Clean Run - March 2011 - 49

Help for Heel Pain:
The Facts About Plantar Fasciitis, Part 1
By Dr. Dan Altchuler, DPM Photos by author Illustrations by Sole Supports, Inc.

“When I wake up in the morning and get out of bed I can’t walk. The pain in my heel hurts badly. After a few steps the pain starts to ease and eventually decreases as the day goes on. And if I sit for any length of time and get up, it starts over again.” I am a competitive agility enthusiast as well as a practicing podiatric physician. I have seen and treated many agility handlers both locally, nationally, and internationally. Since heel pain seems to be one of our most common physical complaints, here I’ll share my experiences regarding the causes and treatments of this ailment. I mention heel pain instead of plantar fasciitis (pronounced plan-ter fash-ee-eyetus) because not all heel pain is plantar fasciitis. Most handlers who have heel pain self-diagnose with the help of the Internet or a doctor and/or friends who have suffered heel pain. Almost always, whether or not it is correct, the diagnosis is plantar fasciitis. Then we educate ourselves about what to do to treat plantar fasciitis. If we do the correct self-treatments and the problem is plantar fasciitis, the condition improves, and we are back to running our dogs with no heel pain. If the treatment fails, however, our condition gets worse, our frustrations grow, and our quality time with our dogs diminishes. This is usually because plantar fasciitis is the wrong diagnosis, or the way we are treating it is wrong. First we’ll discuss what plantar fasciitis is and how it occurs. Then we will begin our discussion on treatment by covering how to stretch correctly for plantar fasciitis. I have found stretching to be the single most important treatment for plantar fasciitis.

around the heel, it attaches to the membrane around the heel bone. The Achilles tendon is now renamed the plantar fascia since it is now connecting bone to bone rather than muscle to bone. If for some reason, the pull at the attachment of the plantar fascia to the heel bone is too great, it rips the membrane away from the bone and we have just created plantar fasciitis, or an inflammation of the membrane (periosteum). See Figure 1. 1

So what causes the membrane to rip from the bone, and why is it so prevalent with agility handlers? To answer this, we first have to understand the mechanics of the foot and then the mechanics of the foot during our sport. There are volumes of technical information on the Internet discussing plantar fasciitis from a biomechanical/medical point of view, and if interested, spend some time doing your research. (Caution: Remember there are no editors on the Internet). For our purposes, here is a simplified overview. During locomotion (movement of the body), the foot goes through a locking and unlocking mechanism. This is known as pronation (unlocking) and supination (locking). The term pronation means the movement of the arch is collapsing. The term pronated is the position of the foot with the arch collapsed. The term supination means the movement of the arch is rising. The term supinated is the position of the foot with a high arch. See Figure 2. 2

What Is Plantar Fasciitis?
Have you ever eaten spare ribs and pulled the meat off the bone? Did you notice that thin membrane that seems to rip off the bone? This membrane (periosteum) is wrapped around all of our bones including the heel bone. As the Achilles tendon comes down the back of the leg, it grabs onto the heel bone (calcaneus) and makes a turn underneath the heel extending out to the toes. As it wraps
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Clean Run - March 2011

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