Stretching out plantar fasciitis

Tight hamstrings play an important role in plantar fasciitis, according to a study published in the June issue of Foot and Ankle Specialist.

“These findings show that while we always consider the tightness of the gastrocnemius/soleus complex and the subsequent restricted ankle motion from this equinus, we also need to consider the role of the hamstrings,” said Jonathan Labovitz, DPM, lead author and associate professor at Western University of Health Sciences, Pomona, CA.

The prospective cohort study included 105 participants (210 feet); 79 had plantar fasciitis, which researchers assessed with palpation, who measured popliteal angle with a tractograph and diagnosed ham­string tightness when the popliteal angle ≤160°.

Without controlling for covari­ates, body mass index (BMI), tightness in the hamstring, gastroc­nemius/soleus, and gastrocnemius, and the presence of a calcaneal spur all had statistically significant associations with plantar fasciitis.

After controlling for covariates, participants (86 of 210 feet) with hamstring tightness were 8.7 times as likely to experience plantar fasciitis (p < .0001) as participants without hamstring tightness. Patients with a BMI >35 were 2.4 times as likely as those with a BMI <35 to have plantar fasciitis.

Researchers at Cappagh Orthopedic Hospital in Dublin, Ireland, first linked hamstring tightness with plantar fasciitis in a study published in the December 2005 issue of Foot & Ankle International. The Western University researchers now suggest that an increase in hamstring tightness may induce prolonged forefoot loading and, through the windlass mechanism, may be a factor that increases repetitive plantar fascia injury.

Triceps surae tightness was not included in the Western University covariate analysis, raising the possibility that hamstring tightness was not actually the cause of plantar fasciitis in patients wth tightness in both areas.

“People who have tight hamstrings are more than likely going to have a tight triceps surae,” said Michael T. Gross, PT, PhD, a professor in the Division of Physical Therapy at the University of North Carolina in Chapel Hill. “The investigators of this study admitted that 96% of subjects who had tight hamstrings also had tight triceps surae. Now there’s a cause and effect. If you can’t get dorsiflexion at your talo-crural joint, this often drives dorsiflexion at other joints and that is going to cause collapse of the longitudinal arch of the foot, loading the plantar fascia with increased tensile stress.”

In people with hamstring and triceps surae tightness and plantar fasciitis it’s not known whether the ankle equinus from a tight triceps surae causes hamstring tightness or vice versa, Labovitz said.

“There is no question that the tightness of the triceps surae will cause flattening of the arch and increase tensile stress on the plantar fascia,” Labovitz said. “The question becomes, are the hamstrings involved in this and, if so, to what effect?”

The timing of plantar fascia loading and hip kinematics during gait raise additional questions about pos­sible hamstring involvement, Gross said.

“When loading is taking place at the plantar fascia, it’s mid to late stance. At mid to late stance, the hip is in extension and even hyperextension. Even though the knee is extended, extension/hyperextension at the hip will limit the amount of passive tension that could be developed in the hamstrings, so it is a mystery to me how tight hamstrings would cause trouble for the plantar fascia,“ he said.

Labovitz suggested, however, that a little hamstring tightness might go a long way in influencing the plantar fascia.

“The practical application is that since the hamstrings have been shown to be involved and possibly have more influence than equinus due to the longer lever arm, showing greater effect on the flattening of the foot and plantar fasciitis, less restriction is necessary to have the same effect as equinus,” he said.

The researchers suggest that treatment of plantar fasciitis should address hamstring tightness along with equinus and obesity. Night splints, orthoses, and gait retraining have been shown to be effective for managing plantar fasciitis pain but will not address hamstring flexibility, Labovitz noted.

“The hamstrings should be examined and treated,” Labovitz said. “Stretching is the best treatment for increasing flexibility.”

Doctors amputate frostbitten feet of Alaska runner

ANCHORAGE, Alaska (AP) — An All-American distance runner who spent more than two days in freezing winter temperatures without winter gear has had his legs amputated just above the ankles.

Marko Cheseto, 28, is one of several Kenyan runners who competed for the University of Alaska Anchorage in cross-country and track. The amputations were reported Monday on the UAA Athletic Department website.

