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over the years, I have consulted and
treated hundreds of runners, from
average joggers to marathoners,
professional athletes and high
school athletes. Foot and ankle
injuries, including plantar fasciitis,
Achilles tendonitis, fibularis
tendonitis and posterior tibialis
strain are the most common we see among this population.
Treatment for these types of injuries presents
additional challenges when dealing with runners given
the nature of their injuries, typically chronic/overuse
type injuries, and the typical runner’s propensity for
training “through the pain.”
A speedy recovery for runners, like all athletes, is
paramount. This fact underscores the need as a clinician
to appropriately identify the nature of the problem from
a biomechanical standpoint and everything contributing
to it, and then implement a treatment approach
addressing what’s been identified through our evaluation
as comprehensively as possible.
With treating foot and ankle injuries, it is easy to
develop tunnel vision, focusing too narrowly on the
affected tissues and not adequately considering the big
picture. Beyond the specific injury, adjacent structures
need to be assessed and treated for their potential role
in the cardinal complaints. In addition, patient education
about factors such as training routines, early injury
recognition, footwear and overall conditioning needs
to be a substantial part of any treatment plan. This will
minimize recovery time and maximize efforts for prevention
of future occurrences.
So how do we satisfy optimal rehabilitation time
and long-term success? We think the key is to use a
comprehensive yet straightforward plan that balances
a combination of manual techniques, varied exercises
for different purposes and extensive patient education
about the injury, normal and abnormal physiological
responses, and strategies to avoid injury in the future.
Localized Treatment
As with any injury, managing symptoms and promoting
tissue healing is initially the primary focus. There
is a wide variety of therapeutic exercises, manual techniques
and modalities that can be employed to assist
the body’s ability to heal. Balancing all of these options
has proven a key factor for success in my experience.
The most common modalities we utilize include various
forms of heat or ice, and educating patients about
when to use either is important. It is also significant to
avoid the habit of “icing after every treatment” or using
heat before every treatment. Consider exactly what the
desired treatment and tissue response is and apply the
modality (or not) that best aids in that effort.
[CoVER stoRY]
Manual techniques: Manual techniques including
joint mobilization and stretching, traditional soft-tissue
manipulation and IASTM (instrument-assisted softtissue
mobilization) can improve circulation, tissue
remodeling and joint mobility, as well as modulate
pain. Plantar fasciitis and tendonitis injuries tend to
respond particularly well to the appropriately implemented
manual techniques.
Therapeutic exercise: I have also had excellent success
treating these types of injuries with therapeutic
exercises that focus on joint and soft-tissue conditioning.
This involves prescribing exercises that promote
ROM, healthy blood flow and oxygenation of tissues,
along with joint lubrication, below a threshold that
exacerbates the inflammatory response when dealing
in the more acute phases of injury. Using very light
resistance with high repetitions (i.e., three sets of 30 for
each exercise) helps promote healing but it is imperative
ADVANCE for Physical Therapy & Rehab Medicine
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