Move Over Back Pain, This Pain is Taking Over

Lower back pain (LBP) has been and remains the number one muscular-skeletal complaint in the United States.  But there’s a new complaint growing by leaps and bounds and, if it continues, could overtake chronic LBP as public enemy number one.  It’s foot pain and it’s a condition that has a name – plantar fasciitis.  On Friday, The Boston Globe declared plantar fasciitis is the “new back pain” afflicting an estimated 10% of the population and growing daily.

Plantar Fasciitis Defined

Plantar refers to the soles of the feet.  Fascia refers to the connective tissue that exists throughout our bodies.  Think of fascia as a net or webbing beneath the skin that covers all our musculature, bones, blood vessels and organs.  Fasciitis is a condition in which the fascia is chronically inflamed.  Plantar fasciitis, therefore, is the chronic inflammation of the connective tissue on the soles of our feet, from the heel to the toes.

The pain can present on any part of the sole of the foot, but the most common complaint is a sharp, knife-like pain in the heel that’s worst when first stepping out of bed in the morning or after having been off the feet for a significant length of time.  It’s not uncommon, however, for runners who have plantar fasciitis to also experience the pain immediately after completing a run.  Some have mild symptoms that come and go.  For others, the pain is daily, long-lasting and, if untreated, can become debilitating.

Risk Factors & Possible Causes

Statistics show plantar fasciitis is more common in women than in men and usually doesn’t occur until middle age or later.  Being barefoot on hard surfaces, wearing ill-fitting shoes or wearing shoes beyond their lifespan increases the odds of developing the condition for all populations.  But, other risk factors and possible causes can seemingly conflict with or contradict one another:

  • Having low arches or having high arches
  • Being overweight/obese and sedentary or being fit and exercising a lot (especially running, power-walking and jumping)
  • Having feet in a pointed-toe position for long periods (such as stomach sleeping and wearing high-heeled shoes) or standing for long periods
  • Wearing rigid, hard-soled footwear or wearing flexible, soft-soled footwear

Treating Plantar Fasciitis

Whatever the reasons, if you’re experiencing plantar fasciitis on a daily basis, treatment is necessary to get rid of the inflammation and, thereby, get rid of the pain.  The tricky thing is, just as the causes can be seemingly nebulous, any given treatment can work for some and not others.  It may mean being patient through some trial and error.

If your condition is relatively mild, try these home remedies first:

  • Stretch calves, Achilles tendon (back of ankle) & soles of feet daily (2x/day+)
  • Ice soles of feet for 15 minutes at a time (2x/day+)
  • Massage soles of feet by rolling a golf ball under foot for 15 minutes (2x/day+)
  • Combine above two steps: freeze a filled, plastic water bottle, roll under foot for 15 minutes (2x/day+)
  • Take OTC anti-inflammatory medication as directed (such as ibuprofen)
  • Don’t sleep on stomach
  • If you sleep on your back, don’t tuck in bedding at the foot of the bed
  • Wear supportive footwear, replace them often & avoid high-heeled shoes
  • Don’t walk barefooted, including first thing in the morning
  • Try shoe inserts for plantar fasciitis (see suggestions here)

If your condition interferes with your daily life or if you’ve tried the above home remedies for over a month with no relief, it’s time to schedule an appointment with a podiatrist.  He’ll first rule out fractures and bone spurs to confirm the diagnosis of plantar fasciitis.  Since treating plantar fasciitis is a bit of a hit or miss endeavor, she is likely to try a multi-pronged approach, beginning with the least invasive treatments first.  Treatments could include:

  • Prescribed stretches and icing regimens
  • Soft boot to keep the feet flexed while lying down and/or sitting
  • Prescription anti-inflammatories
  • Massage and/or pulse therapy
  • OTC orthotic inserts and heel cups
  • Cortisone injections

Most people respond to some combination of these treatments.  Customized orthotics may be necessary in some cases.  Surgery is a last resort.

Once the inflammation dissipates and the pain retreats, many treatments like prescription medicines, boots and therapy can be stopped.  But, the inflammation and pain will likely return if you’re not careful about caring for your feet.  Most people who have experienced plantar fasciitis will need to continue daily stretching and wearing orthotics and to avoid problematic footwear and bare feet indefinitely to keep it at bay.

The one positive result that may come with increasing numbers of people suffering from plantar fasciitis is a push to study the condition to better understand the underlying causes which could lead to better treatments.  In the meantime, if you suffer from it, you’re not alone and relief can be realized relatively easily and affordably.  You need only take a few proactive steps.  (Pun intended!)

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