Time Wounds All Heels: Getting Acquainted with Plantar Fasciitis

Several weeks ago, I suggested that warmer weather would lead to overuse injuries among runners. Admittedly, it’s difficult to increase mileage slowly when one spends all winter waiting for that all-too-brief moment of Goldilocks weather – not too cold and not too hot. If you neglected to take my advice and added mileage too quickly (as I did), youmay now be experiencing some pain on the bottom of your foot starting at the heel and radiating towards the toes. That’s the classic first symptom of plantar fasciitis, a very common running malady.

What am I feeling? The thick bands of fibrous tissue on the bottom of the foot running between the heel and front of the foot – the plantar fascia – have become overly stressed during ground contact and push off. Unlike muscle, the fascia does not contract on its own. Rather, it operates like a fibrous rubber band that stretches slightly and then rebounds. If it stretches too much, micro tears and inflammation can result. The tears may be micro, but the pain is intense, particularly in the morning. Getting out of bed can feel like one is walking across a field of knives.

What causes this? Plantar fasciitis is most often a result of overuse or too-sudden change – building up mileage too quickly or changing form, shoes, or surface rapidly. In my own case, for example, I changed my running form to help prevent knee pain and wound up with foot pain instead. Some researchers also have indicated that runners with lower arches might be predisposed towards bouts of plantar fasciitis because the shape of their feet can cause the fascia to stretch too much. Finally, there is some evidence that suggests the real cause of the problem is an overly stressed flexor digitorum brevis muscle – that is the muscle that helps maintain the foot’s arch and supports the plantar fascia.

Ow, enough with the medical talk. How do I fix this? Just as there are many causes for this painful condition, there are a lot of ways to address plantar fasciitis. Here are some things you might like to try.

To provide immediate relief, roll a frozen water bottle under the foot. This, in addition to taking oral anti-inflammatories such as ibuprofen, will help reduce inflammation. If you’re experiencing morning heel pain, consider slipping into something with a little cushion and structure, like Oofos sandals, to keep your heel and arch in a supported position.

After reducing inflammation, you’ll need to increase blood flow to the region to help repair the plantar fascia and flexor digitorum brevis. To get that started, you can roll a trigger point ball or golf ball under the arch to encourage blood flow. To further promote blood flow, be sure to keep the plantar fascia warm by sleeping in socks. Plantar fascia support sleeves can also help blood flow in the fascia by providing graduated compression to improve circulation. Kinesiology tape, such as Rock Tape, can also be applied to the bottom of the foot (http://www.runnersworld.com/injury-treatment/tape-yourself-plantar-fasciitis) to promote healing by gently lifting the skin to allow better blood flow to the area. You will find what works best for you.

Support strategies change depending on whether you’re active or asleep. To address the constant stress on the plantar fascia during activity, you can support the foot more fully by inserting a custom orthotic or trim-to-fit insole, such as Superfeet, into your running shoes. This will help hold up the plantar fascia in a more supported position and reduce tension. At night, one can use the Strassburg Sock or a night splint to keep the plantar fascia stretched and pliable.

For those interested in a more aggressive medical therapy, doctors often recommend a corticosteroid injection in the bottom of the foot to speed healing. One new treatment, however, involves increasing blood to the plantar fascia by injecting the patient’s own platelet-rich plasma into the plantar fascia to encourage an intensified healing of soft tissue on a cellular level. Although controversial among some podiatrists, the platelet-rich plasma treatment does appear to have the same positive result as a corticosteroid injection without the risk of breaking down the fatty heal pad or, in the worst case, rupturing the plantar fascia.

Most runners find that some combination of these therapies, in conjunction with the exercises below and sufficient time to heal, can help.

What exercises help to avoid injury and speed rehab? First, it’s a good idea to strengthen the flexor digitorum brevis muscle to maintain the foot’s arch. One exercise many foot experts recommend is the towel scrunch. Put a towel under your foot and then scrunch up the towel under your toes while keeping your heel down on the floor. After you have bunched up the towel under your arch, spread it out again under your foot and repeat. Scrunch the towel three times. Repeat this five to ten times a day to strengthen the flexor digitorum brevis muscle. Maintaining the flexibility of the plantar fascia and strengthening the flexor digitorum brevis muscle should be part of your regular maintenance routine.

You’ll also want to pay attention to your calf muscles. If your calf muscles are tight, this can cause a premature liftof the heel in your gait cycle. That lift then puts an excessive load on the plantar fascia and can contribute to chronic pain and inflammation. (The Achilles tendon works with the plantar fascia to store and return energy during a runner’s initial contact and toe-off during their gait cycle.) If you notice that your heels are always slipping out of your running shoes, you might want to do some aggressive calf massage before complaining about your narrow heels. A massage roller (like the Addaday C) or a foam roller can be very useful.

 

Can’t I just tough it out? No. Heel pain should not be ignored. It is important to identify and treat plantar fasciitis quickly to prevent its escalation into a chronic condition. More severe stress starts to degenerate the collagen fibers close to the fascia’s attachment point at the heel. Recently, some expert podiatrists have argued that plantar fasciitis can lead to an acute condition referred to as “plantar fasciocis.” Plantar fasciosis is typified by an almost complete lack of blood flow to the plantar fascia that leads to the degeneration of the fascia. The possibility of plantar fasciosis – possibly misdiagnosed in the past as a severe case of fasciitis – makes it extremely important to treat any suspected case of plantar fasciitis quickly and diligently.

Which of these strategies will work for me? What works for one runner might not be effective for the next. As George Sheehan (coach, fitness guru, and running philosopher) noted, “We are each an experiment of one.” I found that I was anxious to find something that worked, so I tried everything I could all at once. That, plus time to heal, eventually worked.

Have you experienced plantar fasciitis? How did you treat it? Do you have some additional techniques that other runners should know about? Please share your experiences in the comments – and thanks for reading!