Heel pain in runners can be a tough one to treat… The symptoms of this injury can vary from mild to severe, constant or transient. Some runners feel pain along the arch, some directly under the heel bone, but the diagnosis is typically the same dreaded two words: plantar fasciitis.
Modern medicine tends to treat only the symptoms of this condition, overlooking the underlying causes. Medical treatment modalities such as cortisone, night splinting, boots, and steroidal anti-inflammatory medication may help bring relief… for a month.
In runners, since we put constant pressure on our feet, long-term recovery from PF comes from delving into what I consider the two chief causes of this disorder. You may have one or both of these functional problems, but below I have outlined how to treat each to finally heal your heel.
I have had PF in my left foot off and on for three years, but finally got it over the hump using a combination of these therapeutic courses. Now it only gets aggravated during periods of intense speed training on the track, and I can resort to my trusty rehab plan to nip it in the bud.
Cause 1- Trapped Soleus
The soleus is a forked muscle that sits along both sides of the larger calf muscle, the gastrocnemius, and works as a prime mover for propelling the runner forward with each stride. In my opinion, tightness in this muscle is the number one cause of PF in runners.
The first exercise to correct any impingement or tightness here is to use an Active-Isolated Stretch on the soleus directly. Sit on the floor with legs out in front of you. Slide the injured foot up until it is parallel with opposite knee. Take hold of your forefoot with both hands, clasping fingers lightly. Keeping your heel on the ground, use hands to gently raise the forefoot off the ground as far back as you can comfortably go. Repeat 10-12 times for two seconds each. Perform on the opposite soleus as well for muscle symmetry.
First thing in the morning, our PF muscles are tight and shortened from a night of immobility. This is why PF hurts worse in the morning. Before your feet hit the floor, sit up on the edge of your bed with feet dangling if possible. Relax toes and ankles completely. Gently press the inside edges of your feet together, inner arches touching. Roll ankles with feet pressed together 40-50 times both clockwise and counter-clockwise. This activates the soleus alone and allows it to pump fresh blood to the feet and lower legs. This can be done several times per day, and will greatly accelerate healing.
Cause 2- Scar Tissue Over the PF
If you have had PF for a while as many runners often do, then you may have a build-up of scar tissue along the arch and PF attachments. In bare feet, feel around for any tight spots, “crunchy” bits of tissue, or small muscle knots.
Without going straight into the direct point of pain (mine was the inner corner of my heel near a bursa sac), massage in a progressively harder way along the arch, under the metatarsals, and along the heel. Roll the ankle and dorsiflex your foot as you massage up, down, right, and left along the bottom of the foot. Use your knuckles, thumb, palm, and even finger nails to rake across the heel’s fat pad, eliminating any scar tissue you find in the area. Do this for 20min every other day to bring about positive change.
Other Helpful Tips
After 7 days from the onset of symptoms, stop icing the heel and taking NSAID medication; these modalities only decrease blood flow to the area and impede healing. Take acetaminophen when pain is present if you must (after consulting with your doctor, of course). Heat before runs for one month as needed.
Do not stretch the arch/PF directly, as this may only create a cycle of “tear and repair”. Instead, spread toes widely with fingers to relax foot muscles, perform the active soleus stretch above, and keep the calves, hamstrings, and hips loose as well. Finally, WEAR MINIMAL SHOES for running. Strengthening the feet is critical for PF sufferers, and you will never develop such strength in heavily cushioned trainers with thick heels.
Best of luck in your recovery from plantar fasciitis! This is an injury that takes patience and diligent work to overcome, but it can be done by following the above protocol, training intelligently, and modifying your gait/shoe choice to aid in the healing of your heel.