were not elevated and mean arterial pressure was not reduced ( -2.2 ± 1.3 mmHg; P = 0.12). Furthermore, postexercise femoral and systemic vascular conductances were lower (P < 0.05) and mean arterial pressure was higher (P = 0.01) on the ranitidine day compared with control. Ingestion of ranitidine markedly reduces vasodilation after exercise and blunts postexercise hypotension, suggesting H2-receptor-mediated vasodilation contributes to postexercise hypotension.
Thus if you are susceptible to fainting at the end of races, the use of an H2 blocker, such as Zantac, or Cimetidine may help keep your blood pressure up at the end of the race... and reduce the tendency to have heartburn/ GE reflux while cycling..another well known fact.
|
|
|
Strategies for Reducing Impact
and Shear Stress on the Medial Compartment of the Knee Or How to
make your previously injured knee(s) last longer.
1. Remember that knee structures often heal poorly or not at all after injury. After significant injury to the cartilage in your knee, understand that it will never be as good as it was before injury. Most common cartilage injuries to the knee are in the medial compartment.
2. Reduce running hrs, substitute cycling and water running. Remember the adage that "Cycling improves your run but not vice versa".
3. Consider NEVER running on a hard surface except to race.
4. Know that "plant your foot and turn" sports like basketball are the most damaging to knees.
5. You can be nationally competitive as a triathlete running less than 20 mi/wk up to the ½ Iron distance.you have a limited number of miles of running left in your knees.
6. Take Glucosamine daily( 1000 to 2000 mg/day ).
7. The medial compartment is affected in most runners more often than the lateral compartment (80+% of cartilage injury is in the medial compartment) With definitive medical info. about medial compartment injury, consider the use of 20mm pedal extenders to unload the medial compartment during cycling.
These are available from:
http://www.thethirdhand.com/Products/SC-PDA.html
8. Run using a metronome with a cadence of 90-100, this will shorten your stride and reduce knee stress.
9. Get a cycle computer with cadence, and cycle at a cadence of 90-105 to reduce shear stress across the knee. Increased cycling cadence will improve at least the early part of your run in triathlon.
10. Careful attendance to very elements of bike fit such as cleat position.moving the cleat toward the heel may reduce knee stress, and also using shorter cranks (e.g. - 165-170mm). Shorter cranks reduce the maximum angle of flexion of the knee during the pedal stroke. Pedals with increased float often reduce knee stress, especially if you have genu varus (bowlegged) knees.
11. Consider reduced gearing on hills, this may mean that you need a 12-27 cassette if you ride hilly courses. Standing & climbing in a big gear puts lots of stress on your knees.
12. You need to think about video gait analysis with biomechanical evaluation by an expert to look for elements that may be increasing stress on your knee. Corrective measures may help reduce further damage. Specific muscle weakness is actually quite common.
13. Learn to run on your mid/forefoot. Running, with a heel strike can produce instantaneous impact forces up to 4X your weight at the level of the knee.. this may take 3 to 4 months of measured effort to accomplish this change if you are a heel strike runner at present.
14. Body weight is unequivocally associated with knee damage from weight bearing activity. If you are more than 10-15 # overweight, and have a damaged knee. We would recommend that you seriously consider avoiding significant run training until you lose that extra weight.
15. If you have specific muscle weaknesses in your legs and core (and certainly if you're over 40 yrs old), you need to lift weights. You should avoid knee flexion angles of 85-90 degrees or more. Closed chain exercises are safer for your knees than open chain exercise. If you don't know the difference between open and closed chain exercise, get professional help. If any weight lifting exercise causes pain or swelling in your knee .stop & think!
16. Running shoes have a definite lifespan. The midsole and insole lose their shock absorbing capacity after running as little as 200-300 miles. The only solution is to date your shoes and replace them at this interval. Use your running shoes only for running, and replace the stock insoles with better aftermarket ones. Individuals with particular foot problems may benefit from orthotics. Appropriate orthotics in these individuals may reduce knee stress. A physical therapist, orthotist, or prosthetist with athletic experience can help you here.
