Commonwealth Sports Medicine

My Aching Heal!!!!

That ice pick stab into the bottom of your heal when you step out of bed in the morning is probably caused by plantar fasciitis (fashee-EYE-tiss).

The plantar fascia is a band of tissue that goes from the bottom of the heel (calcaneus) to the ball of the foot (metatarsal heads), as seen here.

Its primary job is to support the arch on the bottom to the inner foot.

A normal plantar fascia can get over- stretched by factors acting to flatten this arch. When the arch is over stretched, the plantar fascia pulls on the heal bone. Over time, this causes pain and degeneration of the fascia where it originates on the heel. The condition is called plantar fasciitis

Many factors can inappropriately stretch the plantar fascia, but being overweight is the most modifiable factor. Many people with plantar fasciitis are overweight. Doing sports that involve repetitive pounding, like distance running, is also a risk factor. In fact, plantar fasciitis affects al least 10 % of runners at some point in their life. Overpronation (foot rolling in) flattens out the normal foot arch, thereby stretching the plantar fascia. Pronation is a potentially correctable risk factor. Shoes with broken down arch support can also contribute to plantar fasciitis.

Before treating yourself for this condition, you deserve a trip to your Sports Medicine provider to make sure that you do not have a less common condition like a stress fracture, a compressed nerve, or an inflamed growth plate.

There are many ways to treat plantar fasciitis because none of the treatments are perfect. Since this is not an inflammatory problem, anti-inflammatories (like ibuprofen and naprosen) do not help much.

Plantar fasciitis is actually a mechanical problem. So treatment should focus on changing mechanical factors. Lengthening the fascia while avoiding overstretching is a good idea. Even more important is strengthening the arch so that it does not pull on the heal bone. Specific treatment recommendations are:
• If you are overweight, work on some cross training for a while to shed the pounds. Water running, swimming, and bicycling will not stress the plantar fascia. Even a 10-pound weight loss makes a big difference. Since running transmits 5X your body weight through your foot, a 10-pound loss translates into 50 pounds less at the sole of the foot.
• Back down on running mileage by about 50 percent. Consider it a blessing to be forced to work on cross training with biking, swimming, or other sports.
• Strengthen the arch by making a “fist” with you foot; relax; then do it again. Do enough reps of this exercise to exhaust the muscles on the bottom of your foot.
• Stretch after workouts as well several times during the day. It is important to stretch out both the plantar fascia and the Achilles tendon, since both structures attach to the heal bone. Two good stretches are shown here. Never stretch cold tissue (this causes the tissue to tear). Hold each stretch for at least 30 seconds. Keep the stretch comfortable- it should not cause excessive pain.
Lean forward against a wall with the affected side knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch stretch as you lean forward. Repeat the same stretch with the back knee slightly bent, keeping the heal on the ground.
My Aching Heal

That ice pick stab into the bottom of your heal when you step out of bed in the morning is probably caused by plantar fasciitis (fashee-EYE-tiss).

The plantar fascia is a band of tissue that goes from the bottom of the heel (calcaneus) to the ball of the foot (metatarsal heads), as seen here.

Its primary job is to support the arch on the bottom to the inner foot.

A normal plantar fascia can get over- stretched by factors acting to flatten this arch. When the arch is over stretched, the plantar fascia pulls on the heal bone. Over time, this causes pain and degeneration of the fascia where it originates on the heel. The condition is called plantar fasciitis

Many factors can inappropriately stretch the plantar fascia, but being overweight is the most modifiable factor. Many people with plantar fasciitis are overweight. Doing sports that involve repetitive pounding, like distance running, is also a risk factor. In fact, plantar fasciitis affects al least 10 % of runners at some point in their life. Overpronation (foot rolling in) flattens out the normal foot arch, thereby stretching the plantar fascia. Pronation is a potentially correctable risk factor. Shoes with broken down arch support can also contribute to plantar fasciitis.

Before treating yourself for this condition, you deserve a trip to your Sports Medicine provider to make sure that you do not have a less common condition like a stress fracture, a compressed nerve, or an inflamed growth plate.

