by Mok Ying Ren on Wednesday, December 7, 2011 at 10:41pm.What is it?
Plantar fasciitis is the inflammation of the plantar fascia. If you wake up in the morning and your first step towards the bathroom hurts, you are likely suffering from this condition. Inflammation suggests the migrating of inflammatory cells towards the area, however, some doctors insist that it is not inflammation as if a biopsy was done, no inflammatory cells can be found. But that doesn't really matter because the pain you feel is an inflammatory type of pain - a pain that gets worse after prolonged rest (such as sleep) and gets better after some walking (or even running).
As seen from the picture (photo 1), the pain is felt near the attachment of the fascia to the heel bone on the inner side of your foot.
Treatment
Treatment can be divided into conservative or surgical. However, surgery is usually not necessary. Thus, lets focus on what you can do for yourself at home.
1. Night Splint (Photo 2)
The night splint is a good device however compliance can be as low as 10% for patients who are prescribed this device. I also sometimes get woken up by it in the middle of the night and remove it. Our plantar fascia is usually lax when we sleep as our foot normally goes into a plantar-flexed position as the foot droops down towards the bed. This means that when we wake up and take our first step, the fascia is stretched, causing pain at the attachment. The night splint works by keeping your foot in a dorsiflexed position through the night and almost eliminates the pain on your first step in the morning. Once again, compliance can be a problem for you.
2. Golf Ball (Photo 3)
If you do not play golf, go run around a golf course and get one or two. The golf ball is used to massage the entire sole of your foot. Put it on the floor while at your desk and roll it around. I once thought that it is good to massage the area that hurts as it does feel better after that. However, Dr Benedict Tan from Singapore Sports Medicine Center told me that by doing that, it is equivalent to rubbing an open wound. You wouldn't rub an open skin wound would you? Similarly, you do not want to aggravate the painful area. Thus, massage everywhere except the painful spot. Have a golf ball with you all the time - at work, at home and infront of the TV.
3. Stretch your calves
The calves are attached to the same heel bone as your plantar fascia. Imagine the heel as the fulcrum. As your calves get tight, it pulls on the heel which in turns pulls on the plantar fascia. Stretch daily and as often as possible. Note that there are 2 calves muscles and you need to stretch both. Stand facing the wall and stretch first with your knee straight (Photo 5) and then with your knees bent (photo 4). You should feel a different sensation each time.
4. Non steroidals Anti Inflammatory Drugs (NSAIDs)
These are different from painkillers like padanol that works on your nerves and "bluffs" your body to thinking there is no inflammation. NSAIDs work directly at the area of inflammation and reducing the reaction there, directly leading to less pain. However, these drugs have their fair share of side effects and you will need to consult a doctor to see if you are suitable for it.
5. Cross Train
At the moment, run less. Cut your mileage and cut your intensity. Running is the ultimate weight bearing sport and it is difficult to find a sport that allows you to bring your heart rate as high as running. Thus, stick to non impact sports like swimming, cycling and water running while your heel recovers. Do as much as you can to retain your fitness especially if you have an important race coming up.
6. Extracorporeal Shock Wave Therapy (Photo 6)
This is a treatment that was once invented to treat kidney stones (now still). It is now approved to treat injuries like plantar fasciitis. By using a shock wave to hit the area, it stimulates recovery and new tissue growth. Institutions like Changi Sports Medicine Centre, Singapore Sports Medicine Centre offer these treatment. I went through 2 cycles with Dr Cormac at the Singapore Sports Institute and found it rather effective. However, response can differ from patient to patient.
7. Insoles
Orthotics can help you with PF especially if you have underlying biomechanical issues such as over pronation. Research has shown that the effectiveness of off-the-shelf insoles are as effective as custom made ones. See a podiatrist to get one and see if it helps. I have gotten a pair from the Singapore Sports Institute and I find that it does help. However, during my runs, I wear off-the-shelf insoles which are usually softer and more comfortable for the heel.
8. Taping
Low-Dye taping (Photo 7) is a technique i tried. It is a well documented taping technique which was invented by Dr Ralph Dye to off load the plantar fascia. Check out this video: http://www.youtube.com/watch?v=V_SEfgm6uZU. I find that it does not seem to work well for me. Thus, I abandoned the taping after a few days. It is also very messy as you can see it requires lots of tape. You can get the tape from Watson's, called leukoplast. (Photo 8). Try it - it may work for you.
9. Footwear
Now you need to think if your office shoes is suitable for your feet. For me, I prefer to wear crocs which has a very soft sole and thus very cushioning for the point that hurts. It is also wise to wear a shoe with good support in your home to ensure your feet gets the necessary support. You may choose to buy off the shelf heel cups to add cushion to the heel area to provide it some comfort. I personally use the Dr Scholl heel cushion (Photo 9) from Watsons as it not only cushions the heel but also provides a certain extent of arch support.
Summary
These are techniques that I used to cope with my injury in the past 3 months and allowed me to complete a marathon safely. I hope that these techniques can help you too. However, in some situations, the injury make take months to recover. But most importantly. you MUST not give up and PERSIST in doing the above. I wish you all the best and hope you can get back onto the roads.
Disclaimer: This is a compilation of my knowledge as a medical student and my experience as a runner. Please use this only as a guide. If pain persists, please consult your doctor to get a proper diagnosis and treatment.
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Photo 9
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