NEW YORK DAILY NEWS
Sunday, August 27, 2017, 6:00 AM
Dear Running Doc:
Good afternoon. I hope you are having a fun weekend. I have had PF for 1.5 years now. I have tried stretching, cortisone, PRP injections, etc. and nothing has worked.
I love to run but had to give up last year and would love to get back to running. I have tried a few orthotics but have not tried custom fitted ones. What would you recommend? I live in Houston. I have seen a few foot and ankle surgeons but nothing has worked.
Thank you for your advice. Where is your office? Do you treat people in your office for PF?
Best, Jeff W., Houston, TX
I and the New York Daily News hope you and family are safe during this horrific storm.
The good news is your PF (Plantar Fasciitis) should not prevent you from running for more than three weeks. In my office practice in New York City, no one has had to give up running due to Plantar Fasciitis.
Plantar Fasciitis is an inflammation of tight connective tissue on the bottom of the foot making up its arch. A simple routine of ice, stretching, golf ball exercise, custom orthotics and sometimes PRP is all that is needed to get you back to run soon. Lets go through them to be sure you are doing them correctly. Leaving one out may cause the Plantar Fasciitis to linger.
Ice: You must ice the painful area for 20 minutes twice a day. Use a Ziploc freezer bag filled with ice and water. The water raises the temperature to 32 degrees to prevent freezer burn. Just plant your foot on the ice water bag in the morning after you have woken up and the evening before you go to sleep. Avoid those ice contraptions that are too cold.
Stretching: The Plantar Fascia connective tissue attaches around the heal bone to the calf muscles. It acts as a fulcrum (as we learned in high school). Therefore, stretching both the calf muscles (gastroc and soleus) helps loosen the tight Plantar Fascia. Wall push-ups with the knee both straight and bent should accomplish this. When the Plantar Fascia is less tight, there is less inflammation.
Golf Ball Exercise: A hard golf ball rolled back and forth over the most painful part of your arch for 30 minutes daily should do the trick. Remember with this exercise that your condition will hurt more before it hurts less. Dont get discouraged. Some people use a frozen water bottle for this exercise. In my experience, using a golf ball once a day and doing the ice separately twice a day works better than trying to combine these two steps together.
Custom Orthotics: Custom full-length flexible orthotics are a necessary step to combat Plantar Fasciitis. They stabilize the ligaments and prevent it from coming back. Over-the-counter orthotics are as good as over-the-counter glasses. You do need orthotics custom made properly.
Platelet Rich Plasma (PRP): First, Jeff, stay away from cortisone injections. Cortisone weakens soft tissues and, in my experience, causes an increased risk for further problems. If you do all the above steps, you may never need to get to PRP. If you have a bone spur coming out as a pointed projection from your heal, PRP may be necessary. Usually a PRP treatment is done with two treatments 24 to 72 hours apart.
I hope Jeff that the above information helps you to regain your running at a level that makes you comfortable. If you have any further questions, please do not hesitate to write again.
Enjoy the Ride!
Lewis G. Maharam, MD, FACSM is one of the worlds most extensively credentialed and well-known sports health experts. Better known as Running Doc, Maharam is author of Running Docs Guide to Healthy Running and past medical director of the NYC Marathon and Rock n Roll Marathon series. He is Medical Director of the Leukemia & Lymphoma Societys Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.
Want your question answered in this column? Write to running doc at firstname.lastname@example.org.
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