Member Case Study: Plantar Fasciitis

author : AMSSM

comments : 0

Often pain occurs with the first steps of the day or at the beginning of a run when that tight fascia gets stretched and microtears occur. But pain can also develop with prolonged standing and worsen.

Member question from kesslergk

I changed to a lighter shoe and had some pain in my right arch, near the heel. It hurts a bit in the morning, and for maybe the first five minutes of a run. Then, after warming up, I have no issue. A quick internet search suggests plantar fasciitis. I went back to my heavier shoe, but I am not sure it is really helping at this point. Also, when I went to the lighter shoe, I was making a conscious effort to run with more of a forefoot strike.

I cannot determine whether it was the shoes, the form, or both. I would like to cure the issue and then try the front strike with the heavier shoes. Other than stretching and downing anti-inflammatories, any suggestions for treatment? Or, is this something that likely would require immediate medical attention?

Answer from John K. Su, MD MPH

Member AMSSM

Your symptoms seem consistent with plantar fasciitis, a common cause of heel pain in runners. The plantar fascia is a sheet of connective tissue that connects the ball of the foot to the heel.

Often pain occurs with the first steps of the day or at the beginning of a run when that tight fascia gets stretched and microtears occur. But pain can also develop with prolonged standing and worsen throughout the day. In runners a common cause of plantar fasciitis is changes in training (increase in mileage or intensity, or changes in terrain such as hillwork).

I agree your problem is likely a combination of your lighter shoes and forefoot striking.

There are some racing and lightweight training shoes that do offer some pronation or motion-control features -- but most have none, as it adds weight to the shoe. If you do over-pronate as the majority of runners do, you probably need a least some support in your shoes. If you are using pure racing flats for your training, I would recommend trying a pair of lightweight trainers with some stability features to use for your speed and technique work.

Of course if you are truly forefoot striking, you are effectively negating most of the motion control that is built into the rear of the shoe. Forefoot running is natural for a very small percentage of runners -- the majority of runners are heel strikers. Becoming a forefoot striker (ala "pose method" or "chi running") requires time for the body to adjust. It puts greater stress on your calves (gastrocneumius and soleus muscles). Similar to hill running, you are more on our toes and that translates to greater stresses on your Achilles tendon on into the heel and the plantar fascia. And while forefoot running has been popularized in recent years as a technique to run faster by magazine articles and seminars, it often brings injury if not approached gradually.

Plantar fasciitis treatments include anti-inflammatories and calf stretches, which you mentioned you have tried. Rest or cross training is helpful initially. You can add ice massage with a frozen water bottle or massage with a small ball or can. Other methods to stretch out the plantar fascia are a night splint, a device that keeps the plantar fascia stretched as you sleep – cumbersome but quite effective. Lastly, injections with corticosteroids can sometimes be done if other techniques are not working.

As a runner, you could benefit from an evaluation of your foot alignment and gait. Outside of your training changes, there maybe some biomechanical malalignments (leg length, foot pronation, weak hip stabilizers) which can be improved. For instance, you may benefit from a heel lift or orthotics if you have a leg length discrepancy, significant pronation, pes planus (flat feet). Also, there are other reasons for heel pain such as retrocalcaneal bursitis, fat pad syndrome, or calcaneal stress fracture that a sports medicine physician may be able to identify.

Happy running,
John K. Su, MD MPH
CAQ Primary Care Sports Medicine
Faculty, Kaiser Los Angeles Family and Sports Medicine
Medical Director, Ford Ironman 70.3 California 2008

Rating

Click on star to vote

11831 Total Views  |  32 Views last 30 days  |  8 Views last 7 days

date: March 6, 2008