Plantar Fasciitis ? The Scourge
Written by Dr. Dennis Kiper, D.P.M.
Fitness Runner, Spring 1998, page 28
About 2600 years ago, a soldier named Pheidippedes ran over 26 miles from
the battlefield at Marathon to Athens, Greece to declare the war was won.
The story goes, he then promptly died, probably of a heart attack. Thank
goodness it wasn't "plantar fasciitis"(PF). As anyone who has suffered
with and finally overcome it can tell you, "it isn't fun". It can
disrupt training schedules and even simple walking about.
PF (aka, heel pain, arch pain) is a "pronation" problem, it is the number
one most common foot pain in the world. The pain, felt most at the
inside of the heel, actually derives from the stretch and often micro
tear of the plantar fascia as it attaches to the heel bone. Over the years
this repetitive stretching and tearing at its insertion can cause the tip
of the heel bone to grow outward into a "spur". In runners, it is typical
to hear the pain's onset after an increased time or effort in the activity
("too much, too soon, too fast" syndrome). It starts as an early morning
dull, achy pain, especially the morning following exercise. It is often
described as a "stone bruise". As time progresses, any walking
after prolonged rest will produce pain. As most athletes will continue
to train and "run through the pain", defensive gait patterns may change
and produce a number of other problems throughout the musculo-skeletal
system.
Anatomically, the plantar fascia is a thick, somewhat flat band of fibrous
tissue which starts at a shelf along the bottom of the heel bone, splits
into three more bands which then further divide into "fascicles" and insert
into each of the five toes.
The Mechanism
Considering that the foot goes through an average of 8-10,000 footsteps
per day (not including the mileage of running) everyday, the plantar
fascia gets quite a workout. The foot spreads to the floor as far as it
can stretching and straining, absorbing the impact of shock and setting
up the next foot step. This is called "pronation", (running compounds this
stretching even further). It is at this bottom range of motion that
the "tug" of the plantar fascia at its insertion begins its breakdown process.
It can take years for the problem to come to the surface.
The Cure
The cure is easy: Stop walking, stop running, get into bed and stay there.
Barring that, there are a number of alternatives to resolution. There
is physical therapy (including stretching), ibuprofen, "strapping" techniques
and strap devices (to control pronation), heel pads (of various materials)
with openings below the "spur" to accomodate and cushion the heel, motion
control shoes, cortisone shots, nightsplints, arch supports (over the counter
and prescription) and even surgery. Depending on who is using what, they
can all lend some degree of comfort. The best of the inexpensive
variety is stretching and over the counter arch supports. Increasing flexibility
and reducing some pronation is in my opinion the most helpful to resolving
pain and addressing the "condition" of excess pronation.
Occaisionaly you hear someone who "miraculously" got rid of their pain
with either a cortisone shot or some other device in two weeks or less.
This is really rare. Plantar fasciitis took a long time to develop
and make its presence known and it takes time to heal. How quickly is an
individual thing, but an average minimum is 12 to 26 weeks, if treatment
begins ASAP instead of running through it and delaying treatment for 6
months or longer. The key is addressing the "condition" of pronation
and improving flexibility forever. For some, a generic over the counter
support may not be enough and a prescription support may work better to
resolve and prevent future pronation problems. Every runner at the very
least shoud use some form of better support than the shoe companies provide.
Pain is not the issue, "prevention" is.
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