Plantar fasciitis, inflammation of the ligament on the bottom of the foot, is common in athletes. Arnel Reynon Illustration
Richmond native Kelly Valovalo was a month and a half into training for her first marathon when she began to notice sharp pain in the arches of her feet — the first signs of a severe case of plantar fasciitis, a foot condition that's common among athletes and those who are constantly on their feet.
"Typically, plantar fasciitis is an overuse injury, whether it's from someone athletic or someone who does a lot of standing," says Dr. Sonya Faircloth*, a podiatrist with Foot and Ankle Specialists of Virginia. Faircloth notes that the typical scenario is significant pain after periods of inactivity such as "that first step in the morning or after you have been sitting at your desk a while."
Dr. Simon J. Mest, assistant professor at the VCU Medical Center Orthopedic Clinic (he also diagnosed Valovalo), defines plantar fasciitis as the inflammation of the three-banded ligament on the bottom of the foot, known as plantar fascia.
Faircloth adds that the inflamed plantar fascia tears away from the middle portion of the heel bone and causes pain in the arch and heel, pain that patients often misinterpret as a heel spur.
Valovalo also had her running analyzed by Dr. Robert S. Adelaar, an orthopedic surgeon at the VCU Medical Center, and discovered that she walked on her the balls of her feet. But as she moved, she shifted the weight and ran flat footed, which pulled on her Achilles tendon and produced the inflammation. Adelaar prescribed heel lifts and Power Step insoles for her, which helped distribute the weight.
Although cases of plantar fasciitis vary according to severity of overuse and shape of the foot, Mest says the first treatment steps are always to ice (15 minutes, twice a day), stretch (wall push-ups and calf stretches) and rest the affected areas. Mest immediately treated Valovalo with cortisone shots in her heels — but her case was so severe, the pain escalated. "My plantar fasciitis reached the point that it hurt from the moment I woke up until the moment I went to bed," she says. "It was extremely bad. You could see the tendon sticking off the bottom of my foot." Determined to finish her marathon, Valovalo continued her painful runs and, as a last resort, attended physical therapy, a step prescribed by Adelaar.
"What really made the difference is the deep-tissue massages in my arches," she says. "I saw immediate improvement." These massages, twice a week for four weeks, removed the inflammation and released the pain, Valovalo says. She also began stretching more frequently to reduce the tightness in her Achilles tendon and calf muscles. The combination of measures helped Valovalo soldier through the 26.2 miles of the SunTrust Richmond Marathon.
Faircloth adds that if plantar-fasciitis patients do not respond to treatment in four to five weeks, surgical intervention is an option. "You surgically release the plantar fascia," she says, adding that patients should be back in a regular shoe in two to five weeks post-surgery, depending on the type of procedure.
Runners are not the only ones affected by plantar fasciitis, Mest says. The condition can be prevalent in those who select shoes with improper cushion or fit — particularly frequent high-heel wearers. "If you wear [high heels] all the time, you can shorten your Achilles tendon," he says.
However, Faircloth adds that if one has plantar fasciitis, wearing a small heel can actually help with the painful symptoms. She encourages wearing shoes with arch support, which can be easily identified by feeling the inside of a shoe before purchase.
Mest says shoppers (including runners) should shop where staffers professionally measure the customer's shoe size. Also, he adds, shop at the end of the day rather than in the morning — because feet always swell throughout the day — and look for shoes that are comfortable and flexible.
Valovalo says she has adjusted her shoe habits and now only wears her flats or UGG boots for limited periods of time. "I can feel it in my feet," she says. "They get sore from walking in my flat shoes for so long … I can feel my arches falling."
Back to normal health, Valovalo is donning not only her supportive running shoes for the Ukrop's Monument Avenue 10K on March 28, but a costume as well
*Dr. Sonya C. Faircloth's medical credentials are as follows: DPM, FACFAS (Fellow of the American College of Foot and Ankle Surgeons) and board-certified by the America Board of Podiatric Surgeons.