Foot pain

There are few issues that bring patients into my office quite as quickly as foot pain. Think about it! If you have foot pain, every single step you take is a reminder of the pain. You can't escape it!

Not all foot pain is the same, but one of the most common issues I see is Plantar Fasciitis. The plantar fascia is the white band you see in the picture. It inserts into the heel bone, right in the middle, and extends to the base of the toes where it fans out and attaches to each toe. It's pretty cool and crucial to our ability to ambulate! The most common complaint I receive is pain in the foot when getting out of bed or after sitting for a long time. The pain is so intense patients have had to crawl because the pain of weight bearing is simply too much.

The best way to describe it is as a reverse rubber band. Instead of the plantar fascia stretching out, it is actually contracting and causing the pain. The causes are varied; over use due to running, excessive stretching, weak supporting muscles (hamstring, gastrocnemius, soleus, and even the Achilles tendon), improper foot wear, and even leg length discrepancy.

How is it treated? Like most musculoskeletal problems, we treat with RICE (rest, ice, compression, elevation), anti-inflammatory medications (ibuprofen, naproxen, Advil, Aleve), activity modification, change shoes, orthotic inserts, steroid injections, splinting, and stretching. I have heard old wives tales of patients have bilateral plantar fasciitis and attempting to have steroid injections completed. They have one foot injected but the pain of the injection is so intense that they forgo the second injection. I'm not sure the validity of this, but if you have ever suffered from plantar fasciitis, you know the pain is intense without an injection!

In my experience as a provider and as a sufferer, stretching the foot out over a ball or round object has the best benefit. By using a baseball or frozen 16 oz water bottle and rolling it under your foot, it helps to stretch the fascia back out. Does it hurt? Absolutely. But, it's a pain that hurts so good. Anything round with a diameter around 2" will do the best job at stretching. Other exercises include writing out the ABCs with your foot, scrunching up a towel with your toes, picking up marbles with your toes, bending your toes over a ledge or step, stretching out your calf by pushing against a wall and putting one foot behind the other, toe taps, fascia massage, and Achilles tendon and calf stretches. This study found that by just stretching, 83% of patients felt relief! Even using a foam roller for the foot and calf would help.

Like many other issues, it takes time and consistency. If you believe you have plantar fasciitis, I would try the above suggestions for up to 2 weeks. If you don't see any relief, then schedule an appointment with your PCP.