Why is it that so many runners still suffer from heel pain on a regular basis? Shoe technology has advanced remarkably in the last 20 years, but it seems like the incidence of chronic plantar fasciitis has not subsided at all! Why is this?
Unfortunately the most common cause of plantar fasciitis or arch strain in runners is not shoes; but too much, too soon, too fast syndrome. This is very typical of the American personality. The "I want it all right now!" syndrome.
Let's look a little closer. I also see many patients wearing gorgeous $100+ running shoes that are totally inappropriate for their feet. These are bought because of color, style, advertisements, or simply the fact that their friends really liked them. When will we get away from picking running shoes for looks or peer pressure? Are we still in high school?
That may sound harsh, but let's think about the last pair of shoes you bought. Did you go to the running store with a preconceived notion about what you wanted? Probably. Did you try on different styles? Brands? Anything you had never heard of? If most of us are honest, if we tried something new it was because of some article we read or ad we saw in a magazine.
Off the commercial running shoe soapbox, let's get back to talking about heel pain. So you have arch and heel pain? You get up in the morning and it feels like someone stabbed you in the heel like you have a "stone bruise" in the heel fat pad? It's been getting worse every day, especially the morning after a run? Sounds like plantar fasciitis. At this point it probably doesn't hurt while you are running. It warms up quickly in the morning but as soon as you sit down or get in your car to drive, it tightens up, and when you get back up the pain starts again. Sound familiar?
It is important to have you foot evaluated by a podiatrist to make sure it is really just plantar fasciitis. Other things can mimic the symptoms of plantar fasciitis; a calcaneal stress fracture, tarsal tunnel syndrome (entrapped nerve), bone tumor, and even lumbar radiculopathy (a pinched nerve in your back). An x-ray and physical exam can rule out most other problems and confirm the diagnosis of plantar fasciitis.
What should you do now? Start simple.
- Step one: Look at your running shoes. Are they worn out? Are they the right kind? Are you trying to run in tennis shoes or cross-trainers? When in doubt, consult the shoe guy at the local running store, a pedorthist or your podiatrist. If they fit but just need a little help, add an arch support.
- Step two: Ice is a wonderful thing for heel pain. 15 minutes to the area at least twice a day.
- Step three: lots of stretching! Stretch the arch of your foot and the Achilles tendon (heel cord). Step four: take your running down a notch. Slow down, take walk breaks, and stay off of uneven surfaces or hills. If you feel any sharp pains or tearing, stop immediately! A plantar fascial tear will take you off the trails for at least 2 months.
If these simple things don't help, its now time to see a sports medicine podiatrist. They will evaluate your heel and your biomechanics. Advanced treatments with rest, night splints, anti-inflammatories, injection therapy, physical therapy, and custom foot orthotics may be necessary to curb your plantar fascial pain. Conservative treatment is around 85% effective and surgery is rarely needed except in recalcitrant cases. The longer you wait to seek professional help, the more likely you will need advanced therapy or surgery to control your heel pain.
Don't let heel pain sideline your running! Get started on the road to recovery today!