After a summer of playing golf and tennis, Jan began a fall exercise program that included jogging. She came to me complaining of recurrent pain on the bottoms of her feet.
After ruling out a crack in her heel bone, a pinched nerve or swelling in the cushioning pad under the heel, I diagnosed her problem as plantar fascitis.
The plantar fascia is a ligament extending from the bottom of the heel bone to each of the five toes. It supports the bottom of the foot, especially the arch. If too much pressure is exerted on it, the fascia can tear, usually at the weakest point where the ligament attaches to the heel.
The pain can start right away with a sudden tear, or it can develop slowly over many days. There is usually slight swelling and tenderness. The pain is felt on the bottom of the heel. It's most severe when you get up in the morning, when you just start to exercise and when you raise yourself up on your toes. Eventually, the pain will be so bad it will be impossible to function.
Rest is the only treatment for a torn plantar fascia. Injections of cortisone-type drugs or taking aspirin may reduce the pain, but they also can delay the healing.
The first step in healing is to stop the sport that caused the injury. While the foot heals, you can participate in sports that don't put weight on the bottom of the foot, such as riding a bicycle or swimming.
When you return to your sport, wear shoes with flexible soles, wear arch supports to limit the rolling motion of your foot and stretch your calf muscles before you exercise.
Q: My wife is giving me a bad time about my weightlifting because she read that some weightlifters and bodybuilders have had heart attacks. What can I say to stop her worrying?
A: Even though they may look tough and healthy, people who participate in weightlifting and bodybuilding suffer from a disproportionately high incidence of heart attacks. But their sport is not the problem.
Many weightlifters and bodybuilders are so obsessed with their sport they just don't exercise common sense when it comes to eating. They accept the common myth they should eat enormous amounts of food, especially high-protein foods.
They need to understand the only way to build stronger, bigger muscles is to exercise those muscles against resistance. You can do that by lifting weights or working out on strength training machines.
When you eat more food than you need -- whether that food is a carbohydrate, protein or fat -- the extra food turns into a type of fat called triglyceride. Molecules of triglyceride can combine to form VLDL cholesterol, which is converted into LDL cholesterol, the "bad" cholesterol that clogs arteries to cause heart attacks.
Some weightlifters and bodybuilders also take illegal anabolic steroids to make their muscles bigger. Steroids, too, will increase LDL cholesterol levels.
As long as you are in good health,
don't bulk up on food and steer clear of illegal steroids, you can lift weights without any unusual fear of suffering from a heart attack. It's always a good idea to check with your doctor before beginning any new exercise program.
Q: What can you tell me about the anti-depression drug Prozac? I saw early reports that it can cause suicide, but I haven't read about it lately.
A: A judge in Kentucky recently dismissed a $150 million lawsuit that claimed Prozac caused a woman to attempt suicide.
A few years back, Dr. Martin Teicher of Harvard wrote a paper associating Prozac with suicidal thoughts. The paper triggered a number of lawsuits against Eli Lilly, the drug's manufacturer, claiming that Prozac caused some people to attempt suicide. To date, all of those suits have been decided in favor of Eli Lilly.
There are two types of depression:
Situational depression is caused by environmental factors, such as the loss of a loved one or being in an unhappy situation. It is treated with talking, support, understanding and an effort to improve the unhappy situation.
Chemical depression runs in families and does not improve with talking or even intense psychotherapy. It is treated with drugs. Most anti-depressants are not very effective and cause people to gain weight. Prozac is often prescribed because it helps two-thirds of the people who take it and does not cause weight gain.
Dr. Mirkin is a practicing physician in Silver Spring specializing in sports medicine and nutrition.