(This article by Matt Phillips originally appeared in Running Fitness Magazine, July 2014)
Of all the aches and pains suffered by runners, pain on the heel or sole of the foot is one of the most common – so common in fact that most sufferers are able to refer to it by its Latin name ‘Plantar Fasciitis’ – meaning ‘inflammation of the sole of the foot’. Were this name accurate, treating it could be far simpler; unfortunately, research suggests inflammation is not the main issue, which is probably why traditional methods of treatment with ice and anti-inflammatories do not always help. For this reason, modern texts prefer to rename the condition as Plantar Heel Pain (PHP), which makes sense as pain is typically felt on the inside of the heel as well as the sole of the foot.
Causes Of Plantar Heel Pain
Rather than inflammation, the main characteristic of PHP is thought to be degeneration of tissue due to overloading. Though the precise reason for this degeneration is not clearly understood yet, suggested causes include sudden increase in running volume, excessive standing during the day, being significantly overweight, or having limited dorsiflexion (illustrated by limited shin to ankle angle when you squat).
Treating Plantar Heel Pain
With the slight mystery that still surrounds PHP, the best strategy is to try a range of treatments to see which best helps you. It is also vital that activities that may be exacerbating the issue are avoided, at least initially until symptoms have started reducing. Ignoring the pain and trying to battle on through is not usually recommended with PHP as it tends to be easier to treat it in its early stages rather than wait until the pain has become unbearable.
• Running or Jumping
Difficult though it may be, you will most probably need to refrain from running until symptoms have decreased. Running will become part of the rehab later on but first you really need to give the calves and feet a rest.
• Wear old, flat shoes or walk barefoot
Old or flat footwear can lead to an increased stress on the plantar fascia and cause pain, as can walking barefoot. A shoe with arch support may help alleviate symptoms but be careful as something too rigid may press into the arch and make things worse. The best thing to do is try on a few different pairs of cushioned shoes and see what feels most comfortable.
• Stand for excessive periods of time
Given that PHP has been linked to standing for excessive periods, try to avoid this during the day, especially at work.
Wearing tape specially applied by your sports therapist or physio can often help with short-term pain relief. The low-Dye method developed Dr. Ralph Dye uses traditional rigid tape but application of stretchy kinesiology tape to support the arch can also prove successful in alleviating pain.
• Gel Heel Pads
These heel shape pads can provide a fairly instant decrease in pain when inserted into your shoe.
• Orthoses (insoles)
As with gel pads, it is worth experimenting with orthoses as a temporary way to provide cushioning (make sure they are not too rigid). Off-the-shelf orthoses should be sufficient but do try on a few to see which feels best as the science behind them is far from exact.
Once initial pain has settled, traditional calf stretches are typically recommended along with foam rolling. However, research suggests that specific stretching of the plantar fascia can be more productive: take hold of the heel with one hand and pull the big toe back with the other. You should feel a stretch in the inner sole of the foot. Hold for 30 seconds and repeat a few times a day.
When Can I Return To Returning?
Once symptoms have started to get better, your therapist may suggest it is time to include running in your rehab. As after any period away from running, you need to make sure this return is slow and gradual. PHP has been associated with doing too much too soon so avoid repeating the same error. Temporary moments of mild pain can be normal in the early stages as your nervous system looks out for and makes sure you don’t overstep the mark. Modifying your pace or changing the surface you are running on may be enough to relax the nervous system. If the pain refuses to go away and starts to increase, then that is a sign that you may not be ready to run yet.
Wearing minimalist shoes is not advised in these stages as they will increase the load on the calf muscle, Achilles tendon and plantar fascia and in doing so could cause a return of symptoms. It is worth keeping a range of shoes in your wardrobe for moments like this as returning to running in a slightly more cushioned shoe with a higher heel to toe drop may pave the way in the early stages for a complete recovery.