Plantar Fasciitis is usually caused by a traumatic injury to the foot as in a jump or fall. Or as is more common in runners by a steady pounding over time. This often occurs in coincidence with holidays, golf, extensive yard work (pushing wheel barrows at the cottage etc.)
The underlining cause is often a short or tightened calf/achilles tendon. The plantar surface of the foot itself has little or no flexibility (or we would all be flat footed). By examining the plantar fascia you will notethat the pain is usually at back of the foot just under the heel, this is a point of insertion for both the plantar fascia and the calf/achilles tendons. Hence it provides the weak link in the system.
Assuming that an overly large heel spur is not the problem, dealing with plantar fasciitis should be straight forward (said the spider to the fly). :)
1) Ice after every run for 20-30 minutes using an ice bag of frozen veggies.
2) stretch after every run and 2-3 times during the day. Use only a 10-15% stretch (over stretching will definetly hinder your progress)
3) reduce overall mileage and speed, attempt to run more to the mid foot rather than the heel
4) don't stretch a cold muscle
5) replace old shoes, if the heel of the shoe is worn and the midsole/heel height is reduced it will place undue stress on the achilles/calf
6) Use heel lifts in shoes to elevate the heel at all times running or not. This should be done until the flexibility of the calf is adequate and the pain has subsided.
7) If using orthotics, continue use (they will also act as heel lifts) but have them checked by a professional especially if they are more than a year old.
8) while you are conferring with a professional, have him/her check your leg length. Usually a difference of .5cm or more can cause problems (usually in the longer leg)
9) never never walk around in bare or socking feet, the moment you get out of bed step into slippers (per. with a heel) or running shoes. and also as you step out of the shower.
10) before getting out of bed slowly and gently warm the calves up by *lightly* stretching and moving ankles back and forth, hold all stretches for 20-30seconds.
11) Don't even think of wearing racing flats!!!
12) Massage will help, especially deep massage will help with loosening up calf and breaking down some scar tissue.
13) Sorbothane or gel substances make good heel lifts, as can felt boot liners cut to fit only the heel (ful length liners do not help as much)
14) Ultra sound can help by breaking down scar tissue and soothing the area, accupuncture has also been known to help (in both cases consult your physician)
15) aspirin can definitely help by reducing inflamation again check with your physician
Stretches include:
1) both hands against wall, one leg straight and one bent, bot feet pointed forward. lean into the wall until you feel a stretch and then increase to 10-15% (no more) and hold for 20-30 sec. change legs and repeat at least twice.
2) As above only this time have both legs bent with one foot slightly ahead of the other,gently lower with the rear leg and use the front for balance only. you will feel a slightly deeper stretch than above. Again 10-15%, for 20-30 sec. and repeat
3) There are many stretches you could do but these are the two most effective.remember to do these consistantly and throughly, only You can do these,
If you have any further question please send e-mail, I welcome any feed back,good luck and great running.
>Well, I'm not over 40 (yet >It's kind of hard to describe the wrap, but I'll give it a shot:>Place one strip of tape starting UNDER the ball of the foot at the big>toe, around the heel (over the achilles tendon) and ending on top of the>foot at the base of the small toe. Next, starting near the front of the>foot and working your way back towards the heel, place a series of>strips that start on top of the foot (on the arch side) and extend>across the bottom of the foot, ending up on the top of the foot opposite>the arch. These strips should NOT completely wrap the foot! Finally,>place a locking strip that starts under the ball of the foot at the big>toe, around the heel (over the achilles tendon) and ending on the ball>of the foot beneath the small toe. I found that using some type of tape>adhesive helps since my feet really sweat. Don't use STICKUM! That>stuff's like epoxy and you'll never get the tape off! I hope this>helps. There's nothing more frustrating to a runner than not being able>to run.
