Why the first ten steps hurt and the next hundred do not
There is a rope under your arch. It sits short and slack all night.
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How it works The foot has a rope running under the arch. Mine got angry, and I did not know it was there. Turn your foot over and look at the sole. Under the skin and the fat pad, a thick band runs from the heel bone forward to the base of the toes. It is more rope than muscle. Its job is to hold the arch up… and doctors call it the plantar fascia, which just means the band on the sole. Here is how it takes your weight.
The rope and the winch Stand up and your arch flattens a little. The rope pulls tight and stops it flattening further. Then you roll forward and your toes bend up. That winds the rope around the ball of the foot, the way a line winds on a winch. The arch lifts. A floppy foot firms up under you. And then you push off. Doctors call that the windlass. It is a fine piece of rigging, and it runs on every step you take. You can feel it working. Press a thumb into the middle of your arch, then lift your big toe with the other hand. The band comes up hard under the thumb… that is the winch turning. How much of that firming up is the rope and how much is muscle is still argued over. Newer work gives the muscles more of the credit than we used to. The winding is real. The rest is not settled. So why the morning The usual explanation runs like this, and it fits what I felt. You sleep with the foot pointed. The calf shortens, the rope sits slack and short, and it sets that way for hours. Then you stand. Cold and short, it takes your whole weight in one go. It pulls hardest where it grips the heel bone. Walk a hundred steps and it warms and lengthens. That is why step ten hurts and step hundred does not. Sit still for an hour and you start over. Mine caught me every time after the paper. So the pattern is the tell. Bad cold, better warm, bad again after a rest. And a heel that hurts all day, or hurts most at night, is telling you something else. Not the fire I thought it was For years the name told us the thing was inflamed. The itis on the end of fasciitis means fire. In 2003 Harvey Lemont and colleagues looked at 50 samples of that band, taken out during heel surgery. They found the tissue broken up and degenerated. What they did not find was inflammation. The name is wrong, they said. Call it fasciosis, because it is wear and not fire. And they told doctors to think twice about repeat steroid shots, for two reasons. There was no fire there to put out… and a needle full of steroid into a frayed band can tear it. What that changes It changes the plan. A fire you cool down. Wear you load up, slowly, so the tissue rebuilds. But hold the other half too. Those 50 samples came from people bad enough to need an operation. That is the far end of this, not the average sore heel. There were no healthy heels to compare them against either. And people that far along have usually had steroid shots already, which put out inflammation all by themselves. And no inflammation does not mean nothing is happening. Something is going wrong in that tissue. It is just not the thing the name promised. In other words the label was a guess, and it stuck for eighty years. Anyway, the plan that follows from wear is the one we spend the rest of the week on.
Most of this lands on people between 40 and 60. About one in ten of us gets it at some point. And the dull good news is real. Up to nine in ten settle with simple care and no operation. That phrase up to is doing some work… it marks a ceiling and not a promise, and another count puts it nearer three in four inside a year. Either way the clock is slower than anyone wants. Once heel pain digs in, the average run is a bit over a year.
Here is to step one, |