Heal Your Heel Pain

Eli Manning is just one of countless athletes to acquire the dreaded malady plantar fasciitis. His injury could heal up in short order, or it could linger for the entire season, or longer. It all depends on the actions taken to rectify the condition.

I happened upon a couple of articles on Eli’s injury, and read them with interest, since his condition is the topic of my book Injury Afoot. Sure enough, just a few sentences into one of the stories, a doctor interviewed for the piece mentions injections of corticosteroid, often called cortisone, as one of the top treatment options. I cringed. Horror stories abound regarding heel pain sufferers turning to cortisone injections and experiencing side effects that make plantar fasciitis look quite tame. Yet some in the medical field keep recommending these injections. Yikes.

I’m sure Eli has a team of therapists and trainers working with him on active recovery methods such as icing, stretching and strengthening. Active recovery is what you want Eli; steer clear of the cortisone injections.

Patrick Hafner, Author, Injury Afoot: 30 Things You Can Do To Relieve Heel Pain And Speed Healing of Plantar Fasciitis.

Came across a good article that discusses some unexpected results from frequent use of ibuprofen. This story focused on runners, but the physiology principles are the same for anybody who comes to rely on NSAIDS like ibuprofen for aches and pains.

My thoughts: for the most reliable, long-lasting recuperation from plantar fasciitis, a person should stretch, strengthen, brace, and accommodate – don’t medicate.

I’m all for stretching. A stretching routine helped me heal from plantar fasciitis, and keeps my feet safe to this day. Stretching is an integral part of the book Injury Afoot: 30 Things You Can Do To Relieve Heel Pain And Speed Healing of Plantar Fasciitis, and should be put to use by anyone who suffers from plantar fasciitis.

But regarding stretching, as with most things, there is advice. Then there is questionable advice. And then there is insane advice. Case in point:

Floating about the plantar fasciitis rehab community is one very risky, aggressive, and hazardous stretching technique. It goes as follows: stand on a step, curb, or ledge of some kind, putting your weight on the ball of the foot to be stretched (Fig. 1).

Figure 1

Then, the advisors of this stretch say, lower that heel way down, letting all of your bodyweight pile on to stretch out your calf area. This is to be done on one already tender, injured foot…with your full body weight. (I couldn’t bring myself to fully demonstrate this tactic in Figure 2; I kept a little weight on my front foot to avoid a painful re-tearing. Most instances where this is recommended, however, the “expert” instructs the person to stand fully on the injured foot. Ouch!)

My oh my. I can almost feel the vulnerable tissue give way a little more, exacerbating the injury further. Nice. A forceful, brutal, impatient stretch like this is the last thing you want to do when you are recovering from plantar fasciitis. A plantar fasciitis recovery routine should be more like walking on eggshells, vs. squashing grapes into wine, if you catch my drift. Do not do the stretch as detailed above.

Figure 2

Let’s try a similar and much safer version of this stretch. As demonstrated in Fig. 3, standing next to the step or curb, place the ball of your foot to be stretched against it. Keep most of your weight on your supporting leg, not the leg to be stretched. This allows you to control the intensity of the stretch, and carry it out as all stretches should be carried out: gently.

Proceed to…

Figure 3

…lean ever so slowly into the stretch. Hold it at the point the stretch first starts, not beyond that point (Fig. 4). Hold it 15-20 seconds. Repeat this process once  or twice. Do this twice a day. You’ll realize an effective stretch which you can control, which can be done almost anywhere, and which causes you no further harm.

For a complete rundown of effective stretching and strengthening actions sure to help rid you of heel pain caused by plantar fasciitis, take a look at the book Injury Afoot: 30 Things You Can Do To Relieve Heel Pain And Speed Healing of Plantar Fasciitis. The steps detailed there are safe, can be done at home free of charge, and they work.

Figure 4

The Dynamic Duo of lower leg misery: Achilles tendonitis and plantar fasciitis. I’ve had them both. And based on my experience, Achilles tendonitis is child’s play when compared to plantar fasciitis.

