ASK DR. BAUGHAN April 9, 1999
FOOT PAIN
Your resolve has been firm. As the weather warms, you have been determined to get more exercise, and you have been walking almost everyday. You might even have signed up for the Heart Helpers cardiac conditioning program mentioned last week. Then one morning you swing your legs over the side of the bed and stand up and - “Ow!” - there is a sharp pain in your heel. You limp to the bathroom. Over the next several hours, the pain eases a little, but does not really go away, then by late afternoon, it is aching pretty badly. “What now?” you mutter, and feel crestfallen in your efforts to get in better shape. You mention the problem to a friend or spouse. “Maybe you have a bone spur,” they suggest. That night you take your shoes off and feel your foot. It feels okay until you press with your thumb on the bottom of your foot just in front of the heel where the arch begins. “Ooh! That’s sore!” The area of soreness is about the size of your thumb, and you press it a few more times in perverse confirmation that despite your best efforts, “Life’s a bitch, and then you die.”
Well, don’t give up the ghost quite yet. You have just diagnosed plantar fasciitis, which is quite treatable. The plantar fascia is a fibrous sheet of tissue on the bottom of the foot that goes from the heel to the base of the toes between the skin and the bones of the arch. It may get strained or inflamed by repetitive tension from walking, running or prolonged standing. If there are no other sources of pain in the foot or leg, try the following measures to see if you can resolve the problem before it ruins your exercise plans.
Stretching: Ideally with the foot warmed up from a shower, bath, light exercise or heating pad, lean toward a wall with the affected heel behind the good one (or alternate if both heels hurt, which often happens). With the knee straight, lean forward and gently stretch your heel down to touch the floor, hold for 30 seconds. Repeat 3 times. Do this 2 or 3 times a day. Steady slow stretches are better. Do not bounce. Bouncing may worsen the situation.
Strengthening: Weak calf muscles may contribute to the problem. Standing up onto your toes, then slowly lowering the heel down to the floor 10 to 20 times 2-3 times a day can strengthen the important muscles. For advanced strengthening and stretching, doing this on a stair or ledge where you can let the heel go below the level of the toes can be tried.
Shoes: Worn out shoes are often the culprits in causing plantar fasciitis. Shoes need to have adequate cushioning under the foot, whether built in or foam or gel insoles. The heel needs firm support, preferably from the shoe, but possibly from heel inserts that cradle the heel. Finally, a good arch support can help take some of the tension off the fascia.
Activity: If corrective steps are taken sooner rather than later, you need not cease all activity. You might need to modify exercise, though. You may need to reduce the total distance you walk or run. Walking or running on softer, level surfaces will put less strain on the heel than hard or uneven surfaces.
Medications: If you do not have an ulcer or frequent heartburn and can tolerate medications like ibuprofen or Aleve, taking them regularly for a week or two may help reduce the inflammation.
If these measures do not help, what can doctors do? Sometimes custom fitted orthotics are necessary. Infrequently, patients may need a cortisone shot at the tender spot to reduce the inflammation, or sometimes prescription strength medicines are needed. Wearing a splint at night that keeps the foot slightly flexed up toward your head can help. Very rarely, surgery is needed to release the tension on the fascia. If these symptoms do not quite fit the picture, a visit to your primary provider or podiatrist may be needed to clarify the diagnosis. How about the bone spur idea? It is rarely an issue. Many people have spurs on Xray with no pain. Many people have pain with no spurs. The soft tissue is usually where the action is.