Put your pain-free foot forward

Stay off the sidelines and in the game. Our espnW physical therapists dish out cutting edge advice for avoiding (and quickly rehabbing) common sports-related injuries.

The injury: Plantar fasciitis. If you didn't know the name, you'd simply call it "heel pain." Plantar fasciitis is a very common foot injury (two million Americans are affected each year) that flares when the plantar fascia -- the thick band of tissue that runs along the bottom of your foot -- becomes irritated or inflamed. Normally the plantar fascia acts as a suspension bridge connecting your heel bone to your toes, absorbing shock with every step you take. Put too much strain on it from poor footwear, overuse (i.e., long distance running or high impact activities), or simply spending lots of time on your feet can cause the tissue to breakdown and become painfully inflamed. It's common among athletes of all kinds, especially those who put a lot of stress on the plantar fascia via running and jumping, like marathoners, basketball players and dancers, as well as people who have flat feet or abnormally high arches or who are overweight. Women are more prone to it, especially during pregnancy. And we're all more susceptible with age.

What it really feels like: Stabbing pain in your heel or arch that forces you to limp along until it subsides. It's usually sharpest first thing in the morning and will often subside as the tissue warms up. But don't be fooled. Until it's resolved, it'll come roaring back after long periods of standing or physical activity, or after getting up after sitting for a long time.

Who's been there: Plantar fasciitis pain left Giants starting quarterback Eli Manning hobbling through much of the 2009 season. NBA ballers Rajon Rondo of the Celtics and the Spurs' Tim Duncan have had well-documented battles with persistent foot pain. And in the worst case scenario category, Antonio Gates, star tight end of the San Diego Chargers actually "popped" his plantar fascia in his right foot last year, forcing him to sit out most of the 2010 season. "That's not only painful, but it weakens your foot because you lose some of the tension that literally gives you spring in your step," said ESPN injury analyst Stephania Bell, PT.

Don't feel their pain: Heel pain can easily become chronic, so it's important to act quickly and get off your feet when you feel that first ache, Bell said. "You really need to cut back on activity right away. There aren't any fancy cures for plantar fasciitis, but you can resolve it if you're vigilant." Along with the tried and true advice to rest the foot and take NSAIDs, if you tolerate them, during the first few days, here's what she recommends:

Stretch and pump. Stretching is the single most important treatment for heel pain. It's especially important first thing in the morning, Bell said. "When you sleep, the weight of the sheet pulls the feet in a pointing direction, which puts the fascia in a shortened position for hours. Then you wake up and -- bam! -- load it up in a fully stretched position." Instead: Sit on the edge of the bed with your feet dangling. Pump your ankle and flex and extend your foot up and down 15 to 20 times. Then take a towel or strap and loop it around the ball of your foot, stretching the foot upward. Hold 30 seconds. Repeat 15 to 20 more pumps. Then loop the towel around your toes and bend your toes back toward you. Hold 30 seconds. Repeat that sequence three to four times a day.

Ice rolls. Freeze a ribbed plastic water bottle or a golf ball and roll your foot along it, massaging deeply, three to four times a day. "You want to mobilize the plantar fascia and release that tension," Bell said. The cold helps numb the discomfort.

Establish a support system. Your doctor or therapist may prescribe orthotics to support your foot and stretch the fascia as well as a night splint to help prevent it from tensing up. A therapist may also teach you how to apply supportive tape to the bottom of your foot. Check your footwear. Supportive shoes that are well padded in the heel and fully support the foot, while allowing it to move naturally are a must not just to resolve it, but also to keep pain from coming back. As for barefoot (or minimum footwear) running as a cure-all for plantar fasciitis, not so fast, said Bell.

"Everyone's feet are different. Some folks have a more rigid foot while others are extremely flexible," she said. "While barefoot running may suit some foot structures, other feet benefit from the accommodative support of shoes and they could literally run into trouble."

Consider alternative treatments as a last resort. Cortisone shots, shock wave therapy (where they deliver sound waves onto the affected area) and surgery to release the fascia are all potential treatments for stubborn cases lasting longer than six months to a year. But their track records for relief aren't great and they all carry potentially painful side effects.

* -- This does not substitute for medical advice.

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