Dear GeezerJock Doc:

I'm training for Masters and senior track meets, and I'm hampered by plantar fasciitis. Please discuss your recommended remedies. I'm 53 years old.

-Rick Greene, Riley, Kan.

The GeezerJock Doc Responds:

Plantar Fasciitis is a very common cause of heel pain in the athlete. The plantar fascia is a tough band of tissue that runs along the bottom of the foot from the heel bone to the base of the toes. The primary purpose of this fascia is to provide a strong base of support for the foot.

The most common complaint of an individual who is suffering from plantar fasciitis is morning pain. People state that the first step they take in the morning is excruciatingly painful.  This a.m. pain will often dissipate, but in some people it worsens as the day goes on. People who work or spend large parts of the day on their feet on hard surfaces often complain of increasing pain toward day's end. Repetitive pounding in worn shoes or shoes that do not provide much arch support can also be a cause of this pain.
 
Pain associated with plantar fasciitis usually localizes on the bottom of the foot, about 1 to 2 inches from the tip of the heel bone. This area is usually sensitive to touch. The explanation for increase pain in the morning is that during sleep, the fascia tenses up and shortens. As a result, the first step in the morning is an acute stretch which causes pain.

This leads us to the primary treatment for plantar fasciitis -- stretching. The relative flexibility of the Achilles tendon often affects the flexibility of the plantar fascia. When the Achilles is tight, it pulls on the heel bone and as a result the plantar fascia tightens.

Part of the treatment involves an evaluation of the foot's architecture. Certain abnormalities lead to an increased chance of plantar fasciitis. Orthotics can often be used to address these abnormalities. Shoe inserts that are often custom made, orthotics will help place the foot in a better position during weight bearing activities.

Often your physician may recommend a cortisone injection, but these injections should not be the first line of treatment. My advice: start with the stretches.

Physical therapy can be useful as a treatment to aid in diminishing inflammation.  Another easy treatment option is the use of night time splints. These splints keep the plantar fascia stretched at night which will diminish the morning pain.

A newer treatment that has recently become popular is shock wave therapy. This treatment was originally designed for the treatment of kidney stones but has been used on heel and elbow pain with some degree of success.

Surgery is also an option, but only as a last resort after all conservative treatments have been exhausted. The bottom line is that plantar fasciitis is a very treatable injury. The most important treatment is simple stretching to prevent the Achilles tendon from becoming too short, which can create the problem in the plantar fascia. With proper treatment this problem should completely disappear over a period of a few months.