A Pain in the… Heel?
“Oh my heel hurts… it must be a stone bruise.” Runners often complain of pain on the bottom of their heel. The pain is often worse when taking the first step in the morning and usually aggravated after standing or running.
Sometimes heel pain is indeed caused by stepping on a stone. Sometimes it is a stress fracture or an insufficiency fracture, such as can occur with osteoporosis. But most often the diagnosis is plantar fasciitis, inflammation of the plantar fascia, a thick band of tissue that connects your heel bone to your toes.
One of the most common injuries in runners, plantar fasciitis is a painful condition localized to where the plantar fascia meets the calcaneus (heel bone). It is usually a result of chronic overuse, but occasionally can occur from a traumatic event like stepping on a stone. It is thought to be caused by chronic traction of the plantar fascia from the heel towards the toes that results in small ruptures of the fascia. The fascia then thickens or inflames, which is what is believed to be the source of the pain.
Runners with a high arch who over-pronate or run on hard surfaces are at greater risk for developing this. The diagnosis is based upon obtaining an accurate history and identifying tenderness on the bottom of the heel. A calcaneal spur may be seen on x-ray, but the size or presence of the spur is unlikely to be related to clinical symptoms.
Treatment usually involves limiting your running, taking non-steroidal anti-inflammatory medications like Naprosyn, and placing a soft support in the shoe under the heel. Physical therapy and exercises that involve stretching the bottom of the foot and calf muscle can be very successful.
To decrease the pain, try stretching before getting out of bed and wearing night splints. Occasionally an injection with cortisone near the heel spur can be attempted, but this can also result in a rupture of the plantar fascia or loss of fat in the heel area, which can be devastating to a runner.
There is some growing evidence that PRP injections (platelet-rich plasma) into the plantar fascia may be of some benefit, but so far there have only been limited scientific studies that show this. Removal of the calcaneal spurs by surgery is unnecessary.
The best results are usually observed after a patient keeps a splint on at night and stretches in the morning and uses a soft pad in the shoe. In general, plantar fasciitis typically goes away within six months or one year.
