Plantar fasciitis in runners
 Definition of plantar fasciitis: Plantar fasciitis is an inflammation of the plantar fascia, a thin layer of tough tissue supporting the arch of the foot that runs from the heel to the base of the toes. It looks sort of like a series of fat rubber bands, but the plantar fascia is made of collagen which is more rigid and non-stretchy. Repeated microscopic tears of the plantar fascia cause pain that is most notable in the morning after getting out of bed. Putting weight on the injured area after periods of rest (such as sleep) will cause stress on the area and a more sudden, aching pain. Plantar fasciitis may also be called “heel spurs,” but this is not always accurate because bony growths on the heel may or may not be involved.
Plantar fasciitis (piriformis) in runners: Do you realize how often your foot strikes the ground? In a Runner’s World article, “A runner’s foot hits the ground about 1,500 times per mile, and the heel and its attaching tissues bear the brunt of that force.” Furthermore, “Drastic or sudden increases in mileage, poor foot structure, and inappropriate running shoes can overload the plantar fascia, the connective tissue that runs from the heel to the base of the toes.” At Caring Medical, we often see runners with plantar fasciitis who may have increased their mileage too quickly, run on hard surfaces (like the streets of Chicago), ran in old shoes, overpronate, and/or run on a sloped surface (such as streets with gutters.)
Development of plantar fasciitis in runners.
The plantar fascia is a layer of ligamentous connective tissue that runs from the heel bone to the ball of the foot. It not only maintains the arch of the foot, it is also one of the major transmitters of weight across the foot as we walk or run. The stress placed on the plantar fascia is tremendous, and when inflammation occurs it can be quite painful. The inflammation can result from excessive stretching, too much pressure or trauma. If the plantar fascia becomes partially detached at the heel, a heel spur results. A number of possible causes, often working in combination, result in plantar fasciitis. They include tightness of the foot and calf, improper athletic training, stress on the arch or weakness of the foot. Shoes that don’t fit, running on hard surfaces, or overuse (running too fast, too far, too soon) may also be involved. People with low arches, flat feet or high arches are at an increased risk of developing plantar fasciitis. We not only see cases of plantar fasciitis in runners (distance and sprinters), but also in sports that involve running such as tennis, soccer, football, etc.
What are the symptoms of plantar fasciitis?
At Caring Medical, we find that symptoms of plantar fasciitis can occur either suddenly or gradually. When they occur suddenly, intense heel pain on taking the first morning steps or after sitting a long time, known as first-step pain, is usually involved. The foot tries to heal itself in a contracted position while the person is sleeping or sitting. Although this heel pain often subsides as the individual begins to walk around, it may return in the late afternoon or evening. When symptoms occur gradually, a more chronic form of heel pain causes individuals to shorten their stride while running or walking. Individuals may also shift their weight toward the front of the foot, away from the heel.
Traditional sports medicine treatment of plantar fasciitis: The first line of treatment is usually to recommend that the runner stop running and then to only gradually begin running again. Massaging the foot with a tennis ball and application of ice are commonly recommended. A standard practice of traditional sports medicine doctors when these things do not work is to inject steroids into the foot or to prescribe anti-inflammatory medications in order to relieve the pain associated with weakened the plantar fascia. Often taping, orthotics, and night splints are used as well. However, in the long run, these treatments do more damage than good. Cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain relief benefit, but both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. For example, cortisone will eventually weaken the fascia. If they are not strengthened, a painful heel spur will result. Plus, long-term use of these drugs can lead to other sources of chronic pain, allergies, and leaky gut syndrome. Ross Hauser, MD, wrote a very interesting scientific paper that appeared in the February 2010 issue of the Journal of Prolotherapy entitled The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-inflammatory Drugs. To read the full article, click here. He also authored another study entitled The Deterioration of Articular Cartilage in Osteoarthritis by Corticosteroid Injections that appeared in the Journal of Prolotherapy in 2009. These articles discuss in great detail how these two mainstay treatments actually accelerate the degenerative process for which they are being given in the first place.
Surgery: Not a good option: When all else fails, patients who experience chronic foot pain are usually referred to a surgeon. Unfortunately, surgery often makes the problem worse. Surgeons will typically use x-ray technology as a diagnostic tool, which does not always properly diagnose the pain source. Surgery does not do anything to repair the weakened fascia and ligaments and, thus, does not alleviate the chronic pain that people with this condition experience. Therefore, it is not uncommon for us to see patients post-surgery who are still in pain and still looking for answers.
Caring Medical’s alternative treatment for Plantar Fasciitis
We find that a better approach for treating plantar fasciitis is to strengthen the fascia with Prolotherapy, and provide an arch support if the condition has remained untreated for years. Prolotherapy is the safest and most effective natural treatment for repairing tendon, ligament and cartilage damage and ending the chronic pain associated with this troubling condition. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing.
Prolotherapy offers the most curative results in treating chronic pain. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves. What’s more the tissue strengthening and pain relief stimulated by Prolotherapy is permanent!
To learn more about the Prolotherapy procedure, click here. To read about a 37-year-old man who has benefited from Prolotherapy and been relieved from chronic pain in his right heel and left ankle, click here. To learn why the treatment approach referred to as MEAT (Movement, Exercise, Analgesics & Treatments) is superior to RICE (Rest, Ice, Compression and Elevation) when treating injuries, click here.
Exercise prescriptions: Dr. Hauser, being an avid runner himself, also guides the runner/athlete through an aggressive rehabilitation program that includes getting the runner back to running as quickly as possible. Running on soft surfaces such as soft tracks can accelerate the process, as well as wearing proper running shoes. He will also provide the runner with foot strengthening exercises that will help prevent development of a recurrence in the future.
If you are interested in more information about Prolotherapy or to schedule an appointment with Dr. Ross Hauser, please contact Caring Medical at 708-848-7789 or online using our contact form.
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