Many runners will consult a podiatrist for their initial physician visit for lower extremity injuries. Diagnosing and treating the most common running injuries requires finding the cause of the injury and going beyond simply treating the symptoms. Injured runners will often show up in the office with a bag full of old running shoes, a training log and a self-diagnosis. In my practice, runners tend to be the most well-informed patients and simply advising these patients to refrain from running could lead to them seeing another doctor.
Stretching of the gastrocnemius-soleus complex remains the mainstay of treatment of heel pain. Encouraging patients to perform stretches three times a day during a three-week period should improve most cases of fasciitis. Ask patients to perform the stretches barefoot, hold the stretch for 30 seconds and repeat it five times for a total of 15 per day. Treatment must also include good supportive shoes that do not bend in the arch, icing, a night splint (I prefer the Strassburg Sock) and NSAIDs in the initial 10- to 14-day period. Rolling the heel over a frozen water bottle will provide a massage of the area that helps break up scar tissue in addition to the benefits of icing. If the patient’s symptoms persist after this intial treatment course, then one may institute a local corticosteroid injection, custom orthotic devices and physical therapy. Extracorporeal shockwave therapy (ESWT) may be indicated in recalcitrant cases that are confirmed to be plantar fasciitis.1 Once one has eliminated the patient’s symptoms, one should proceed to initiate strengthening of the intrinsic musculature in order to prevent future recurrences of plantar fasciitis. Instruct runners to begin strengthening by picking up a towel with their toes, balancing on one foot and then progress to barefoot strides. If grass fields are unavailable for barefoot running, a new shoe, the Nike Free 5.0, shows excellent promise as a training tool to strengthen the intrinsic muscles. Nike’s research shows that the shoe allows the foot to function similar to being barefoot. When it comes to chronic cases of plantar fasciitis, keep in mind that having a runner wear a custom orthotic device and/or a motion control running shoe is akin to placing the foot in a cast, and atrophy of the intrinsic musculature is inevitable.
Here at Charlestown Podiatry Clinic, we have the skills and experience to treat patients with all types of podiatry requirements. Our clients range from children to the elderly and everyone else in between. We treat athletes’ injuries from the elite to social levels and have developed quite a reputation amongst the sporting community.