Oh, my aching feet

By Denise Plastiras

When your feet hurt your whole body hurts. My mom said this many times when I was in my 30s and she was in her 50s. It didn’t mean much then but I get it now. Recently I have seen a surge of patients coming to my practice for treatment of foot pain associated with various diagnoses. By far, plantar fasciitis is the most common.

There are two reasons. More people are exercising — walking and running way into their 70s and 80s and many baby boomers are now suffering with stiffness and pain in their knees and hips from degenerative arthritis. Since these symptoms are usually unilateral, stress can be put on the opposite foot.

Taking the first step in the morning can be agony for those who suffer from tightness in the foot associated with plantar fasciitis or heel spurs. As the foot hits the ground, a burning pain may be experienced in the arch of the foot, at the heel, or in both areas. The pain may last for several moments, several hours, or throughout the day depending upon the amount of tightness and inflammation.

Plantar fasciitis is a repetitive-stress injury to the fascial sheath which surrounds the muscles on the bottom of the feet. Fascia can best be described as a protective envelope of connective tissue. Fibrous in nature, fascia runs in line with our muscles, therefore, it shortens and lengthens as muscles contract and relax. When injured, the fascia may shorten and pull at its insertion at the heel, causing inflammation and pain.

Specific activities which call for repetitive motions such as walking and running can put undue stress on a posturally normal foot. Increasing mileage or speed or exercising with poorly constructed athletic footwear can elicit an acute plantar fasciitis. Ice and rest from prolonged weight-bearing activities and new supportive footwear should enable a quick return to activity. On the other hand a person with a high arched foot or a flat foot who has an onset of symptoms may not return to activity as fast and may be forced to seek out podiatric care and physical therapy.

Probably 90 percent of my patients who present with a diagnosis of plantar fasciitis have high arched feet, known medically as pes cavus. Patients with pes cavus have a shortened plantar fascia predisposing them to strains at the heel and along the fascia due to excessive loading. If symptoms are not treated early and become chronic, tissue will continue to lose extensibility. Physical therapy treatment usually involves moist heat, ultrasound, massage, and fascial release techniques. Instruction is then given to the patient on self-stretching techniques to the arch of the foot and to the heel cords.

Chronic plantar fasciitis may take months of treatment. Close monitoring of the patient by the podiatrist and the physical therapist is a must to ensure a return to pain-free weight-bearing and function. A steroid injection may be indicated and shoe inserts prescribed during the course of treatment.

Denise Plastiras is a physical therapist at Maximum Performance in Greenport.