Plantar fasciitis is quite common these days and treatments are many and often low-tech and low-cost, writes Marie McCullough
WHEN her heels began hurting, Amy Montemarano did what surveys show most people do. She tried to ignore it.
She figured her daily running was to blame, so she cut back. Not only did the pain keep worsening, it would spike after periods of complete inactivity.
“I had to limp when I got out of bed in the morning,” said Montemarano, 42, assistant dean for professional development at Drexel University’s Earle Mack School of Law.
After six months she finally went to a podiatrist. The diagnosis: plantar fasciitis.
Despite the exotic-sounding name, plantar fasciitis is almost as ubiquitous as stinky feet, affecting an estimated 10 per cent of American adults. And since the ailment becomes more common with age, creaking baby boomers are swelling the ranks of the gimpy, fuelling a booming market for foot-fix products.
Plantar fasciitis occurs when the tough ligament that runs from the heel to the toes on the bottom of the foot — the plantar fascia — becomes irritated and swollen. Both heels may be affected or just one.
Athletes, couch potatoes, weekend warriors, people who are obese or on their feet a lot — in short, just about all upright adults — are vulnerable.
“I was in agony for years,” recalled David Geltzer, a podiatrist who has offices in Philadelphia and Haverford. “In podiatry school, I was finally diagnosed. I can empathise with my patients.”
Fortunately, studies show that about 90 per cent of sufferers eventually get relief from relatively low-tech, low-cost, low-risk treatments such as shoe inserts, stretching exercises, ice packs, night splints, and non-prescription pain relievers.
Unfortunately, these remedies require persistence and diligence. For those with intolerable, recalcitrant pain, the last resort is surgery to detach part of the fascia or newer, costly sound-wave treatments.
The plantar fascia is a shock absorber, protecting the bones, nerves and muscles of the whole leg while supporting the foot’s all-important arch. The fascia connects to the heel bone, which is also connected to the Achilles tendon running down the back of the lower leg.
Although many patients say their heel pain started out of the blue, the inflammation develops gradually. Among the contributing factors:
1. Anatomical imperfections, such as high arches, ‘fallen’ arches (flat feet), and tightness of the Achilles tendon or calf muscles.
2. Biomechanical abnormalities, such as twisting or rolling the foot while walking, called pronation.
3. Repetitive stress from jobs or sports that involve hours of standing, walking or running on hard surfaces.
4. Extra weight due to obesity or pregnancy.
Plantar fasciitis is usually diagnosed through a foot exam, plus X-rays to rule out a stress fracture.
Doctors say the following measures do work for the vast majority of patients:
• Shoe inserts that firmly support the arch and heel.
• Exercises to stretch and strengthen the fascia, Achilles tendon and calf muscles. Ideally, these are done two or three times a day.
• Night splints. Worn during sleep, the devices maintain a constant mild stretch of the fascia. Many patients find them uncomfortable.
• Walking casts. These padded, boot like devices keep the foot angled slightly toward the shin to stretch the fascia, Achilles tendon and calf muscles.
Christopher Daukaus, 45, a Philadelphia Police Department Swat team member, tried everything — steroids, stretches, orthotics, splints, even acupuncture. Still, he said, after a long day or a game of football “my feet would be on fire, and I’d have them in buckets of ice”.
In the past, the last resort for such a patient was surgery to release part of the fascia from the heel. Surgery is risky; side effects include numbness or fallen arches and yet more pain.
But now a variety of sound-wave treatments are available.
Paradoxically, the therapy is believed to work by causing micro-trauma to the fascia, thus triggering the formation of blood vessels and stimulating the body’s natural healing processes.
The therapy worked for Daukaus.
“I didn’t expect anything from it,” he said. “But two days after the treatment, I woke up and thought, ‘My feet feel good.’ I’ve haven’t had any more problems.”
MCT News Service