Heel of Fortune
Q: About 3 years ago I felt severe pain in my right heel and had to take some time off from running. Now the pain is back, and sometimes I can’t even walk normally. Why is this happening and what should I do about it?
A: When you first experienced severe heel pain, you probably had acute plantar fasciitis. The plantar fascia is a membrane that connects the big toe and forefoot with the heel, forming the lining of the arch.
During a normal running gait, you push off from your big toes with most of your weight. This creates a strong pull against the attachment of the plantar fascia to the inside of the heel. Sometimes this area may become inflamed or tear. In most cases, those who suffer from plantar fasciitis will experience their worst pain during the first few steps of a run or when they step out of bed in the morning.
Normally the first episode occurs when you train too hard. Repeat injuries can occur with minor changes, such as when you wear different shoes, run on different surfaces, try new workouts, suffer more job fatigue, etc.
What can you do to ease the pain? First, try icing. Use an ice bucket and submerge the heel area for 10 minutes several times a day. The cold may ache, but it helps relieve pain better than any medication. Use ice after every run, whenever you feel severe pain, and in the evening. Use anti-inflammatory or pain-relief medication only if ice isn’t enough.
Next, do exercises to strengthen the muscles of your feet and lower legs. Walk barefoot on a carpet on your toes, then your heels, and then backward for a total of 10 minutes each day. Strengthen your Achilles and calves by doing three sets of 15 heel raises on a step. Allow your heel to drop below the level of the step.
When running, wear best shoes for plantar fasciitis and stay on soft surfaces. Sometimes a heel cup, heel lift, or arch insert makes running more comfortable. I prefer that my patients continue to run regularly, but only if they don’t limp after the first few steps. Usually runners with plantar fasciitis have to reduce their mileage by 50 percent. When you begin increasing your mileage, increase by only 10 percent a week. Recovery typically takes 3 to 4 months.
If these general treatment techniques don’t help, see a sports-medicine doctor. Other treatments range from medications and injections to night splints and orthotics.
–Bert Fields, M.D., the family practice and sports medicine fellowship director at Moses Cone Hospital in Greensboro, N.C., and a former collegiate runner now in his 38th year of racing.
Asking for Support
Q: I’m a high-mileage runner with a medium arch. I currently wear a stability shoe, but I want to move toward ashoe with more cushioning. Do I have to worry about my arches falling if I buy a shoe with less arch support?
A: Arch support comes from a shoe that fits well and has a supportive insole. The midsole of a dual-density stabilityshoe can add support to your arch, but so can a cushioned shoe if you find one that has a similar midsole construction.
There are cushioned shoes on the market today that are built like stability shoes, but with softer single-density foam. If you do choose a cushioned shoe, you may need to add an insole support such as Superfeet or Powerstep. Another option: You may not need to change shoe styles if you simply add a cushioned insole to your current stability shoe. This will maintain the stability you need but also provide you with the cushioning you want. A knowledgeable salesperson at a specialty running store will be able to help you decide.
If you do switch to the new type of shoe, remember to rotate it with your current stability shoe for several weeks before going over to the new one entirely.
–Paul Carrozza, RUNNER’S WORLD’S footwear editor and owner of the RunTex specially running stores in Austin, Tex.