Plantar Fasciitis Tips
Many of us will suffer with plantar fasciitis at some time in our lives. Studies have shown this condition will affect up to one third of the population. It is the most common running injury and affects all walks of life. The “common denominator” is excessive stress loading on the foot. A rapid change in activity is often a culprit. This happens each spring here in Utah as we get out in the yard and onto the trails and roads to shed those extra “five pounds”. This makes our “spring season” also “fasciitis season”. Remember to stretch and warm-up gradually and increase running and exercises or yard work slowly. Make sure your shoes have less than 300-500 miles for runners. Also, most of the data show that a rigid sole and heel collar will reduce the number of fascia injuries. There are many over the counter inserts that may help foot function. I prefer Superfeet and Powerstep inserts for starters. Most athletic shoe stores will carry these. Remember that most fasciitis will resolve with proper care, however, resolution may take 2-3 months. Only 5% or less of fasciitis patients will require surgery. Injection therapy and physical therapy should be considered prior to any surgical options.
- Heel cord “achilles” stretching before and after activities and through the day.
- Toe crunches each day to strengthen the small muscles in the feet.
- Ice after activities and at the end of each day.
Patients often suffer from foot pain that might simply resolve with proper shoes. Here are a few suggestions when shoe shopping:
- Pick a good shoe with a solid shank, stiff heel counter, and adequate cushion. Make sure there is adequate room in the toe-box area to avoid pressure on the toes.
- Ask to have your feet measured, as feet tend to lengthen over the years. Realize there are often descepancies in sizing between manufactueres.
- Fit shoes at the end of the day if you have swelling in your feet or legs as this us usually worse in the evening.
- Remember to wear socks and shop in the evening.
A neuroma is a painful growth of scar tissue within a nerve in the ball of the foot. These are often found between the third and fourth metatarsals. Women tend to suffer with Morton’s neuromas more than males due to shoe pressure. Patients often have numbness, tingling or burning in the toes and the foot or that they may feel as if they have a “sock wadded up” underneath the foot. Neuromas are treated through biomechanical endeavors, injection therapy and surgical excision.
- Avoid high heels and tight shoes.
- Avoid foot positions requiring excessive loading of the forefoot often seen in sports such as cycling, rock climbing.
- Remember to choose shoes which are wide in the forefoot and have excellent support.
Patients who suffer from bunions often have a strong family history related to this deformity. A bunion is a misaligned bone and joint on the big toe side of the foot. Bunions can cause a significant foot deformity making shoes difficult to fit properly. Bunions are oftentimes associated with arthritic changes at the big toe joint and may cause considerable pain and discomfort. If the deformity is left unchecked patients may oftentimes develop numbness or pain at the big toe due to nerve impingement and arthritis.
- Use shoes which accommodate the deformity.
- Seek medical attention to determine the extent of the deformity and determine both conservative and surgical options.
- Many bunions are caused by poor foot biomechanics. As such, orthotics may offer benefit in this patient population.
The lesser toes are little levers that assist in propelling us as we walk. A hammertoe develops due to tendon imbalance. They are initially flexible and then progress to rigid deformities. They can cause the toes to blister and do pose some risk for infections if the skin breaks. Corns are also a common side effect of having hammertoes.
Here are a few suggestions for hammertoes.
- Pick a shoe with a large toe box which has enough room to accommodate the deformity.
- Use a toe spacer in shoes to alleviate pressure on the skin.
- Stockings with toes can help assist in protecting the toes from friction & blisters. These can be purchased at many local running stores
- Seek medical attention to determine the extent of the deformities and determine both conservative and surgical options.
Ingrown Toenail Tips
Patients who develop ingrown toenails usually have a family history of this condition. Infections can progress rapidly and may need urgent attention. They result from the nail growning into the skin that surrounds the nail.
- Warm water soaks, proper shoes may aleviate some symptoms temporarily.
- Get medical attention as the nail border may need to be removed from the cuticle to resolve any potential infection or foreign body reaction.
- The base of the nail can be treated with a chemical to prevent regrowth of the nail border. This treatment is a very successful way of long-term ingrown toenail prevention.
Get your Motor Running
Running season is plantar fasciitis season. This is a top 3 ailment among runners and active individuals who spend a lot of time on their feet. The common denominator is increased stress loading on the feet which is typically classified as an overuse injury. With the increase in running popularity and the desire for more physical fitness we are finding that plantar fasciitis has been rampant. In fact, one third of the population will have plantar fasciitis in their lifetime. There are many things that one can do to assist in relieving this condition and preventing its onset. As a long time distance runner I have found that many individuals become injured due to training errors and poor choice of equipment. One of the most common denominators in this injury is increasing activities dramatically over a short period of time instead of a gradual break-in strengthening phase. For example, one of my old college running teammates decided to train for the Masters Division race circuit. In doing so he chose to increase his mileage from approximately 50 miles per week to 70 miles per week in one week. After having spent many years running through high school, college and life he developed plantar fasciitis for the first time in his running career. This sudden increase in mileage was the inciting event. We see plantar fasciitis increase dramatically in springtime. Many of us her in Utah have been “pent-up” during the winter months and then go out to lose the extra 5 pounds of “body fur” we gained over the winter months due to our inactivity. We also experience a rapid increase in activity working in the yard, hiking, biking, golfing etc. as we make the transition from winter to spring and summer. In my office we call springtime “plantar fasciitis season” which extends well into the summer months.
Things to do decrease likelihood of onset of plantar fasciitis:
- Gradually increase activity levels and stay fit generally in the off-season.
- Use supportive, well structured shoes.
- Stretch the Achilles tendon area through a consistent and gradual stretching exercise program.
- Consider the use of over-the-counter supports such as Powerstep™ and or Superfeet™ inserts which may be obtained at your local running store to be used as a replacement insert for the sock liner of your athletic shoes.
- Ice after activity.
- Exercise the intrinsic musculature of the feet bilaterally performing gripping exercises with your toes such as picking up marbles or bunching up a towel with the toes.
- Consider seeking medical attention if these modalities do not render improvement over a period of 4-6 weeks. Medical treatments may include such things as corticosteroid injections, PRP injections referral to physical therapy and custom orthotics. Surgery is indicated in very few patients. Recent studies show that approximately 5% of patients with plantar fasciitis will faill conservative care and may benefit from an operative procedure.
Dr Clark enjoys seeing patients from all walks of life, however, due to his running background he particularly enjoys his running connection with the community. He has been involved with both BYU and Weber State athletic departments over the years assisting them with athletic injuries of the foot and ankle.