>One final piece of advice: this injury is aggrivated by an>over-backward curling of the toes. When you walk up or down stairs, be>careful to place the ENTIRE foot, not just the ball of your foot on the>step. Believe it or not, that's one of the main causes of this injury!>Good luck! DON'T LET FOOT PAIN SPUR YOU TO DESPAIR The problem of a painful heel is often diagnosed as a "heel spur," but moreoften than not the pain is due to inflammation of the tissue known as plantarfascia and not to a spur of bone that may or may not be present on an x-ray.Hence, the correct diagnosis is "plantar fasciitis." ("Plantar" refers to thesole of the foot, a point to be noted with reference to another problem thatmay cause pain when walking--plantar wart, a term often corrupted by the laityto "planter's wart.") Fascia is a form of fibrous, fatty tissue that connectsor surrounds muscle tissue and various organs throughout the body (thus called"connective tissue," more familiar to us as one form of "gristle" found inmeat). Why the fascia becomes inflamed is not always clear, although unusual traumato the heel may precipitate the condition. Whatever the cause, the cure isusually a do-it-yourself project. The pain normally occurs only when puttingpressure on the heel and tends to be worse when one first gets out of bed inthe morning or gets up after sitting for an extended period. Rest is thus thebest treatment, but not a very practical solution most of the time. Wearingcomfortable shoes, with rubber heels and thick soles, is recommended, with theaddition of a sole cushion (available in any drug store and most supermarkets)to soften pressure on the heel. Cutting a circular hole about the size of aquarter in the sole cushion just under the painful spot may give furtherrelief, thus supporting the area just around it and relieving some pressure onthe painful spot itself. If one has flat feet, arch supports may help. The good news is that the inflammation itself, together with the pain itproduces, can be treated with over-the-counter ibuprofen. The condition isusually self-limited. The bad news is that treatment may taken some time,occurring intermittently for a year or more. If the suggested procedures failto relieve the pain, consult your doctor, who may find that inflammation ofother tissues (tendon, nerve or joint) may be the cause and thus prescribeother treatment. OVERUSE INJURY: PLANTAR FASCIITIS Recreational runners are prone to foot pain. Among the most frequentproblems are plantar fasciitis and Achilles tendinitis. Plantar fasciitis presents as pain at the point where the plantar fasciaattaches to the os calcis. It is classically worse in the morning and afterperiods of sitting. Generally, runners find that the pain disappears duringrunning, only to return afterward, intensified. Often they continue theirregimen until the injury progresses to a chronic state, which is much moredifficult to treat. The plantar fascia--the tough band of fibrous material that enhances thearches of the foot--is especially susceptible to chronic repetitive trauma,particularly in running sports. Fascial strain is also seen in jumpers wholand on the ball of the foot or in patients with excessive or abnormal shoewear. Physical examination reveals point tenderness at the origin of theplantar fascia, which is immediately anterior to the calcaneus on the medialplantar aspect of the foot.(*6) In severe cases, mild swelling may be presentin the area, and occasionally the pain may extend to and include the mediallongitudinal arch itself. Results of radiographic examination are usually normal. Because chronicinflammation causes bone to form at points of traction on the periosteum, aheel spur is often visible, but this is irrelevant to diagnosis. Excision ofthe bone spur is generally discouraged as it is not the cause of inflammation. Treatment of plantar fasciitis is directed at decreasing the acuteinflammation as well as correcting any underlying biomechanical abnormality.Depending on the severity of symptoms, the patient should reduce running in aswimming pool where buoyancy will decrease weight bearing. A course of NSAIDsmay be useful in reducing local inflammation. Ice massage for 10-15 minutesfollowing a run, and for two or three additional times during the day, shouldreduce pain. If the underlying biomechanical abnormality is not corrected, gait analysis isessential. Observe the patient during a brief run and then watch him or herwalk barefoot down the hall. Many times a patient will hyperpronate whilerunning but have a normal walking gait. Correcting the abnormality with asemirigid orthosis is recommended; the plantar fascia taping method is alsoused to mimic an orthosis, and it will tell you as soon as the patient stepsoff the examining table whether an orthosis will ease the pain. Also importantin correcting a physical imbalance is a flexibility program aimed atstretching the plantar fascia and posterior leg muscles (see the patienteducation aid, "Exercises for the painful foot and ankle"). Deep heating modalities such as ultrasound and phonophoresis are often of nolasting help. Plantar