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Plantar Fasciitis

Running into problems...

Plantar Fasciitis and associated foot injuries seem to be alarmingly common in agility. Ask at any show and you will be amazed at how many people admit to having suffered foot pain or foot injury at one time or other. It happened quite suddenly to Soraya Porter who ripped her plantar fascia whilst competing at the Axstane show. She was referred to Jo Coates, a podiatrist in her area, who helped her get back to agility. Together they have written this article.

It was a beautiful sunny Sunday in early 2014. I was on the start line with my extremely vocal Jack Russell girlie. I decided to do a running start, so off we went at a flat out run. As I pushed off, my back foot (left) gave a horrible tearing sensation. It was like the extra strong Velcro you can buy  - that feeling when you try to tear it apart.

The pain was excruciating but, lame brain that I was, I thought that we stood a good chance of getting a placing and so a combination of adrenalin and extreme competitiveness somehow got me round the course. My dog kept giving me odd looks all the way round, but for once she decided not to tell me off for not handling her like normal and we somehow went clear.

As I crossed the finish line, the pain came charging back to meet me. After rewarding my dog, who was now looking at me like I'd grown a second head, I hobbled to the car to return her to the crate. I realised something was seriously wrong, and I was very concerned that I might not be able to make the hours drive home. As is usual in these kind of situations, I was on my own and no-one who lived near me was visible.

I reported to the first aiders, who confirmed my worst fears that I had done myself a mischief and it needed looking at by a medical professional. I sat there with the foot iced and elevated and wondered if that was my agility competing over for the season. I didn't realise at the time, but the short answer was yes! I had become a fully paid up member of that elite agility group known as the 'dodgy foot brigade.'

Self diagnosis
This group has certain strange and illogical characteristics. They all know someone who had something similar and they were told that it was 'Policemans Heel' or Plantar Fasciitis. It was exactly the same as they are now suffering and so therefore, by definition, it MUST be the same thing. They've looked it up on the internet, and they describe all the same symptoms as they have got, so it MUST be the same thing. They've had a conversation on the Internet and the general consensus was that it MUST be Plantar Fasciitis.

So having reached this diagnosis, based on no professional specialist advice, they either get some exercises off the Internet, or they speak to a friend of a friend of a friend who was given some exercises and they do those same exercises when they had it. Or they go to a running shop and the sales assistant there gives them some generic exercises and recommends some specialist shoes (usually rather expensive ones!). I am not knocking the running shops. They are a mine of useful information and help but, at this stage, it is sort of putting the cart before the horse – i.e. the individual hasn't actually got a specific diagnosis, they just think they know what’s wrong with their foot – based on no medical training whatsoever.

They may also go into a large chemists - or the Internet again - and buy various types of gel inserts for different area's of their foot. Probably all the time this is going on, they are trying to carry on with agility, walking the dogs etc. and only really resting the offending foot when it hurts and throbs soooooo much that they really can't carry on any longer.

This whole cycle may go on and repeat itself for several months.

I am not taking the mickey out of all this – I was 'guilty' of doing several of these things. The problem is made worse by the fact that many doctors do not really recognise plantar fasciitis and associated foot problems. If one does take you seriously, then you are normally referred to a physiotherapist and or recommended to have a steroid injection in your foot which, I am told, is very painful and rarely effective in curing the problem.

Plantar fasciitisLooking for help
If there was something wrong with our dogs, we'd be straight off to the relevant specialists but we don't seem to do that for ourselves until we are in so much pain we just can't train any more by which time we have done further damage to the site of the original injury.

So why is it so few of us do what I eventually managed to do – which was to consult a specialist?

I went to see sports podiatrist on the recommendation of a very kind lady on the Agilitynet Facebook page. It was the best thing I could ever have done – but why didn't I - and many others like me - not think to consult a podiatrist sooner?

This is why I decided to approach Agilitynet to write this article. Firstly, I didn't think to consult a podiatrist because I don't think I really knew what one was, let alone knew that there was such a thing as a sports podiatrist. I mean I vaguely knew that podiatrists had something to do with feet, but I think I got them muddled up with chiropodists and I think I also thought they dealt with old peoples feet and general foot deformities. We are all very quick to seek specialist help and advice on every aspect of our dogs wellbeing, behaviour, structure etc. but we don't do the same for ourselves.

I think the other thing that would possibly have put me off, if I'd thought of a podiatrist, is the price. If they are a specialist, its bound to cost loads of money right? Well, no. When you speak to your doctor you can ask to be referred to a podiatrist. There will probably be a long waiting list depending on where you are in the country, but you can be referred. Or you can claim under your health insurance if you have it. Or you can self fund. As a guideline, for the initial hours consultation which included gait analysis etc .,I paid £45. After that, I had a series of regular half hour appointments which cost £30 a time – I didn't need 'shed loads' of appointments. If you think about all the money you have wasted with paying out for inserts, shoes etc. which didn't fix the problem, the cost of an expert is considerably cheaper.

It turned out that I did not have plantar fasciitis, although it displayed many of the common, similar symptoms. I was given a few, very specific to my problem, simple exercises, which I still do in addition to my regular massage treatments of my left calf and foot - not always a pleasant sensation it has to be said. They work because they have been specifically tailored to my specific problem. I have a special polymer insert in both shoes (both different) and, along the way, she corrected the lopsidedness in my hips caused by an old horse riding accident!

