For many people, the warmer weather offers motivation to get back outside and put the running shoes to good use again. Unfortunately, if you spent the previous months indoors running on a more forgiving treadmill, pounding the hard pavement can be a setup for injury, especially to the feet. One of the more common foot problems is plantar fasciitis — a big word for an annoying and painful condition.
What is plantar fasciitis?
The plantar fascia is a thick band of fibrous tissue located on the underside of the foot. It runs from the inside edge of the heel to the toes. The plantar fascia provides support to the arch and acts as a shock absorber.
When the fascia is overloaded, pain can develop anywhere along the course of the plantar fascia, but most commonly the pain is located where the band of tissue attaches to the inside edge of the heel. With repetitive overloading and over use, the plantar fascia becomes irritated, starts to breakdown, swells, and causes pain.
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▪ Pain most commonly located at the inside edge of the heel
▪ Worse with the first step in the morning
▪ Generally improves with movement, and returns after periods of rest — sleeping or sitting for long periods
▪ Generally occurs with excessive weight-bearing activities, and while walking barefoot or in shoes without any arch support, such as flip-flops or sandals
▪ Tight calf muscles
▪ Flat feet
▪ Recent increase or change in activity level
Evaluation by a sports medicine physician should include a complete history of your foot problems and a thorough physical exam. The physician will:
▪ Evaluate your gait and foot shape
▪ Determine flexibility in your foot and ankle
▪ Determine the location of the pain
▪ Obtain X-rays. These may be obtained if there is concern about a stress fracture in the heel.
▪ Potentially perform a sport ultrasound. A physician trained in sport ultrasound can determine if there is thickening or tearing in the plantar fascia.
Treating plantar fasciitis usually involves multiple approaches, which may include:
▪ Decreasing training or activities that involve impact to the heel. During this time, athletes can usually participate in alternative, pain-free cross-training activities like biking or swimming.
▪ Limiting the amount of time spent walking barefoot or in sandals
▪ A change in running shoes or the use of heel cushions, arch supports or custom orthotics.
▪ A short course of anti-inflammatory medication like ibuprofen or naproxen.
▪ Physical therapy. This is almost always recommended and commonly includes treatments like ice massage directly on the plantar fascia and stretching and strengthening of the foot and ankle muscles.
▪ A night splint. Many physicians advocate for this to help keep the tissue stretched out overnight.
▪ A corticosteroid injection, if the above measures have not been successful. Surgery is rarely required to treat plantar fasciitis.
▪ The most important thing is to pay attention and be kind to your body.
▪ Use caution and transition gradually when changing your training intensity, training surface or shoe wear.
▪ If you start to develop pain in the heel, seek evaluation by a sports medicine physician early in the course of your symptoms. Plantar fasciitis is a condition you want to address early before it becomes a chronic and more debilitating problem.
Kyle Goerl is a family medicine and sports medicine physician at Via Christi Clinic Family Medicine Clinic on Emporia.