17. If you get 'professional' advice about your knees and an exercise program, try to evaluate the source with circumspection. Many trainers and others offering advice in this area have little educational background. We see lots of patients with knee damage as a result of poor professional advice in their past. ACSM certified trainers, physical therapists with significant orthopedic experience, certified athletic trainers, and medical sports physicians with interest and experience in this area may be more reliable sources of information.
| |
|
Iliotibial band syndrome
 |
The iliotibial band (ITB) originates on the lateral rim of the pelvis and the gluteus muscle where it is wide and thick over the vastus lateralis muscle. Then it travels downward over the outside of the thigh becoming a narrower and denser structure. It then crosses the knee joint on the outside toward the front and attaches to the main bone of the lower leg, the tibia (see diagram.) Because it is a 2-joint structure, the athlete can have discomfort at the hip and/or the knee.
Running and cycling involve require repetitious extension of the knee joint. This can cause the ITB to shorten and tighten. The tightness then causes pressure on the outside (lateral) aspect of the knee which can cause lateral knee pain. The other common symptom is lateral hip pain, especially if you press on the bony bump (trochanter) on the outside of your hip. |
This can be caused by the friction and pressure of the tight ITB across that bony prominence and the associated hip (trochanteric) bursitis.
Bursitis is an inflammation of the bursa, the sack of fluid between the ITB and the bone that works as a lubricating cushion.
Trigger points in the hamstrings and gluteus minimus can also refer pain to the lateral knee and must be treated. Other problems that may contribute to ITBS include tightness of the gastroc/soleus group(calf) and the psoas (deep hip flexor muscle.) Inflammation and/or previous injury can contribute to scar tissue (adhesions) between the ITB and underlying structures.
Treatment may include deep tissue or friction massage which can release the adhesions, trigger point release, ART (active release therapy), icing, stretching, anti-inflammatories, focused exercise and other physical therapy modalities. Specific painful areas lateral to the knee and at the hip may need to be injected with steroids if unresponsive to the more conservative treatment strategies. There is then often marked improvement in, or elimination of the pain, if treatment is done properly. To maintain the post-steroid (or post intensive treatment) improvement stretching and strengthening exercises must be continued indefinitely.
The athlete with ITBS will probably have both tight and weak hip abductor muscles, especially the gluteus medius, on the affected side. There may also be tightness in the piriformis and hamstrings on that side.
The cyclist or triathlete may need to have some adjustments made to their bike, particularly the clipless pedals. Frequently, changing to a pedal with some degree of rotation is helpful, because if the ITB and other structures that want to rotate the leg outward are tight and the foot is held in one position by a non-rotational pedal, those structures will become fatigued and overworked, causing soreness and more tightness "fighting" the non-rotating foot. Some brands of pedals have more rotational freedom than others and should be considered.
Specific exercises to treat Iliotibial Band Syndrome:
 |
"The Clam:" Start in side-lying position, knees bent, feet together, keeping your hips "stacked." Lift the top knee, keeping the feet together. Repeat 10x. Do not roll forward. This warms up your hip (gluteus medius), making the stretch more effective.
|
 |
The position: Move the bottom leg forward, slightly. Keep the top knee bent and the thigh pushed back, to extend the hip. Keep your abs tight, to avoid arching your back. |
 |
The stretch: Place the ankle of the bottom leg on the top knee and gently press downward, while you are pressing upward with the bottom leg. Hold for 6 seconds, relax, but keep the position. Your leg should be able to drop toward the floor a bit more. Check your position and repeat. Do this 3 times. Then repeat on the other side. Be sure to start with “The Clam.” The goal is the inside of the upper knee touches the ground. This may take weeks of effort with real tightness. *If you don’t feel any stretch, you need to adjust your position and be sure your abs are tight!*.
|
Strengthening Exercises:
"The Clam": This is done like the beginning of the stretch, but hold the top and bottom legs apart for 10-30 seconds, before pulling them together. Repeat 10 times each leg and work up to 3 sets of 10. Done right, you will feel like there is a burn in your glutes. When you can easily do this, you can add 2-3# wrap-around weight to the upper thigh.
Single leg hopping, single- and double-leg jump rope.
Single leg hopping, single- and double-leg jump rope.
Lateral hip drop: This requires a stool 3-12 inches high. Stand with the affected leg on the stool and while keeping your knee straight, allow the suspended leg to drop as far as possible. Keep the knees straight. Then raise that side of your pelvis as far as possible. Repeat 10 times, then reverse the leg on the stool. Repeat the set 3 times. See the illustration above. This exercise is actually considerably harder than it seems. You may find that you have to progress slowly to the recommended 3 sets of 10 repetitions each.
Realize that if the ITBS is too severe to run without pain, you may need to substitute deep-water running for your run until the symptoms subside.
As always, when in doubt, consult a professional.
|
|
|
