Plantar Fasciitis: A Few Agonizing Steps in the Morning…
One of the easiest diagnoses one can make is plantar fasciitis (PF). Unfortunately, the condition is not as easy to treat as it is to diagnose, especially in active people, like runners. Like almost all running injuries, PF, is an inflammatory condition that usually results from overuse: doing too much, too soon, too fast. Inadequate footware is nearly always the rule; shoes with too many miles, and with little cushion remaining. A good rule of thumb is shoes with 300 miles have probably lost 50% of their shock absorption capability.
The sole of the foot, especially the heel, is well-designed for energy storage and shock absorption.
The bottom of the heel is compartmentalized, with fatty "chambers" separated by tiny walls called septae. This arrangement helps to absorb impact, and reduce loads transmitted up the leg. The plantar fascia, on the other hand, is a thick, tough band of tissue that runs from the ball of the foot to the heel. It serves as a spring to store energy during the flattening of the arch that normally occurs during the stance phase of gait.
The weak link of this system seems to be the attachment of the PF to the bottom, inside edge of the heel bone. Following sudden or repetitive overuse involving this sheet of tissue, inflammation develops at the attachment point, causing pain and stiffness, especially with weight-bearing activities, and classically, during the first few steps in the morning. There is inevitably point tenderness at the attachment site, and Achilles tendon type stretches, as well as upward stretches of the toes typically reproduces one’s pain. The pain may disappear entirely during the day and during running, only to come back in the morning.
Like almost any other running overuse injury, the key to recovery is relative or complete rest, cross-training with low impact sports, such as swimming or cycling, use of ice, anti-inflammatory medications, and most importantly, PF stretches. The latter include Achilles stretches, toe and shin curls, and upward toe stretches. Heel cups, or heel "cut-out" orthotics, can also provide relief, especially if running continues. Lay off the hills, as uphill running can aggravate the condition. Rarely, complete rest is necessary, with casting and/or steroid injections reserved of resistant cases. Surgery is almost never needed.
Dan Wnorowski, M.D.