Tips for Treatment and Prevention
By Christine Dobrowolski, DPM - For Active.com
I saw Dave in my office for a complaint of
heel pain. He had developed the pain two years ago and despite seeing other
doctors, he had not had any improvement.
His running had suffered considerably. He
used to compete in half-marathons throughout the year, but he was no longer
able to run because of the pain. He insisted that he had done all the
treatments available, but seemed hesitant to try a more aggressive
He left the office with a home therapy
regimen and some education on the importance of resting.
That weekend I spotted Dave running through
the neighborhood, at quite a strong pace. At his next appointment I confronted
him about his running and he confessed. His was currently running about 30
miles a week, about half of his weekly mileage two years ago. During the summer
months he used to run 70-80 miles a week while preparing for marathons. Thirty
miles a week seemed like resting to him.
Dave's behavior is common among athletes.
Sticking with a routine and ignoring the pain is typical. An injury can be
devastating, even for recreational athletes. Many avoid the doctor for fear of
what they may find out.
Many injuries require 6-8 weeks of rest, and
that is not what an athlete wants to hear. With a high tolerance for pain,
athletes will frequently train through the pain. Unfortunately, this tends to
make injuries worse, particularly when it comes to the foot.
According to Running Research News, a
million runners develop heel pain (plantar fasciitis) every year. The American
College of Foot and Ankle Surgeons has stated that heel pain has reached
epidemic proportions in weekend athletes.
This common condition is typically ignored,
especially by athletes who tend to seek treatment only after the problem
becomes severe. Starting treatment early will help prevent the problem from
becoming chronic and limiting activity for 8 to 12 months.
Plantar fasciitis ("plan * tar fash *
ee * I * tis") is the tearing of a ligament on the bottom of the foot where it
attaches at the heel. The tearing causes inflammation and the inflammation
Pain is felt at the bottom of the heel and
sometimes in the arch and usually is the worst at the first step in the
morning, but may also occur only during or after a run or activity.
Plantar fasciitis is not typically caused by
a direct injury or trauma, but commonly the result of running or walking in a
worn-out pair of shoes, training on a new surface or adding hills into a
At the first sign of pain in the arch or the
heel, consider the following:
1. Rest. No running, walking,
treadmill or stairmaster. Cross-train by biking, swimming, yoga (no downward
dog) or weightlifting (avoiding squats and calf exercises).
2. Ice. Take a sports water bottle,
put it in the freezer and roll your arch over it for 20 minutes every
3. Stretch. Stretch your calf
multiple times throughout the day. Use a belt or a towel to stretch your calf
in the morning, BEFORE you get out of bed for 30 seconds to a minute. Perform
the runner's stretch (with both hands against a wall for support, extend one
leg behind you, keeping that heel on the ground, and lean forward slightly to
stretch your hamstrings/calves) as many times as you can throughout the day for
30 to 60 seconds (I tell my patients 10 times a day).
4. Wear shoes. Make sure you are in
shoes all the time. No going barefoot. Wear shoes that are rigid and bend only
where the foot bends, at the toes. Test your shoes by turning them upside down,
grabbing the toe and the heel and bending them. If they fold in the middle --
throw them away. They may have caused your pain.
Many shoe companies are designing shoes to
be lightweight. This compromises the stability in some brands and results in a
breakdown of the shoe within a few months after purchase. Testing your shoes
often for stability will help avoid injuries.
If your pain does not resolve in 2 weeks,
visit your podiatrist. Other treatments may include anti-inflammatory
medications, night splints, steroid injections, pre-fabricated or custom-made
orthotics, castboots, shockwave therapy or surgery.
To avoid developing plantar fasciitis, make
sure that you are always training in good shoes. If the shoe starts to wear
down on the heel, your foot will take on abnormal stresses and will have a
higher chance of injury.
If you have flat feet, consider buying a
pair of sport orthotics at you local running store or sports store. Try to run
on soft, even surfaces. Running on a sloped concrete surface will increase the
chance of injury. Add mileage slowly and incorporate hills gradually.
Christine Dobrowolski is a podiatrist,
runner and author of "Those Aching Feet: Your Guide To Diagnosis and Treatment
of Common Foot Problems," available via her publisher,
and at Barnes & Noble and Amazon.com.