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A sharp pain in the heel

Plantar fasciitis is a common overuse injury in your foot

Tuesday, September 19, 2000

By Loriann Hoff Oberlin

The pain in the bottom of my right foot began two summers ago. I'd traveled to New England and had done some walking, but not an extraordinary amount. Nor had I worn high heels.

Yet the first step in the morning was often excruciating. The pain would subside for several hours, then I'd feel tense in the heel again by evening.

Like other people, I tried to ignore the pain. Weeks later on a trip to Disney World in Orlando, Fla. I walked around with new sneakers that were well cushioned, but my right foot still hurt well before the 9 p.m. laser light show.

I continued along this painful path for months until I finally visited a podiatrist. He had a diagnosis within minutes: plantar fasciitis (fashee-EYE-tiss) -- a strain to the plantar fascia, the strong fibrous band of tissue that stretches along the bottom of the foot from the heel bone to the base of the toes.

"I never heard of this," I said, wincing as I received a cortisone injection in my heel to reduce the inflammation.

Dr. Eric Leonheart of The Foot & Ankle Institute of Western Pennsylvania assured me I wasn't alone. In fact, plantar fasciitis is the most common overuse injury in the foot, and he, too, suffers from the condition.

"This started over 10 years ago when I was a resident," he said. "I've had to take my own advice."

The inflammation occurs when the plantar fascia has been stretched excessively.

There are many causes; the leading one is overpronation, or flatfeet, which results in the arch collapsing upon weight bearing, stretching the plantar fascia from the heel bone.

A person usually feels the pain near the inside of the foot where the heel and arch meet. The pain is often acute first thing in the morning or after a long rest because the plantar fascia has contracted back while a person has been off his feet. As the day progresses and the plantar fascia is stretched, the pain usually subsides.



Treatments range from simply finding proper shoes to cortisone injections or even surgery.

Dr. Stephen F. Conti, associate professor of orthopaedic surgery at the University of Pittsburgh School of Medicine, advises seeking medical treatment if heel pain persists beyond four weeks.

Yet, in a survey conducted for the American Podiatric Medical Association, more than half of those who experienced heel pain in the past 12 months tried to treat themselves. Nine percent visited a podiatrist, and only 6 percent went to an orthopedist.

"I'm not an advocate of walking through the pain," said Dr. Suzanne M. Levine, a New York City podiatrist who has written several books on foot care and also has plantar fasciitis. "For every week you walk around hurting, it takes two weeks of therapy to stop hurting."

A person must correct the cause, Conti said, which may take time and experimentation.

Examining footwear is often the first step.

Proper shoes keep a foot from overpronating, or rolling inward after the heel strikes. This can create an abnormal amount of stretching or pulling on the fascia while jogging or walking briskly.

 
    Wear proper footwear

Buy shoes with adequate arch support, good cushioning and a deep heel cup. Shoes with laces are generally better than slip-on styles.

Have your feet measured, preferably at the end of the day when they're largest. Judge fit by the larger foot. Stand during the fitting process to check that there is up to a half-inch between your largest toe and the end of the shoe. Never purchase too tight a shoe thinking that you will break it in; it should feel comfortable from the start.

Choose a shoe for the proper activity, especially in sports. For women, the best heel height is one inch -- this cushions impact. Shoes that are flat or have heels more than 2 inches high should be avoided.

Going barefoot, even around the house, can aggravate plantar fasciitis. Buy a sandal with proper arch support and heel cushioning.

Orthotics and other aids

Heel cups, readily available at the pharmacy or discount store, take pressure off the back of the heel.

Shoe inserts, or orthotics, can be purchased at pharmacies or discount stores, or custom fitted. Check with your insurance carrier to see if they are covered. Most custom orthotics are made of at least semi-rigid material to prevent overpronation and provide adequate arch support. If these products do not provide relief, see a podiatric specialist and/or be cast for prescription orthotics.

 
 

"Shoes should have arch support, adequate cushioning and a deep heel cup," said Leonheart. "A style called a motion control shoe is helpful for some. I recommend jogging or running shoes since they're the most advanced. A cross-trainer is next in effectiveness, and lastly a walking shoe is the least supportive style of shoe."

In her book "Your Feet Don't Have to Hurt," Levine writes, "Women should wear shoes with a one-inch heel or padded athletic shoes with an inner arch, in preference to flats or uncushioned tennis shoes. Men can use a heel cushion or over-the-counter orthotic arch inside their shoes."

On my previous vacations and even around the house, I'd done all the wrong things. I'd worn flats and gone barefoot at home.

During a trip to Manhattan, I visited Eneslow, The Foot Comfort Center. The staff measured my feet, and I bought new shoes with an inch heel and orthotic device already inside. While Eneslow is known in the foot care industry for its orthotic shoes, several stores in the Pittsburgh area also offer these services: Best-Made Shoes and Foot Menders at Gordon's Shoes, both in Bloomfield; Colaizzi Pedorthic Center in Bellevue; Otto's Shoe Store in Aspinwall; StepRightIn in Robinson; to name a few.



Stretching exercises and wearing proper cushioning also can help protect your arches. "There's no way to get arches back once you've lost them," Conti said.

"Stretching exercises for both the Achilles tendon and plantar fascia are helpful, as is icing the area before and after activity," said Dr. Robert Mendicino, chief of podiatric surgery at The Western Pennsylvania Hospital. Over-the-counter anti-inflammatories such as ibuprofen help, but may take several days or weeks to provide the full effect.

Plantar fasciitis is considered a chronic condition if it lasts six to 12 months, and more aggressive treatment may then be needed. This may include cortisone injections into the heel, which reduces inflammation; physical therapy; prescription or custom orthotics; night splints; casts or even shock wave or sound wave therapy. The need for surgery to release the fascia is rare.

For me, treatment began with a cortisone injection into the right heel. Six months later, I reinjured myself after I took up walking to lose weight after the holidays, and had injections in both heels.

Most doctors prefer to wait several months between injections and they urge patients to limit activity. Too many injections can cause tissue to degenerate.

For more than two months now, I've been diligent about not walking around barefoot, even to pour my morning coffee. I bought a quality sandal with arch and heel support. I've tried a number of over-the-counter foot-care products, including sports orthotics, heel cups and gel socks, and I've replaced several pairs of shoes. I try to do many of the stretches I've learned about.

"The key to preventing recurrences of heel pain is cutting back whenever you feel a slight strain," writes Levine in her book. And all experts agree that lifestyle changes are important in conquering plantar fasciitis.

While my symptoms are improving, it's too early to tell if I've eradicated the problem. Injured twice now, I may be prone to heel pain for years.

So as much as I enjoy walking, I'll probably move to low-impact cycling or swimming to keep in shape -- at least for now.


Loriann Hoff Oberlin of Monroeville is a freelance writer and book author. You can e-mail her at LHOberlin@aol.com.



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