It’s an athlete’s worst nightmare: Right before the big race, you’ve been training for months, eating right, watching the seconds on your stopwatch lower with every practice session.
Then, one morning, you get out of bed and you feel it.
Most patients should see a doctor if they have heel pain for greater than seven days, and it’s not getting better with ice or stretching or anti-inflammatory medication,” says Dr. Pedram Hendizadeh, D.P.M. “The most common cause of heel pain is a condition called plantar fasciitis.”
Plantar fasciitis can be brought on by a number of factors, one being a sudden increase in activity – making it a common sports-related injury, particularly for runners. “The plantar fascia is a ligament on the bottom of the foot that expands and contracts,” Dr. Hendizadeh explains. “It’s sort of like a rubber band. Its purpose is to expand and contract to support the arch.” When the elasticity on the rubber band wears out, it’s painful. “When you’re sleeping at night, your foot’s relaxed but the plantar fascial ligament actually gets tight…the foot steps down on the ground and the bottom of the foot is stretched out, and the plantar fascial ligament can’t handle that.”
But that doesn’t mean you have to be stuck on the sideline. Plantar fasciitis has long been considered a very treatable condition, known to benefit from ice, stretching, and anti-inflammatories. Specialized orthotics, or inserts for shoes, can be made and podiatrists can also provide a night splint, used to stretch the ligament. Newer treatments also include shockwave therapy and extracorporeal pulse activation therapy (EPAT), which uses sound waves to reduce inflammation. “It’s relatively new here in the States,” says Dr. Hendizadeh, “but we’ve been using this treatment modality in Europe for many years and there have been…numerous studies to show that it’s about 88% effective.”
Physical therapy is often hugely helpful, as a therapist can identify any underlying issues – an imbalance a walking or running gate, for example – that may be contributing to the plantar fasciitis. Dr. Hendizadeh refers his patients to physical therapy because “it really works…It will help patients get better quicker.”
Joscelyn Bayer, D.P.T., is a physical therapist at Panetta Physical Therapy in Roslyn, New York. She starts heel pain treatment with a gait analysis, to determine if there’s anything about a patient’s stride that is irritating the plantar fascia. Once the gait has been addressed, approaches are taken to correct the problem. “Physical therapists utilize soft tissue work to reduce restrictions in the tissues of your foot, as well as the surrounding ankle, that could be causing you to put extra stress on your plantar fascia,” Bayer says. “We will perform manual stretching and educate patients on self-stretching. Finally, we also have multiple modalities to reduce the inflammation, and kinesiotape to help keep your foot in a stress-free position until the tissue heals.” She strives to help her patients maintain an active lifestyle, despite their condition. “The key is to reduce the cause of stress so it does not keep coming back and you can return to life and activities, pain-free.”
Plantar fasciitis doesn’t have to mean a prescription for bed rest and pain killers. If you’re feeling suspicious pain, get in touch with your primary care doctor, who can refer you to a podiatrist or physical therapist. And there’s good news for plantar fasciitis sufferers who seek medical attention, according to Dr. Hendizadeh: “99% of the time, we can get rid of this heel pain in a short period of time and the patients can get back to their active lifestyle without the need for surgery…The prognosis is very good.