fasciitis responds to local injections, but mostspecialists do not recommend injection into this area. If you deem injectionnecessary, remember that corticosteroid injections into this tendon and itsorigin are very painful to the patient, so technique is extremely important: Amedial approach for injection is less painful than a direct plantar approach,and preparatory local anesthesia is vital. Using a long and very small caliberneedle is helpful. >Simple alternatives to foot surgery or orthotics for the most common cause of>pain MY HEEL PROBLEMS ALL started when I went out dancing in my supertraction boatmoccasins. I went at the last minute, and I didn't think about changing myshoes. So when I got on the dance floor, I tried to overcompensate. It didn'twork. I twisted my ankle. For the rest of the weekend, I did smart things. I treated may injury byfollowing the RICE method: Rested the foot; Iced the sore spot; Compressed thearea with a makeshift Ace bandage; Elevated the foot on a chair as I watchedTV. My ankle felt better, but a little sore. For the next couple of weeks, Ikept my weight toward the outside edge of my foot to baby the injury. And thatminor change in my stride is what finally sent me to the podiatrist-with aroyal pain (ouch!) in my heel. My situation was unusual. My heel injury was not. The podiatrist told me I hadplantar fasciitis (PLAN-tar fassy-EYE-tiss), probably the single most commoncause of heel pain. The plantar fascia (FAS-see-uh) is a ligamentlike piece of connective tissueon the bottom of the foot. It runs the length of the arch, from the fivemetatarsal bones in front to the heel bone in back. The fascia is not very stretchable-and that's where your heel problems canbegin. Walking normally, your arch stretches and flattens a little with everystep. Your foot rolls in slightly as well. Podiatrists call that pronation.Any movement that overpronates puts stress on the arch and on the plantarfascia. If this happen repeatedly, the fascia begins to tear or pull away fromthe heel bone and the whole area becomes inflamed. Plantar fasciitis is afoot.In time, it hurts-a lot! But the sneakiest aspect of plantar fasciitis is that, at first, it doesn'tfeel like anything serious. In fact, for a while you might not feel anythingat all. (I was an exception. I had a mild pulling sensation down the length ofmy arch, like a stretching rubber band.) When the pain does begin, itconcentrates in a small spot on the inner front of the heel, just behind thehighest part of the arch. "People describe it as a ~stone bruise' that won'tgo away," says Joe Ellis, D.P.M., a podiatrist and consultant to theUniversity of California at San Diego. "It's usually annoying, but they'll putup with it for weeks. That's how it gets worse." Another telltale sign: pain that's worse in the morning, when you first standon the affected foot. That happens because the fascia is being newly stressedafter an overnight rest. As you walk around, the fascia gradually "warms up"and lengthen slightly. That reduces the tension: Less pull means less pain.But after several weeks, the pain doesn't go away as quickly. And the worse itgets, the longer it will take to cure the problem. DETERRING PAIN Plantar fasciitis is an oversue injury, which means it can happen to anyonewho repeatedly overstresses a foot. "You can be a gold-medal Olympian inperfect shape, training 15 miles a day. One day you push hard to 16. Or youcan be a 350-pound ~couch potato' who gets off his butt and walks, one mile.In each case, if that extra mile is more than your feet can take, you'll getan overuse injury," says Jeff Bronson, M.D., an orthopedic surgeon in SanDiego, California. People who run or do high-impact aerobics are more likelyto overstress their plantar fascia. But anybody who begins an exercise program(even walking) and does too much, too soon is at risk. But no one is doomed to get plantar fasciitis. Several careful studies ofinjured runners revealed little evidence that anatomical differences were atthe root of overuse problems. Out of several studies, only one physical markerhas been consistently associated with a greater risk of plantar fasciitis:being able to flex your foot downward (bending at the ankle and pointing yourtoes down) more than 60 degrees. "You can't measure that accurately athome-and you may not need to worry about it anyway," says Stephen P. Messier,Ph.D., director of the J.B. Snow Biomechanics Laboratory at Wake ForestUniversity in Winston-Salem, North Carolina, "since many people with thatdegree of flexibility don't get heel pain." The bottom line: Plantar fasciitis is avoidable, if you don't do more thanyour feet can handle. An overuse injury is a self-inflicted wound. The bestway to avoid it: Know your limits. Work up slowly to new milestones. Know whento quit for the day. And wear the right shoes with good cushioning,shock-absorbing capability and stability. GIVING YOUR INJURED FOOD A HAND Okay, let's say you've been dancing in boat shoes, and you're hurting now. Ifyour pain fits the two telltale signs: (1) concentrated in the front of theheel pad, and (2) worse in the morning