Health: Foot Fault

All of a sudden I had this searing pain in my left heel when my foot hit the floor,” says Steven Knight, a 46-year-old Newman High School alumnus now living in Birmingham, Ala. “I was training for a run at the time, but I didn’t remember any injury.”

“It was a throbbing pain, especially when I walked. It moved up my leg and every step I took hurt. After a few days, I made an appointment to see an orthopedist who treats some runners I know. She X-rayed my foot,” he continues. “I had a bone spur growing sideways off my left heel bone but there was no stress fracture.

She diagnosed plantar fasciitis and told me that the bone spur didn’t have anything to do with it.”

Plantar fasciitis is the most common cause of foot pain in adult males age 40 and older. “Plantar” refers to the bottom or sole of the foot, while fasciitis implies inflammation of the fascia, an anatomical term for gristly tissue. The plantar fascia is a thick band that connects the heel bone to the toe bones.

“Most patients with plantar fasciitis describe the gradual onset of a burning pain, worse in the morning and when getting up from rest, like from a chair after watching a movie. Typically the discomfort lasts six to 12 weeks (or less) and resolves on its own,” says Dr. Field Ogden, an orthopedist who completed an additional fellowship in foot and ankle surgery and practices with Southern Orthopaedic Specialists.

“There really is no need to go to the doctor if your heel is hurting for two or three weeks without an injury as the pain usually resolves on its own. If something ‘doesn’t seem right’ it’s important to see an orthopedist or a podiatrist as it could be another diagnosis such as a stress fracture,” says Ogden. “The folks with plantar fasciitis who show up in my office usually have more disabling pain or their symptoms have persisted over three months. The worse case I ever saw was a woman with so much swelling that I was worried she might have a tumor.”

“My first line of treatment is almost always physical therapy – plantar fasciitis starts with an abnormal tightening of [the] Achilles tendon and calf muscles,” says Ogden. “An aggressive stretching regimen usually starts the patient on the road to improvement. An occasional patient wants an injection, and a steroid and numbing mixture injected into the heel area will occasionally help.”

“There are all sorts of popular remedies,” he continues. “Google ‘plantar fasciitis’ and you find at least 1,000 different straps, stretches and treatments. None of these things you can order from the Internet are great, hence the myriad options. Both prescription and over-the-counter anti-inflammatory medications like aspirin, Tylenol, Aleve and Motrin can help significantly.”

“Surgery to remove the damaged fascia is rarely needed. More than 98 percent resolve with conservative treatments. Further, surgery is rarely indicated unless the patient has had symptoms for greater than 12 months,” adds Ogden.

Knight owned the popular live music club Zydeco in Birmingham for years and now books musical groups for events, both private and large, across the southeast.

He is the go-to person for college groups in the southeast looking for the New Orleans sound. In keeping with his business of booking bands such as Rebirth Brass Band and The Dirty Dozen Brass Band, Knight attempted to tackle plantar fasciitis with a big bang, a multimodality attack rather than just the stretching exercises Ogden initially prescribes.

“The orthopedist gave me a cortisone shot in the heel. This male nurse came in and said the shot was going to hurt so much he would lie down on top of me so I wouldn’t jump. I passed on that, and the shot wasn’t all that bad,” says Knight. His orthopedist also had him fitted for a night splint and some custom-made shoe inserts. Then Knight began an aggressive physical therapy program.

“I had to get larger shoes to hold both my feet and the arch supports. The physical therapist would massage and stretch my leg muscles and foot. Then they would hook me up to some device that shot electricity through my leg that tingled like ants crawling all over my left foot.”

As for home exercises, the therapist instructed Knight to roll up a towel, hook it under his foot, and pull his foot towards himself to stretch the foot and leg muscles. Cold helps, and Knight used some blue gel packs from a sporting goods store. For a more New Orleans approach for cold therapy, roll the arch of your foot over a frozen can of petit pois, the ingredient in Chicken Clemenceau at Galatoire’s that always stuns the tourists.

“Nothing seemed to help. I wasn’t getting any better. The running shoe they told me to buy was a level-4 – big, bulky and stiff. Both feet began to hurt and I would get calf pains when I ran,” Knight says. “The orthopedist told me I just had to get accustomed to the shoe inserts. After six months I listened to a trainer at my gym. He said get rid of all that stuff, wear flip-flops for a few weeks and get a neutral shoe. All my pain was gone in a couple of weeks.”

Knight had flat feet and wore arch supports for years. “My wet footprint looked like a bear paw,” he recalls. Now he wonders if those arch supports might have precipitated his problem. For the last three years, he has worn flat shoes, such as a driving shoe, with almost no heel, and his feet feel fine.

Often in the art of medicine, less treatment is the wiser course. The treatment of plantar fasciitis calls to mind one of my favorite definitions of the art of medicine: keeping the patient entertained until Mother Nature heals him.

Getting Well-heeled
Plantar fasciitis is commonly described as a local inflammatory reaction, but it’s really more of a degenerative process. Repetitive micro-tears in the plantar fascia that cushions the foot typically cause heel pain, variously described as dull, sharp, throbbing or bruise-like.

Plantar fasciitis is the bane of runners, but even couch potatoes are susceptible. More intense training or a change in terrain or running surface often precipitates the condition in runners. It is more common in professions with prolonged standing – hairdressers, store clerks, nurses and police officers in at least some communities.

Specific risk factors are hard to determine with certainty for a condition that affects about 10 percent of the adult population at some time. Various conditions and predisposing factors over the years include flat feet, feet with overly high arches, weight gain and obesity, shoes with overly soft soles and shoes with poor arch support. If a doctor says you need surgery to remove a bone spur, run, don’t walk (or at least mount a fast hobble) for a second opinion.

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