One of the most common causes of heel pain in runners is plantar fasciitis.
It’s typically a painful condition — your plantar fascia (the flat band of tissue that connects your heel bone to your toes) gets weak, swollen, and irritated and causes pain when you stand or walk. This is usually a result of chronic overuse, but occasionally can occur from a traumatic event like stepping on a stone. Sometimes heel pain is caused by something else and could be a stress fracture, or an insufficiency fracture seen in osteoporosis.
What causes plantar fasciitis?
We think plantar fasciitis is caused by traction of the plantar fascia from the heel towards the toes. You are straining the ligament that supports your arch. The chronic traction results in small ruptures of this fascia. This thickened fascia is thought to be the source of the pain.
Who is at risk for plantar fasciitis?
Runners with a high arch and overpronatation, or those who run on hard surfaces are at greater risk for developing plantar fasciitis.
Runners tend to complain of pain on the bottom of their heel. The pain is worse when taking the first step in the morning and usually aggravated after standing or running.
How is plantar fasciitis diagnosed?
A diagnosis of plantar fasciitis is based upon obtaining an accurate history and identifying tenderness on the bottom of the heel. A calcaneal spur may be seen on an x-ray, but the size or presence of the spur is unlikely to be related to clinical symptoms.
How is plantar fasciitis treated?
Treatment is usually based upon limiting running, taking nonsteroidal anti-inflammatory medications like Naprosyn, and placing a soft support in the shoe under the heel.
Physical therapy and exercises that involve stretching the bottom of the foot and calf muscle are very successful. Stretching before getting out of bed and wearing night splints helps to decrease pain significantly. Occasionally an injection with cortisone near the heel spur can be attempted, but this can result in rupture of the plantar fascia or loss of fat in the heel area, which can be devastating to the runner.
There is some growing evidence that PRP injections into the plantar fascia may be of some benefit, but sound scientific studies are needed to support this. Best results are usually observed in those that undergo night splinting and early morning stretching with the use of the soft pad in the shoe. Removal of the calcaneal spurs by surgery is unnecessary.
In general, plantar fasciitis is a self-limiting process that typically goes away within six months or one year. Stretching and splinting and bracing are usually curative.
James Slauterbeck, MD, is an orthopedic surgeon at the University of Vermont Medical Center and associate professor at the Larner College of Medicine at UVM. He is also the team physician for UVM Athletics.