or after a long rest period-then you'veprobably got plantar fasciitis. You may want to check with a podiatrist tomake sure it's not something else (see "Other Things That Can Affect YouHeel"). Then you can try some of the simple self-help methods listed below.Reliable podiatrists will recommend that you try these low-tech methods beforesuggesting surgery or custom-made orthotic shoe inserts: * Give the foot a rest. Fasciitis is, after all, an overuse injury. If you'vebeen running or walking farther than usual, cut back to half your distance.Better yet, rest for a week or two, then come back slowly. If you've juststarted to get a tender spot, you may get over it in a few weeks. But ifyou've had pain for a while, don't expect miracles. It took me about sixmonths to get my fasciitis completely. * Try other forms of exercise. Simply varying your workout with a lessfoot-dependent sport might be all you need in the early stages of fasciitis.Swimming is an excellent substitute. * Take a nonsteroidal anti-inflammatory. As the name says, these drugs reduceinflammation and so decrease pain. Follow instructions for 7 to 10 days, andtake after eating to reduce stomach upset. * Massage the painful area with ice. This is another good way to reduceinflammation. Once or twice a day for no more than 20 minutes at a time shouldsuffice. * Stretch your Achilles tendon. Crazy as it sounds, this works! That's becausea tight Achilles tendon, which runs from the bottom of the heel to the calfmuscle, pulls the heel bone up and back, stressing the fascia. A more relaxedtendon and calf muscle put less strain on the injury. Here's one goodstretching technique: Stand facing a wall, with one leg in front of the other.Keeping the back foot flat on the ground, bend the front leg slowly at theknee. Balance yourself against the wall as you lean forward. Keep the back legstraight. You'll feel a pulling in the calf muscle and Achilles tendon. Hold20 to 30 seconds. Switch legs and repeat. * Wear shoes with good arch and heel support. Running shoes and the newer"pro" walking shoes are excellent choices. Don't skimp! "There's a bigdifference between the support you get from the $50 shoe and the $11 shoethat's supposed to look like the $50 shoe," says Dr. Bronson. Arch supporthelps prevent overpronation. Solid heel support prevents the heel frompressing down too hard and therefore putting too much pressure on the fascia.I was able to wear my running shoes most of the time-even at work. If youcan't, then... * Buy non prescription arch supports. These are relatively inexpensive and canbe switched from one pair of shoes to another. Sometimes they come with anextra "metatarsal pad" under the ball of the foot. Peel that off-it won't helpfasciitis. My supports were great when I had to wear dress shoes. I even morethe supports in my running shoes! That felt a little strange at first, but ithelped a lot. I still use them once in a while, because they feel so good. * Have your foot taped by someone who knows what they're doing. Two styles oftaping, the "heel lock" and "low-dye taping" can reduce overpronation. "Butit's really difficult to tape your own foot effectively for this condition,"says Dr. Ellis. "An athletic trainer from a local college can do a good job.Amateurs have a tough time. * All of the Above. Try various combinations of these simple therapies, andgive them time. You should start to feel some improvement in a week or so, ifyou've caught the problem early. If you've had pain for a while, be patient. There are several things you shouldn't try: * Don't apply heat. It won't help fasciitis. * Don't use a foot soak. Again, it won't do much. You can soak your foot incoll water (about 50 [degrees] F.) for 20 minutes as an alternative to icemassage. But the ice is better, since it can be held directly on the sorespot. * Don't expect extra padding or heels cups to solve the problem. The injury iscaused by overstretching, not impact. A heel cup or pad might feel better, butthat's because it relieves pressure on the inflamed area. Extra cushioningwon't stop the stretching. WHAT THE DOCTOR CAN DO When these simple measures fail-if you don't notice any improvement after amonth or two, or if your improvement has leveled off-it's time to visit apodiatrist, orthopedic surgeon or sportsmedicine specialist. A professionalcan provide four things that you can't: * Cortisone injections. It's not pleasant, but an injection of thisanti-inflammatory drug directly into the sore spot can provide powerful relieffor a few days. Be careful, though. There are two main types of cortisone:water-soluble and fat-soluble (also called insoluble). Since long-termexposure to cortisone can actually damage the fascia, make sure the specialistis using the water-soluble variety, or a mixture of the two. To be safe, don'thave cortisone injections done more than three times in the same foot. * Advanced physical therapy. Under the guidance of a physical therapist, youcan learn a regimen of ice massage, friction massage and stretching exercise.Or you can be given ultrasound treatments, in which sound waves are used tomassage the