Summer time is upon us, and so often shoes are exchanged for flip flops. The problem with flip flops is that they offer little support, and if you have abnormal foot mechanics such as flat feet, you can develop a painful arch, a condition called plantar fasciitis.
Plantar Fasciitis is caused by the breakdown and inflammation of collagen fibers in the thick band on the bottom of the foot that maintains the arch. The pain can develop gradually over time with the most common symptom being pain in the morning or after prolonged sitting, as the band has shortened but limbers up after a few steps. Xrays may identify a heel spur, which is caused by the prolonged pulling of the plantar fascia from the heel. Secondary complications can develop as the difficulty in walking produces abnormal mechanics causing stress to knees, hips and the lower back.
Risk factors in developing plantar fasciitis include:
· Increasing age as the ligaments are less supportive
· Flat feet or high arches which causes faulty foot mechanics
· Runners or ballet dancers who put abnormal stresses on the feet
· Obesity and pregnancy places increased weight on the feet
· Occupations which require prolonged standing
· Improper shoes which lack arch support
Treatment includes:
· Rest from activities that require being on the feet
· Ice and oral anti-inflammatory (Aleve) or creams (Voltaren)
· Laser, acupuncture or other modalities to increase healing
· Massage therapy to relax and stretch the fascia and increase blood flow
· Manipulation of a rigid mid foot to return normal function
· Orthotics to support the arch and distribute weight for better mechanics
· Exercises to stretch and strengthen the plantar fascia
· Taping the arch to maintain support
· Advice to avoid going barefoot, wear supportive shoes, and maintain a healthy weight
· Severe cases may require steroid injections when unresponsive to conservative treatments but caution should be used as steroids weaken the collagen fibers
Often there is a combination of treatment that is required to be successful at keeping plantar fasciitis under control. While individual results may vary, I have had success with laser treatments (approximately five), soft tissue stripping of the fascia of the arch, manipulation of the mid foot, and fittings with orthotics. Home advice of using a 500 ml ice water bottle to offer both inflammation control and massage, as well as doing stretches also complement the therapy.
So if you are finding you still want to wear your fancy summer shoes, take care of your feet so you don't develop that chronic pain in the foot!
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