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October 20, 2020

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Dr. Samuel Heiks: Foot Pain. When to start running again?

Dr. Heiks is a board certified Family Medicine doctor and lives in  Bluffton, Ohio.

Dear Dr. Heiks: This summer I started running and have really enjoyed walk/running about 3 miles 3-4 times a week. When I run I have improved energy and mood. However, my 50-year-old feet aren't so happy. I think I developed plantar fasciitis: my feet started to feel stiff and uncomfortable when I got up in the morning or after I sat for a long period.

I've had relief from icing, massage, stretching, exercises, better running shoes, and day-time oxfords rather than flip flops, etc., but I'm confused about if and when I should graduate from low-impact exercise to running again.

Reader from Bluffton, Ohio

Dear Reader: Plantar fasciitis is a real pain in the foot, or more precisely, pain in the heel.  It is caused by inflammation and degeneration of the plantar fascia - a thick band of ligament fibers that attaches to the heel, runs to the toes and supports the arch of the foot. 

Women are affected twice as much as men and symptoms often begin gradually without any injury.  Pain during the first step in the morning is classic.  Pain with standing is common.  Not a fun wake-up call.

In the anatomy lab, a continuous band of ligament fibers can be dissected from the base of the foot to the base of the skull.  Why is this relevant?   The body is a connected system, so pain in one area (such as the heel) may affect pain in other areas (knees, hip, back or neck).

So it is important to pay attention to the pain and allow healing to occur.  Thankfully, nonsurgical treatments work 95% of the time.  

Rest is the most crucial factor for successfully healing the ligament.  This often means finding an alternative form of exercise, such as a stationary bike, until usual activity can be resumed.  Be patient- it can take six to nine months for healing to occur.

Stretching, orthotic heel pads and supportive shoes are good places to start.  Rolling the foot over a cold can of soda is a good way to massage the area.  A flare of plantar fasciitis is not the time to go barefoot running. 

Sometimes a device to help stretch the ligament at night is helpful.  One of my favorites is the Strassburg Sock, which can be purchased online for $30.  It keeps your foot positioned so that the ligament is stretched while sleeping.

When it comes to running again, my advice is to go slow, and listen to your feet!

Let your symptoms be your guide.  If you start running and have pain, stop: you’re not ready to run yet.  Even though it is difficult, be patient. 

For a more “scientific” approach, use the 50% rule, or, if feeling old and out of shape, the 25% rule.  It’s simple.  Start at 50% (or 25%) of your usual distance or 50% (or 25%) of your usual running time and gradually increase your activity level by 10% each week.  If you feel twinges of pain, back off.

A note of caution: The term plantar fasciitis implies an acute “itis” or inflammation.  If the pain has persisted for weeks it is likely that the acute phase has ended and has been replaced by a more chronic, degenerative “osis.”  

NSAIDs such as Aleve, ibuprofen and aspirin can be helpful if there is an “itis” problem.  However, they are much less helpful for an “osis” problem.  When used sparingly, and for a short duration, NSAIDs work.  I get nervous when I see them used on a long-term basis due to their effects on different systems in the body.

So, in a nutshell, rest, stretch, go slow and be patient.  Use low- impact alternatives until your feet are happy again.

This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Heiks to people submitting questions.

Please email your question to Dr. Heiks: heiks@creeksidebluffton.com  If your question is selected your identity will remain confidential.