Every runner has to deal with an injury at some point in his or her journey. It may be as serious as a stress fracture, or it could be something minor like a small muscle strain. Whatever end of the spectrum one’s injury may be, every runner can be certain that at least a small ache or pain will creep up during training. Though injury prevention is critical, it is very important to be prepared when an injury comes.
Many injuries share similar symptoms, and it is important to be able to identify accurately what is going on. This is important because different injuries require different treatments – some may require simply going a bit easier for a day or two, while others require more treatment before returning to full training.
Two injuries that can be easily confused with each other are plantar fasciitis and heel spurs. Plantar fasciitis can develop into heel spurs, but these are two different injuries with two different treatments. However, both have very similar symptoms that could be easily confused with each other.
Both plantar fasciitis and heel spurs are conditions that cause one to develop chronic or periodic pain in the heels. It is important to know the difference though so that if you feel this pain, you can first accurately assess what is really going on with your feet or heels. From that assessment point, you can determine treatment in order to reduce or eradicate symptoms.
What is the Difference?
The source of pain from plantar fasciitis and heel spurs is slightly different. Though they both originate in the feet, plantar fasciitis will be felt more in the arch of the foot and the heel.
This injury occurs because of overuse of the plantar fascia. a ligament that stretches underneath the sole and attaches the ball of the foot to the heel.
1. Plantar Fasciitis
For someone who runs quite a few miles every week, it is clear that this ligament receives its fair share of pounding. In addition to an excess pounding from running, this can be caused by carrying weight your body is not accustomed to, wearing unsupportive shoes, or spending too much time on your feet.
In addition to pain through the arch of the foot and the heel, you might experience redness, swelling, and inflammation in the plantar fascia. This would likely result in sharp pain in the morning. However, as the plantar fascia gets warmed up by usage throughout the day, the pain may subside. The telltale sign of plantar fasciitis is an aching and burning pain in the heel.
Though these are different injuries, plantar fasciitis, if untreated, can actually develop into heel spurs, which is a more serious condition.
2. Heel Spurs
Heel spurs are a more serious condition than plantar fasciitis. Heel spurs develop from either plantar fasciitis or Achilles tendonitis. If the pain is located on the bottom of the heel, it is likely from overuse of the plantar fascia. If the pain is located more towards the back of the heel, then the spur likely developed from overuse of the Achilles tendon.
Heel spurs are small calcium deposits on the heel bone. These develop in a jagged shape in response to trauma or overuse of the plantar fascia ligament or Achilles tendon.
Since these are not simply tenderness or overuse injuries, they may have more serious symptoms. The most common symptom is stabbing pain in the heels. This pain is caused when the calcium deposit sharpens and stabs into the fatty pad of the heel.
Just like plantar fasciitis, pain from a heel spur is at its worst first thing in the morning, but it becomes more intermittent throughout the day. Heel spurs are especially important to treat right away because these jagged calcium deposits can damage the fatty pad that supports the heel and cause permanent damage.
How Should I Treat Plantar Fasciitis and Heel Spurs?
If you have now determined that you have either plantar fasciitis or heel spurs, you are probably wondering how you can begin to treat this problem. It is important to start treatment immediately so that plantar fasciitis does not develop into a heel spur, or a heel spur does not cause permanent damage to the foot.
1. Plantar Fasciitis Treatment
For treating plantar fasciitis, it is important to avoid doing additional damage to your foot. If you are someone who spends a lot of time on their feet, make sure to give yourself a few breaks during the day to sit down and relax.
For runners, this is admittedly hard. We spend so much time on our feet every single day. So for you, this might mean taking a few days easy or completely off from training until the pain subsides. Additionally, it can be very beneficial to ice your sore feet.
Like any other muscle, the ice will speed up recovery and will get you back to training quicker. Once you are back to training, make sure that your training shoes have a thick cushioned sole that will reduce the impact on your plantar fascia. If you need a little extra cushion, it also could be helpful to invest in a pair of orthotic inserts.
Heel spurs are slightly more difficult to treat because they often are the result of either plantar fasciitis or Achilles tendonitis. Unfortunately, since heel spurs are calcium deposits that build up on the bone, they may require surgery. However, not all heel spurs need treatment to this extreme.
Treating Both Plantar Fasciitis and Heel Spurs
Don’t worry about taking an extended time off of training just yet. There are a few ways that you may be able to alleviate pain without having an operation. Like plantar fasciitis, it would be a good idea to take a few days completely off of training to allow your plantar fascia to rest.
When training, make sure you are wearing a good shoe with a thick and cushioned sole. Orthotic inserts would also be a good investment if you are struggling with a heel spur. Furthermore, it might be a good idea to invest in some night splints or tape the stressed tendon.
Night splints stretch the plantar fascia while you sleep, as does taping, keeping the muscle flexed, which relieves pain and tension during the day. A night splint is my personal favorite way of dealing with plantar fasciitis as it requires little to no extra effort on your part, only to remember to put on your night splint before you go to bed.