But that opinion could be influenced by the order in which I had the two conditions. I acquired plantar fasciitis first. It was pretty much healed up once I felt the Achilles tendonitis symptoms creep in – a nagging soreness and tightness in the band of tissue which attaches at the heel and travels upward into the calf region, often called the heel cord. And being a veteran plantar fasciitis sufferer, I knew what to do immediately: back off. I stretched the area a little more than I had been, but other than that, my course of action was to ease off on the things that were causing it, mainly uphill sprinting in this case. I had not been doing much of that type of training, and after deciding to embark on it regularly, I went ahead and overdid it. Going from zero to full-tilt will almost always have deleterious effects, regardless of the activity. Sound familiar?

So my particular case of Achilles tendonitis healed in short order, thanks to NOT doing what I did upon first feeling plantar fasciitis’ soreness approaching: keep doing the same thing and hoping it would disappear. It doesn’t work, trust me.

So what if you acquire Achilles tendonitis, and keep on keeping on with whatever is aggravating it? Well, if you make that choice, the initial soreness is going to end up feeling pretty mild compared to what may be awaiting you. Continuing with the straining activity, be it training on risky surfaces, activities with plenty of jumps or stops and starts, uphill walking, walking or hiking longer than you’re prepared for, etc. may in fact result in a rupture of the Achilles tendon…yes, a complete tearing of the tissue. Often the procedure to rectify it at that point is surgical reattachment. Ouch.

Sound worth the risk of continuing on with the aggravation? I don’t think so. I’m glad I made the right choice and readjusted my activities to accommodate the blossoming Achilles injury. You should do the same, if you sense Achilles tendonitis may be starting. And remember, prevention is always easier than a cure. To see a description of stretching and strengthening motions which will head off both plantar fasciitis and Achilles tendonitis, take a look at my book Injury Afoot: 30 Things You Can Do To Relieve Heel Pain And Speed Healing of Plantar Fasciitis. The exercises are compiled into one brief, easy-to-read source.  They’re easy, they work, and they don’t take long to learn or do.

Beauty of cumulative damage? Am I crazy?? Well, maybe, but not in this case.

The plantar fasciitis condition is one which results from long-term, repeated wear and tear where you accumulate micro-injuries. In other words, cumulative damage. Not sounding too beautiful so far. So, what’s my point?

My point is, you have a fair amount of leeway when experimenting with recovery methods and the altering of your routine as you allow your feet to recover and heal. It’s hard to recuperate from plantar fasciitis while being largely inactive. Conversely, it will be far more beneficial to you and your feet if you are active, engaging regularly in strengthening, stretching, and endurance-building motions. But…you can’t overdo it either. And that’s where the beauty of cumulative damage comes in. You actually can do some trial and error, push your limits here and there, and ease back on efforts which prove to be too much. It took a long time to get to the injured state called plantar fasciitis; the body will adjust if you do a little too much now and then according to your individual physical makeup and injury severity. For example, you won’t undo months of recovery if you applied too much enthusiasm to one extra long walk or one arch strengthening session. Back off, let the soreness recede, and do a little less the next time. Make your recovery journey a learning experience as well as a comeback to a healthy state. When it comes to active recovery, proceed with confidence, not fear. Adjust as you go.

For a complete listing and description of every stretching and strengthening motion you will ever need to vanquish plantar fasciitis, consider my book Injury Afoot: 30 Things You Can Do To Relieve Heel Pain And Speed Healing of Plantar Fasciitis. The exercises are easy, painless, don’t take long, and can actually be relaxing. They are all consolidated into one brief, easy-to-read resource.  And they work.

Poor footwear is a major contributor to plantar fasciitis. Case in point: the flip flop craze. It’s hard to believe that the recent surge in popularity of flip flops and the continued rise of plantar fasciitis cases is pure coincidence.  Flip flops give no support to your arch, and provide about as much shock absorption as a sheet of cardboard. If you’re in a warm weather area and want the flip flop style, you’d be better off with a high-quality sandal featuring an arch support in its design. Brands like ecco, Birkenstock, and Dr. Martens all make quality products in this regard, but this list is not exhaustive. These are just brands I’ve worn personally. The point being here, better alternatives to flimsy flip flops exist.

