Hardly a day goes by at the Running Spot without a conversation between our salespeople and one or more customers who has or has had heel pain. I have had the problem for well over a year, and after talking with customers, reviewing the literature, and trying a range of self-treatments, I feel I can not only empathize with those with heel pain, but also offer suggestions on avoiding the problem, as well as treating it once it develops.

Plantar fasciitis is the most common form of heel pain in runners, walkers, and active individuals. It can result from over training or contact with hard, irregular surfaces during walking, running or exercising. It most often occurs in an individual with a rigid, high-arched foot that tends to overpronate or roll to the inside. The plantar fascia (a connective tissue structure) stretches from the toes and the ball of the foot through the arch and connects to the heel bone in three places. (See diagram) The most common sight of injury is the medial attachment on the inside of heel, although it can occur directly under the heel or further forward under the arch. It usually makes its presence known as you rise in the morning when you take the first few steps. When you walk around, the pain may subside, only to return the next morning.

In my own particular case, I had some early warning signs months before I developed a “full-blown” case. I experienced severe, sharp pain on the inside of my left heel, which would subside after five to ten minutes of jogging. Had I not ignored these symptoms, I may have been able to avoid this common problem with some simple measures such as adding an insert to my shoes, taping, stretching, icing or simply reducing the intensity of my training or resting until the pain subsided.

However, due to a lack of information or just plain stubbornness, I developed a moderate case that persisted for several months. Since then I have talked to others who have had much more severe bouts with this condition. Some have required professional steroid injection, and in one case, surgery. I was able to resume my running just two weeks after severe pain, and in fact have been fairly competitive in races ranging from 5-K’s up to and including a marathon. While I know I may never be totally free of the problem, and my case may not be severe, I can offer a few tips on avoiding the condition, and treating it once it develops. I will list them in order of which was most helpful to me:

1. Rest. Once pain starts and before severe inflammation develops rest and ice the area of pain for four to five days.

2. Support the arch with inserts. At the Running Spot we have a half dozen different inserts. You should bring in your shoes and try on the inserts in order to determine which works best for you.

3. Support the arch by taping. (See diagram) I have found this most helpful, especially before a run or when I am going to be on my feet for a long period of time. Arch Aid is another Running Spot product that may be a good substitute for taping. (For me it was helpful, but not quite as supportive as taping.)

4. Purchase shoes that stabilize the heel and help the foot resist overpronation.

5. Stretch the hamstrings, calves, Achilles tendons, and plantar fascia before and after exercising. Remember, when the calf muscles are tight the motion in the ankle can be restricted which can prevent the ankle from bending up (dorsiflexing), causing the foot to overpronate, creating a pull on the plantar fascia. Several of the exercises I have found helpful include, wall stretching from both a straight knee and bent knee position for 30 seconds each. Hamstring stretching. Below the knee stretching by placing the toes on a wall and rotating the foot from big toe side to little toe side for 20 seconds each.

6. Icing the painful area after exercising by submerging in ice water for up to 10 minutes, or by simply placing an ice pack on the affected area. Icing in the evening with an ice bag, and/or rolling the arch of the foot over an ice filled bottle for two 10-minute periods interrupted by 10 minutes of warming.

7. Strengthening the plantar fascia and supporting areas by: 1. Standing on steps with the heels below the toes and rising to a position where your heels move above your toes for several minutes several times a day. 2. Rotating the foot from big toe to little toe as mentioned above in stretching. 3. Picking up or grasping a towel or other objects with the toes on a daily basis. Caution: Starting these strengthening exercises too soon after injury may only aggravate the injury.

8. Use the over the counter anti-inflammatory of your choice. (Some of the literature suggests that this produces no healing but only masks the pain.) I feel anti-inflammatories were helpful to me.

Most cases of plantar fasciitis/heel spur syndromes will improve will with conservative self- treatment. Be patient! If, despite these self-treatment methods, your heel pain persists, seek help from your sports medicine professional.

Orthotics prescribed by a podiatrist versed in the biomechanics of running and walking may allow the bones, tendons, and muscles to function more effectively, taking stress off of the fascia.

Chiropractic massage and ultrasound treatments may promote a more rapid “healing of the heel.”