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Heel pain a classic sign of common foot injury

Connie Glen, whose foot pain was diagnosed as plantar fasciitis, at her home in Oakville, Ont., last Saturday.

Aaron Vincent Elkaim/THE CANADIAN PRESS

Connie Glen isn't sure what she did exactly, but in February she started getting unexplained pain in her left heel – and seven months, several practitioners and about $2,000 later, it's still not entirely healed, though she's finally seeing some improvement.

Glen has plantar fasciitis, a common foot injury that can make walking even short distances an ouch-inducing exercise and one that has derailed many a planned marathon among running enthusiasts.

The condition occurs when the plantar fascia – a thick band of tissue that runs along the bottom of the foot from the heel bone to the toes – becomes inflamed, typically causing stabbing heel pain that for some people can be nothing short of excruciating.

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This band of tissue supports the arch of the foot; putting too much tension on the fascia through exercise, improper footwear or being overweight can cause microtears that lead to inflammation and pain.

Glen, whose exercise routine had ironically included yoga and pilates to help stretch and strengthen her muscles to prevent injury, had started taking twice-weekly barre classes that incorporate some of the "up-on-your-toes" exercises ballet dancers use to limber up.

"And I started getting this funny pain in my heel once in a while, but I didn't relate it to the barre class," says the 49-year-old from Oakville, Ont., who works as a quality manager for a major food company.

"The mornings were just excruciating until I'd taken the first five or six steps," Glen says of getting out of bed. "But it wasn't just the mornings. It was every time I got up from my desk."

Vancouver podiatrist Joseph Stern says that's a classic sign of plantar fasciitis, experiencing heel and often arch pain when walking after non-weight-bearing rest .

"Some people will say it hurts for the first bunch of steps, then it calms a bit and then as the day progresses, it hurts," says Stern, president of the Canadian Podiatric Medical Association.

About 90 per cent of cases have biomechanical underpinnings, in which the foot does not have a sound foundation when a person is standing, walking or running, he says, pointing to such common causes as wearing worn-out or unsupportive shoes, carrying excess pounds or having tight calf muscles.

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"Treatment is like making a cake, as I tell patients. It's going to be a little bit of this, a little bit of that. And sometimes one thing works and thank you very much."

Initial treatment usually involves having a patient roll the arch of their sole over a cold water bottle or tennis ball several times a day to stretch out the fascia.

"Stretches are good, like pulling your toes up towards your nose, holding it for 20 to 40 seconds, then do it again," Stern says.

If the pain persists, practitioners may tape the heel and sole to correct overpronation, where the foot and ankle rolls inward .

"And that kind of gives a good support to the foot, so it's simulating an orthotic," he says. "It's putting the foot in a better alignment, a more 'neutral' position or supporting the foot from the heel up to the forefoot."

Orthotics – inserts for shoes that support the arch – can also help eliminate plantar fasciitis, but Stern recommends those created from a 3-D cast of the patient's foot rather than orthotics based on two-dimensional foot impressions read by a computerized mat.

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Other treatments include physiotherapy, acupuncture or a shot of cortisone in the affected part of the foot to calm the inflammation. Some practitioners recommend a night splint, a brace that holds the foot with the toes pointing up to gently stretch the fascia while a person sleeps.

Glen, who saw a chiropractor, physiotherapist and osteopath before being referred to Toronto sports-medicine specialist Dr. Chris Woollam, says it was shock-wave therapy that started her stepping in the right direction.

"What's frustrating for me is it's not like I ignored it. I was on this within the first week of getting it and it just kept progressing."

That's why Stern advises that anyone with heel/sole pain shouldn't put off seeking treatment.

"With most of my patients, it's months and months until they come in," he says. "Jump on it, don't let it linger … because if you let it linger, it's just harder and harder to get rid of."

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