Heel Pain In A Runner by Dr William Chan

The pain came on slowly while I was running the Kuala Lumpur International Marathon few years ago. As a runner, this is the first time I experienced heel pain while running for many years. From my experience seeing many runners with this injury I stop running for the next two months.   For most long distance runners, the heel pain seemed like just another pain in the foot, it feels like a bruised heel. The heel hurt in the morning on the first step getting out of bed. The pain then disappears after few steps. It may hurt when you walked in your work shoes during the day. If you continue to run, and most of the runner will try to run through the pain. The pain will eventually become so bad that you will stop running.

One runner said “The pain started suddenly, at the bottom of my left foot. It moved around the heel and was never very bad that I couldn't run, but I was afraid it does serious harm if I continued to run through the pain."

Another runner described the pain would start in the foot and shoot up my leg with every stride. He couldn't find any stride that wasn't painful, the pain stop when he walks.
The symptoms may have been different in different runner, the diagnosis was the same: plantar fasciitis.

I see it in the young and old, athletic and non-athletic, fat and slim. I believe that plantar fasciitis are second to knee pain as the most common complaint among runners.
The heel bone is the largest bone in the foot and bears all of the body weight with each step. As a result, the stress on the heel and all the soft tissue structures connected to it is enormous. The plantar fascia, a long band of fibers that attaches at the bottom of the heel bone and extends to the base of the toes, takes the brunt of our body load in running or walking. Pain occurs when these tissues become irritated or inflamed a condition known as fasciitis. The pressure in the heel is 3.5kg on each additional 1 kg we on our weight.

If you have plantar fasciitis, you may feel a sharp pain first thing in the morning because the plantar fascia shortens during the night, while you're asleep. When you get out of bed in the morning and start walking around, the band along the bottom of your foot stretches and pulls on the heel. When the pull is too hard or tight, pain will results. This can also happen when you sit for long duration.

There area many reasons for this injury.

• Tight calf muscles and Achilles tendon increase stress on the plantar fascia
  
• Flat foot - overpronation (feet rotate too far inward on impact)
  
• High arches and rigid feet
  
• Incorrect or worn shoes
  
• Switching surfaces (particularly grass to concrete)
  
• Overtraining
  
• Sudden increases in training mileage
  
• Beginning speed work
  
• Over weight or increase weight recently.
  
• Women who wear high heels all day and then switch into flat running shoes.
  
• Too many long runs

The good news is plantar fasciitis can be treated successfully without surgery. The bad news is ultimate success depends on your patience. It may take three to twelve months to heal.

• Stop running, especially in the case of severe pain
  
• If pain is mild, then reduce 50% of training load and intensity
  
• Apply ice to the plantar fascia for 15 minutes (3-4 times per day), in order to reduce the inflammation
  
• Do not massage the heel
  
• Stretching exercise for Achilles tendon, calf and plantar fascia
  
• Return to running gradually when recovered.
  
• Heel cup.
  
• Correct shoes

• Wear well-cushioned shoes, and change shoes regularly.
  
• Run on soft surfaces.
  
• Keep your running mileage at a relatively consistent level.
• If you change your training, increase total weekly distance by no more than 10 percent per week.
  
• When beginning speedwork, ease into it gradually over several weeks.
  
• Stretches your leg and ankle regularly before and after run.
  
• For those with stiff and tight leg muscles daily stretch is recommended.
  

Questions to Dr William Chan can be directed to him. His contact number is 03-563 55113 or 012-252 1898. His e-mail is spinesportmed@yahoo.com. See also the Sports and Backcare Specialist page.