Part One of a Two-Part Series

Covering:
Plantar’s Fasciitis • Morton’s Neuroma • Ankle Sprains • Arthritis • Exercises • Proper Shoe Fit • Female Foot

One foot—26 bones, 33 joints, 107 ligaments, 19 muscles and tendons—and fertile ground for pain.

And also, conversation.

Mention your plantar’s fasciitis at a party, and you’ll have five new friends, all willing to commiserate and compete for the “you don’t know from pain” award. Mention Morton’s neuroma, and you’ll own the crowd.

So, in an age of hi-tech shoes and brilliant medicine why is it so hard to find a best foot to put forward?

One reason is that we are an aging population who actually exercises, says Thomas Clanton, M.D., professor in the Department of Othorpedic Surgery at The University of Texas Medical School at Houston and co-medical director of the Roger Clemens Institute for Sports Medicine & Human Performance.

And ankle sprain is “the most common time-loss injury in sports,” says Dr. Michael Altman, assistant professor in Family Practice and Community Medicine at UT Medical School who also specializes in sports medicine. While it’s great that we’re exercising to stay healthy, he sees an increasing number of injuries from overuse. Considering these maladies as well as long-term problems from trauma or wear and tear, it’s no wonder that 55 percent of Americans missed a day of work last year because of foot problems.

With a footlocker full of over-the-counter shoe inserts, exercises and other helpful remedies as well as shoes that fit properly, you can take steps to alleviate pain. When discomfort persists or there is inflammation, visit your doctor. Clanton says there are more than 100 surgeries for bunions alone.

The Painful Step—Plantar Fasciitis

What is that painful first step out of bed in the morning? Often, the source is plantar fasciitis. The plantar fascia is fibrous tissue that starts at the heel bone and is attached at the base of the toes. It supports the shape of the foot, acts as a shock absorber, and provides resiliency when the foot is coming off the ground.

“Unfortunately, it’s like a really tight bowstring,” explains Altman. Wearing high heel shoes creates an artificial arch inside the foot. Stress originating in tight calf muscles or a relatively short Achilles tendon can also cause pressure on the heel, where the fibrous tissue is attached.

Try This

Both physicians recommend trying heel cups, available at shoe shops, drug counters and sporting good stores, to relieve pain. Clanton suggests replacing the shoe’s standard insole with one with better cushioning or more support.

Altman also suggests at-home exercises.

Clanton says nearly 95 percent of patients with planter’s fasciitis respond to non-operative treatment like insoles and specific exercises. When surgery is necessary, small incisions, using fiber optic visualization, may be an option.

Like a Nail through the Foot—Morton’s Neuroma

Morton’s neuroma is irritation and/or degeneration of the plantar digital nerve causing a palpable and painful mass on the bottom of the foot, usually between the third and fourth toes. “You guessed it. This is also often caused by the pinchy, pinchy shoe!” says senior research nurse, Thea Troetscher, RN., who works with Clanton.

Try This

Troetscher lists these suggestions:

• Shoes with a wide toe box
• Padding under the foot or attached inside the shoe
• Possibly cortisone injections to reduce the inflammation

Altman explains, “The felt padding splays out the toes, so they are less likely to be squeezed together when you’re walking. Then you don’t get that pressure on the fibrous tissue around the digital nerves. You have to get away from these pointy shoes.”

Clanton adds, “A certain percentage of people will get better simply from the injections. Those who don’t respond might require surgery. Most surgery can be done under an ankle block or a local anesthetic.”

Alternative Therapies

Both physicians have prescribed physical therapy to regain strength or balance or reduce pain after injuries or surgery.

“I think certain patients with the planter’s fasciitis might benefit from some type of intervention other than addressing biomechanics and exercises. Iontophoresis is a treatment that requires a physician’s prescription. It employs a battery-operated unit with wires attached to electrodes,” Altman says. Electrodes on small pads are immersed in a steroid solution, then, placed on the site of the pain. A safe electrical charge discharges the medication directly into the foot.

