Vic Goradia, MD
Knee, Shoulder & Sports
Medicine Specialist
Go Orthopedics
GoOrtho.net

Question: I began running about a year ago and have really enjoyed the sport. I had been steadily increasing my frequency and mileage until recently when I began experiencing pain in my heel and along the arch of my foot. It is typically worse in the morning when I wake up and subsides a little throughout the day but becomes aggravated again when I run. Have I done something serious or will this go away as I readjust to my latest increase in mileage?

Answer: This sounds like plantar fasciitis, which is an injury to the tissue on the bottom of the foot.

The plantar fascia is a strong band that runs from the heel to the ball of the foot and helps to maintain a normal arch. Repetitive injury can lead to microscopic tears in the tissue which cause pain. The condition, however, is also common in individuals that stand or walk for prolonged periods.

In some people a small bone spur will form on the bottom of the heel bone. Fortunately this spur does not have to be removed and symptoms of plantar fasciitis will go away in most people with Achilles stretching, ice and a heel cup insert (available at most pharmacies). It is not commonly associated with increasing running mileage, but you should cut back to your previous level or even lower in order to rest the fascia. If that doesn’t help then you may need to cross train into other aerobic exercise such as cycling or swimming for a short period while the plantar fasciitis heals.

If symptoms persist then a doctor may prescribe physical therapy, a night splint, custom orthotics or in some cases a cortisone injection. A therapist can help you do the correct stretching and tape the foot to reduce stress on the fascia. A night splint is a device you wear on your foot and ankle at night; it helps to stretch the Achilles while you are sleeping.

If simple heel cups do not provide relief and taping the foot helps, then a custom orthotic insert may be needed. I rarely give cortisone injections for plantar fasciitis because repeat injections in this area can actually be harmful. However, if symptoms are very severe and disabling then a single injection may be indicated.

Finally, any runner, who has bone pain after increasing mileage, raises suspicion for a stress fracture. A stress fracture of the heel causes pain with the first step of running and gets worse as you continue. Compressing the sides of your heel with your hands will increase the pain if it is a stress fracture while plantar fasciitis causes tenderness on the bottom of the heel. If there is any concern for a stress fracture then you should visit a sports medicine physician for an exam and x-rays.