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Plantar Fasciitis is a common cause of foot and heel pain in runners. It is caused by repetitive impact resulting in strain and tearing of the plantar fascia attachment at the runner’s heel. If left untreated it may become plantar fasciosis which his described as “degeneration and scar tissue formation at the origin of the plantar fascia”. This happens because the runner never allows the tendon to truly heal and instead causes repetitive inflammation that overcomes their body’s ability to heal itself.
The classic sign of plantar fasciitis is pain in the heel/arch especially when getting out of bed in the morning or after sitting for an extended period of time. Runners will often report that the pain is much worse after running than during. This is in part because they have torn the plantar fascia further.
The function of the plantar fascia is to provide dynamic support to the runner’s medial longitudinal arch and help to dissipate shock on heel strike and forefoot loading. Runner’s with extremely low arches and runner’s with extremely high arches seem to be more prone to this painful foot condition. Other anatomical factors include over-pronation, leg length discrepancies, tibial torsion and being either bow-legged or knock-kneed. It seems that individuals that have these anatomical discrepancies, combined with overuse, result in excessive trauma to the plantar fascia and exceeds their body’s ability to recover.
A typical orthopedic examination reveals tenderness at the medial side of the runner’s heel or near the plantar fascia insertion near their ball of the foot at the first toe. Pain at the heel is called proximal plantar fasciitis and pain at the ball of the foot is called distal plantar fasciitis. The location of the plantar fasciitis does not matter, treatment is the same.
X-rays or MRIs are usually not necessary to make the correct diagnosis. X-Rays may sometimes show a heel spur but this does not necessarily change the course of treatment. Heel spurs seem to respond to the same treatment as plantar fasciitis.
Other causes of heel/arch pain that must be ruled out are tarsal tunnel syndrome, Jogger’s foot which is an entrapment of the medial branch of the plantar nerve, stress fractures, bursitis, fat pad syndrome, and tendonitis. There is another more uncommon diagnosis such as tumors but these are rare.
Typically, plantar fasciitis will eventually heal on its own. However, many runner’s do not have the patience to wait that long. Many internet sites report that it may take from 6-18 months for it to heal, assuming you are not running on it and making it worse. There is a direct relationship between when a runner stops running and seeks treatment and how long plantar fasciitis takes to heal. Early recognition by the runner, rest and proper treatment can result in a dramatically shortened duration of the condition. Most cases of plantar fasciitis we treat get better within 4-6 weeks as opposed to 6-18 months!
Other forms of exercise such as biking, swimming, elliptical and weight training do not appear to aggravate the condition. It may be difficult but runners must stop running and allow the plantar fascia to heal.
Proper treatment includes very specific stretching of the Achilles, calf and plantar fascia. The plantar fascia is a continuation of the calf muscles and Achilles tendon. They must all be stretched in unison for maximum effectiveness. A Strassburg Sock can also be used to stretch your plantar fascia while you sleep, watch television or work at your computer. Long, slow sustained stretching that does not cause an increase in pain is very helpful in preventing the plantar fascia from shortening and causing more scar tissue formation.
Changing shoes can also be effective. Many runners report that simply changing shoes helped their plantar fasciitis or even alleviated the condition. If you currently have plantar fasciitis it is probably a good idea to experiment with new running shoes. If you are currently wearing stability shoes try a neutral shoe. If you are currently wearing a neutral shoe try changing to a stability shoe or add a stability over the counter orthotic.
Both over the counter orthotics and custom orthotics have been found to be superior to taking NSAID’s (non-steroidal anti-inflammatory drugs), cortisone injections and gel heel cups. In my experience orthotics have been useful in about 30% of plantar fasciitis patients I have treated. Over the counter orthotics such as SUPERFEET can be useful and cost roughly $35. Sometimes custom orthotics are necessary with the cost being $327 at our clinic.
Of course there is always typical medical treatment of plantar fasciitis. You start by taking Ibuprofen (did anyone ever tell you….plantar fasciitis is an Ibuprofen deficiency?), when that does not work maybe they give you a big bulky splint to wear at night (no one can, the thing is huge!), now the cortisone shot is given (man that hurt! How do you know they simply did not miss?) then surgery is offered. Do you really want surgery and all the complications that go with it? Things like plantar fascia rupture and infection do happen.
Here is the recommendation by the American Family of Physicians:
Plantar fasciitis is one of the more common running injuries I see at the San Diego Running institute. The runner often complains that they have pain in their heel or arch that is worse in the morning and gradually “warms up”. They also say that the pain either gets progressively worse as they “run through it” and following the run the pain is much worse sometimes causing them to limp. If they continue to run their plantar fascia will eventually tear or rupture and prevent them from running for a long time. It is surprising how many of these runners with heel and or arch pain have been either misdiagnosed or given bad advice or ineffectual treatment. There are simple plantar fasciitis exercises and stretches as well as a plantar fasciitis night sock that should be used first in plantar fasciitis treatment as recommended above.
When the “quick fixes” fail, the San Diego Running Institute can refer you to Dr. Victor J. Runco. He is a marathon runner and running injury specialist. When the simple fixes for plantar fasciitis are not effective he can recommend therapy, plantar fasciitis taping and sometimes custom foot orthotics or better shoes for the orthotics you already have. If you have foot pain, arch pain or heel pain or have already been diagnosed with plantar fasciitis stop by the San Diego Running Institute and let one of our running experts show you some of the easy fixes that have helped thousands of runners with this foot condition or simply call Dr. Runco at (858) 268-8525 for an appointment.