Plantar Fasciitis

Plantar Fasciitis

Korn, Jeanne
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Flip-flop disease, dog's heel, or plantar fasciitis-however you name it, it hurts. The hallmark symptom is pain on the inside of the heel first thing in the morning, usually relieved somewhat by walking around a bit, then worse again as you continue to load it. That's in the early stage; as it gets worse it can be extremely debilitating, changing your lifestyle from outdoor enthusiast to coffee-shop wannabe.

The mechanics are relatively simple. The plantar fascia is a band of tissue connecting your heel to your toes. It covers and supports the underlying longitudinal arch (the arch of your foot). As you load your foot and lift your heel, the plantar fascia stretches and stores potential energy. As you "toe off," it springs back and returns that energy to help push you off to the next step.

Several factors can break down that elegant system. Likely suspects include a sudden increase in training (e.g., getting ready for a big race), wearing shoes that don't provide good arch support (like flip-flops or broken-down running shoes), excessive pronation, or previous injury to the foot or ankle.

If you've only had pain for a few weeks, good news: it's relatively easy to treat. Start by evaluating your footwear. Get new running shoes if flexing the toe results in a bend of the shoe behind where the toes usually bend. Get out of your flip-flops and into a shoe with a cushioned supportive foot bed. And consider putting a gel heel cup in your shoe.

You can also try these early stage exercises:

1. Start by gently stretching the calf muscles... a lot! Stand with your affected foot behind you and lean into the wall. Then bend your knee and stretch again, feeling the stretch down near your Achilles' tendon. Hold each stretch for 20 seconds and do it several times a day. Make sure you do these in your supportive shoes-you can micro tear the plantar fascia if you don't.

2. Use a frozen water bottle for ice massage (roll your foot back and forth across it) several times a day.

3. Stretch the plantar fascia itself by pulling up on your toes gently.

Now, if it's something you've been trying to ignore and it's been going on for a few months, we are talking about a different animal. Consider a custom orthotic that provides total contact foot support, corrects poor biomechanics, and provides plenty of cushion. Do not get a rigid orthotic! Try these exercises:

1. Place your heel on a smooth surface and put a towel under your foot. Use your toes to scrunch the towel toward you for about three minutes. Do this 3-4 times a day.

2. Stand on the edge of a step and quickly push up onto your toes with the affected foot. Start to drop it down, then slowly lower all the way down. Repeat 3-4 times a day until tired.

A full recovery can take two or three months or longer if you've let it go on too long. There are several other treatments that either a physical therapist or sports medicine physician can provide, so if you're not seeing some changes in about a month, don't wait! This one can be a bugger, or you could have something entirely different going on.

Jeanne Korn specializes in outpatient orthopedics and sports medicine at Vail Physical Therapy. She holds a Master's in Physical Therapy from Northern Arizona University and has personal experience with the dreaded flip-flop disease.

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