A foot hold that spurs healing (heel pain of plantar fasciitis)

[Guest guest]

A foot hold that spurs healing

By Janet Cromley, Times Staff Writer

November 13, 2006

http://www.latimes.com/features/health/la-he-

plantar13nov13,1,5726009.story?ctrack=1 & cset=true

Ow. Ow ow ow ow ow. The sharp heel pain of plantar fasciitis is all

too familiar to court-stomping superstar dunkers and pavement-

pounding regular Joes alike.

Now a study by a team of foot experts provides new evidence that a

simple exercise can help give that pain the boot — potentially

bringing relief to the more than 2 million Americans hobbled

annually by the injury.

Plantar fasciitis is caused by a small tearing, or micro-tearing, of

the plantar fascia — a rope-like band of fibrous tissue that runs

from the heel to the toes and supports the arch. Caused by working

or exercising on hard surfaces, it bedevils nurses, teachers and

athletes of all stripes. Lakers guard Kobe has had it. So has

Cardinals slugger Albert Pujols.

Unlike many overuse injuries caused by excessive strain, plantar

fasciitis often follows relatively mild activity, such as standing,

walking or jogging, on a hard surface. The injury is vexing because

it can take from six to nine months to recover completely. For about

10% of unlucky sufferers, it takes longer.

The study, led by Dr. Benedict DiGiovanni, an orthopedic surgeon and

associate professor of orthopedic surgery at the University of

Rochester, tested a new exercise specifically designed to stretch

the plantar fascia. DiGiovanni theorized that it might be more

effective than the Achilles tendon stretch — a common exercise for

the injury.

The stretch involves curling the toes backward while flexing the

ankle (see sidebar). In an earlier investigation published in 2003,

he compared the exercise to the Achilles tendon stretch in an eight-

week clinical trial of 82 patients who had suffered from plantar

fasciitis for more than 10 months.

Patients were taught protocols for either the Achilles stretch or

the plantar fascia stretch. After two months, the plantar fascia

stretch group reported significantly less pain and more improvement

in their condition than the Achilles tendon group, based on their

responses to questions about pain and satisfaction with treatment.

DiGiovanni's new study, published in a recent issue of the Journal

of Bone & Joint Surgery, examined the progress, two years on, of 66

patients from the first study. All had been instructed in the proper

way to perform the plantar fascia stretching exercise at the

termination of the initial study.

Based on their responses, patients in the original Achilles tendon

group who had been taught the plantar fascia stretch showed marked

improvement, essentially catching up with the plantar fascia group.

In all, 92% of patients in both groups reported total or near-total

satisfaction with the treatment, and 94% reported a decrease in pain.

Dr. Charlton, an orthopedic surgeon and assistant professor

of orthopedic Surgery at USC's Keck School of Medicine, says he

likes the stretch and recommends it to his plantar fasciitis

patients.

Other treatments include icing; night splints (to keep the foot at a

90-degree angle while sleeping); orthotics and heel inserts; anti-

inflammatory medications; shock wave therapy; and surgery.

The pain of plantar fasciitis tends to be most intense after periods

of inactivity, such as in the morning, when first getting out of

bed, or after extended sitting. During those periods, " the body

tries to heal those micro tears, " DiGiovanni says. But the reverse

can occur as soon as the sufferer gets up. Small movements, such as

the simple act of walking , creates further tearing.

DiGiovanni believes that part of the success of his stretch is due

to the fact that he recommends doing it immediately after getting

out of bed and after other periods of inactivity — before the damage

is done.

The key to avoiding plantar fasciitis, say foot doctors, is to

exercise conservatively; avoid hard surfaces (such as concrete and

asphalt) both at work and at play; invest in a pair of good,

supportive, properly fitted shoes; and replace them regularly.

DiGiovanni himself has experienced the pain of plantar fasciitis —

after a round of golf.

" I woke up in the morning, put that first step down, and said, 'Oh

my goodness, I've got it. I can't believe I've got it.' "

Fortunately, he knew what to do. " I started the stretch right off

the bat, " he says.

Recovery stretch

Got a hurtin' heel? The following exercise can speed recovery from

plantar fasciitis. The best time to do the stretch is immediately

after the foot has been immobilized for a while, such as when you

first get out of bed or the car.

• Sit upright in a chair, barefoot. Place the ankle of the affected

foot on the opposite knee.

• Using the same hand as the affected foot, reach across and grab

the toes.

• Flex the ankle forward and pull the toes toward shin.

• To test the stretch, place the thumb of your other hand on the

bottom of the foot. You should be able to feel the cord-like plantar

fascia running the length of the foot.

• Hold the stretch for a count of 10, then relax. Repeat 10 times.

Perform the sequence at least three times a day.