The opposite extreme is high heeled shoes, meaning anything from stilettos to cowboy boots. High heels jack the back of your foot way up, and in addition to providing little support, contribute to a shortening in your calf region and Achilles tendon. This is bad news if you already suffer from plantar fasciitis, and will increase the odds of acquiring it immensely if you don’t.

For a full description of what to look for in footwear, you may want to check out my book Injury Afoot: 30 Things You Can Do to Relieve Heel Pain and Speed Healing of Plantar Fasciitis. But in short, avoid flip flops and high heels as one more step in conquering and staving off plantar fasciitis.

“The natural healing force within each one of us is the greatest force in getting well.” – Hippocrates

I love that quote. There’s simplicity in it but also plenty of power.  As you proceed with a plantar fasciitis recuperation campaign, you will need to pave the way, set yourself up for success, whatever cliche you want to use; your body will heal itself if the best possible environment is created in which to do so. So do whatever it takes to make this happen. Alter your behavior to avoid foot-aggravating activities; commit to your healing effort. Don’t skip strengthening and stretching sessions; don’t panic and give in to despair. Stay positive and stay on track. As you learn more about plantar fasciitis healing from the discussions here, just keep in mind the overriding theme of active recovery: the body can and will heal itself. You just have to promote healing and let it happen.

In addition to running in one form or another for the past 30 years, I spent many years as a wrestler and judo athlete, and through that experience learned lots of things about flexibility, and what works and what doesn’t. Stretching is an integral part of a plantar fasciitis recuperation plan, so I thought it apt to pass along some of my thoughts on the subject. I’ve posted a section straight out of my book Injury Afoot: 30 Things You Can Do to Relieve Heel Pain and Speed Healing of Plantar Fasciitis relating to stretching and flexibility.  (Fellow publishers, feel free to use any of the text below for your own content, but see the Copyright section on the sidebar first.)

A Word About Stretching

No absolute verdict has ever been reached on the very best method with which to stretch muscles of the human body. If a person researched the topic until locating 100 articles or books on stretching, I think that person would find some glaring discrepancies. Probably 30 or 50 or 70 different takes on the number of repetitions, length of time to hold a stretch, stretching a cold muscle vs. a warmed-up muscle, and how far to stretch an inflexible muscle would appear. Overwhelming agreement amongst the experts on stretching does not seem to exist.

I don’t have the final answer on stretching, but I know a couple of things:
- Stretching can help you recover from plantar fasciitis, and
- Stretching can injure you.

Over the years, I got into the bad habit of never stretching. My best guess is that this lack of stretching helped me acquire plantar fasciitis in the first place. But once I started stretching on a regular basis, the healing process accelerated. I mean, really accelerated. The healing seemed to take place several times faster. And on walks and hikes where the soreness would recur, taking the time to stretch again would usually reduce the pain or make it go away completely. Stretching is a good thing, and most experts on the subject agree that it is not only helpful but imperative to stretch to resolve a case of plantar fasciitis.

But if you stretch a muscle with too much force and in too much of a hurry, the muscle can tear. And your injury problem will then become compounded. So keep three words in mind for a successful stretching venture: Consistent. Patient. Gentle.

Stretch regularly, at least once a day, as you help yourself heal from plantar fasciitis. A few times a week will not be enough. And try not to hurry. You must hold a stretch for it to work, and you might find yourself becoming a bit bored. Practice patience. And above all, be gentle when stretching. If it hurts, back off. If a stretch goes no further without discomfort, don’t force the stretch past that point. Ever. Be gentle and you won’t injure yourself while stretching.

How long should you hold a stretch? Over the years I’ve heard figures from two seconds all the way up to sixty seconds, and a wide variety within that range. Basically, they’ve all worked for me. As long as I did the stretches in the first place, and didn’t get too rough while doing them. I’ve listed the very general estimate in this book of holding a stretch 15-20 seconds, then repeating that stretch three or four times. Why? It’s worked for me. If you find holding a stretch shorter or longer than 15-20 seconds works better, then do it that way. Experiment and find the best duration of stretching for you personally. Just remember to be consistent, patient, and gentle, and your stretching endeavor will be effective.

