One of the most common injuries in tennis and jogging is plantar fasciitis, pain on the bottom of the heel. A band of tissue called the plantar fascia extends from your five toes, along the bottom of your foot to attach on the bottom of your heel. When you run, you land on your heel and raise yourself on your toes as you shift your weight to your other foot, causing all your weight to be held up by your plantar fascia. This repetitive force can tear the fascia from its attachment on your heel.
Several factors increase force on the fascia, such as shoes that have stiff soles that do not bend in the right place just behind the ball of your big toe, shoes that are too wide for your feet, running too fast for the present strength of your plantar fascia, or not allowing enough time to recover between fast workouts. It can also be caused by:
• wearing high heels, loafers or flats without support
• gaining weight
• increased walking, standing, or stair-climbing
• starting a new exercise program too quickly
• tight heel cords or abnormally high or low arches
Plantar fasciitis can also be the first site of pain for arthritis. Doctors have no medications that help to heal the plantar fascia. Cortisone injections and aspirin-like pills can reduce pain, but they may also delay healing.
If you have plantar fasciitis, stop running and limit walking until you can run without feeling pain. Since you pedal with your knees and hips and place little force on your fascia, you can usually pedal a bicycle without feeling pain. Use shoes that have flexible soles. Wear arch supports that limit the rolling in motion of your feet, stretch your calf muscles and wear night splints. Surgery to cut the plantar, called fasciotomy, is usually ineffective and may even prevent healing. I have treated some patients with intractible pain, unconventionally, with 10 mg/day alendronate for three months.
Some podiatrists now offer a non-surgical treatment for plantar fasciitis that does not respond to the conventional treatments. The Food and Drug Administration has approved The Dornier EPOS extracorporeal shockwave machine that has been shown to cure persistent plantar fasciitis. If your heel pain has not been cured by other treatments, check with a podiatrist to see whether extracorporeal shockwave treatment is for you.
Contributed by Gene Mirkin, DPM
1) Phys and Sprts Med August, 1991.
2) MS Mizel, JV Marymont, E Trepman. Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom. Foot & Ankle International 17: 12 (DEC 1996):732-735.
3) HB Kitaoka, ZP Luo, KN An. 3) M Powell, WR Post, J Keener, S Wearden. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: A crossover prospective randomized outcome study. Foot & Ankle International 19:1 (JAN 1998):10-18.
4) Mechanical behavior of the foot and ankle after plantar fascia release in the unstable foot. Foot & Ankle International 18: 1 (JAN 1997):8-15. Operations involving fasciotomy affect arch stability and should not be performed in patients with evidence of concomitant pes planus deformity.
5) DB Thordarson, PJ Kumar, TP Hedman, E Ebramzadeh. Effect of partial versus complete plantar fasciotomy on the windlass mechanism. Foot & Ankle International 18: 1 (JAN 1997):16-20. Partial plantar fasciotomy decreases the arch-supporting function of the plantar fascia in addition to weakening the structure.
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