Tuesday, March 19, 2013

Free-Tip Tuesday Volume XXXVI: Plantar Faciitis/-osis and Achilles Tendonitis/-osis

I’ve grouped these two painful conditions together because the both occur across the same joint – the ankle – and therefore the causes and treatments of each are very similar.

To begin, let’s first define a few terms. The suffix –ITIS simply refers to inflammation of the affected tissue. –OTIS on the other hand, refers to a situation where said inflammation has been allowed to propagate long enough that the condition has now become degenerative in nature. Yes, that is as bad as it sounds.

You may be surprised to know then that tendonITIS is actually a pretty rare condition; in reality what most people are suffering from is tendonOSIS. The bad news is that while tendonITIS is fairly easily treated and resolved, full resolution once things have progressed to tendonOSIS is also rare.

Therefore, the idea is to not get to this point in the first place!

Lastly, this post is not meant to serve as an attack on runners or long distance running, but more simply just a function of runners being the population most commonly seen suffering from these afflictions in our practice and therefore whom we thought would benefit the most from the following information.

That being said, most people would be well served to appreciate the difference between ‘running to get fit’, and ‘getting fit to run’. But at the end of the day if running provides you with joy, provides an outlet for stress, and encourages you to be more active – these are all positive things!

If you choose running as your preferred activity, we just ask that you do so intelligently.

Without further adieu, our top tips for avoiding foot frustration:


The foot of the matter – bad pun intended – in all of these conditions is OVERUSE. Especially overuse stacked on top of dysfunction. Due to the ‘No Pain, No Gain’ mentality, using soreness as a marker of a ‘good workout’, and other similarly misguided attitudes towards health & exercise, many people simply do too much. Whether it’s too much volume, frequency, or intensity – eventually you are asking for problems.

So how much is too much?!

- Soreness is severe enough to effect movement
- Soreness lasts more than one (1) day
- Observed decrease in performance

If any of these things are present, your volume/mileage needs severely adjusted. Period.

Pushing through pain isn’t ‘tough’, it’s foolish.


Whether it’s the FMS or one of the many other assessment protocols available, have your movement QUALITY measured. Who cares how many or how much of something you can do if you repeatedly do it incorrectly and with compensations?! There is a reason the FMS is used by every major professional sports league.

Is your body any less valuable to you as a multi-million dollar athlete’s is to them?

Common dysfunctions can include:

- Lack of ankle mobility and/or stability
- Lack of hip mobility and /or stability
- Weak glutes and hamstrings
- Tight hip flexors

Any or all of these dysfunctions severely distort running mechanics. The result is a stride which more resembles ‘hopping’ across the ground as opposed to correctly ‘pulling’ it behind you.

Have your movement screened and your gait analyzed, not only will you reduce your risk of injury – you’ll see your times go down too!

3. Examine Your Running Surface

While we are fans of the barefoot and minimalist running movement and the substantial improvements in gait that are often observed, one must also realize that 100’s of years ago everyone also DID NOT RUN ON CONCRETE! It’s only logical that the harder the surface is that you are impacting the more stress it will place on your body. Just like over doing it in terms of mileage, frequency, or intensity; constantly running on hard surfaces is just another example of tissue loading exceeding tissue tolerance.

Split time between running on hard surfaces, as well as more gentle options like crushed limestone, grass, and track work. The key is to do this early in your career while you have the choice, not after your body removes that option for you!

4. Spending Too Much Time In Shoes

The over-reliance on shoes, orthotics, etc. removes all stimuli for the many small muscles, tendons, and similar structures of the foot and ankle to do anything. In essence, they are asleep. Running mechanics will once again be negatively affected, and these structures will remain weak and possess little to no tolerance for tissue loading.

Spend more time barefoot, but again, be intelligent about it and build up more and more time in a progressive fashion. Strength train barefoot and establish YOUR OWN arch and support by strengthening all of those aforementioned structures of the foot and ankle.

BOTTOM LINE: Again, once things progress to the –OSIS stage, full resolution is unlikely. Combine this with the realization that many rehabilitation protocols produce lukewarm results due to solely focusing on the immediately affected tissues (i.e. strengthen the calves, stretch, etc.), and it makes much more sense to use these tips that are more global in nature in order to be proactive as opposed to reactive!

If you are too late to the party and already trashed yourself, no worries, check the following link to see a few of the modalities we instruct our clients to use in order to begin providing relief:


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