Kick up Your HeelsBy: DEREK SPINNEY, PT, CSCS DIRECTOR OF REHABILITATION SERVICES EISENHOWER MEDICAL CENTER
Foot related problems are common but largely ignored until they begin to impact daily activities. A number of foot conditions can be treated or even prevented, including plantar fasciitis, the inflammation of the plantar fascia — the connective tissue between the heel (calcaneous) and the forefoot and toes, which is extremely common among active people. WHAT IS PLANTAR FASCIITIS? Symptoms of plantar fasciitis include sharp pain at the bottom of the heel, often upon getting out of bed or after exercise. The pain may be “knife-like” in quality, usually on the inside or bottom of the heel, and is often accompanied by swelling in the area. The tissue normally functions like a shock absorber for body weight as it comes in contact with the ground. CAUSES The plantar fascia can become inflamed by repeated overloading or micro tearing of the tissue through repeated activity. Such inflammation can result from walking, climbing stairs, or performing household activities, as well as running. In almost every case, individuals experience tight calf muscles. Other contributing factors can include obesity, pregnancy, arthritis, diabetes, and increased time standing or walking. People with flat feet or an extremely high arch are predisposed to plantar fasciitis, since both conditions place more tension on the plantar fascia before even taking a step. Poor foot alignment or “biomechanics” (how the joints of the foot work in harmony to accomplish motion) also contribute to the condition, as well as wearing shoes lacking proper support of the plantar fascia. TREATMENTS Conservative treatment of plantar fasciitis includes the use of splints worn overnight to maintain the proper length of the fascia. Orthotics, devices inserted into the shoe designed to assist with controlling motion during weight bearing, can improve the alignment of the joints and equalize weight distribution through the foot, reducing strain on the plantar fascia. Physical therapy is helpful for pain and swelling reduction. Proper stretching and strengthening and athletic taping may also be effective. Nonsteroidal anti-inflammatory over-the-counter medications are frequently recommended, as well as prescribed medications, typically corticosteroids. In addition, surgery may be a consideration when conservative measures fail. Plantar fasciitis can develop without trauma or known onset, be quite painful, and limit activity and lifestyle. PREVENTION Plantar fasciitis can be prevented by maintaining a healthy weight, choosing supportive shoes and not walking on hard surfaces in bare feet. Start weight bearing exercise slowly and gradually increase your activity. Perform foot-stretching activities daily before getting up in the morning to restore the length of the plantar fascia, which shortens overnight. At the first signs of plantar fasciitis symptoms, ice your heels for 15 to 20 minutes or massage the same area with an ice cup (a paper cup filled with water and then frozen) for five to 10 minutes. Elevate your feet if you experience swelling. Most importantly, a decrease in activity level until the symptoms start to resolve can prevent further damage. In addition, consider low impact alternatives for exercise, such as swimming and cycling. WELL-HEELED Plantar fasciitis can develop without trauma or known onset, be quite painful, and limit activity and lifestyle. Adherence to preventive techniques is the best way to avoid developing the problem. In addition, a referral to Eisenhower Medical Center’s physical therapy program can provide a specific stretching and strengthening program to keep you on your feet.