18-24 July 2014 #716

Sole Therapy

Dhanvantari by Buddha Basnyat, MD

Ever heard of Plantar Fasciitis? It is Latin for ‘sole inflammation’, and leads to pain on the heel pad. The plantar fascia is a band of tissue that runs from the heel and supports the arch of the foot. A 45 year-old surgeon at a local hospital started experiencing pain in his right heel as he was operating on his patients. He would typically feel better for some time when he soaked his feet in hot water. The pain was worse in the morning after he woke up and walked around. There was increased pain and tenderness when he pressed his finger on the soft pad of his heel. Other than this bothersome, dull ache in his right heel, he felt completely normal with no other complaints. There was no history of trauma or any neurological diseases. He took ordinary pain medicines which gave him some relief.

Like the surgeon, individuals who spend a significant amount of time on their feet either walking, standing or running may be more predisposed to this ailment. Athletes who are constantly pounding their feet on a hard surface are also liable to suffer from plantar fasciitis. Obese people and those above 40 may also may suffer from this problem due to the excessive weight bearing, and pressure on the heels over many years. Most experienced clinicians will make the diagnosis without doing any tests just based on the history and the tenderness on the heel after careful examination.

In Western countries where data is available, up to 10 per cent of adults have had this kind of heel pain at least once in their lifetime lasting from days to months. The surgeon’s story is indicative of “classic” plantar fasciitis. For many people, it may be just heel pain for the first couple of steps in the morning and heaviness in the heel for the rest of the day. In some cases patients may have heel pain when standing up after prolonged sitting or they may have a dull ache in the heel at the end of the day. Some people may note that the heel pain occurs only after vigorous exercise and this may suggest an “overuse” injury. The pain may decrease with a proper warm up before vigorous exercise. In severe cases, there may even be localised swelling in the heel if regular exercises is continued despite the pain.

Unfortunately there is no single, effective treatment for plantar fasciitis. Educating patients about their condition can be an integral part of therapy. Athletes with plantar fasciitis may need to modify their activity and opt for temporary rest. Obese people will need to lose weight. Not walking with bare feet and using shoes with good arch support and cushioned heels may help. Massaging and stretching the fascia in the morning, for example, by rolling the foot over a can may be beneficial. Besides taking ordinary pain medicines, using ice on the heel pad after exercise or just soaking the feet in warm water can provide temporary relief.

Some doctors will inject steroids locally into the fascia, but this is a drastic measure for pain control. In most instances the pain will improve within a year or earlier even without any therapy. Importantly, plantar fasciitis is not related to nerves as this is primarily a problem of muscle and connective tissue, so if there are any neurological symptoms (numbness or weakness of the affected heel) an alternative diagnosis has to be sought.

Read also:

Pain in the sole, BUDDHA BASNYAT