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Plantar Fasciitis: Your Heel's Worst Enemy by Jordan Metzl, M.D

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Plantar Fasciitis: Your Heel's Worst Enemy by Jordan Metzl, M.D TRAINING DOCTOR’S ORDERS Plantar FFasciitis:asciitis: YYourour heel’heel’ss worst enemenemyy By Jordan Metzl, M.D. he symptoms of plantar fasciitis are easy termed fasciitis, inflammation which usually muscles—holding each stretch for 15 to 20 to recognize. The pain generally starts occurs at origin of the fascia on the bony seconds, several times in each position— as an ache in the heel that hurts with bump on the bottom of the heel called the and will lessen the stress on the tendon and T ahooMedia.com the first several steps out of bed in the morn- calcaneal tuberosity. Injury to the fascia gen- fascia. Ideally, this is done daily, before and ing. Like many injuries, if the pain is ignored, erally results from excessive tension, both after exercise. it worsens quickly. By the time patients with from the muscles above and from the shape of The second type of love, reparative love, plantar fasciitis come to see their doctor, the the foot below. happens when you mess something up and John Segesta / W pain has often become debilitating; they are The calf muscles, the gastrocnemius and it’s time to make amends (it would be much often hobbling around in the morning and the soleus, attach to the back of the calcaneus easier if we could buy our plantar fascia a box enduring a pain that limits their ability to run via the Achilles tendon. When these muscles of chocolate to say sorry, but it doesn’t work and sometimes even walk. are tight, the tendon pulls on the bone from that way). The best advice for plantar fascia So what do you do if you begin to suffer the top, which stretches the fascia and creates pain is get it checked out early! Don’t wait this way? The pain from plantar fasciitis has more strain. In addition, some people are built until you are hobbling. The injury to the fas- brought many a grown man and woman to with very high arched feet which pull the fas- cia is often done by that point. If it hurts, have tears—it hurts. Plantar refers to the bottom cia from below, and are especially prone to it evaluated, including x-rays of the foot that surface of the foot; fascia is the medical term plantar fascia injury if they are not supported check for an osteophyte (bone spur) that can for a thick strand of collagen that runs between with orthotics (the over the counter brands indicate part of the discomfort. two structures. The plantar fascia connects are usually sufficient to start with). Treatment often includes a period of rest the calcaneus (the heel bone) to the Once inflamed, the fascia is more likely to from any offending activity, good stretching, metatarsals. It serves to support the arch, and develop microtears, a consequence of inflam- night splints, physical therapy, sandals helps give shape to the bottom of the foot. mation, and mild pain can quickly progress with an arch next to the bed for the first steps When working properly, the fascia helps to to rapid and debilitating pain within a period in the morning, and sometimes an injection accentuate the lever action of the foot and of days. Respecting the fascia means under- of corticosteroid at the calcaneal tuberosity. gives more stability to the foot strike and push standing the potential severity of injury to this Surgery is required rarely, except in off phases of running. small structure. extreme cases which don’t respond to non- More than almost any part of your body, So this brings us to love: love your plantar operative care. however, your plantar fascia needs both your fascia. Of course, there are two kinds of love, So if your heel hurts in the morning, if you respect and love. preventive and reparative. The best way to find yourself hobbling to the shower, puh- Respecting the plantar fascia means under- prevent plantar fasciitis is to never go there. leeze get it checked out early. As it the case standing that despite a funny sounding name, This can be accomplished with good with most injuries, the longer you wait, the if you injure this thin band of collagen, the stretching of the Achilles tendon complex and tougher it is for us to fix you. s pain and suffering can last many months. My the calf muscles. The best way to stretch is to youngest brother Josh, in fact, was sidelined put your foot against a step with the heel on Jordan D. Metzl, MD, is a nationally recog- for 10 months with a painful plantar fascia, the ground and slowly lean forward, nized sports medicine specialist at Hospital for Spe- and many patients in my office come in with feeling the stretch at the top of the calf and cial Surgery in New York City. In addition to his similar stories. then repeated with a bent knee, feeling the medical practice, Dr. Metzl is a 25 time marathon The most common injury to the fascia is stretch lower in the leg. This stretches both runner and three time Ironman finisher. 126 MARCH 2005 WWW.TRIATHLETEMAG.COM.
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