The “KISS” Approach to Heel Pain
Heel pain is one of the most common conditions affecting runners and other athletes all over the globe. Millions of patients visit doctors’ offices every year with complaints of foot discomfort. Heel pain is one of the most common foot complaints in our nation today. The cause of heel pain can be the result of injury, arthritis, or even a stress fracture. However, any runner who has done a little research is aware that the most common cause of heel pain is plantar fasciitis. This inflammation of the plantar ligament in the foot can result in pain at the heel attachment as well as pain along this structure into the arch. The cause of plantar fasciitis can be the result of over training; however, the actual cause often cannot be completely determined. Factors may include: errors in training, a change in footwear, improper footwear, and lack of exercise. There are many simple ways that you can prevent and treat plantar fasciitis and heel pain.
First and most importantly, training routines for runners and athletes should be discussed. Types of training (interval training, hill training, distance training, terrain training) should be considered at length and modified if the runner is experiencing pain. If the pain is severe enough, a period of rest may be a very wise choice. An avid runner would agree that total rest is never a first choice. Cross training makes it possible to keep your fitness level intact. Stationary biking, swimming, and the elliptical, to name a few, are alternative options that can be used to stay in shape. If the symptoms are not too severe, a modification of training can be adjusted overall. For instance, mileage and speed can be decreased.
It is always important to address the inflammation, pain and discomfort of the foot. Ice is a very simple measure that can bring a significant amount of relief to the area of pain. Icing can be done 3-4 times a day. The best time to ice is immediately following training. A new product called Icy Feet ™ has made it easier to ice regularly. It consists of contour molds, which are placed in the freezer for two hours and then strapped to your feet for an easy ice. This product is now becoming more and more popular in clinics surrounding our area.
Another very simple measure is assessing and improving overall flexibility. A stretching program is an absolute must for runners. Over the years, some individuals have pointed this to be one of the most significant factors for any athlete. Dr. Joseph Godfrey, a renowned orthopedic surgeon, founder of the Orthopedic Sports Medicine Society, and former surgeon for the NY Buffalo Bills, was a great proponent for flexibility and stretching. I had a great opportunity to have Dr. Godfrey as a mentor at the National Naval Medical Center in Bethesda, Maryland where he could always be heard making the statement, “I never had problems when I was the surgeon for the Buffalo Bills; we had a great flexibility program”. Godfrey approached heel pain by simply giving patient instructions on how to build their own slant board. A slant board was a tool designed to place a steady stretch on the gastroc-soleus muscles in the leg. While using the slant board, tension is placed on this muscle group and the Achilles tendon. The tension could be self regulated. It was always important to do a slow, steady, and constant pull which every runner is familiar with, rather than a multitude of quick stretches. Yoga is another recommended activity for athletes. There are many entry-level yoga programs that can meet the needs for a runner.
Anti-inflammatories such as Motrin or Naproxen can also be of value. It is critical to recognize that these are helpful in an acute stage of an injury. Most runners realize that taking an anti-inflammatory is not only for pain, but also for the inflammation, that can cause pain. In order to achieve the best result in regard to inflammation, a standard dose of anti-inflammatories, 600-800mg, may be taken three times a day if tolerated, with meals. I am not a huge advocator of long-term anti-inflammatory use for plantar fasciitis, as it does not address some of the factors contributing to pain. Anti-inflammatories can also cause serious problems, such as GI bleeding, if abused. You should always consult your physician before any long-term use.
Most experts are in agreement that plantar fasciitis is an inflammation caused by an excessive pull or strain along the anatomical structure. Often the injury is at the site of the heel attachment. A useful tactic to help prevent plantar fasciitis is to ensure that there is stable support to the arch of the foot. Support always starts with a runner’s shoe. We are fortunate in our area to have many knowledgeable running shoe experts including, but not limited to, The Finish Line (now known as the Emmaus Run Inn), Aardvark, and New Balance running shoe store located at the Promenade Shops. Most sports physicians, therapists, and trainers have plenty of knowledge in footwear. If the shoe isn’t providing enough support, there are unlimited options in regard of over the counter arch supports, which come in all makes and materials.
If your plantar fasciitis condition does not improve with the above steps, it may be time to get advice from a professional. There are many opinions regarding custom orthotics. This is perhaps a topic of its own since there are so many materials to choose from and so many philosophies regarding customized devices. The casting or data capturing technique is crucial and used in the first step of the customizing process.
When treating your plantar fasciitis, it is helpful if you choose someone who has experience with orthotics. Today, there are many podiatrists, pedorthists, chiropractors, and physical therapists that may be knowledgeable in foot orthotics. I have also felt that physicians, who have had first hand experience with athletes, as well as an athletic background, may be more accommodating to your needs. The most informed providers about custom orthotics are those who have a background with actual fabrication. This background adds to their overall understanding of the treatment of heel pain and plantar fasciitis. In our office, Allentown Family Foot Care, we offer simple test padding, which can be added to a shoe before any expensive custom approaches are considered. We also have the ability to fabricate direct molded orthoses at the time of your visit, and can adjust them expediently.
Timing is critical to most athletes, as they need to return to their desired level of activity as quickly as possible. Based on my experience as a former Navy Seal, tri-athlete, long distance runner, and someone who has personally experienced plantar fasciitis, I truly can appreciate anyone who is experiencing the discomfort of plantar fasciitis and the frustration that comes with it. I understand the proper steps needed to correct this problem and get athletes and runners back on their feet.
