Heel Pain: Plantar Fasciitis and Plantar Heel Pain Syndrome
Plantar fasciitis is the most frequently encountered cause of plantar heel pain (I suffered with it for 6 weeks!). For many years pain in this region has been incorrectly termed the "heel spur syndrome". It would be better termed a "plantar heel pain syndrome". While heel spurs sound ominous, they can be present (50% percent of the population has one) and not cause any pain.
Plantar Fasciitis - Cause: The most frequent cause is an abnormal motion of the foot called excessive pronation. Normally, while walking or during long distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch. Your arch should only dip slightly during this motion. If it lowers too much, you have what is known as excessive pronation placing increased tension on the fascia. For this reason certain shoes MUST be avoided such as Flip-Flops, flat sandals and loafers.
Other factors which may contribute to plantar fasciitis include a sudden increase in daily activities, increase in weight (not usually a problem with runners), or a change of shoes. Dramatic increase in training intensity or duration may cause plantar fasciitis. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia. Make sure your shoes are not excessively worn. These shoes and other shoes that are not sufficiently controlling of pronation combined with an increase in training can lead to this condition. A change in running style, such as starting speed work, running on the ball of your foot or sudden increase in hill workouts up and/or down may also lead to this condition
Cortisone injections are not recommended in runners. Cortisone can weaken the fascia and rupture of the fascia is possible. If a cortisone shot is given then NO running for a minimum of 3 weeks
As with most running related injuries, an evaluation of changes in your training should be done. A good rule to follow is: if your workout has not dramatically changed and a sudden pain develops – change shoes.
The most important part of self treatment for this condition is being sure that your shoes offer motion control and are optimal controlling the forces that contribute to plantar fasciitis and heel spurs. Check your running shoes to make sure that they are not excessively worn. They should bend only at the ball of the foot, where your toes attach to the foot. This is vital! Avoid any shoe that bends in the center of the arch or behind the ball of the foot. It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here and neither should a shoe be designed to do this.
Never purchase your running shoe from a department store. Seek out a running shoe store and speak with someone who works there. Usually they are runners themselves and can evaluate your foot type for a proper match.
You should also be doing gentle calf stretching exercises. This will reduce stress on the plantar fascia in two ways. The first manner in which a relaxation of the tension in the calf muscles can help heel pain is that it will reduce the direct pull backwards on the heel bone (calcaneus). The second reason is a little bit more complicated, but essentially it is that a tight achilles tendon and calf muscles causes the rearfoot to move in a manner that causes over pronation as your leg and body move forward over your foot.
So go ahead and gently stretch the calf muscle by doing the runner's wall leaning stretch. Stretching & Icing after running is critical. Consider using a Night Splint, this device gently stetches the achilles and fascia by keeping your ankle at 90 degrees while you sleep.
Self-Treatment Summary: Self treatment for this problem should include
Never try to run through pain
Gentle Stretching of calf muscles. Wall stretches - 10 seconds each side. Repeat ten times. Do two sets of 10 reps each day.
Check shoes for flexion stability. Avoid and replace any shoe that bends before the ball of the foot. Put your flip flops in the closet and forget about them for a very long time.
Try wearing shoes that offer more anti-pronation control
No Bare feet– that also means those first steps out of bed in the morning (5 minutes barefoot will cause damage). Also, no slippers, flip flops, or sandals.
Try over the counter orthotics - Superfeet are my favorite (see my store)
Consider custom orthotics - See “Orthoses” page
Conservative treatment is usually successful for this problem. There are non-invasive procedures that we perform for the resistant cases. Click "advanced treatment".
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