I can't sing her praises high enough and I no longer dread that first step out of bed in the morning when you almost go through the ceiling because of the bruised pain in the damaged foot.  My foot is a lot better now, but these things take time to heal and if I forget to do my exercises regularly I soon know about it.

Footwear
The podiatrist told me that the majority of foot problems are caused by incorrect footwear – not only when taking part in a sport, but in day-to-day life. Leaving aside the rights and wrongs of fashion, take a good look at the shoes you are wearing for agility. Have you got them just because you like the colour, or your best friend or your sporting hero has got the same ones? Or have you got them because they are the right ones for the way you move, run etc? Do your shoes make your feet hurt by the end of the day? If they do, then this could be a warning sign. This is when a specialist running shop comes into its own. Go and have a gait analysis, explain what you want them for and see what they suggest. Do it now, and don't wait like me until your foot gives up the ghost and you end up losing money in entries to shows you can't compete in because you can hardly walk!

I have asked Jo Coates, the podiatrist who treated me, to write an article about the most common foot injury – plantar fasciitis, and it follows this article. However, if you are dealing with long term persistent foot pain, please learn by my mistakes. Please stop and have a think about what you actually know about your foot injury. Have you sought professional advice? Do you definitely know what is wrong with it? If there was something not right with your dog you'd go see a specialist. Do yourself a favour – if things aren't right go see a podiatrist. Ask on Agilitynet for recommendations and stop self diagnosing – it will save you money in the long run!

Plantar Fasciitis - A Podiatrist's View

Foot pain, especially heel pain, is the worst problem for an active person who spends a lot of time on their feet! The most common cause of heel pain in an active healthy person is a condition called plantar fasciitis.

The plantar fascia is a tough and flexible band of tissue that runs under the sole of the foot. It connects the heel bone with the bones of the foot, and acts as a kind of shock absorber to the foot. Sudden damage, or damage that occurs over many months or years, can cause tiny tears (microtears) to develop inside the tissue of the plantar fascia. This can cause the plantar fascia to thicken, resulting in heel pain. Plantar fasciitis is the medical term for the thickening and inflammation of the plantar fascia. Plantar fasciitis is an incredibly painful, activity-limiting and frustrating condition if it is not treated quickly and correctly.

Causes

  • A sudden increase in activity

  • Change in training surface

  • Incorrect unsupportive footwear

  • Abnormal biomechanics of the foot

Symptoms

  • Pain in the underside of the heel first thing in the morning or after periods of inactivity

  • Pain eases after walking for a short period but returns as weightbearing activity continues.

Treatment

Address footwear!
Shoes with a thick supportive sole and a fastening are essential!

Stretch

  • Gastrocnemius (upper calf) stretch
    Keep the back leg straight and push the back heel into the ground. Keeping a straight upper body and gently lifting up your hips helps. There shouldn’t be much pressure on the front foot.

  • Soleus (lower calf) stretch
    Stand closer to the wall and bend one leg, keeping the foot flat on the floor. You should feel a stretch in your lower calf. Leaning towards the wall intensifies the stretch; there should be little pressure on the other foot.

  • Plantar fascia stretch
    The plantar fascia can be stretched is by pulling up on the foot and toes with the hands. Hold the stretch for about 30 seconds. Repeat this plantar fasciitis stretch 5 times and aim to stretch 3 times a day.
    Or whilst sitting roll a golf ball backwards and forwards along the bottom of the affected foot for 3 reps of 30 seconds.

Ice the painful area
Apply a pack of frozen peas wrapped in a damp clothj for 10 minutes. Never apply ice directly to the skin.

Limit activity to non-impact until your symptoms have settled.
Basically if the activity makes your foot hurt, either at the time or the following day, then don't do it!

If symptoms remain after following the above treatments, the problem may be due to abnormal biomechanics of the foot. To address the issue and resolve the problem it is highly recommended that a podiatrist is consulted. The podiatrist, a specialist in foot problems, will conduct a thorough assessment of your foot and leg and assess whether insoles, also known as orthoses, in your shoes would be beneficial to address any biomechanical issues.

About the author...
Soraya Porter has taught, judged and been competing in agiity for many years at all grades. She lives in the smallest town inEngland with her two dogs and a vry vocal Siamese cat.

About the podiatrist
Jo Coates
started running in 1999 and began competing in road and cross country races soon after. She has completed 10 marathons with a PB of 2:59:49 and has set personal best times for every distance on the road and track in the 2014 season..

Having initially qualified as a gym instructor and personal trainer in 2000, Jo quickly developed an interest in Sports Injury Treatment and was awarded a higher diploma in Sports Therapy in 2001. In  2003 she enrolled at the University of Northampton to study Podiatry and in 2006 was awarded a 2:1 BSc(Hons).

Following extensive research, Jo realised that a high proportion of the injuries that athletes were presenting with were most likely due to gait and biomechanical abnormalities. To treat the cause of these injuries as well as the symptoms, she determined that gait analysis and insole prescription in combination with sports massage and sports injury treatment would be beneficial.

It is the complete assessment and treatment of both the cause and the symptoms of sports injuries that makes the Suffolk Sports Injury Clinic so unique. Jo launched this dual approach in 2006 and has been helping athletes recover from injury and enhance their performance ever since. 

Suffolk Sports Injury Clinic
Tel. 01284 760020
www.suffolksportsinjuryclinic.co.uk

First published 1 April 20156