How to Treat and Prevent Plantar Fasciitis

Techniques to help treat and prevent this common and frustrating injury

Nevit Dilmen

Foot pain can be a drag, especially for an athlete. The most common issue we see in feet that effects the heel first thing in the morning is plantar fascitis. 

By definition, this is an inflammation of the tissue on the bottom of the foot that stretches from the base of the toes all the way to the heel, the plantar fascia.

Plantar fasciitis is a common and very frustrating injury for many runners and non-runners alike, but it doesn’t need to be. It's quite simple to treat, although often not alone. It generally requires a trip to the physical therapist.

Symptoms include pain or burning on the bottom of the foot, either by the heel, arch or both. Pain is generally worse in the morning, with static standing, running or sometimes even just walking. Often, people describe the first few steps out of bed as “walking on nails”; it can be that uncomfortable.

For runners, we generally find the same usual suspects that tend to trigger plantar fasciitis pain: increasing mileage too much or too fast; speed and hill work; a change in shoewear while running; or poor biomechanics/genetics and the wrong running shoe for your foot. Predisposing factors are usually a chronically tight calf muscle and/or plantar fascia, and a very high or very collapsed arch; the extremes are usually affected, but not always. Plantar fascitis doesn’t always play favorites.

To get rid of this pain, calf stretching plays a big role. If the morning is most painful, before getting out of bed put a towel around the ball of your foot, extend your leg while you are sitting, and pull the towel back toward you for 30 seconds a few times. Also move the ankle up and down and circle it, just to get some circulation. With these two small exercises you will begin to stretch the calf and plantar fascia, also getting some much needed blood to the area.

A second option is to invest in a night splint. The Straussberg Sock, for one, has been highly successful in ridding morning heel pain because it stretches your calf and plantar fascia while you sleep. I know stretching is boring and time consuming—we all want to just go out and run without the bother of stretching, so night splinting is a fantastic way to stretch while you sleep.

I am all for any way to cheat when it comes to taking care of my tight spots. However, I will warn you that the sock takes a while to get used to overnight, and is not especially attractive.

For stubborn plantar fascitis, it's best to work on the tissues manually, especially on deep tissue and scar tissue reduction in the fascia. We will often find the fascia is thickened, a sign of chronic tightness and scar tissue. The massages will hurt, but they are therapeutic. Therapy will also help free the joints in the foot and ankle that are involved. Reducing your exercise whether in length or terrain will also be a big help. Hills and speed are an obvious no-no if you are still in pain.

Other caveats: flip-flops and shoes with no support. You will need the arch and fascia well-supported during this period. Often times women will feel better in a slight heel than flats because it takes some pressure off their calf muscle. This is fine. The bottom line, find supportive shoes you have the least amount of pain in and wear those as much as possible.

Another consideration with heel pain is correct running shoes. I often find runners are in the wrong running shoe for their foot. See a specialist if you are unsure you picked the correct running shoe for your specific needs. In addition, many (mostly women), are unaware that they may be a narrow AA width instead of the standard. This is more common in women or men with high arches.

Often with heel pain, especially pain that is on either side of the heel, it can occur from lack of support of the heel bone. When you run without heel lateral support, the heel rocks too much back and forth in the shoe. A firmer grip on the heel of any shoe will keep this from happening and causing pain, which is why for many women a narrow shoe may work much better. It will keep the heel tight in the shoe so there is no rocking. Also, special taping to support the arch and lock the heel is especially helpful to avoid pain walking and allow healing.

With the heel, like the ankle and foot, proper biomechanical support in the absence of innate stability is sometimes all we need. We cant all have perfect anatomy or genes, but we can all make the modifications necessary to improve what we were born with.

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