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Wednesday, October 22, 2008
Heel pain is common complaint in runners. Actually, heel pain is common in all people. 40% of all visits to podiatrists in the U.S. are because of heel pain. Of all of the different causes of heel pain, the vast majority is due to a condition known as plantar fasciitis. This is the most frequent cause of pain on the bottom of the heel and is an inflammation in the band of tissue (the plantar fascia) that runs from the heel to the toes. This condition is most often caused by a tight achilles tendon or poor foot structure such as overly flat feet or high arches. It can also be caused by wearing non-supportive footwear on hard surfaces, spending long hours on your feet, or obesity.
The pain from plantar fasciitis is usually a sharp, stabbing pain on the inside of the bottom of the heel that can feel like a knife sticking into your heel. Pain from plantar fasciitis is usually most severe when you first stand on your feet in the morning. Many people complain that the first step out of bed is the worst. Many also have pain as they get up and start to walk after sitting for a period of time while working at a desk or computer. This heel pain will usually subside as you walk, but can return with prolonged standing, walking or running.
For runners, the plantar fascia may become inflamed after a period of running hilly courses or running in excessively worn shoes or the wrong type of shoe for your foot type. Once this happens, a cycle of inflammation ensues. There is a nerve (called the medial calcaneal nerve) that runs along on the inside of the heel bone and actually curves down around the bottom of the heel between the bone and the plantar fascia. As you walk and place stress on the plantar fascia, the tugging of this ligament where it attaches to the heel bone stimulates inflammation. The inflammation results in fluid being collected around the nerve between the bone and the plantar fascia. When you get up and step on the heel, the nerve gets compressed by the collection of fluid. This causes the sharp pain. By stepping on the heel, some of the fluid is pushed out of the area and away from the nerve. The second step may also hurt less as even more fluid is pushed away from this space around the nerve. Once you get moving, the pain then usually subsides. Once you go to sleep the whole cycle begins again.
In short, plantar fasciitis is a combination of two separate problems. First, there is a tight Achilles tendon that can lead to abnormal tension on the plantar fascia when you walk or run. Second, there is inflammation from all of the tissue damage as the plantar fascia is tearing away at its attachment to the heel bone. You must address both in order to get better.
The main question I get from patients about treating plantar fasciitis is “will I need surgery?” The answer to this is almost certainly not. Based on the results I have seen among my patients at the Ankle & Foot Center of Chattanooga, 98-99% of heel pain sufferers can effectively self-treat their heel pain and get permanent relief without ever visiting a doctor. The reason I know this to be true is that I have tracked the progress of those patients that have been seen in my office. I see several patients with heel pain every single day in my office. In the last year I only performed surgery on four patients for plantar fasciitis.
My treatment philosophy and practice style is simple. I firmly believe that simple, reliable, cost-effective treatments should always be attempted before expensive and evasive treatments like surgery. Although I am an award winning foot and ankle surgeon (and admittedly love doing surgery) I truly believe that surgery is just a bad idea if any other treatment will work. For that reason I wrote a book called No More Heel Pain which we make available free to anyone in Chattanooga.
The main question I get from runners is “can I run with plantar fasciitis?” The answer is yes, provided it has been diagnosed as plantar fasciitis. As I said earlier, plantar fasciitis is by far the most common form of heel pain, however there are other causes. Stress fractures of the heel bone, bone cysts (weak areas) and bone tumors can all mimic the symptoms of plantar fasciitis. The difference is that they are usually more painful when you run and will not subside (but instead get worse) while you are walking or running. These can also lead to serious problems such as a fracture of the heel bone. A fractured heel bone will definitely interrupt your training schedule.
Provided that it is in fact plantar fasciitis, the first and most often effective treatments for plantar fasciitis include stretching, icing, and anti-inflammatory medications. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence. Achilles tendon stretches are essential to eliminate heel pain. Perform the Achilles tendon stretches twice-a-day; morning and evening. This will only take 1 minute in the morning and 1 minute at night.
Stand upright about one large pace away from the wall with your feet parallel and about hip width apart. Keep your feet in line as shown. Place your hands against the wall, at shoulder height. Move your right leg half a pace forward. Lunge forward on your right leg so that the knee is brought directly above the ankle. Stretch your left leg back as far as is comfortable with the foot and heel remaining flat on the floor. Slowly lean forward to stretch the left leg calf muscles and tendon. Hold the stretch for 10 seconds, relax, and repeat on the other leg. Perform each stretch three times per side. You can find additional helpful stretching videos on our website at www.MyRunningDoc.com.
Icing your heel is vital to decrease inflammation that accumulates while you walk during the day, and to prevent more inflammation while you sleep. Apply ice to the sore area for 20 minutes two or three times a day to relieve your symptoms. Do not go barefoot. Do not wear flip-flops or house shoes while recovering. Only wear shoes with a moderate heel that do not bend through the arch. Always wear shoes when walking, even in the home. If you have our recommended custom orthotics, or over-the-counter inserts, wear them in your shoes at all times. Most people with plantar fasciitis improve significantly after two months of initial treatment.
Keep on running, but seek help if your heel pain gets worse while you run or if the heel pain just won’t go away after trying the treatments described above. Once you get rid of the heel pain, keep stretching your Achilles tendon periodically and you can prevent your heel pain from coming back. No more limping out of bed before your morning run!
Award Winning Foot and Ankle Surgeon
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