There are many ways to treat plantar fasciitis because none of the treatments are perfect. Since this is not an inflammatory problem, anti-inflammatories (like ibuprofen and naprosen) do not help much.

Plantar fasciitis is actually a mechanical problem. So treatment should focus on changing mechanical factors. Lengthening the fascia while avoiding overstretching is a good idea. Even more important is strengthening the arch so that it does not pull on the heal bone. Specific treatment recommendations are:
• If you are overweight, work on some cross training for a while to shed the pounds. Water running, swimming, and bicycling will not stress the plantar fascia. Even a 10-pound weight loss makes a big difference. Since running transmits 5X your body weight through your foot, a 10-pound loss translates into 50 pounds less at the sole of the foot.
• Back down on running mileage by about 50 percent. Consider it a blessing to be forced to work on cross training with biking, swimming, or other sports.
• Strengthen the arch by making a “fist” with you foot; relax; then do it again. Do enough reps of this exercise to exhaust the muscles on the bottom of your foot.
• Stretch after workouts as well several times during the day. It is important to stretch out both the plantar fascia and the Achilles tendon, since both structures attach to the heal bone. Two good stretches are shown here. Never stretch cold tissue (this causes the tissue to tear). Hold each stretch for at least 30 seconds. Keep the stretch comfortable- it should not cause excessive pain.

Lean forward against a wall with the affected side knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch stretch as you lean forward. Repeat the same stretch with the back knee slightly bent, keeping the heal on the ground.

Put the ball of the foot on a wall, leaving the heal on the floor. Gradually lean your body toward the wall. Do this with the knee straight, and then repeat with the knee slightly bent.
• Ice after stretching and strengthening for 15-20 min. Massage with a frozen paper cup is very beneficial. Heat-strength-stretch-ice should go in that order.
• Proper footwear is necessary. Shoe inserts may help correct misalignments. An arch support insole can help by providing a continuous mild stretch. There are many such insoles available. Check with your Sports Med provider to determine what your footwear needs are.
• Similarly, your Sports Med provider may use athletic tape to hold the arch up, thereby providing a constant gentle stretch.
• There are many types of night splints available. These splints lengthen out the plantar fascia while you sleep. These may help a great deal if your symptoms are worse when you first step out of bed in the morning. The best splints stretch the arch of the foot; not just the Achilles tendon.
• Cortisone injection may be attempted. This is generally a temporary fix, and may weaken the fascia in the long term.
• Shock wave therapy is a fairly new treatment (although it has been used in other countries for many years). Applying strong shock waves to the plantar fascia helps stimulate healing of the degenerated tissue.
• Surgery should be kept as a last resort and is falling out of use as shock wave therapy becomes more available.

Put the ball of the foot on a wall, leaving the heal on the floor. Gradually lean your body toward the wall. Do this with the knee straight, and then repeat with the knee slightly bent.
• Ice after stretching and strengthening for 15-20 min. Massage with a frozen paper cup is very beneficial. Heat-strength-stretch-ice should go in that order.
• Proper footwear is necessary. Shoe inserts may help correct misalignments. An arch support insole can help by providing a continuous mild stretch. There are many such insoles available. Check with your Sports Med provider to determine what your footwear needs are.
• Similarly, your Sports Med provider may use athletic tape to hold the arch up, thereby providing a constant gentle stretch.
• There are many types of night splints available. These splints lengthen out the plantar fascia while you sleep. These may help a great deal if your symptoms are worse when you first step out of bed in the morning. The best splints stretch the arch of the foot; not just the Achilles tendon.
• Cortisone injection may be attempted. This is generally a temporary fix, and may weaken the fascia in the long term.
• Shock wave therapy is a fairly new treatment (although it has been used in other countries for many years). Applying strong shock waves to the plantar fascia helps stimulate healing of the degenerated tissue.
• Surgery should be kept as a last resort and is falling out of use as shock wave therapy becomes more available.