Our nightly routine never varied in the first months after our baby was born: My husband and I took turns carrying the sobbing bundle round and round the dining room table, until either she quieted down or we couldn't take another step. Finally, the baby was diagnosed with reflux, got drugs and felt better; but Doug and I both had mighty sore heels from our midnight walking.
My heel pain gradually subsided and hasn't returned, but Doug's right foot felt so uncomfortable that he went to his doctor and got two things: a name for the ailment -- plantar fasciitis -- and a $330 pair of inserts (not covered by our health insurance, sadly) for his shoes. Our baby turned 5 last week, and she's doing fine. Doug is still wearing inserts.
More than 2 million Americans seek treatment for plantar fasciitis annually, according to the American Podiatric Medical Association. And, as Doug and I can attest, it's not just a problem for athletes, though clinicians note an influx of patients at this time of year as people dust off their running shoes and get back into shape.
The condition occurs when the plantar fascia -- the band of tissue that fans out from the heel to the base of the toes -- becomes inflamed or torn.
Typically, the pain is felt at the front of the heel pad toward the inside of the foot, where there may be swelling. It's often more intense first thing in the morning; the heel usually feels better after taking a few steps, but the pain returns after prolonged walking or standing. Plantar fasciitis can be so excruciating that a person can't bear any weight on the foot; more often, it produces a moderate piercing or burning-type pain.
Many people with plantar fasciitis also develop heel spurs -- growths of extra bone that are thought to be caused by the fascia's or tendons' pulling on the heel. The spurs don't always cause pain, and they often require no treatment.
Your risk of developing plantar fasciitis is greater than that of most adults if you:
* have a gait that overly stresses the heel bone and the soft tissue attached to it;
* often feel tightness in your Achilles tendon;
* suddenly increase your amount of walking;
* wear shoes without good cushioning;
* have a job that keeps you on your feet all day (or parenting duties that make you pace the floor all night); or
* are overweight.
Treatment is often simple and successful, with proper stretching considered the best way to prevent the condition and promote healing. These exercises make the fascia more elastic and counteract the tightness and shortening that occurs when the tissue is abused or overused.
You probably don't need to consult a physical therapist to learn how to limber up the fascia. If you're in doubt, ask your doctor or see the Resources list at the end of this article for information about the most beneficial stretches.
In addition to recommending exercises for the fascia, the Achilles tendon and the calf muscles, clinicians treating plantar fasciitis are apt to suggest taking anti-inflammatory medications, staying less active for awhile, wearing shoes that give proper support and using orthotic devices until the foot heals.
Stephen Pribut, a podiatrist in the District, tell patients to stop walking barefoot (or in socks or slippers) for at least six weeks and instead wear a supportive running shoe. (Now we know: Before you reach for a howling baby, lace up your Reeboks.) Pribut notes that a proper shoe, if held lengthwise between your hands and squeezed, should bend only where your toes flex.
Typically, plantar fasciitis affects one foot, and the Achilles tendon is often quite tight on that leg. But pain can also be caused by atrophy of the heel pad, bursitis, tendinitis, nerve damage or even a stress fracture or a tumor in the heel. Pain in both feet may be caused by arthritis or other ailments.
Orthopedic surgeon Paul Cooper, director of Georgetown University Medical Center's foot and ankle center, cautions that it's not safe always to ascribe heel pain in the morning to plantar fasciitis. If stretching does not alleviate the problem in a few days, he advises seeing a doctor.
In addition to a general physical exam for a complaint of heel pain, experts say, it's reasonable to get X-rays to rule out a broken bone. They also say magnetic resonance imaging, or MRI, is used too often by some practitioners and shouldn't be routinely used to make a diagnosis.
For short-term pain relief, mainstream clinicians recommend oral anti-inflammatory medications such as ibuprofen (Advil); they may also suggest Aspercreme, an over-the-counter topical drug. Ice is sometimes used to help decrease acute swelling, and foot whirlpools or heat therapy to promote blood flow and aid healing. To help people with weak arches, some practitioners may wrap the arch with tape for a week or so to help support the plantar fascia.
Panos Labropoulos, associate professor of orthopedic surgery at George Washington University Medical Center, often arranges for his patients to wear a night splint to stretch the plantar fascia and prevent the foot from going into its natural flexed position during sleep. The device, available only through a physician or other licensed practitioner, is usually worn for three months. In the rare cases where plantar fasciitis persists after at least six months of continuous treatment, many physicians agree that surgery may be needed.
Before giving up on conservative care, some clinicians use a new ultrasound technique to drive anti-inflammatory medicine or steroids into the sore spot, trying to increase flexibility in the tendon and ligaments.
But there's scant evidence supporting this new technique, and most practitioners shy away from such measures. Even though the Food and Drug Administration recently approved the use of a so-called lithotripsy device, which bombards an aching heel with ultrasound waves, Judith Peterson, a physician in Philadelphia, doesn't like the idea. "That just strikes me as so extreme," she says. "Here you have this condition that should resolve with conservative care 99 percent of the time."
To treat heel pain that affects each patient differently, Peterson, a certified acupuncturist who specializes in physical medicine and rehabilitation, devises multiple combinations of mainstream, complementary and alternative therapies. While practitioners of all sorts say proper stretching is essential for treating and avoiding plantar fasciitis, Peterson says one patient may need an anti-inflammatory medication while another may be better served by acupuncture.
Peterson says TENS (transcutaneous electrical nerve stimulation), in which a gentle current is applied to the skin's surface, also may be helpful for pain control. She sometimes suggests using topical arnica to reduce inflammation, but she tells patients not to use this herbal remedy on broken skin.
New to the array of therapies for plantar fasciitis is kinesiotaping, a popular technique in Japan that is relatively unknown in the United States. Advocates of this approach claim it works by pulling the skin away from the underlying tissue, creating space for fascia.
After the painful areas are stretched gently and sometimes massaged, strips of a specially made tape are applied and left on for several days or longer. In contrast to conventional taping, which acts to restrict movement, this method is thought to stimulate the muscles and fascia to function properly.
"Normally we wrap tighter and tighter. This [kinesiotape] is laid on gently," explains Alan Alper, staff massage therapist at George Washington University's Center for Integrative Medicine. He notes that the tape isn't available in drugstores, but is being used by some chiropractors and massage, occupational and physical therapists.
Alper says he has tried kinesiotaping on about six patients with plantar fasciitis in the last two years. "I would say in probably 50 to 75 percent, they've been very, very pleased," he says. "In others there hasn't been as big an improvement, but it seems to help." Resources
* American Academy of Orthopaedic Surgeons: http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=144&topcategory=Foot
* American Physical Therapy Association: http://www.apta.org/Consumer/ptandyourbody For a free brochure, send a self-addressed, stamped envelope to "Taking Care Of Your Foot And Ankle," APTA, P.O. Box 37257, Washington, DC 20013.
* American Podiatric Medical Association: www.apma.org For a free brochure on heel pain -- no need for an SASE -- write to AMPA, Public Relations Dept., 9312 Old Georgetown Rd., Bethesda, MD 20814, or call 800-366-8227.
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