Aching Heel Blues

Back when I was a runner, thinking I was someday gonna do the Boston Marathon, there were some injuries joggers had to try and avoid: Getting run over was at the top of the list; shin splints, back spasms, sprained ankles, knees and hip problems, and plantar fasciitis.

I was doing five or six miles a day, ten on the weekends, and was largely healthy. I pulled a back muscle once; got run off the road by a drunk coming out of the Federation of Eagles Christmas party -- which resulted in a badly-sprained ankle, but I had good shoes and avoided other foot, knee, or hip injuries, plus the drunk missed me.

I quit running some years back when I moved to Oregon and discovered ice storms, and other than walking the dogs and doing martial arts's forms, (djurus), don't spend a lot of time on my feet on hard surfaces. Even so, I have, somehow in the last couple of weeks, developed in my right foot what I am pretty sure is plantar fasciitis. This is known by a variety of other colorful names, ranging from "dog heel," to "policeman's foot," to "flip-flop disease." We were basically designed to walk on soft earth, and the sidewalk isn't that.

For those of you who slept through the Podiatry 101 lecture in medical school, this condition is an irritation of the -- ahem -- plantar fascia, aka the plantar aponeurosis -- which is the ligamental structure under the foot that supports the arch. In severe cases, you can get a calcaneus (heel) spur that makes things worse.

The differential diagnosis for heel pain is a short one, and the symptom that generally decides it is a horses-not-zebras thing: The heel hurts when you get up, either from sitting for a while or when you first awaken in the morning. It tends to get better after you stretch out a little, but worse if you push things. Given that presentation, the diagnosis is 90% for fasciitis, with a couple of other things, like stress fractures and nerve impingement to be ruled out.

About one person in ten has this at any given time, and it is more common in folks who pound a lot of pavement -- "mailman's foot"" is another name for it.

Everything is all connected down there around the foot bone, and the treatment for mild to moderate plantar fasciitis is pretty much the same for most tendon problems -- rest, ice, compression, elevation. Working the foot and ankle helps, Achilles tendon stretches. Picking up marbles with your toes, calf-raises on a step, like that.

One of the ways to ice it is novel -- freeze a water bottle or use a frozen juice can. Put it on the floor and roll it back and forth under your heel and arch. NSAIDs -- aspirin or ibuprofen -- help. Arch supports, heel cups, good shoes. Apparently New Balance makes walking and running shoes designed to treat this, and I expect I'll be hunting down a pair of them.

Never a dull moment.