Stepping Into Better Health: Overcoming Plantar Fasciitis

You are not alone if the new run­ning sea­son’s promise has encour­aged your promise to devel­op health­i­er habits and increased activ­i­ty. You may have start­ed a walk­ing or run­ning pro­gram, joined a gym, or even resumed a sport that once brought great enjoy­ment. The ben­e­fits can be immea­sur­able — phys­i­cal­ly, emo­tion­al­ly, and mentally.

By now, how­ev­er, you may also have dis­cov­ered set­backs in the form of injury that can become cost­ly, time-con­sum­ing, and discouraging.

As a podi­a­trist, one of the most com­mon overuse injuries I see is heel pain after begin­ning a new exer­cise pro­gram. The indi­vid­ual is often inter­est­ed in weight loss and has begun a walk­ing or run­ning pro­gram. The first few weeks go well, and they feel more ener­getic. Encour­aged, they increase their exer­cise fre­quen­cy, dis­tance, and/​or speed. Be care­ful! Too much too soon can lead to a grad­ual onset of pain in the bot­tom of one or both heels. The dis­com­fort grows from a dull ache to a sharp stab­bing pain. It’s usu­al­ly worse with the first step in the morn­ing or stand­ing up after sev­er­al min­utes of sit­ting, then resolves (some­what) with five to ten min­utes of walk­ing. Some­times, the pain can be so severe it affects the abil­i­ty to work.

The plan­tar fas­cia is a lig­a­ment on the bot­tom of the foot that extends from the heel to the fore­foot, almost to the toes. It serves as a thick cov­er­ing to the four lay­ers of mus­cles on the bot­tom of the foot and is a con­tin­u­a­tion of the Achilles ten­don. The Achilles ten­don resides in the back of the leg and flows con­tin­u­ous­ly from its inser­tions above and below the knee to the back of the heel. When micro-tears devel­op in the plan­tar fas­cia at its ori­gin under the heel, inflam­ma­tion results, and plan­tar fasci­itis begins. With chron­ic plan­tar fasci­itis, the body begins rein­forc­ing this weak­ened area with cal­ci­um, and a heel spur can become vis­i­ble on X‑rays.

Eti­ol­o­gy: What caus­es plan­tar fasciitis?

Fac­tors con­tribut­ing to plan­tar fasci­itis can be intrin­sic or extrinsic:

Intrin­sic Anatom­i­cal con­sid­er­a­tions–

Flat feet, hyper­mo­bil­i­ty in the joints, high arch­es, knock-knees (genu val­gum) or bow-legs (genu varum), a tight Achilles ten­don (equi­nus).

Extrin­sic Con­sid­er­a­tions–

Inap­pro­pri­ate shoes that are worn out, with poor motion con­trol, too much cush­ion, or inad­e­quate arch sup­port. Extrin­sic con­sid­er­a­tions also include train­ing sched­ules that increase inten­si­ty or dura­tion too rapidly.

Treat­ment: What you can do:

Even Sun Tzu agrees that avoid­ance is the best strat­e­gy for over­com­ing any bat­tle. Many great sources for train­ing sched­ules are avail­able to both begin­ning and advanced ath­letes. Select your pro­gram in advance, lis­ten to your body, and give your­self per­mis­sion to rest if need­ed. Remem­ber that injury can be one of the great­est set­backs to your train­ing goals. In the event of heel pain onset:

Rest: Sub­sti­tu­tion with cross-train­ing in the form of swim­ming, bicy­cling — sta­tion­ary or out­side — cir­cuit weight train­ing and ellip­ti­cal train­ing may offer a viable sub­sti­tute in the short run. How­ev­er, com­plete rest from exer­cise may be required. For some, this may mean six weeks of an altered sched­ule before morn­ing pain sub­sides. If this is suc­cess­ful, grad­u­al­ly return to nor­mal impact activ­i­ty, such as run­ning, walk­ing, or both.

Sup­port: With a rig­or­ous train­ing sched­ule, be sure to replace run­ning shoes every six months. Running/​walking shoes are also designed with the intend­ed pur­pose of sta­bi­liza­tion, motion con­trol, trail run­ning, cush­ion­ing, etc. Be sure your shoes are in the appro­pri­ate con­di­tion and designed for your type of foot. You may also find that over-the-counter arch sup­ports help.

Stretch­ing: The root cause behind most heel pain is a tight Achilles ten­don com­plex. The ​“runner’s stretch” per­formed with the knee straight and knee bent will mobi­lize both mus­cles, con­tribut­ing to this com­plex. You should tar­get stretch­ing each leg three times a day for a con­tin­u­ous minute with each stretch. This will allow your foot to prop­er­ly load with each step and decrease the ten­den­cy toward hyper pronation.

What your doc­tor can do:

Your podi­a­trist can deter­mine the under­ly­ing cause of your heel pain and devel­op a strat­e­gy for resolv­ing it. This may include anti-inflam­ma­to­ries, phys­i­cal ther­a­py, a steroid injec­tion, and/​or cus­tom orthotics. Most bio­me­chan­i­cal­ly caused heel pain can resolve with con­ser­v­a­tive treat­ment; how­ev­er, in some cas­es, surgery may be required.

May your year be blessed with good health.

Dr. Kline is a board-cer­ti­fied podi­a­trist spe­cial­iz­ing in injury, wounds, and dis­eases of the foot and low­er extremity.