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Ask the Doctor: Alleviating the Foot Pain From Running

Do you have plantar fasciitis? Not sure what to do about it? Read on.

The question I received for this week comes from Rich:

I run about four times a week and sometimes have pain in the arch of my foot. It isn't too bad, but it can cut my runs short. Any advice?

I work on quite a few runners, ranging from the recreational runner all the way to the IronMan athlete, and plantar fasciitis, along with knee and hip issues, is just one of the problems runners can develop. 

The arch of our feet has fascia (connective tissue) that helps support the tendons, ligaments, and other small muscles in the bottom of our feet. During natural gait mechanics, as one foot takes the majority of our body weight, the foot actually lengthens a little and the plantar fascia is supposed to stretch as well. When the plantar fascia becomes too tight from overuse (or sometimes not enough use), it doesn't like to lengthen and stretch with the rest of our foot. Over time, pain and swelling develop and it hurts every time we put weight on the affected foot. 

Although I recommend getting this checked out by a health care professional, there are some simple things that can help alleviate the problem.  

  • Ice— Anytime you hear the word 'itis' attached to the end of something, it means there is inflammation. Ice is a great way to get the inflammation down. When applying ice, make sure you have at least one layer of a small towel between the ice and your skin. When icing small areas like the feet or hands, you really only need to ice for 10 minutes at a time. Icing two to three times a day can really help.
  • Running Biomechanics— Most of us tend to heel strike when we run.  This leads to a lot of impact on our joints and muscles. There is a technique to running even though it seems so simple. Mid-foot or forefoot striking both alleviate the pressure caused by heel striking and can lead to fewer joint and soft tissue problems. There are a lot of videos and articles around the Internet to describe this style of running further.
  • Shoes— Shoes can actually cause more problems than they are supposed to help. While it isn't feasible to run barefoot in a city, shoes that take a minimalist approach may be an option for you. This varies widely from person to person - some do great with these style of shoes and some don't. Vibram and Merrell Pace or Trail Gloves are examples of shoes out there that mimic barefoot running. I recommend the New Balance Minimus. I currently run in shoes that have a 4mm heel drop, meaning that the heel is only 4mm higher than my toes (they have a 10mm and a new 0mm style as well). Your typical style tennis shoe has a pretty elevated heel, forcing us to heel strike. There is also a small arch support built into shoes, but this keeps the plantar fascia in a chronically shortened position so that when it needs to lengthen, it doesn't have the flexibility.  
  • Tennis Ball— Using a tennis ball, golf ball, or a lacrosse ball on the bottom of your feet can help break up some knots and restore some blood flow to the area. This is easy enough to do while sitting: just roll your foot over the ball. Be careful not to overdo it— two to three times a day for about a minute each time is all you should need.
  • Walk Barefoot— When possible, shed the shoes and walk around barefoot. This helps keep the small muscles in our feet and ankles flexible and strong. There is also a direct brain connection going on - when we walk barefoot, our feet have to respond to the environment they are walking on. Walking on a sandy beach, for example, is a great way to work on balance and coordination and strengthen our feet. Because our brain has to respond to these changes in environment as well, the number of synapses increases and there is more brain activity - keeping our brain stronger and more flexible.
  • Active Release Techniques (ART)— This is a great method for restoring mobility into the bottom of the foot. I see a lot of great results with my runners and we soon get them back on track (no pun intended).

These are just some of the things you can do with plantar fasciitis to help alleviate any pain. Again, it is important to check with a health care professional. 

Do you have any questions for Dr. Qureshi? Email them to QureshiDC@gmail.com, or post in the comments section below.

RUBY HENRY April 19, 2012 at 12:47 PM
HI Dr.Qureshi, I have been having foot pain for awhile especially along the side, inside of the arch, back of heel to the lower calf, and down the top of foot. My question is what is causing this problem. I have been diagnoise to having flatfeet.
Ez Dav April 19, 2012 at 06:21 PM
I had plantar fasciitis and I managed to cure it with exercises like they show here - http://www.plantar-fasciitis-elrofeet.com/plantar_fasciitis_exercises.html
Lou Renner April 19, 2012 at 08:55 PM
Actually it IS feasible to run barefoot in the city. Well, as close to barefoot as you can get. I wear Invisible Shoes sandals -- they're a thin layer of rubber, just enough for protection and they let your foot move totally naturally.
Ayesha Qureshi April 20, 2012 at 02:09 PM
Thanks for reading and I hope some of the tips in the article can help you out! Without actually taking a look at you and your biomechanics, it's hard to give you a clear cut answer as to what is happening. It sounds like plantar fasciitis is only part of the problem. If you're having pain in the back of the heel and up the calf, there could be some achilles tendon involvement as well. Flat feet contribute to any foot pain and certainly alter normal gait biomechanics; the trick is to strengthen and correct what we can. I usually give my patients quite a few stretches and exercises to help. Again, without actually seeing what you look like, it's hard for me to give a definitive answer for you. I hope this was helpful! Email me if you have any further questions!
Ayesha Qureshi April 20, 2012 at 02:12 PM
My husband actually purchased some Invisible Shoes as well last year. And yes, that is as close to barefoot as you can safely get in a city environment! Thanks for reading!

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