Monday, June 29, 2009

Aching Heel Blues




Back when I was a runner, thinking I was someday gonna do the Boston Marathon, there were some injuries joggers had to try and avoid: Getting run over was at the top of the list; shin splints, back spasms, sprained ankles, knees and hip problems, and plantar fasciitis.

I was doing five or six miles a day, ten on the weekends, and was largely healthy. I pulled a back muscle once; got run off the road by a drunk coming out of the Federation of Eagles Christmas party -- which resulted in a badly-sprained ankle, but I had good shoes and avoided other foot, knee, or hip injuries, plus the drunk missed me.

I quit running some years back when I moved to Oregon and discovered ice storms, and other than walking the dogs and doing martial arts's forms, (djurus), don't spend a lot of time on my feet on hard surfaces. Even so, I have, somehow in the last couple of weeks, developed in my right foot what I am pretty sure is plantar fasciitis. This is known by a variety of other colorful names, ranging from "dog heel," to "policeman's foot," to "flip-flop disease." We were basically designed to walk on soft earth, and the sidewalk isn't that.

For those of you who slept through the Podiatry 101 lecture in medical school, this condition is an irritation of the -- ahem -- plantar fascia, aka the plantar aponeurosis -- which is the ligamental structure under the foot that supports the arch. In severe cases, you can get a calcaneus (heel) spur that makes things worse.

The differential diagnosis for heel pain is a short one, and the symptom that generally decides it is a horses-not-zebras thing: The heel hurts when you get up, either from sitting for a while or when you first awaken in the morning. It tends to get better after you stretch out a little, but worse if you push things. Given that presentation, the diagnosis is 90% for fasciitis, with a couple of other things, like stress fractures and nerve impingement to be ruled out.

About one person in ten has this at any given time, and it is more common in folks who pound a lot of pavement -- "mailman's foot"" is another name for it.

Everything is all connected down there around the foot bone, and the treatment for mild to moderate plantar fasciitis is pretty much the same for most tendon problems -- rest, ice, compression, elevation. Working the foot and ankle helps, Achilles tendon stretches. Picking up marbles with your toes, calf-raises on a step, like that.

One of the ways to ice it is novel -- freeze a water bottle or use a frozen juice can. Put it on the floor and roll it back and forth under your heel and arch. NSAIDs -- aspirin or ibuprofen -- help. Arch supports, heel cups, good shoes. Apparently New Balance makes walking and running shoes designed to treat this, and I expect I'll be hunting down a pair of them.

Never a dull moment.

11 comments:

  1. You've got my sympathy...

    I've been dealing with a case of plantars fasciatis since February. Like you said -- not a lot to do for it. I have found some heel pads that seem to be helpful...

    The best part is when your knee starts to hurt 'cause you've got to be on your feet, so you unconsciously adjust your walking gait...

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  2. When I was training for the Marine Corps Marathon years ago, I had a problem with plantar fasciitis.

    I went to my doctor and explained my symptoms. She looked at me like I was nuts. Now, I probably have the label "hypochondriac" in my file.

    I went to my local running store and the owner told me what it was before I could finish explaining the symptoms.

    One of the things the owner told me was that the problem is compounded while you sleep. If you have heavy blankets, they'll cause your feet to point out, which shortens everything up.

    I picked up something like this. It was very uncomfortable, but it made the problem go away.
    http://www.amazon.com/Swede-O-Adjustable-Splint-Plantar-Fasciitis/dp/B001RUU8X6/ref=sr_1_10?ie=UTF8&s=sporting-goods&qid=1246305183&sr=8-10

    My aunt had the same problem. I lent her my brace and she said that helped fix it. She also picked up to what amounts to a rod you install at the foot of your bed. It props up the blankets over your feet.

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  3. You know those boil-and-bite mouthpieces, to protect your teeth while sparring? Well, there are now heat-and-mold shoe inserts. Stick 'em in the oven for a couple minutes, put 'em into your shoes, and stand on them for another couple minutes ...

    So, with some new shoes, new inserts, and heel cups, along with the stretching and manipulating and icing and all, maybe I can nip this thing in the bud before it gets any worse.

    I knew about the brace, and we used to use a little tent frame for blanket for burn patients when I was working in the hospital years ago. Might try those, too.

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  4. Steve,
    Had that and heel spurs in 2000.
    Went to my local foot clinic and the Doc taped up my foot with a pad in a strategic place and the pain was gone in a couple of days. Wouldn't cut me for the spurs, got me custom orthotics instead. Been wearing them for 8 yrs. I can take or leave most Docs, but this guy really knew his shit. Don't mess around, bite the bullet and go see the pros. I put up with the pain for far too long.
    Dave

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  5. I've been considering the night splints... they just ain't cheap. I hadn't heard the thing about the blankets before though...

    And this is at least the second time I've dealt with plantars fasciatis.

    My primary care physician is a sports medicine doc. I did (after a couple of months...) go in and let him check my foot out, just in case it was something else. He told me pretty much that there just wasn't a whole heck of a lot to do. Stretch, strengthen, and RICE. And hope it goes away...

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  6. Yep, go see the pro's.
    Even with the heat up ones, if your foot is not in proper alignment when you make them, it will not help solve what caused it. I had mine done years ago by a PT and they lasted for quite a while till things got really bad. I had the tape wrap, ect and 4 cortisone shots eventually. I had what they call a callusing on the inside third near the heel. Felt like a bone chip for a long time. Dr. sent me to the PT and he found that the cuboid bone was way out of place. It doesn't hurt because there's nothing attached to it but causes problems with ROM and gait which results in Plantar issues. Popped it back in and started getting better that day. That's what caused me to trust Dr's again and go on to get my shoulder fixed.
    It still took several months of never going barefoot, morning stretches, lots of ice until the foot was better. If I hadn't had the custom inserts, who knows how long it would have taken. My wife is a long time runner and had it as well. She credits the inserts to helping get over it but also the correct shoes for her body. It's amazing how much difference even the right shoes will make.

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  7. With the new shoes, inserts, heel cups, ice, tennis ball exercise -- thanks to Craig Brown, for Mike Robertson's book on myofacial release for that one --
    and some applications of balour and vigorous stretching and massage, already my foot feels better.

    Too soon to tell, but I have hopes that I go to it before it needed more drastic attention.

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  8. Had my massage therapist work on the foot today.

    Ow. Ow. But it feels better now. I think ...

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  9. Happy Ending?

    Sorry, couldn't resist.

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  10. Well, I'm usually happy when I leave the therapist's studio, but not *that* way. Not one of those places out by the airport ...

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  11. Got a set of orthotics back in '01, right before a trip to Europe, to aid with the fasciitis. Walked all over parts of France and Italy without problem. I've worn them nearly every day since. The cool part about orthotics is that every pair of shoes you buy is custom fit to your feet.

    Before being referred to a specialist, my PCP tried several things to resolve the problem, including instructing me to never go barefoot on hard surfaces. Our house is all hardwood floors, so that meant getting a pair of shower sandals to wear around (including in the shower, an odd feeling). I don't go to the doc much, and on a visit some years later I mentioned to her that the orthotics really helped the fasciitis, and that even though it was a real PITA to do it, I was still wearing shower sandals everywhere in the house. She looked startled. Turns out she expected me to stop that after I got my orthotics, which was a matter of two months after she told me to start wearing the sandals. I think I did it for four years total. Going barefoot on hardwood floors was hard to get used to after that.

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