I have a wincing pain that shoots through the bottom of one of my feet when I get out of bed in the morning. It’s tolerable, but I have a half-marathon coming up in two months. What should I do?
Runners are at increased risk for developing heel and foot pain. One of the most common causes of foot pain in adults is called plantar fasciitis. A band of tissue called the plantar fascia connects the heel bone to the toes. The plantar fascia supports the foot bones in an arched position. When there is pain in the bottom of the foot or heel, it may be due to the plantar fascia being inflamed, irritated or swollen.
Plantar fasciitis is typically caused by poor foot mechanics. For example, if the foot flattens too much, the fascia may overstretch and swell, or if the foot flattens too little, the fascia may ache from being pulled too tight. It occurs when the tissue tears or pulls away from the bone, or when swelling causes the tiny fibers to fray. Common symptoms include pain under the heel and sole of the foot. The pain is worse in the morning when you first get out of bed and improves with walking. The pain may return when you get up after being seated for an extended period of time. The pain may be sharp, like a knife sticking in the bottom of your foot, or it may feel like a dull ache. Plantar fasciitis can develop gradually or suddenly. It usually affects one foot at a time, but occasionally it occurs in both feet.
What might you be doing to exacerbate this?
If this sounds familiar, consider ways to both reduce the pain and address the underlying condition. Your top priority: avoid activities that cause the pain. Standing for long periods of time, running, walking, tennis and other weight-bearing sports can put stress on the heels and tear the tissue. Ice your heel for 20 minutes up to four times a day. Take pain medication that reduces inflammation, such as Ibuprofen.
Shoes with poor cushioning, high heels or poor arch support can add to your risk. Wearing thin, flat sandals or flip flops this time of year is tempting, but may exacerbate the problem. Wear sturdy shoes with good arch and heel support and shock absorbency. Also, tight lower leg muscles or Achilles tendon can contribute to heel pain. First thing in the morning and before being active, stretch the bottom of your feet by gently flexing your ankle so the foot moves toward your knee.
Other factors that can contribute to plantar fasciitis include arthritis, diabetes, obesity, recent weight gain, flat feet or having high arches.
What if nothing helps?
Our active patients are often frustrated to hear that it may take up to nine months of reduced activity before their plantar fasciitis goes away. It’s best to take care of the problem fully so that it is less likely to reoccur.
If your symptoms do not improve, see your provider to confirm a diagnosis and discuss what other treatments are appropriate. There is no test for plantar fasciitis, but we can tell if you have it by learning your symptoms, doing an exam and possibly ordering a radiology test if the diagnosis is unclear.
We may recommend shoe inserts (off the shelf or custom), night splints, taping the foot to help provide support. In rare cases, surgery may be needed. Talk to you provider today if you have unrelieved foot and heel pain.
Michelle Napral is a nurse practitioner at the University of Minnesota Health Nurse Practitioners Clinic, 3rd Street & Chicago. Send questions to firstname.lastname@example.org.