A real pain in the foot
By Paula Rath
Advertiser Staff Writer
| |||
 |
|
||
|
|||
|
|
||
| |||
|
|
||
| |||
|
|
||
| |||
|
|
||
One of the most common foot problems for Island people is plantar fasciitis (fashee-EYE-tiss) — inflammation of the tough, fibrous band of tissue (fascia) connecting the heel bone to the base of the toes.
Podiatrist Dr. David Yee of the Hawai'i Foot Clinic said he sees three or four cases a day and it is "the first or within the top three diagnoses" in his practice. Why? Certainly bare feet and rubber slippers have a hand (or foot) in it.
American shoes can also contribute to the problem, Yee said, because they don't pair well with lu'au feet.
"They are designed for Caucasian foot widths, mostly medium, but it's not uncommon to have patients in Hawai'i with EE widths or even EEEEE widths, so they have stuffed their feet into shoes that don't fit."
Who is at risk for plantar fasciitis?
It's important to seek treatment for plantar fasciitis because ignoring it may result in a chronic condition that hinders regular activities. It's not uncommon to develop knee, hip or back problems because of the way plantar fasciitis changes the way a person walks.
We researched plantar fasciitis with Dr. Yee, the Mayo Clinic newsletter and the American Orthopaedic Foot & Ankle Society for this story.
CAUSES
Under normal circumstances, the plantar fascia acts like a shock absorbing bowstring, supporting the arch in the foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.
Develops gradually.
Feels like sharp pain in the heel.
Commonly affects just one foot, although it can occur in both feet simultaneously.
Is worst with the first few steps in the morning, although it can be triggered by long periods of standing or getting up from a seated position.
Treatments
Medications
Nonsteroidal anti-inflammatory drugs such as Advil, Motrin and Aleve may ease pain and inflammation, although they won't treat the underlying problem.
Corticosteroid injections can reduce the pain but multiple injections are not recommended because they can weaken the plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering the heel bone.
Therapies
Stretching is the primary therapy because it helps to loosen the inflamed tissue.
The doctor may prescribe orthotics or heel supports, either over-the-counter or custom fitted, to help distribute pressure to the feet more evenly. Podiatrist David Yee asks patients to wear appropriate footwear even in the house. No bare feet or rubber slippers. "It's like when you break your arm and have a cast. You don't take the cast off in the house," he explained.
A night splint fitted to the calf and foot and worn while sleeping holds the plantar fascia and Achilles tendon in a lengthened position overnight so they can be stretched more effectively.
A physical therapist can develop a series of exercises to stretch the plantar fascia, calf muscles and Achilles tendon and to strengthen lower leg muscles that stabilize the ankle and heel. A therapist may also assist with athletic taping to support the bottom of the foot.
Surgery is a last resort, used only when the pain is severe and all else fails. Yee said patients who opt for surgery usually do so because they don't want to wait for other therapies to work, which can take months or years.