Cheseto was seen at about 7 p.m. in a UAA building on Nov. 6, a Sunday night, as two snow storms started to blanket the city. His roommates reported him missing the next morning. The disappearance prompted a citywide search.

Cheseto was found early the following Wednesday outside a hotel near the campus. He was wearing athletic shoes, a jacket and blue jeans but no hat or gloves. He was suffering from hypothermia and severe frostbite on his feet and hands.

The hotel manager told the Anchorage Daily News when Cheseto was found, paramedics could not remove the runner's shoes because they were frozen to his feet.

UAA officials said Cheseto's hands are expected to make a full recovery but his lower extremities were severely injured and required amputation. He is expected to remain hospitalized for recovery and rehabilitation, UAA officials said.

University of Alaska Anchorage police interviewed Cheseto after he was found and reported he had suffered a "personal crisis" when he disappeared. Authorities concluded he had spent the entire time outside.

In a statement on the athletic department website, Cheseto thanked volunteers and professionals who searched for him.

"As some may know, I've been going through a lot of personal issues," he said. "While I am still recovering — both physically and emotionally — I will do my very best to give back to the community that has helped me so much and to my home country, Kenya. I sincerely apologize for any problems that I may have caused."

Cheseto left the campus one day after accompanying the UAA cross-country team to the NCAA Division II West Region championships in Spokane, Wash.

Cheseto had won the West Region championship the two previous seasons. Cheseto had used his final season of cross-country eligibility but was expected to compete in spring track. He took last season off following the suicide of teammate William Ritekwiang, who also was from Kenya.

Cheseto was studying for a nursing degree at the school.

Athletic Director Steve Cobb said the university will continue to support Cheseto.

"We take our responsibility and commitment to the student-athletes entrusted to our care very seriously," he said on the athletic department website. "It was meaningful that our community was there for us in our time of need and we are sincerely appreciative of everyone's efforts."

Prevent the five most common running injuries

It doesn’t matter if you’re just beginning to run or you’re a marathon veteran: running injuries can happen to anyone. And when a runner gets hurt, plantar fasciitis, Achilles tendinitis, iliotibial band syndrome (ITBS), shinsplints, or runner's knee usually is the diagnosis. Allison Lind, a physical therapist in New York City, developed an exercise program that will make you less vulnerable to these five injuries. Do them together as a prerun routine.

1. Prevent ILIOTIBIAL BAND SYNDROME with side-leg raisers Prevent ITBS by strengthening the gluteus medius muscle near the hip. When it's weak, another upper-leg muscle overcompensates and pulls on the ITB, causing pain along the outside of the leg, down to the knee.

Lie on your side with your hips and legs stacked. Lift your top leg up, keeping it straight, but point your toes inward and toward the ground to isolate the gluteus medius. Hold for 30 seconds, then release. Roll over so your opposite leg is on top, and repeat. Do three sets on each leg, working up to one minute per set.

2. Prevent SHINSPLINTS with heel walking and big-toe raisers Prevent shinsplints by strengthening the muscles that attach to the shinbone. A. Walk in place barefoot for one minute with your forefeet off the ground. Do three sets. B. Lift the big toe of one foot as high as you can, lower, repeat 10 times. Switch feet. Do three sets.

3. Prevent RUNNER'S KNEE with half-squats on a downward slope Prevent runner's knee, or patellofemoral pain syndrome, by strengthening the quads to keep the kneecap aligned. Stand facing down a hill or on a decline board. Squat halfway between the start position (straight leg) and a full squat (90 degrees). Do three sets of 10. Too easy? Try single-leg squats.

4. Prevent ACHILLES TENDINITIS with calf drops Prevent Achilles tendinitis by strengthening the calves.Stand barefoot with the balls of your feet on a step. Rise up on your toes with both feet. Shift your weight to one foot; lower down on that foot. Rise up on both, lower on one. Do three sets of 10 on each side.

5. Prevent PLANTAR FASCIITIS with arch raisers Prevent plantar fasciitis by strengthening foot muscles. Stand barefoot on one leg. Imagine your foot is a tripod and place even pressure on your big toe, pinkie toe, and heel. Ground these three points as you "scrunch up" your arch. Hold for 30 seconds; repeat three times.