By Lori S. Weisenfeld, DPM
Dashing Whippets Team Wellness Partner Dr. Lori S. Weisenfeld, Sports Podiatrist, has some important advice for those who suffering from heel pain which could be the early stages plantar fasciitis.
If you have plantar fasciitis, you’re not alone.
Pain in the bottom of the heel is the most common orthopedic complaint that I take care of in my practice. There’s rarely a day that goes by without someone leaving the office with advice on how to manage a painful heel. That’s not to say that it can’t be debilitating, but it may be comforting to know that you are in good company.
The other bit of good news is that heel pain is fairly easily treated if caught early enough. Although there are many causes of heel pain, mechanical stress on the plantar fascia is, by far, the most common cause of aching heels in runners.
How do you pronounce that anyway?
The plantar fascia (fa-shuh) is the tight band of tissue that runs from the heel to the ball of the foot. Unlike a muscle, the plantar fascia doesn’t have that much stretch to it. It’s relatively inelastic. Every time you take a step, your arch flattens a bit and the plantar fascia becomes taut. That’s normal. If you are not getting enough support, if you have weak arches, or if you overpronate your arches will flatten too much with every step, resulting in too much tension on the plantar fascia.
If the fascia pulls too much, it will become inflamed. Inflammation in the plantar fascia is called plantar fasciitis (fa-shee-eye-tis). You can feel the strain in the fascia anyplace along its length, but most people feel it right where it originates from – where the heel meets the arch.
In the early stages of plantar fasciitis, you may feel soreness only after you run, but it resolves after an hour or so. Or perhaps you will feel it only upon arising on the morning after a run, but, again, it resolves fairly quickly.
Your foot may feel stiff or as if you are walking on a lump below the heel. As the condition progresses, the soreness lasts for longer periods of time and eventually, if left untreated, you will feel pain during the run and then with each step during the day whether or not you go for a run. It’s fairly easy to treat the plantar fasciitis when you are feeling the ache just after periods of rest, so that’s the best time to begin treatment.
First line of self-treatment involves checking your shoes. They may have too many miles on them or they may be too cushioned and, therefore, not supporting your arches enough. You can try an over-the-counter arch support inside your shoes. Icing the heel for 10-20 minutes a few times a day will help reduce the inflammation.
The most important and helpful exercise for plantar fasciitis is calf stretching. When your calves are tight, the plantar fascia is more prone to excessive pulling.
Other things that may be helpful are: rolling the fascia on a ball or a frozen water bottle, special socks that support the fascia and avoiding walking barefoot or in unsupportive shoes even when you’re not running.
Enough is enough
If your heel pain does not resolve within a week or two it’s time to see your podiatrist. You will probably get an x-ray to rule out other causes of heel pain and to see if you have a heel spur. Your podiatrist may recommend orthotics to better control your arches and to reduce over-pronation.
In my practice, I prefer to hold off on cortisone injections until after the biomechanical control (orthotics) is in place. I find that most people get better with the orthotics and don’t require the injections.
Also, if you do need an injection I like to have the orthotics in place to help prevent recurrence of the pain after the injection.
I keep my runners taped up with a specific strapping while they are waiting for the orthotics so that they can continue running. Other treatments that may be recommended are physical therapy, night splints which hold your foot in an extended position while you sleep, oral anti-inflammatory medication, and extracorporeal shockwave therapy.
Fortunately, it is extremely rare for plantar fasciitis to require surgery. Luckily, most people never need to go further than the first few treatments.
Lori S. Weisenfeld, DPM is a 2017 Dashing Whippets Running Team Wellness Partner, and one of New York’s most highly-regarded sports podiatrists.
Dr. Weisenfeld has an active practice treating runners, dancers, and other athletes. She has been a finish line medical volunteer with the New York City Marathon for the last twenty years. Dr. Weisenfeld’s practice can be reached at (212) 947-2320. Her office is located at 161 Madison Ave, #7NE (33rd Street), New York, N.Y. 10016.