Plantar Fasciitis(PF) is a common health issue amongst the general population – it’s thought to account for 15% of adult foot complaints and runners are in the “at risk” group with prevalence rate in athletes around 21%. Plantar fasciitis accounts for about 10% of all running related injuries. PF usually develops with repeated impact or pressure, which, over time, can cause damage to the tissue in the foot, so it’s easy to see why running may contribute to this condition.
Today we are going to discuss;
1. What is plantar fasciitis and what are the risk factors and triggers for runners to be aware of?
2. A focus on the inflammatory aspect of plantar fasciitis and how nutrition may be utilised as part of your recovery and prevention strategy
3. Some food ideas to help you prevent, manage and recover from plantar fasciitis
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Our personal experience of plantar fasciitis.
What is plantar fasciitis, what are the risk factors and triggers for runners to be aware of?
Plantar fasciitis is a condition that occurs when the plantar fascia, the tissue that connects your toes to your heel, becomes damaged or torn. This condition is commonly experienced by runners and causes extreme pain in the bottom of the feet and the heel. Rest is essential if you have damaged your plantar fascia but preventing the condition in the first place is the best way to protect your feet. Stretching properly is an important factor, but your diet can also play an important role.
It’s thought that an inflammatory component of PF is a result of prolonged loading on the tissue which perpetuates the inflammatory cycle.
We know that inflammation is part of the healing process.
In PF it’s believed that the healing response results in production of new connective tissue which may be laid down in a disorganised fashion and this causes the formation of adhesion and thickening of the plantar fascia. It’s believed that the thickness of PF is related to the pain levels experienced.
The main triggers seem to be;
· Changes in activity – perhaps a new type of exercise activity or a change in intensity
· Tight calf muscles or an achilles injury
· New or old footwear
· Weight gain or being overweight
· Chronic inflammation may be driving the ongoing symptoms of PF – we can talk about that later in our conversation
The main risk factors for developing PF are considered to be;
· High Foot Arches
· Excessive foot pronation
· Weak plantar flexor muscles (that run along the bottom of the foot)
· Prolonged standing or walking
A Focus on the inflammatory aspect of plantar fasciitis and how nutrition may be utilised as part of your recovery and prevention strategy
Acute inflammation occurs in response to infection and injury. Immune cells identify a stressor i.e the infection/injury and take action to resolve the issue. Pro inflammatory mediators (histamine/cytokines/eicosanoids/prostaglandins) help to increase blood flow and vascular permeability around the site of infection/injury and enable pro inflammatory immune cells to do their job.
This is known as the INFLAMMATION INITIATION PHASE. You may notice redness, heat, swelling, pain and loss of function during this phase. The following phase is INFLAMMATION RESOLUTION when tissue repair and healing takes place and the body returns back to a normal balanced state
Sometimes there is an over or inappropriate activation of these responses which can lead to a persistent pro inflammatory state, this is known a chronic inflammation and in this instance the resolution phase is prolonged.
There is also a state of inflammation known as systemic chronic inflammation (SCI) which develops as a result of a number of contributors which are different for every individual e.g. physical inactivity, smoking, exposure to environmental pollutants, medication, stress, poor diets.
If a person is in a state of SCI then it’s possible that the immune system may not respond appropriately when there is an injury or infection as it is focused on dealing with systemic chronic inflammation.
PF is a chronic condition which takes time to resolve so, if you are experiencing PF you may wish to consider your inflammatory status and how this may be contributing to PF.
How do I know if I chronic inflammation and what do I do about it to help me recover from PF?
As a Nutritional Therapists, we’d make an assessment based on health status, ability to heal and recover in a timely way, I’d consider what they were eating/drinking/smoking, what their exposures to toxins were, and as we said earlier look at what potential contributors may be modified.
Testing of nutritional biomarkers such as Low Omega-3-Index, Vitamin D Status below 30nmol/L and Low Serum Magnesium are all associated with high inflammatory biomarkers.
In a medical setting functional tests may measure High Sensitivity C Reactive protein (hsCRP) although this is a marker of acute inflammation rather than systemic.
Tests are helpful but not always necessary.
Nutritionally the approach regarding following an anti-inflammatory food plan would be to consider what you may ADD to your food plan and what you may REMOVE or MINIMISE to support your inflammation status.
Our suggestions would broadly be to;
· Low GL carbohydrates, Omega 3 rich foods (oily fish, nuts and seeds), organic/grass fed meat, non-farmed fish, legumes and a wide range of vegetables and fruit (pesticide free)
· High Intake of fried foods/refined grains/sugar/processed meats/ultra processed foods/food additives, for some people dairy and gluten foods may also be considered to be inflammatory.
The aim of having this approach nutritionally is to provide your body with the nutrients it requires to support the immune system in healing and repairing and removing the burden of the foods which contribute to chronic inflammation. We’ll talk about some specific
Some food ideas into action to help you prevent, manage and recover from plantar fasciitis
One study recommended eating 8 servings of carotenoid rich foods each day for 4 weeks.
Participants who followed this had increased plasma carotenoid concentrations and lower CRP compared with participants who consumed 2 portion per day.
