By Brad Skiff
July 9, 2007 -- Other than the unwanted buzz of the alarm clock, is there anything more painful in the morning than the first step on an injured heel? An electric shock shooting through your heel to your toes and back up your calf is not the way you want to wake up. After a few mornings like this makes the thought of getting to the shower unbearable. The culprit? Plantar fasciitis.
The plantar fascia is a group of strong bands that support the medial longitudinal arch in the foot giving the instep an arched shape. It originates in the middle of the calcaneus on the medial tubercle and inserts near the metatarsal heads in the forefoot. This structure is important in keeping the foot in a neutral position for proper gait pattern. If the plantar fascia is not strong a common foot condition known as pes planus or flat foot can occur. Trauma to the heel, or not wearing proper foot wear during exercise can cause the attachment of the plantar fascia on the calcaneus to become irritated and inflamed. In many situations this can be accompanied by a heel spur protruding from the medial tubercle of the calcaneus. Either way, the result is electrifying pain during the heel strike of the gait pattern after inactivity, which gradually lessens as the activity progresses.
Icing and stretching multiple times a day is the first line of defense for plantar fasciitis. Freezing a plastic water bottle and rolling it under the foot is a great way to ice the area and massage the plantar fascia. Stretching the plantar fascia and the gastroc/soleus muscle groups help to keep the hind foot loose. Cross your legs with the affected foot resting on the opposite knee, pull back on the toes and massage the fascia with your thumb (see photo). Rolling a tennis or racquet ball under your heel is another way to massage the fascia (see photo). From the standing position, facing a wall, put one foot in front of the other. Then, keeping your back heel flat on the ground, lean forward to stretch the gastroc. Bend your knee slightly to get the soleus while continuing to keep the heel down.
Rest is the best thing for this but is really not something you can afford to do in the middle of your training. So, the next best thing is to modify your activity to limit the “pounding” you put on the heel.
Look to do more activities that can keep your heart rate up for conditioning but will not aggravate your heel -- cycling, rowing, swimming or even the elliptical machine. If you are a triathlete, decrease the running miles and concentrate on swimming or cycling.
If symptoms persist for a six to eight week period, a doctor may prescribe a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen in combination with a night splint to keep the plantar fascia stretched while you sleep. A cushioned heel cup for your shoe or a semi-rigid orthotic would also be advised. Two other scenarios that should be considered as last options are an injection of a corticosteroid and/or surgery to release the ligament.
By attacking the pain with ice, stretching and modifying your activity in the early stages of heel pain you can greatly reduce the risk of letting the plantar fasciitis get the better of your training.
Article by Brad Skiff, MA, ATC, LATSkiff is a certified athletic trainer at the National Training Center in Clermont, Florida. For information on sports science testing including functional assessment tests, please contact Carol Kneller:
Carol Kneller, Human Performance Lab
(352) 241-7144, ext. 4202
National Training Center