fascia, break up scar tissue and promote healing. * Custom orthotic shoe inserts. Orthotics are high-tech supports for theentire foot. To achieve a custom fit, the doctor makes a cast impression ofyour feet. The orthotics are then molded out of any one of a variety ofmaterials. Semirigid materials such as polypropylene are probably the bestsince they provide support without being hard on your feet. Orthotics are a mixed bag. On the plus side, a good pair can provide permanentrelief. On the minus side, they are expensive: anywhere from $300 to $1,000per pair. (It pays to shop around, since a higher price doesn't always meanbetter quality.) But when they work, they can be worth every penny. Some people wear them for afew months, take them out and never have pain again. Others have to wearorthotics for life. While most orthotics are very good, there are noguarantees. Sometimes it takes weeks for the pain to go away. And anunfortunate few don't get relief from orthotics. They are the only people whoshould consider surgery. * Fascia-release operation. In most cases, this is relatively simpleoutpatient surgery done under local anesthesia. The surgeon cuts into the sideof the heel and snips partway (up to one inch) through the fascia to releasethe area being pulled. Contrary to popular belief, this surgery won't leaveyou with flat feet. Once the site of the operation heals, the pain is usuallygone. And major complications are rare. As Dr. Ellis reports, " I performedthis operation on a former Olympic miler. Five weeks later, he went running.The first time out, he thought he felt a twinge. Since then, he's had noproblems." It sounds so wonderful, but it truly should be a last resort. As with anysurgery, there is a risk of infection and minor nerve damage. The heel canswell excessively and heal slowly-keeping you off your feet even longer. Andthe resulting scar tissue may thicken over time and cause a recurrence ofpain. These complications occur in about 15 percent of cases. One operation that won't help plantar fasciitis is heel-spur removal. A fewyears ago, these bony growths were popularly thought to be the cause of heelpain, and many were removed unnecessarily. Actually, the spurs aren't a cause,but an effect. The bone reacts to the pulling of the fascia by growingoutward. "A good number of people who have heel spurs feel no pain, and manycases of plantar fasciitis are not accompanied by spur formation," saysSuzanne M. Tanner, M.D., a sportsmedicine physician in Denver and an alumnaeof the prestigious Hughston Sports Clinic. MY HEEL HEALED My podiatrist gave me a cortisone shot, a variety of felt-material archsupports, a heel cup and the advice to stay off my foot as much as possible.The shot was momentarily unpleasant, but it helped. The arch supports feltlike they did me the most good. When they wore out, I bought nonprescriptionsupports in a drugstore. I never tried the heel cup. I truly did try to followthe advice and succeeded about half the time. But when you have an overuseinjury in a part of the body you can't avoid using, healing time will beunbearably slow. Your best course is to use common sense, try the simpleremedies if possible and have plenty of patience. It took me six months to do it, but now I'm completely pain-free. Anybodywanna go dancing? OTHER THINGS THAT CAN AFFECT YOUR HEEL. "There are more than 140 different problems that can manifest themselves asheel pain," says Barry Scurran, D.P.M., chief of podiatry at Kaiser PermanenteMedical Center, in Hayward, California. "Fortunately, most of them are rare." Arthritis, bursitis and plain old bacterial infection are some of thenot-entirely-rare findings. Stress fractures of the heel bone are atheoretical possibility, but most doctors discount them. "You're more likelyto break other bones in the foot and ankle first," according to Suzanne M.Tanner, M.D., a sportsmedicine physician in Denver. And there's an interestingcondition called "tarsal tunnel syndrome," involving a pinched nerve in theankle area. (It's similar to the better-known wrist problem, carpal tunnelsyndrome.) Jeff Bronson, M.D., an orthopedic surgeon in San Diego, is one of ahandful of doctors studying this problem, which may be involved in a number ofoveruse injuries. Pain in the back of the heel can have a variety of causes. Two common ones area bursitis known as Haglund's deformity, and the so-called pump bump, whichcan be aggravated by the back of your shoe. Perhaps the most seriousback-of-the-heel problem is Achilles tendinitis. Bad Achilles inflammation canmake it difficult to walk. If the tendon snaps, it must be reattachedsurgically. To prevent Achilles-tendon problems, do regular stretchingexercises. If tendinitis strikes, use rest, ice and NSAIDs (non-steroidalanti-inflammatory drugs) to bring the swelling down. Some podiatristsrecommend the use of a heel pad to take stress off the tendon, but long-termuse could actually cause the tendon to shorten. Above all, when in doubt, check it out: See a podiatrist to pin down the causeof any serious or persistent heel pain.
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