Clanton mentions, “Acupuncture can be helpful... It tends to work best with soft tissue problems rather than bone problems.” Clanton says that some of his patients who are dancers with the Houston Ballet have had success.

Altman also suggests paraffin treatments, the application of warm wax, which can be helpful in the management of foot pain from arthritis.

Both physicians suggest:

• Sample over-the-counter heel and insole inserts to see if they help relieve pain.
• Wear shoes that do not exacerbate your problems.
• Wear shoes appropriate to your sport or work.
• Try exercises to help relieve foot pain.

Foot Note:
When It’s More than Foot Pain

Clanton points out that while many foot ailments are nothing more than what they seem, he cautions that foot problems may indicate underlying problems:

• rheumatological disease such as rheumatoid arthritis
• ankylosing spondylitis, inflammation or fusing of joints
• psoriatic arthritis, sometimes present in those who have the skin condition, psoriasis
• Reiter’s syndrome, a disease that has a genetic predisposition that can cause inflammation of the joints, along with other seemingly unrelated symptoms.

If pain persists after home treatment, trek over to a physician. There are almost as many solutions as there are feet.

Sports Injuries and Ankle Sprains

Ankle sprains, Clanton says, are the number one injury keeping people from participating in their sport, with thousands occurring every day. “In the very minor sprains, where the ligaments that support the ankle are simply stretched, it hurts but it doesn’t create instability in the joint. Therefore, the individual may have to rest it temporarily, but is able to resume activity rather quickly.” In more severe ankle sprains, a partial tear of the ankle ligaments occurs, or worse, a complete tearing of the ligaments causes instability and requires treatment.

Altman confirms that many patients ignore injuries until the damage requires medical attention. “You can usually tell with the amount of pain, the amount of bruising and swelling that occurs and how the joint feels after the injury. You may still be able to walk on it, but it doesn’t feel as stable as you would expect it to.”

Non-operative treatment is RICE (Rest, Ice, Compression, Elevation).

• Rest. Stay off the foot
• Ice, to reduce inflammation
• Compression, to reduce swelling
• Elevation, to reduce swelling

Warning…

If you are allergic to ice treatment,( some people do have serious reactions to cold), if the compression is so tight it cuts off circulation, or if you already have a circulatory problem (such as you’d have with diabetes), see a physician.

Troetscher adds, “Chronic ankle sprains can affect the integrity of the joint, resulting in future problems with post traumatic arthritis. It just gets really ugly after that.”

Stretching Exercises for the Plantar Fascia

1. Take a tennis ball, and put it in your freezer. Then take the frozen tennis ball and roll it under your foot from the arch to the heel, for about 5 minutes, twice a day.
2. Place the ball of your foot against the wall with rest of your foot on the floor, so you are stretching the arch of the foot. As you lean against the wall, bring your knee to the wall. This stretches not only the fascia, the fibrous tissue, but it also stretches the Achilles tendon.
3. Before you get out of bed in the morning, on your back with your heel against the mattress, stretch your toes up towards the ceiling a few times. This will help eliminate that first painful step.

My Right Shoe

Troetscher says there’s nothing wrong with purchasing a little strappy flash for the occasional evening out, but when shopping for shoes that will be daily companions, please consider the following:

1. Shop for shoes at the end of the day when your feet are their largest.
2. Most people have one foot that may be slightly larger than the other. Base your shoe size on the size of the larger foot.
3. Choose a reasonable heel height that won’t put too much pressure on the ball of your foot.
4. Look for a wide toe box, the area at the front of the shoe. Toes need room to wiggle. The top of your shoe should not rub the tops of your toes. There should be about 1/2 inch from your big toe to the end of the shoe

The Female Foot

The female foot is proportioned differently from the male foot. Women have smaller heels in relationship to the balls of their feet than men. Women should shop for athletic shoes designed specifically for their gender – shoes with an ample toe box, but narrower, snug heel.

Have a fetish? For more information about healthy feet and proper shoes, you can visit the American Orthopaedic Foot & Ankle Society website: http://www.aofas.org

Last Updated: 8-11-2003

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