As I was heading off to visit my daughter at Visitor’s Day in New Hampshire, I had to consider what shoes to wear so that my feet wouldn't hurt while walking around the hilly campus. Several weeks ago, I came down with unremitting foot pain – seemingly as a direct result of some new "light hikers" I purchased for an adventure trip to Maine. Now, I have a greater appreciation for plantar fasciitis, a common affliction of patients in my practice.
 
As soon as I was in my daughter's bunk, the mother of another camper started telling me about her terrible ordeal with plantar fasciitis. And then another told me about hers. As I was spewing advice I thought it might make sense to blog about it.
 
The plantar fascia is a thick connective tissue that supports the arch of the foot. It runs between the heel on the undersurface of the foot and goes all the way to the metatarsal heads (ball of the foot). I liken the plantar fascia to strong packing tape with fibers. If you've ever seen that tape you would understand immediately. The plantar fascia can get inflamed, and become quite troubling.
 
Most often the pain is localized by the heel on the undersurface of the foot or towards the midfoot on the undersurface. It's unclear what brings on plantar fasciitis but it is usually associated with tight heel cords, lack of good arch support, weight gain, or increase in activity. Frankly, it happens commonly to people between ages 40-60, sometimes without evidence of precipitating event.
 
Treatment is directed at providing proper support for the arch, and by stretching both the heel cord and plantar fascia. Early on, it may be helpful to use ice to massage the undersurface of the foot. My preference is for a bag of frozen peas, which allows greater surface area of contact. Anti-inflammatory medication may be prescribed but is usually not sufficient on its own to cure the condition. Once the acute inflammatory phase dies down I often prescribe home massage of the plantar fascia by rolling the foot over a tennis ball. I've also used a seltzer bottle filled with warm water (with the cover on, of course). This provides both gentle stretching and massage.
 
Often, people with foot pain/heel pain will get an X-ray. This may or may not show a heel spur. Usually a heel spur is not the source of the pain. Rather, it is a development of the plantar fascia tugging on the heel over time, causing inflammation. Most treatments of plantar fasciitis are not directed at getting rid of the heel spur.
 
It is important to provide adequate arch support. If the patient has a low arch to begin with, then we usually start with store-bought orthotics. If the patient has a high arch, the store-bought orthotics are usually too low to help. If store-bought orthotics don't help, it may be necessary to move to a custom orthotic.
 
In almost all cases, stretching of the heel cord and plantar fascia is recommended. There are actually night splints that keep those areas stretched while you sleep. If you've ever had plantar fasciitis, you know you dread that first step out of bed in the morning, and you'll be willing to wear night splints if you don't improve with other treatments (including physical therapy). In some cases, it may be worthwhile to try a cortisone shot where the plantar fascia attaches to the heel. I try to avoid this, as it is not the most comfortable shot, and can also erode the fat pad that protects the heel. This can lead to further problems.

If all else fails, there's always surgery. But it's very uncommon to need it.
 
I'm happy to report my orthotics are in my shoes and my feet are beginning to feel much better. As for my "light hikers," L.L. Bean was nice enough to take them back.