Thinking Outside the Box…or Foot?

I've recently had many patients requesting cortisone injections for plantar fasciitis.* While I'm happy to do this procedure, I tell these patients that oftentimes an injection is not the panacea they are seeking for their pain.

Plantar fasciitis is the most common cause of heel pain. Entire chapters of books are devoted to the causes and treatment options for this condition. Athletes, such as runners, can develop heel pain by increasing their mileage too much, too soon, too fast. Specific foot conditions (such as high, rigid arches or very flat hyper-mobile feet) seem to create excessive motion within the foot that can lead to this painful heel ailment. I often hear patients describe their pain being the worst with the first step in the morning.

Sure, an injection might bring relief from the symptoms of plantar fasciitis. But, ultimately the pain could be there because of another condition. To find out what that could be, we often have to do a gait analysis (studying the way an individual walks) and a complete musculoskeletal assessment to see if there are other muscle weaknesses. A careful analysis of the entire hip and leg area is often helpful in discovering why someone may have developed plantar fasciitis.

The Heel Bone's Connected to…

A recent study done with a group of runners from the Minnesota Runner's Club revealed that many common running injuries result from specific hip weaknesses. The study showed that a specific group of runners who were injured as a result of Achilles tendonitis, plantar fasciitis, shin splints, and knee pain also had characteristic muscle weakness within the hip flexor (iliopsoas), hip abductor (gluteus medius), and tightness within the groin muscles (hip abductors). This study is an excellent example of thinking beyond the area of pain to address the root of the problem.

The Right Footwear

All of our patients are given specific footwear recommendations. We believe the right shoe on the right foot (no pun intended) is a critical component to preventing and treating lower leg and foot problems. But if heel pain occurs, taking the time to look beyond the foot for clues as to what might be contributing to plantar fasciitis is key. That's what I call "thinking outside the box"—or, in this case—the foot.

*Please see our Foot Health section for further foot health descriptions.


Dr. Greg Coppola


Gregory W. Coppola, D.O., FAOASM
Birkenstock USA Health and Wellness Advisor
Lead Provider
Saint Vincent Sports Medicine