The Plantar Fascia attaches to the Calcaneal Tuberosity and runs to the head of the metatarsal bones( the bones your toes are attached to). It forms a bridge, the arch of your foot and is made to flatten out when weight moves across it, than springs back up again as the weight moves off it. But if you have pain in the arch or the heel, it may be your weight is taking the wrong path along the bridge. If the bridge doesn't bounce back again with each step, you may have a fallen arch. First you may have PF, this means the the fascia has been pulled too hard and it's inflamed. If some of the fascia fibers have pulled away from the Calcaneal Tuberosity and droplets of blood were laid down. They eventually become calcified and form an extra bit of bone called a heel spur. As this process proceeds the body responds by putting a cushion along the line of the heel spur called a bursal sac, thus leading to a Calcaneal Bursitis. All three conditions are aggravated by running on hard surfaces, doing alot of hill running or speed work, or putting in alot of mileage( overuse). Tight calf muscles and hamstring muscles make the strain on the arch even worse. Also a leg length difference will change the path your weight is taking along the bridge(plantar fascia).
If the problem is in only one foot, look at the wear pattern on the bottom of each shoe, are they identical? If one shoe shows excessive wear on the extreme lateral aspect of the heel, you are probably a hyperpronator, which alters the path along the bridge(plantar fascia) leading to PF, heel spur formation and ultimately Calcaneal Bursitis. PF and heel spurs cause pain on the bottom of the heel, this pain is usually first thing in the morning, but lessens after 10-12 steps and usually not painful when running. With PF you feel pain when you press on the middle of the heel, with heel spurs you feel pain when you press the front of the heel, where the heel meets the arch. With bursitis, you also feel pain at he front of the heel. In fact if you have a heel spur you probably also have bursitis, it's not the spur that hurts, it's the inflammed bursa that hurts. Three things can help PF, ice the area after you run, stretch the heel cords, and an arch support to limit the excessive stretching of the PF during stance phase which will decrease the infammatory response. If one leg is longer than the other place a lift in shoe of the shorter leg that is slightly less in thickness that the leg length difference. If none of these seem to work, see a Doctor who treats sports injuries. Take your running shoes along with you so he can compare wear patterns, if he expects a heel spur a simple x-ray will show this.I would never allow a Dr. to give me a cortisone shot into my foot, it offers only tempory relief, hurts like h..l, and could weaken the fascia because cortisone also demineralizes structures like tendons, and ligaments. Hyperpronation can also lead to knee pain, because it causes the tibia to externally rotate relative to the patella, causing the patella to move laterally outside of it's normal groove formed by the Femoral Condyles leading to denerative changes on the under surface of the patella. Shoes, choose shoes with a straight last and a very firm heel counter, because you need rear foot stability. If your Dr blows you off, by telling you all you need to do is lose weight, I would seek a second opinion from a Dr that treats sports injuries. But do what ever you want, it's your foot. I'm not claiming to be an expert, but I was a Physical Therapist for over 38 years, avid runner for over 25 years, and logged over 50,000 miles in those more than 25 years.
I only sought advice from 2 Doctors. One, an Orthopedic Physician, when I developed pain along the anterior shin bone, expecting either shin splints or even worse a compression fracture, after spending 5 minutes with me, never touching my shin bone, he told me to quit running( not what a runner wants to hear) so I agressively started stretching my heel cords and the pain went away. The second time was when I first experienced PF, causing me to crawl out of bed, rather that take those first painful steps. His advice was to take to Advil before running, when I told him I couldn't take 2 Advils for the rest of my life, he suggested I quit running, not an option. After that I did my own research, reading Runner's World and "The Runners Repair Manual" treated my self and continued running for 20 more years pain free.
I hope this has given those suffering from PF some insight into their problem, and things to think about.
I wish you all many more happy miles along the highway of life!
