An open letter to President Obama about chronic foot pain


President Obama shoots at a basket on the South Lawn during the 136th annual White House Easter Egg Roll in April. (Jim Lo Scalzo/EPA)

Dear Mr. President:

On Thursday it came to my attention that we have more in common than a liberal political philosophy and work space near Washington's Lafayette Park. I refer, of course, to the second page of your latest physical exam, which cites your "recurrent right plantar fasciitis."

Oh, sir. As a lifelong Democrat and fellow sufferer of this nasty condition, there's only one thing I can say: I feel your pain.

I do. Literally. Well, more accurately, I did, twice. Until my doctor took care of it with a brief, magical procedure. That's why I'm writing.

But first, for the uninitiated at the NSA and elsewhere who may be reading this, plantar fasciitis is a sometimes extremely painful irritation of a thick band of tissue, the plantar fascia, that runs along the bottom of the foot, connecting the heel to the toes. It can produce severe heel pain, especially in the early hours of the day, because the tough connective tissue tightens at night when your weight is off it. Grown men with plantar fasciitis have been known to prefer listening to a Rand Paul filibuster to placing their heels on a hard wood floor first thing in the morning.

Countless people have endured it, including basketball star Kobe Bryant and New York Giants' quarterback Eli Manning, as well as people who are on their feet a lot, like Mitt Romney. And now, apparently, you.

Experts used to believe the pain stemmed from inflammation of that long band of tissue, but according to this interesting piece in the New York Times last year, they're not so sure any more. Now it seems more likely that plantar fasciitis is the result of weakening of the tissue, small tears that the body is unable to heal. Which means that ibuprofen you're taking "to treat intermittent plantar fasciitis," as it says in your medical workup, will dull the pain for a while, but it won't address the problem.

Sir, after reading the results of your checkup, I feel almost uniquely qualified to advise you on this matter. You're almost 53, I'm 56. We're both workout junkies. You like to hoop, I like to run. You're 6'1" and 180 pounds, I'm 5'11" and ... heavier than that. Let's face it, sir, we've both reached that stage in life when our health must be constantly, meticulously, managed, like those hairs that grow out of my ears.

I'm going to go out on a limb and assume you enjoy the best medical care on the planet. That means, like me, you've tried orthotics in your shoes, icing your foot and stretching exercises. You've probably massaged your foot with a tennis ball until you rubbed all the fuzz off. I even wore that stupid sock that kept my foot locked in a flexed position while I slept, though I would invariably tear it off and throw it across the room in the middle of the night.

These are good, conservative therapies, Mr. President, if I may use that word. But none of them worked for me.

So let's say you get a short break from trying to bring the Sunni, Shia and Kurds back together in Iraq and want to address something difficult like chronic foot pain, and we could chat for just a minute. Here's what I would say:

Sir, there can be no grand bargain with plantar fasciitis. You need to hit it with everything you've got. You might need a cortisone shot.

Cortisone shots for plantar fasciitis are controversial, and they are not for the squeamish. After applying a topical anesthetic to your heel, your doctor will stick a needle directly into that already-sensitive part of your foot and inject the medication, possibly mixed with another anesthetic. For a few seconds, it will burn so bad, you'll promise to give up basketball and golf. But if you're like me, in a day or two your pain will be gone, if not forever, then for a long time.

Sometimes it takes more than one injection, and it doesn't always work. There is some concern with tendon injuries that corticosteroid injections relieve pain in the short term but delay healing. Many physicians are cautious about using them on plantar fasciitis at all, because they fear rupturing the plantar fascia or causing atrophy to the heel fat pad.

But for me, it worked beautifully and revived my exercise routine. It may be worth considering.

Best of luck, sir.

P.S. Way to go with the nicotine gum. We're all rooting for you.

Lenny Bernstein writes the To Your Health blog. He started as an editor on the Post’s National Desk in 2000 and has worked in Metro and Sports.
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