Dr. Kiper offers Silicone Orthotics for arch support.

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.