Night splints and taping are especially helpful for morning heel pain. Taping the stressed tendon keeps everything in place and allows it to resume normal functioning. Additionally, night splints and taping do not have to continue once the pain is alleviated. Lastly, there are several stretching exercises that anyone, whether you are struggling with heel spurs or not, should consider incorporating into your routine:
- 1. Calf Stretch: To stretch your calf, lean forward towards a wall with one knee straight and your heel on the ground. Put your other leg forward with your knee bent. You should feel the stretch in the calf of the leg that was straight. Hold for ten seconds, relax, and repeat about 20 times. Make sure to stretch both legs.
2. Plantar Fascia Stretch: Sit down and cross your foot over your opposite knee. Grab your toes and pull them towards you slowly. Place your other hand on the plantar fascia to make sure it is being stretched properly. It should feel like a tight band. Like the calf stretch, hold for ten seconds, relax, and repeat about 20 times. Make sure to stretch both feet.
If the heel spurs continue to be aggravating and painful, then a medical procedure may be necessary. However, 90 percent of patients that struggle with heel spurs will improve within ten months. This means that it is very rare to have truly exhausted all of your options and still need surgery.
But, before surgery, you may want to try a cortisone injection. Cortisone is a type of steroid. It is a powerful anti-inflammatory that can help ease pain in tight and sore muscles. However, do not overdo these cortisone injections. Multiple injections to the plantar fascia can cause the ligament to tear, which leads to chronic pain. Make sure to consult with a doctor before considering this option.
If you have been actively and aggressively treating your heel spurs for over one year and they have not gone away, then unfortunately, you may need surgery. There are two types of surgery that treat heel spurs: gastrocnemius recession and plantar fascia release. Before considering either of these, you want to ensure you have spoken to one or more specialists.
Gastrocnemius recession is a lengthening of the calf muscle. Tight calf muscles further strain the plantar fascia. If you are still having difficulty with flexing your feet after a year of treatment, then this is likely the surgery for you. The calf, also called the gastrocnemius, is comprised of two muscles. In this surgery, one of these muscles will be lengthened to increase the range of motion in the ankle. There is a very low complication rate for this procedure.
Plantar Fascia Release
Plantar fascia release is a better option if you do have that normal range of motion in your ankle, but the heel pain persists. This surgery takes the plantar fascia ligament and partially cuts it to relieve tension that has built up in the tissue. Additionally, if you have a particularly large heel spur, then this will be removed during surgery as well.
This surgery will take a little longer to recover from because it is most effectively done with an open incision, while gastrocnemius recession can be done without an incision. The biggest complication from this surgery is if the pain is not completely relieved, but most patients have good results.
How Can I Cross Train While Injured?
I know that for runners, taking a break often takes more of a mental toll than a physical toll, even if it is only for a few days. However, there are ways to continue training for the runner that only needs a few days off and for the runner that needs a more extended time to recover. Some good ways to stay active while still resting and recovering are elliptical/elliptical, biking, and pool running/aqua jogging.
1. Elliptical: An elliptical relieves some pressure from the foot, but not all. Some runners have invested in a piece of equipment called an Elliptigo. This is simply an elliptical on wheels so that you don’t have to be stuck in a gym staring at the wall because as runners, we are used to absorbing the scenery and changing locations on the run. This is a good option to stay active, but only if the pain is already very minimal. Be careful with this option, however, because the elliptical can contribute to stress on the plantar fascia if used in excess.
2. Biking: For the stress on the feet, this is an even better option than the elliptical. However, this may work the leg muscles in a very different way than running would, so be careful that you are not overworking your legs. You do not want to injure something else by cross-training too aggressively on a bike.
3. Aqua Jogging: This is the best option for an injured runner with heel spurs or plantar fasciitis. This completely relieves pressure on the foot because there is no pounding at all. Additionally, the water pressure relieves sore muscles.
However, it might be the most difficult option logistically because most need a flotation device called an aqua jogging belt and a pool deep enough that you do not end up hitting the ground. Although, there are ways to replicate this without a flotation device or deep pool. Swimming is one way, but if you’re like me, the strong running lungs do not translate into the water very well.
Just because you cannot continue to train normally does not mean that you have to stop training altogether. Even when you are back to running, it is still good to take one or two of these and incorporate them into your weekly routine.
For example, after a harder run, take 30 minutes later in the day to get in the pool and swim or aqua jog. The water pressure acts as a natural massage on sore muscles and will ease tightness for the next day. It is also good to have one day to just cross-train. This helps avoid future overuse injuries while still keeping your active lifestyle in place.
While plantar fasciitis can prove to be a mild annoyance, heel spurs can be a debilitating injury that may require surgery and lead to weeks off running. Therefore, if the pain in your foot is significant and consistent over time, consider seeing a doctor to ensure that you do not have heel spurs.