riders with heel pain

["Beth Glace" <lb@nismat.org>]

For those of you who suffer from heel pain, the majority of adults 
have heel spurs on xray.  However, most do not experience pain.  A 
typical scenario for plantar fascitis is pain first thing in the 
morning upon stepping out of bed.  The pain is due to tightening of 
the plantar fascia, a wide band of tissue lining the bottom of the 
foot.  It attaches into the achilles tendon on the back of the heel, 
runs under the heel and up towards the base of your toes.  It is not 
a very elastic tissue.  People with tight calf muscles who then 
attempt to drop their heel [either in walking, riding or whatever] 
put excessive strain on the this restrictive plantar fascia.  
Orthotics or shoe inserts can sometimes decrease symptoms by 
decreasing the stretch  on the plantar fascia.  The orthotics are 
alleviating the symptoms; they are not alleviating the problem which 
is tight calf muscles [gastrocs].  A better long term remedy for 
plantar fascitis may be to:

1.  if very severe, ice the heel and arch area several times a day.
2.  stretching the calves and plantar fascia; stretching; stretching, 
stretching!!  This can be best done by doing wall pushes: face a 
wall,  lean against it with your arms.  Place the affected foot 
farther away from the wall than the non affected foot and gently lean 
into the wall for a count of 5.  Repeat 2 or 3 times, several times a 
day.  You can also stand at the edge of a stair, holding the 
knee straight and allowing the heel to drop.  After a brief period, 
 allow your knee to bend.  You should feel the stretch in the upper 
calf with the knee straight and in the heel area with the knee bent.  
3.  You can lengthen the plantar fascia by massaging it with your 
thumbs.  Gently press your thumbs into the bottom of your foot just 
in front of your heel, and while gently pressing run your thumbs up 
the length of the foot over the arch, towards the toes.  You can also 
grasp your toes, and pull them towards your shin, flexing the foot 
and ankle.
4.  ICE AFTER STRETCHING.
The most important time to stretch is first thing in the morning.
Good luck!

***** Many podiatrists inject the foot with cortisone.  Cortisone 
injections are potentially danerous.  They may rupture the fascia and 
should only be done as a last recourse when all other treatment has 
failed.****************


 Christine Murphy, Phys. Assistant

 Sports Medicine, Dept of 
Orthopaedics Lenox Hill Hospital NY, NY