A blog by runners. For runners.

Haunted by Heel Pain? It Could be Plantar Fasciitis

This is the first running injury post by Dr. James Nace. He will be covering all sorts of common running injuries, as well as specific questions from runners. If you have a specific question, or a running injury that you would like covered by Dr. Nace, click “Ask the doctor” at the bottom of the page. This week he is covering the dreaded plantar fasciitis, as requested by numerous WalkJogRun fans.

Plantar fasciitis is one of the most common causes of heel pain in runners. A common myth is that all heel pain is caused by heel-spurs. This is not the case and has been disproven time and again by medical research.

According to research from the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention, PF accounts for an average of one million patient visits per year to medical doctors! Safe to say, if you are suffering from PF, you're not alone.

Before we get into treatment options, let's examine what plantar fasciitis is and how it presents in patients, especially runners.

What is Plantar Fasciitis?

Plantar means bottom or sole of your foot and fascia means a connective band of tissue. Your plantar fascia is a band of tissue along the bottom of the foot that connects the foot to the heel and is in continuity with your Achilles tendon. Plantar fasciitis occurs when this tissue becomes damaged.

Plantar fasciitis is also known as painful heel syndrome or chronic plantar heel pain and the disorder is typically diagnosed on the basis of a history alone. In runners and the general population, it typically presents as pain when taking the first few steps in the morning, worsening pain with weight-bearing (especially running) and pain and tenderness to palpation over the bottom, inside aspect of the foot.

A review in the British Medical Journal found 10% of the population may present with heel pain over the course of their lives. 83% of patients seen with plantar fasciitis were active, working adults ranging from 25 to 64 years of age. So most active runners are in the prime age and activity classification to suffer from PF.

(Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: A national study of doctors. Foot Ankle Int 2004;25(5):303-310)

Risk Factors

  • excessive or inappropriate training-especially long distances and downhill
  • prolonged weight-bearing (being on your feet for long periods of time)
  • obesity / weight gain
  • changes in length or intensity of running routes
  • inappropriate shoe wear
  • foot arch problems (more frequent for people with excessive flat feet, foot pronation  also those with high arches and supinated feet)
  • limited ankle flex from tight calf muscles

Treatment Options

There are some treatment options runners can consider before scaling back distances, which most of us would rather not do. My advice is to stretch, stretch, and stretch some more! A combination of bent and straight knee stretches is advisable. The key to stretching is long duration stretches instead of more reps. Hands down, this really is the best treatment for plantar fasciitis and should help alleviate symptoms in majority of cases.

Taking acetaminophen or ibuprofen to reduce pain and inflammation also helps. Just check with your doctor to make certain you are medically able to take these medications on a regular basis.

Icing and elevating your feet also helps. Apply ice twice a day for 10-15 minutes at a time when you are experiencing pain. A few of my favorite tricks  freeze water in a Styrofoam cup and then peel the cup off. This leaves you with a nice contoured block of ice. Also, freeze a water bottle and roll your foot over top of it (better to “up-cycle” an old plastic bottle for icing  no need to rub your feet all over a new, unopened bottle of water after a run!)

You can continue your normal training schedule while trying the treatments above, however, if you are still experiencing pain, increase the amount and frequency of stretching. If it still doesn't work, it's advisable to decrease the distance of your runs by 50% until the pain subsides.

When to Say When

If pain continues, shut it down for a week, follow the treatments outlined above and then start back at the end of the week at 50% reduced distances. If it continues to plague you, seek medical attention. A doctor can prescribe more intense treatment options and provide a definitive diagnosis. It could actually be a more serious problem such as a stress fracture, tendon tear, blood clot, etc.

While you should always be sure to wear quality shoes that fit correctly and offer good support and cushion, a doctor may advise that you get custom-fit orthotic inserts for your shoes. Another option an MD may prescribe is steroid shots or other injections to the heel.

The treatment options outlined above almost always improve the pain associated with plantar fasciitis. Treatment can last from several months to two years before symptoms get better  so be patient. The duration of symptoms is often directly related to how long you have had the problem. Once your symptoms have resolved completely, remember to STRETCH as much as possible, even if you are feeling no pain!

Running Injuries

Dr. James Nace

James Nace, MD is an orthopedic surgeon-joint replacement and doctor of general orthopedics specializing in hip, knee and shoulder joint preservation and reconstruction. He practices out of the Rubin Institute for Advanced Orthopedics at Sinai Hospital of Baltimore, Maryland. Throughout his career as a physical therapist and orthopedic surgeon, Nace has gained the most satisfaction from treating runners and all types of athletes for their injuries and helping get them back to training and competing.

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