September 11 2018
Make sure you know the rules of the road before you head out the door.
If you’ve ever stepped out of bed in the morning only to wonder who put porcupines under your feet, you know just how painful plantar fasciitis can be. The hallmark symptom of heel pain typically is felt when standing after periods of rest, and can also strike during or after a run or other activity. Eventually, it can become constant.
Experts have theorized that inflammation in the plantar fascia, the band of connective tissue on the bottom of the foot, is to blame for the pain. However, research is now showing that inflammation is not always present.
“There’s a movement getting away from using the term ‘plantar fasciitis,’ and instead calling it ‘plantar fasciopathy’ or simply ‘heel pain syndrome,’” says Greg Lehman, D.C., M.Sc.P.T., a physical therapist and chiropractor in Ontario, Canada, who specializes in treating running injuries.
“With plantar fasciopathy, the plantar fascia fails to adapt to the loads placed on it. The quality of the tissue changes and doesn’t heal properly,” Lehman says.
Unfortunately, there is no proven, quick fix for heel pain. Once symptoms appear, it’s not unusual for them to stick around for months at a time. Below, Lehman shares tips for preventing heel pain and advice for injured runners.
“Most running injuries come from doing too much, too fast,” says Lehman, who recommends following a training program that allows you to gradually adapt to changes in speed, distance or terrain. In the same respect, give your body time to gradually adapt to changes in footwear, such as when going to a more minimalist shoe or when wearing flip-flops in summer, he says.
If you are symptomatic, Lehman advises wearing comfortable, supportive shoes while walking, running and during daily activities to unload some of the strain on the plantar fascia.
However, in order to strengthen and repair the damaged tissue, it is also important to apply stress to the bottom of the foot and surrounding muscles. Lehman recommends strengthening the feet and calves, as well as including exercises that incorporate the hips and core to increase the load tolerance of the tissues and the entire kinetic chain.
Treatment methods commonly prescribed to heel pain sufferers include rolling your foot over a tennis ball or frozen water bottle, and wearing a Strassburg Sock or night splint. While these methods may provide temporary relief of symptoms, they have not been shown to cure plantar fasciopathy. Consider stretching and massage to be part of your pain management strategy, but use these methods in moderation and do not rely on them to resolve the problem.
Aerobic exercise is the best natural anti-inflammatory you can find, so make it a priority to keep moving, Lehman says. He advises runners to check in with their symptoms as they relate to running. If the pain seems to get progressively worse with each run, substitute running with the elliptical machine, pool running or another low-impact cardiovascular activity. “But if running is a meaningful activity that you love, and it is not making your symptoms worse, keep doing it,” Lehman says. He adds, “The most important thing to remember when treating plantar fasciitis is patience.”
Strengthening your calf muscles and the intrinsic muscles of your feet can improve tissue quality and increase these muscles’ capacity to sustain a load. If you have heel pain, practice this exercise at least three times a week, each time completing three sets to fatigue (about 5–15 reps).