Plantar faciitis high on list of heel pain causes
DEAR DRS. DONOHUE AND ROACH: This is the second time I have had plantar fasciitis. The first time was more than five years ago. A doctor outlined a program for me, but I have forgotten the details. Will you give me a refresher course? -- L.O.
ANSWER: "Plantar" is the sole of the feet. The plantar fascia is a band of sturdy tissue that runs from the heels to the toes. It supports the feet and the foot arches. Plantar fasciitis is one of the most common causes of heel pain. Professional baseball, football and basketball players get it. People with flat feet or very high arches, overweight people, those who stand on hard surfaces for long periods and runners who suddenly increase their mileage or running time are the ones most likely to develop this injury. It happens to nonathletes, too.
It causes intense pain when an affected person gets out of bed in the morning and takes a few steps. During the day, the pain lessens, but it returns toward the end of the working day. The pain can be so severe that people are forced to take time off from work.
Other causes of heel pain include entrapment of a heel nerve in scar tissue, a loss of the fat pad that cushions the heel (found mostly in older people) and tiny fractures of the heel.
Weight loss is the answer to this problem if a person is overweight. Limit your walking, and don't do any running. You can bike and swim to stay in shape. At night, splint the foot so the toes point to the ceiling when you lie on your back. If the foot falls downward toward the bed, it aggravates heel pain. Ice the heel four times a day for 15 minutes. A silicone heel insert often proves helpful. Make sure your shoes are well-cushioned. Loop a towel around the front of the foot and, while seated, pull the towel so the foot is drawn to the body. This stretches the fascia. If this program fails, then see a doctor. A cortisone shot can bring rapid relief.
The booklet on aerobics, fitness and abdominal exercises can give newcomers a start in their exercise program. To obtain a copy, write: Dr. Donohue -- No. 1301, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DRS. DONOHUE AND ROACH: Playing handball, I twisted my ankle. It's a little swollen and slightly painful, but not enough to see a doctor. A friend tells me about a treatment called platelet-rich plasma. What's your opinion of it? -- B.C.
ANSWER: It's a novel approach to promote quicker healing of muscle strains, ligament sprains and injuries like tennis elbow. The doctor draws a sample of blood from the patient and spins it in a centrifuge to separate platelets (the clot-forming cells) and plasma (the liquid part of blood) from red blood cells. Platelets are rich sources of factors that promote healing. This material is then injected into the injured site. The science behind this therapy is solid, but it's going to take more study before it becomes a standard practice. I do know that it's not harmful.
DEAR DRS. DONOHUE AND ROACH: In the first football game of this season, I hurt my big toe from a tackle I didn't know was about to hit me. I showed my coach, and he said it was turf toe. The toe is black and blue, and hurts some, but I think I could play if I was allowed to. How long will I be off? -- H.J.
ANSWER: Turf toe happens when the toes are on the ground and the heel is high off the ground. When you're hit in this foot position, ligaments that stabilize the big toe are stretched, and some might be torn.
If your ligaments have only been stretched, you can play as soon as the toe moves painlessly in all directions. This might take a week. If ligaments have been partially torn, it will take you three weeks before it's safe to play. And if they're completely torn, your foot should be in a cast. It takes 10 weeks to four months before such an injury heals.
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Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu with medical questions. Readers also may order health newsletters from www.rbmamall.com.
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