Health — Many people suffer from the malady, but there are steps to help you to combat it

Dear Colin: I’m a 38-year-old runner and have been running since I was 16. I’ve never really had any serious injuries, but over the past few months I’ve been getting more and more heel pain in my right foot after running for only 10 to 15 minutes. My preferred care provider referred me to a podiatrist who diagnosed me with plantar fasciitis, which he says is best treated using a cortisone injection, orthotics, ice, rest and lowering my running speed. Is there anything else I can do to help this? I really don’t like running slower ... boring! — Laura W.

Plantar fasciitis is the leading cause of adult heel pain, so you’re in good company. There seems to be considerable confusion and inconsistencies, however, in how to best treat it. Our approach is based on a combination of research and biomechanics; we see consistently positive results, so I’ll share them with you. But first, a little background on the ailment. by: SUBMITTED PHOTO - Practice good form -- The forefoot must be supported during the calf stretch, which should last 15 to 20 minutes.

The term plantar fasciitis is actually a misnomer, as it implies that the plantar fascia (a band of tissue running from your heel to bones near the ball of your foot) is inflamed. Studies show there’s actually little inflammation present; rather, the fascia thickens dramatically (usually 6-10 millimeters compared to 2-4 mm in people without plantar fasciitis) as a result of being tugged on too intensely and frequently (this is called tendonoses). Think of the plantar fascia as a continuation of your Achilles tendon; it simply continues in a wrap-around fashion from the heel to the front end of your foot.

The advice your podiatrist gave you is accurate, but I recommend adding a stretching routine. The cortisone injection, ice, rest and running slower will probably decrease pain but don’t address the cause (excessive pulling on the plantar fascia on the underside of your foot). The orthotic can help by limiting foot pronation (collapsing of your arch), although hip strengthening may be more effective.

“In addition to orthotics, calf/hamstring stretching and lower extremity strengthening are the keys to addressing the root cause of PF,” says Clifford Mah, a Beaverton-based podiatrist. “If the mechanical loads aren’t lowered on the plantar fascia, symptoms will persist. Daily stretching is important, especially before and after activities.”

My recommendations:

Low load, prolonged calf stretching. Stretching the calves for 60 seconds won’t do it, as research shows that to lengthen tissues that have changed structurally (as is the case in plantar fasciitis), stretches should be held for 15-20 continuous minutes (yes, minutes). To do this safely, the forefoot must be supported. It’s not a good idea, for example, to hang your heels off the edge of the stairs, which collapses your arch and loads the plantar fascia.

Strengthen the hip and thigh muscles. Strong hips and thighs will absorb forces while you run, protecting the plantar fascia. I’ve found that most runners don’t do any strengthening, which opens the door to all types of injuries (including plantar fasciitis). Just be sure to keep your ankles in a neutral position during the exercises or you’ll be wasting your time.

You seem to care enough to help yourself, which is required for anyone seeking recovery from chronic injury. Keep me posted on your progress!

Colin Hoobler is a licensed physical therapist, hosts a live health segment on KGW Channel 8 and has written two books on exercise as treatment for disease and injury

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