Dr. Randall Kline, a Podiatrist from Allied Bone and Joint, will be contributing articles to Race Play Michiana about some of the more common exercise-induced injuries related to the foot and ankle, how to avoid them and what to do if you don’t. In this first article, Dr. Kline shares insight into the much-feared and terribly inconvenient plantar fasciitis.
You are not alone if the promise of the New Year has encouraged your own promise to develop healthier habits and increased activity. You may have started a walking or running program, joined a gym or even resumed a sport that once brought great enjoyment. The benefits can be immeasurable—physically, emotionally and mentally.
By now, however, you may also have discovered setbacks in the form of injury that can become costly, time consuming and discouraging.
As a podiatrist, one of the most common overuse injuries I see is heel pain after beginning a new exercise program. Many times the individual is interested in weight loss and has begun a walking or running program. The first few weeks go well and they feel more energetic. Encouraged, they increase their exercise frequency, distance and/or speed. Be careful! Too much too soon can lead to a gradual onset of pain in the bottom of one or both heels. The discomfort grows from a dull ache to a sharp stabbing pain. It’s usually worse with the first step in the morning or standing up after several minutes of sitting, then resolves (somewhat) with five to 10 minutes of walking. Sometimes the pain can be so severe it affects the ability to work.
The plantar fascia is a ligament on the bottom of the foot that extends from the heel to the forefoot, almost to the toes. It serves as a thick covering to the four layers of muscles on the bottom of the foot and is a continuation of the Achilles tendon. The Achilles tendon resides in the back of the leg and flows continuously from its insertions above and below the knee to the back of the heel. When micro-tears develop in the plantar fascia at its origin under the heel, inflammation results and plantar fasciitis begins. With chronic plantar fasciitis, the body begins to reinforce this weakened area with calcium, and a heel spur can be readily visible on X-rays.
ETIOLOGY: What causes plantar fasciitis?
Factors contributing to plantar fasciitis can be intrinsic or extrinsic:
- Intrinsic Anatomical considerations—Flat feet, hypermobility in joints, high arches, knock-knees (genu valgum) or bow-legs (genu varum), a tight Achilles tendon (equinus).
- Extrinisic Considerations—Inappropriate shoes that are worn out, with poor motion, control, too much cushion or inadequate arch support. Extrinsic considerations would also include training schedules that increase intensity or duration too rapidly.
Treatment: What you can do.
Even Sun Tzu would agree that avoidance would be the best strategy in overcoming any battle. There are many great sources for training schedules available to both beginning and advanced athletes. Select your program in advance, listen to your body and give yourself permission to rest if needed. Remember that injury can be one of the greatest setbacks to your training goals. In the event of heel pain onset:
Rest. Substitution with cross-training in the form of swimming, stationary bicycling, circuit weight training and elliptical training may offer a viable substitute while recovering. However, complete rest from exercise may be required. For some, this may mean six weeks of an altered schedule before morning pain subsides. If this is successful, gradually return to normal impact activity, running/walking.
Support. With a rigorous training schedule be sure to replace running shoes every six months. Running/walking shoes are also designed with an intended purpose; stabilization, motion control, trail running, cushion, etc. Be sure your shoes are in appropriate condition and designed for your type of foot. You may also find an over-the counter arch support helps.
Stretching. The root cause behind most heel pain is a tight Achilles tendon complex. The “runner’s stretch” performed with the knee straight and knee bent will mobilize both muscles contributing to this complex. You should target stretching each leg three times a day, for a continuous minute with each stretch. This will allow your foot to properly load with each step and decrease the tendency toward hyper pronation.
What your doctor can do.
Your podiatrist can determine the underlying cause behind your heel pain and develop a strategy for its resolution. This may include anti-inflammatories, physical therapy, a steroid injection and/or custom orthotics. Most biomechanically caused heel pain can resolve with conservative treatment, however, in some cases surgery may be required. May your year be blessed with good health.
Dr. Randall Kline is a board-certified podiatrist specializing in injury, wound and diseases of the foot and lower leg. Contact Allied Bone and Joint at (574) 247-4667 or visit AlliedBoneandJoint.com for more information.