Examples of carotenoid rich vegetables are carrots/broccoli/courgettes/tomatoes/brussel sprouts, red cabbage, spinach and fruit apples/pears/kiwis/peaches/nectarines/cherries/strawberries/red currants
That sounds a lot of servings but that may be achieved by adding a portion of cherries or strawberries to porridge or yoghurt for breakfast, having a Carrot/Spinach/Broccoli soup for lunch and a side dish of roasted courgettes and tomatoes with dinner and adding 2 pieces of fruit as snacks during the day.
Our next suggestion is around increasing cruciferous vegetables so that is vegetables like cauliflower, cabbage, broccoli, kale, brussels sprouts. Some studies suggest that eating lightly cooked cruciferous vegetables contribute to the reduction of inflammatory markers.
You may have soups made of cauliflower/kale/broccoli. Steaming or stir frying these vegetables and adding flavours like lemon/lime/ginger/chilli are tasty. Oven baked kale is good for a crunchy snack. I love making a raw cauliflower rice or cous cous style salad and also roasting cauliflower or broccoli with curry style spices is delicious too.
Anthocyanin rich foods.
You’ll find these in Berries – blueberries/raspberries/cranberries/blackcurrants/strawberries. It’s thought that 150g of berries contain around 300mg of anthocyanins and if consumed at this level will help to reduce inflammatory markers such as CRP/IL-6/THF alpha.
150g is approx. ½ cup of berries. It is certainly an amount you could add to porridge or overnight oats or to a pot of natural yoghurt. Another positive aspect of berries is that they are low GL fruits so you may have a large portion without worrying about the effect on blood sugar balance.
Omega 3 Fatty Acids
Specialised Pro Resolving Mediators known as SPMs are produced in the body from long chain polyunsaturated fatty acids, and different classes of SPMs work together to actively resolve inflammation.
The SPMs are involved in balancing the inflammatory response, following the INFLAMMATION initiation phase they reduce pro inflammatory cells entering the area and promote more anti-inflammatory cells. This helps with tissue repair and resolving low grade chronic inflammation.
The Omega 3 family pf long chain polyunsaturated fatty acids are involved in the production of different series of SPMS. Specifically EPA, DHA and DPA.
Dietary sources of EPA and DHA are mostly from oily fish. Grass-fed animal products, such as dairy and meats, also contain some EPA and DHA.
The body can convert ALA (another Omega 3 fatty acid which is from plant sources) however the conversion is not efficient so people following vegetarian or plant-based food plans should consider supplementing with an EPA and DHA supplement derived from microalgae.
DPA is also found in fish oils and grass-fed animal products but in smaller quantities than EPA and DHA.
The main point here to consider is are you consuming an optimal amount of Omega 3 fatty acids in your food or supplement plan so that you are providing your body with the nutrients required to create the SPMs we have been talking about.
As a vegetarian how do you ensure you get optimal omega 3 fatty acids?
Include sources of flaxseed, and hempseed oil regularly and take a vegan supplement. The one we suggest is sourced from algae.
ONE EASY ACTION POINT we’d suggest to runners who suspect they have PF
Don’t ignore the signs – take professional advice pick up the phone and book and appointment with your physio or podiatrist.
1. Plantar fasciitis accounts for about 10% of all running related injuries.
2. Plantar fasciitis usually develops with repeated impact or pressure, which, over time, can cause damage to the tissue in the foot.
3. An inflammatory component of Plantar fasciitis is a result of prolonged loading on the tissue which perpetuates the inflammatory cycle.
4. The main risk factors for developing Plantar fasciitis are considered to be;
b. High Foot Arches
c. Excessive foot pronation
d. Weak plantar flexor muscles (that run along the bottom of the foot)
f. Prolonged standing or walking
5. The main triggers of Plantar Fasciitis are:
a. Changes in activity – perhaps a new type of exercise activity or a change in intensity
b. Tight calf muscles or an achilles injury
c. New or old footwear
d. Weight gain or being overweight
e. Chronic inflammation may be driving the ongoing symptoms of PF
6. Plantar Fasciitis is a chronic condition which takes time to resolve so, if you are experiencing Plantar Fasciitis you may wish to consider your inflammatory status and how this may be contributing to Plantar Fasciitis.
7. Following an anti-inflammatory food plan may help you reduce systemic chronic inflammation and support your recovery.
8. Nutrients to include in your anti-inflammatory food plan include carotenoids(e.g. carrots, broccoli, spinach and fruit, cruciferous vegetables, anthocyanins found in a variety of berries and Omega 3 fatty acids, specifically EPA/DHA and DPA.
9. If you have any signs of Plantar Fasciitis immediately consult with a physio or podiatrist, reduce or rest from your run training and add some
The suggestions we make during this episode are for guidance and
advice only, and are not a substitute for medical advice or treatment.
If you have any concerns regarding your health, please contact
your healthcare professional for advice as soon as possible.
Aileen Smith and Karen Campbell met at as nutrition students (Institute for Optimum Nutrition, London) and became lifelong friends and nutritional buddies! Both have a love of running and a passion for nutrition, delicious food and healthy living.
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