Plantar fasciitis and other heel pains send more people to foot specialists than just about any other complaint, and it's one of the most tenacious, frustrating conditions for runners to deal with, and something I have been dealing with for the better part of this year.
Now what is it....?
The heel bone is the largest bone in the foot and bears all of the body's weight with each step. Thus, lots of stress.
The plantar fascia, a long band of fibers that attaches at the bottom of the heel bone and extends to the base of the toes, takes the brunt of it. Pain occurs when these tissues become irritated or inflamed --a condition known as fasciitis-- or when small spurs begin to grow on the heel bone itself.
If you have plantar fasciitis, you may feel a sharp pain first thing in the morning because the plantar fascia shortens during the night, while you're asleep. I have gotten into the habit of flexing my foot and ankle before getting out of bed, and also curling my toes for five minutes. Both of which loosen the plantar fascia. Now, when you get out of bed in the morning and start walking around, the band along the bottom of your foot stretches and pulls on the heel. When it pulls too hard, pain results. Lots of pain.
But what causes Plantar Fasciitis....?
Biomechanical flaws --including flat feet, high-arched feet and a tight Achilles tendon-- can result in considerable stress on the plantar fascia. Other causes are: excessive pronation, sudden increases in training mileage, beginning speedwork or switching surfaces (particularly to concrete sidewalks). Also at risk: women who wear high heels all day and then switch into flat running shoes. In my case I believe it is a combination: change in running surfaces and an increase in milage.
So what do I do....?
The bad news is success in overcoming it depends on something we runners have a very little of: patience. It can take as much as three months for it to heal properly.
Medical experts treat plantar fasciitis with many of the usual approaches: stretching; icing after running; oral anti-inflammatories, such as ibuprofen; shoe inserts or custom-made orthotics; night splints and even injections of steroidal anti-inflammatories, such as cortisone.
Surgery, which involves severing the attachment of the plantar fascia to the heel or removing the heel spur, should be considered only when all else fails.
The mainstay of any treatment program for plantar fasciitis is stretching: specifically, Achilles tendon stretches performed first thing in the morning. You can do one effective stretch while you're still lying in bed. Loop a towel around the bottom of the foot and pull your toes toward your nose for 30 seconds, and do three sets. Also, during the day, do wall pushups with straight legs for one set, then with bent legs. It's best to do the pushups barefoot if possible. Stretching and more stretching.
Though I've never used one, some doctors recommend using a night splint, removed in the morning, to keep the plantar fascia from shortening overnight. At night everybody sleeps with their feet pointing down, and in that position the Achilles and plantar fascia tighten up. And that is what causes so much pain when you first get out of bed in the morning. The band suddenly stretches, which perpetuates the problem. By putting a splint on and holding the foot more perpendicular to the leg, you can prevent that.
Most important.....Prevention
In any case, plantar fasciitis is troublesome enough to be worth avoiding, and there are many simple, effective ways to prevent it. Here are the best:
* Wear well-cushioned shoes, and make sure the heels do not become significantly worn.
* Run on soft surfaces. The best: grass, trails, a good track. Worse: asphalt. And worst: concrete.
* Keep your mileage at a relatively consistent level. If you do pick up your training, increase total weekly miles by no more than 10 percent per week.
* When beginning speedwork, ease into it gradually with a several-week buildup.
* Perform Achilles tendon stretches regularly.
* Women: don't wear high heels during the day, then switch to running shoes in the evening. It's probably better to run in the morning and then put on your heels. Or don't wear heels at all.
- Posted using BlogPress from my iPad
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