What we can Learn about Running from Barefoot Running
Daniel E Lieberman, PhD
Department of Human Evolutionary Biology
Harvard University, Cambridge, MA
Grand Rounds presented on March 15, 2012 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA
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For most of the day, our feet are bound within stiff shoes and many of the soft tissues within the feet are infrequently used. This is a simple yet very effective exercise to stretch the heel, the plantar fascia and the toes.
If you have heel pain, perform this stretch as you wakeup and place your feet on the floor. This can also be performed while sitting in the office or on the couch.
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A warm-up exercise to perform before running or participating in sports. This stretches the Achilles tendon as well as calf muscles. If you have heel pain (plantar fasciitis), this stretch may help alleviate the pain. You don’t need to go to a health club or gym to do this exercise, it can be performed while sitting in your office or waiting in the coffee line, or even during a walk in the park.
Stretches demonstrated by Meg Vitter of Boston, MA.
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Heel Pain Can Be Debilitating:
“Getting out of bed each morning was painful,” recalls a patient of her yearlong experience with heel pain. “As I place my foot on the floor, I could feel a sharp pain in my heel and could only shuffle about the room. It would loosen up after a few minutes, but my foot would continue to hurt as I went through the day.”
Heel pain with the first steps getting out of bed in the morning, or when standing from a seated position, are the most characteristic symptoms of plantar fasciitis (fashee-eye-tiss). Pain can also occur with prolonged standing and walking. The sharp pain is usually on the bottom inside part of the heel. While it most often occurs in only one foot, it can affect both feet.
Plantar Fasciitis Causes Heel Pain:
The plantar fascia is a tough, fibrous tissue band running under the soles of your feet, and connects the heel bone (calcaneus) to the base of the toes. It also helps support the arch of the foot in its role as a shock absorber. An injury or continuous irritation of this tissue causes plantar fasciitis and the resulting heel pain.
Multiple factors likely cause plantar fasciitis. It tends to affect people between 40 and 70 years of age, more likely in women, people who are overweight, or have jobs that require a lot of walking or standing on hard surfaces. Runners may be at a higher risk. People with flat feet or high arches are also more prone to plantar fasciitis.
Treatment Options:
The following self care measures may help reduce symptoms.
Day wear splints can be worn with regular shoes. They keep the heel stretched and provide pain relief throughout the day.
Night splint worn to bed is effective in keeping the plantar fascia stretched while sleeping and can prevent early morning heel pain.
In the vast majority, plantar fasciitis will resolve itself within three to six months, but in some patients it can take a year or more. When symptoms fail to improve after 4 to 6 weeks of home treatment, see your doctor or foot specialist.
If heel pain is accompanied by unusual symptoms such as back pain, burning in the foot, or recent trauma, see a specialist. In case of severe and persistent pain that has not responded to conservative treatments, your doctor may prescribe a removable walking cast. This will keep your foot immobile for a few weeks, to allow it to rest and heal. Other treatments include ultrasound therapy directed at the area of heel pain, or even cortisone injections.
Surgery As Last Resort:
Only a tiny percentage of people undergo surgery, which includes detaching the plantar fascia from the heel bone. “Surgery should be the last resort when all other treatments have failed, and the pain remains severe for over a year,” insists Dr. Richard de Asla, Co-Director of the Foot and Ankle Service at the Massachusetts General Hospital and Instructor of Orthopaedic Surgery at Harvard Medical School, Boston, MA.
“We rarely operate on this condition because in most patients the pain resolves on its own with time. Furthermore, the surgical success rate is only about 70% with the potential for other complications,” reminds Dr. de Asla.
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