Member Case Study: Plantar Fasciitis

author : AMSSM

comments : 1

I think I have Plantar Faciitis? The bottom of my foot is sore in front of the heel in the mornings. It sort of gets better during the day, I can run without increasing in pain.

Member question from mikelcycle:

I think I have Plantar Faciitis? I was only logging about 20 miles per week, but I have the symptoms. The bottom of my foot is sore in front of the heel in the mornings.  It sort of gets better during the day, I can run without increasing in pain. Leading up to this, I had not had a moments worth of foot pain and did two events (one Olympic and one sprint distance) in one week where I wore a new pair of tri specific race flats for the run.

My questions are these:
#1 Is there anything else I should be doing?
#2 Is it ok to run before the pain is completely gone?  The GF people seem to think that is ok
#3 Is this partially hereditary?  All of my Aunts have this.
 

Answer by Rachel A. Biber, MD

Member AMSSM
 

Plantar fasciitis is an extremely common condition affecting an estimated two million people each year. It is a challenging problem to get better so please respect it so as to not make a small problem into a larger one. Basic treatment involves icing, arch supports and stretching. However, there are several other adjuncts that may also be helpful.

Rest of the plantar fascia is an essential component of treatment. Allow the inflammation at the heel to calm down by not running. Use this time to focus on your swimming and biking. Running prior to the complete resolution of pain will likely lengthen your recovery time, causing continued microtrauma.

Stretching focused on the plantar fascia and gastrocnemius (calf)-Achilles complex can be helpful. The Achilles tendon attaches to the top of the calcaneus (heel bone) and opposes the forces of the plantar fascia. The more flexible the Achilles is, the less pull on the plantar fascia. Strengthening complements stretching, serving as a mode to improve longitudinal arch support and decrease stress on the plantar fascia. Strengthening exercises once the pain is gone should include heel raises and gathering a towel or other object with your toes to strengthen the intrinsic foot muscles.

Night splints provide continued passive stretching during sleep by keeping your foot in 90 degrees of dorsiflexion. They are particularly effective in individuals who's worse pain is the first step in the morning. Anti-inflammatory therapy with ice and NSAIDs is also effective in shortening the course of plantar fasciitis. Steroid injections are controversial and usually reserved for cases more severe than yours. Injections can provide some pain relief initially but the pain often returns in weeks to months. In addition, repeated injection can result in fat pad atrophy and a subsequent decrease in force dissipation during heel strike while running.

People with flat feet, abnormal shaped arches or other anatomical abnormalities of the lower extremity are predisposed to developing plantar fasciitis. Such anatomical risk factors do have a genetic component, and may make plantar fasciitis appear “hereditary.”

With patience and a multi-faceted treatment approach you can recover from plantar fasciitis and will be back competing in no time.

Rachel A. Biber, MD
Vanderbilt Sports Medicine
 

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date: October 28, 2009