What's Causing That Pain in Your Feet?

I developed plantar fasciitis about 20 years ago. The most prominent symptom for me, as for many others, was terrible pain on first putting my feet on the floor when getting out of bed in the morning.

These first steps caused pain because the calf muscles and the plantar fascia — a strong ligament that begins as a single band at the heel bone, runs along the entire bottom of the foot, and fans out toward the toes — can contract and shorten up overnight, as well as during longer periods of sitting.

One of the most common causes of foot pain in adults, plantar fasciitis is estimated to account for about a million patient visits to a doctor each year. The incidence of the disorder peaks between ages 40 and 60 in physically active people but the problem may begin at an earlier age in runners and professional athletes.

One famous example is the baseball player Joe DiMaggio, whose later playing days were severely hampered by heel pain, which was probably caused by plantar fasciitis but was attributed to heel spurs. DiMaggio underwent several surgeries for heel spurs that required long postoperative recoveries but did not relieve his pain. Although bone spurs may accompany plantar fasciitis, they are rarely the cause of the intense pain.

Plantar fasciitis is thought to be caused when this ligament along the bottom of the foot suffers degeneration, small tears, and inflammation from the frequent and excessive pounding that accompanies running or other strenuous activity.

Following are some of the suggested risk factors for plantar fasciitis:

  • Training excessively, especially by running downhill or suddenly increasing the distance covered
  • Training while wearing shoes that have poor arch support or stiff soles
  • Running on unyielding or uneven surfaces
  • having flat feet
  • Landing on the outside of the foot (pronation) while walking or running, thus causing the foot's outside surface to roll inward

One of the common recommendations for preventing and treating plantar fasciitis is to perform stretching exercises before engaging in sports or a workout, so as to loosen up the calf and foot muscles.

Stretching exercises include dangling your heel from a stair step or grabbing your bare toes and pulling them toward you. You can find instructions for a good stretching routine on the Internet.

Treatment of plantar fasciitis begins with conservative therapy:

  • Applying ice to the painful foot
  • Performing stretching exercises to improve flexibility
  • Taking nonsteroidal anti-inflammatory medications
  • Resting the foot by avoiding the activities that brought about the problem in the first place
  • Wearing footwear that provides adequate support
  • Avoiding wearing bedroom slippers or going barefoot

The exercise that cured my plantar fasciitis is the plantar fascia stretch: While facing a wall, situate your toes close to the wall, and then bend your knees toward the wall while keeping the balls of your feet flat on the floor. You should feel the stretch in the arch of your foot and in your calf muscles.

Plantar fasciitis resolves in 80 to 90 percent of cases, but you may have to follow the measures described above for a year or longer.

If pain has not improved after you've carried out these measures for several weeks, you should consider seeing your doctor. He or she may find you are doing your stretching exercises incorrectly.

Possible treatments that the doctor may recommend include getting cortisone injections, wearing a splint at night to keep the fascia stretched out, and wearing (rather expensive) custom-molded inserts, called orthotics, that are usually manufactured by podiatrists. Shock-wave therapy for fasciitis has been studied extensively, but its effectiveness is still debated.

Last resort: Surgical procedures are available for chronic plantar fasciitis.


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