Central Texas runners usually know when they went too hard around Lady Bird Lake. A cramp, a pulled hamstring or a blister are immediate feedback that you need to cut back or do something different. There's another condition that sometimes makes itself known with sudden pain but may also be disguised as another problem. It's called plantar fasciitis and it's a fairly common problem for runners who run more than three times per week or engage in high mileage. Do you think you have a bruised heel? Do you feel discomfort in the heel when you first wake? Is it uncomfortable to run? If the answers are yes, you may be experiencing plantar fasciitis.

Plantar Fasciitis is caused when stress is placed on the plantar fascia ligament resulting in tears and inflammation. The ligament runs from the heel along the arch of the foot to the ball of the foot. Runners who experience plantar fasciitis may have less flexible feet and weaker foot muscles. In addition, much of the stress during the walk or run is placed on this tendon. There is a a tendency to flatten and roll inward (pronate) when walking or running.

Common Causes of Plantar Fasciitis

• Improper shoe wear
• Shoes that should be replaced
• Increasing mileage too rapidly
• Inadequate stretching

"If a person is running five to six days a week, they should typically change their shoes out every three to six months or every 300-500 miles," says orthopedic surgeon Scott Welsh, MD. "Obviously, this will vary from runner to runner. The important thing to remember is to recognize when symptoms first appear so that you can take action to alleviate the pain. Deconditioned shoes and over training both can contribute to plantar fasciitis. Heel cord stretching, ice massage, gel heel cups, and modification of running surfaces will usually alleviate the plantar fasciitis symptoms. Custom orthotics are occasionally necessary."

"Depending on the amount of pain experienced with plantar fasciitis, it is possible to keep a running routine while rehabilitating the injury. However, the runner should trade asphalt and concrete running surfaces for aqua jogging, soft grass, a track, or treadmill," says Dr. Welsh.

What To Do

• Stretch your heel cord (Achilles tendon) and plantar fascia aggressively.
• Use of a small lift or gel heel cup in the shoe.
• Apply ice massage to your heel to relieve pain and inflammation.
• Use trigger point rollers to apply pressure or use a rolling pin or tennis ball. While seated, roll the rolling pin or ball with the arch of your foot. If you are able to, progress to doing this exercise while you are standing up.
• Strengthen the muscles of the foot and ankle with exercises.
• Run on soft surfaces if at all.

"If those actions don't alleviate the pain, the person may need to wear a night splint to correct the problem," says Dr. Welsh. Night splints hold the ankle and foot in a position that keeps the Achilles tendon and plantar fascia slightly stretched.

"A runner should consult with their doctor who may also recommend shock wave therapy or even cortisone injections. Surgery is rarely necessary."

Extracorporeal shock wave therapy, (ESWT) is a fairly new treatment. It induces microtrauma to the heel area stimulating the body's ability to repair tissue. For more information, review the GoodHealth.com encyclopedia entry on plantar fasciitis .

You don't have to be a runner to develop plantar fasciitis. Anyone who wears shoes that have far passed their prime are candidates for development, especially when walking or standing on hard pavement or floors. A lack of flexibility in the calf muscles or being overweight can cause the problem as well. A study reported 50 percent of its sample of 411 plantar fasciitis patients were on their feet most of the day. Regardless of the cause or whether you are a runner or not, the treatment is the same, i.e., stretch the plantar fascia, add an orthotic to the shoe (or purchase a new pair) and trade hard surfaces for soft ones whenever possible.

Helpful Stretches

The following exercises will help improve plantar fasciitis symptoms:

• Wall stretches to loosen the gastrocnemius and soleus muscles.
• Floor board straight leg calf stretch.
• Lunging straight leg calf stretch.
• Tibialis anterior (shin) stretch.

Scott A. Welsh, MD

A specialist in sports medicine and general orthopedics, Dr. Welch has a particular interest in arthroscopic cartilage restoration procedures for the knee. He received his undergraduate degree from the University of Illinois and attended medical school at Loyola University Chicago. He then completed his orthopedic residency at Michigan State University and a sports medicine fellowship at the Florida Orthopedic Institute in Tampa. He has worked as a team physician for the University of South Florida, University of Tampa, Western Michigan University, Saint Leo University, and several high schools in the Tampa area.

Appointments: 512-301-9922
Cypress Creek Orthopedics & Sports Medicine
Seton Southwest Hospital Medical Plaza
7900 FM 1826 Suite 170
Austin, TX 78737