Plantar fasciitis causes pain on the underside of the foot, mostly in the heel, particularly at the heel’s inside edge. The back of the heel may become quite tender as well. A slight swelling may occur where your heel meets your instep. Usually, most of the pain from plantar fasciitis occurs near the heel, since that is the spot where the plantar fascia is thinnest and where it withstands the most pressure. The first few steps taken after getting out of bed are generally the most painful. With these first steps of the day, you may feel a piercing sensation along with a pulling at your heel. The pain can be quite sharp, as if you just stepped on a sharp rock while barefoot. As you move on with your day, the heel pain may lessen and often disappears. The discomfort can return, however, after prolonged walking and standing, and resting may only bring temporary relief. The pain can actually be more intense after resting. And even if all soreness disappears during the day, the tenderness may resume once again in the evening, even if you manage to stay off your feet.

You may also develop “heel spurs” as a result of the plantar fasciitis. Heel spurs are calcium deposits which result from the inflamed plantar fascia being pulled and strained where it attaches to the heel. The heel spurs form at the front of the heel and can be felt through palpitation. Heel spurs themselves do not hurt, and do not cause plantar fasciitis. They are instead a symptom of it.

When stricken with a torturous condition like plantar fasciitis, it is understandable for you or anyone else to seek out a quick fix. Who wouldn’t? Unfortunately, quick fixes for plantar fasciitis are in short supply. But that doesn’t mean some “instant cures” won’t be dangled in front of vulnerable plantar fasciitis victims.

The two most common, supposedly quick solutions people turn to in hopes of reprieve from the agony are

1) surgery, and

2) corticosteroid injections.

In the great majority of cases, both are poor choices for the plantar fasciitis sufferer, and here’s why:

In the case of surgery, the procedure often makes no difference. The New England Journal of Medicine reports that in approximately 25% of all people who have surgery for plantar fasciitis, the heel pain remains. And even more unsettling: the release of tension on the injured plantar fascia, meant to relieve pressure and the “pull” on it that allows the fascia to stay vulnerable, is done by cutting it. This same relief of pressure can be achieved by thorough and consistent flexibility exercises. Regular stretching sounds easier and less frightening to me…how about you?

Corticosteroid injections often bring instant, albeit temporary, relief. But the relief is supplied in some cases at great cost. The majority of experts agree, corticosteroid injections can come with some nasty side effects. Some of these side effects are as follows:
•    Muscle damage in the immediate area.
•    Complete rupture of the fascia (as opposed to the much milder micro-tears associated with plantar fasciitis).
•    Skin pigmentation changes.
•    Injury to peripheral nerves.
•    Atrophy of the fat pad in your heel (padding which provides crucial protection).

Repeated injections increase these risks. Since they provide temporary pain relief and not healing, once on the injection treadmill, you may in fact come to rely on these repeat injections. Watch out. Get dependent on corticosteroid injections and you could end up with a condition that makes plantar fasciitis look pretty tame.

And what’s more, neither surgery nor corticosteroid injections address the things that cause plantar fasciitis in the first place. Neither “remedy” makes key areas of your body flexible; neither makes weak supporting muscles strong. They have nothing to do with better footwear, arch supports, and foot protection. Neither encourages you to increase or decrease certain activities according to your specific situation and level of injury. These are the things needed to make plantar fasciitis disappear and make it stay gone.

It’s my opinion that a person avoid both surgery and corticosteroid injections, and instead embrace a regimen of active recovery. Such a program will reduce or eliminate pain from plantar fasciitis. It will make you more flexible and strong, and the exercise routine may even help you become a little lighter! (Shedding excess weight definitely helps your feet during plantar fasciitis recovery.) And other than good footwear and possibly devices like a night splint and over-the-counter shoe inserts, this kind of self-directed program is FREE. Compare that to the costly surgery and injection procedures some folks undergo.  Besides being cheaper and safer, steps involved in an active recovery program are generally easy, painless, and can even be pleasant.