Heal Your Heel Pain

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.

Just an update to yesterday’s post: I ran and finished the Twin Cities Marathon 10-miler today. My feet held out and no heel pain occurred. Yes! This was my 5th TC 10-miler, but my first after wrestling with and beating a bad case of plantar fasciitis.

Just a couple of years ago I limped and winced with the condition, and thought I might never run a city block again. Since then, I’ve run maybe 10 or 11 races, and have had no recurrence of the heel agony. So, if you currently suffer from plantar fasciitis, know that there’s hope! I’ve never had any surgery, shots, or ultrasound therapy of any kind. Just a regular routine of conservative, active recovery activities and a readjustment from the abuse I used to subject my feet to. I detail them in my book Injury Afoot, and I’ll be discussing them here. If I can do it, so can you!

Pat Hafner_TC 10-miler #5

Well, I guess tomorrow morning is when the rubber meets the road, or in this case, the running shoe meets the road. Sunday, Oct. 5, at 7:13 AM Central Time, the Twin Cities Marathon starting gun sounds. (Yes, 7:13…not 7:15 or 7:30…the marathon organizers run a pretty tight ship!) Several thousand runners will stride through the picturesque and chilly Minneapolis/St. Paul streets, enjoying the fall colors & the camaraderie, and trying to not collapse in a heap. A few of us more gravity-challenged folks are opting for the less grueling, more realistic 10-mile run. This will be my 5th TC 10-miler, but my first after recovering from the plantar fasciitis ordeal. So I guess we’ll see if the strategies I’ve listed in the book Injury Afoot – which this blog is based on – stand the 10-mile test. (Actually I know they do…I just ran 6-9 miles several times in recent weeks, but proving it on the course of a nationally-recognized race makes it more official.)

A few things I’ll be sure to include in my pre-race prep for foot protection:

Gently stretched Achilles tendons, calf muscles, and hamstrings. Same thing for the lower back. I have good, sturdy inserts in the shoes already to support my arch. And I’ll make sure to warm up thoroughly, with plenty of slow, gentle walking, then working up to faster walking, then to a slow jog. All just precautions. I currently have no heel pain at all, but I never want a recurrence.

Anyway, wish me well. For me 10 miles is a long way!

To all you fitness enthusiasts and avid exercisers who acquired plantar fasciitis: I feel your pain. Or at least I used to.

What a maddening condition it is…the very activities which bolster your health, tone your muscles, and burn calories are often those that contribute to the arrival of plantar fasciitis. Running, hiking, walking, maybe even yardwork or other projects. And to a greater extent, working a job on your feet all day. Sound familiar? Grrr. What a deal. Proof that fairness often does not prevail.

But reality is what it is. The best first step is to decide you can and will overcome it. Don’t do anything rash, as in things involving scalpels and injections. I’ll continue to post ideas and exercises to guide plantar fasciitis sufferers through the ordeal. You’re almost certain to find a combination of actions therein that works for you and your particular injury level. Once you’ve talked to as many folks as I have when researching material for the book Injury Afoot: 30 Things You Can Do to Relieve Heel Pain and Speed Healing of Plantar Fasciitis, you realize a couple of things: almost everyone you speak with knows someone who’s acquired it, or has had it themselves. And, fortunately, a great many of those victims eventually beat it…for them it’s now just a bad (very bad) memory.

So active, productive, wholesome people are often the ones who fall under the spell of plantar fasciitis. It’s the sad truth. But those same people often overcome it and get back to an active lifestyle. Be one of them.