Staying off feet to cure pain is a stretch

July 30, 2002|By SUSAN REIMER

MY FELLOW MOTHERS and I are walking these days like a bunch of fellow grandmothers.

It is a kind of limp accompanied by a facial expression that is equal parts flinch and exasperation.

Our feet hurt from the minute we step out of bed in the morning, and, frankly, we don't have time for this.

According to the sports medicine doctors and orthopedists who usually treat our pampered child athletes, we are all suffering from plantar fasciitis, a fancy name for what happens when you are on your feet all day.

"Good luck," says Stephen Baitch, a physical therapist with Union Memorial Hospital's sports medicine clinic. He's been treating this stubborn injury for 22 years.

"It is very common and very difficult to treat. If you get to it early and treat it aggressively for three or four months, maybe."

But otherwise, he says, it can take more than a year for the pain to subside.

Plantar fasciitis is the No. 1 complaint of people who seek treatment from podiatrists, and it affects more than 2 million new patients a year.

If you wake in the morning and your first few steps out of bed are extremely painful, your plantar fascia - the broad band of connective tissue that extends along the bottom of the foot from the heel to the toes - is probably inflamed.

Often the pain is located primarily in the heel and is erroneously referred to as a heel spur, experts say.

An X-ray will reveal whether there is a broken bone or calcium deposits, but generally the pain comes from dozens of little micro-tears where the plantar fascia wraps around the heel and connects with the Achilles tendon.

The pain can be piercing or burning, or it can feel like a stone bruise. Whatever the description, it is miserable and the only sure cure - complete rest - is next to impossible for those who are most at risk: athletes and mothers.

"Basically, I am seeing women," says Michele Amini, a physical therapist with Physiotherapy Associates in Annapolis.

"I see a few athletes, but usually there is a trauma associated with them. Give them orthotics and it goes away.

"But 80 percent of my patients are women."

Amini and Baitch blame women's shoes. Most of us wear high heels or sling backs or slides or cute little strappy nothing shoes during the workday.

Baitch says 10 hours in such laughable footwear shortens the Achilles tendon and the calf muscle. Women get home and switch over to some kind of athletic shoe and the plane on which the foot treads changes drastically.

"And women never stretch when they change shoes," he says.

Heck. Women don't stretch when they exercise. That, Amini says, is the problem.

"Women don't realize the importance of stretching, and it is the first thing they give up for the sake of time. They want to burn calories and condition the heart, but they don't know what they are giving up when they try to save 15 minutes by not stretching."

And we are not talking about that 10-second bouncy stretching some weekend warriors use before they take off down the jogging path. That kind of stretch is worse than none at all, Amini says.

She recommends stretching the calf muscles in a sustained manner three times each for 20 seconds, and Baitch says women should do it when they change shoes, not just when they are leaving the house for the Sunday 5-mile power walk.

What women may not realize is that this injury doesn't originate in the foot. That's only where the pain is. Plantar fasciitis has its nexus in the calf muscles that are so abused by our bad shoes and our run-around lifestyle.

"You have been in heels all day, shortening your calf muscle," says Baitch. "Then you kick off your shoes and ask it to release itself. It can't elongate if you haven't stretched."

"You can't stretch the fascia," says Amini, "so you have to go back up and stretch your calf and your hamstring."

Plantar fasciitis, I think, is the classic motherhood injury.

Those of us who used to run 10-milers and play in racquetball leagues or do step aerobics four times a week have had to find a kinder, gentler form of exercise that will fit our tightly packed schedules and our changing bodies.

So we are all walking. And we are walking many, many miles each week to burn the calories we used to burn in a spinning class.

We are also walking because we can talk with friends while doing it, and most of us have a tremendous need for advice, commiseration and laughter from our fellow mothers.

(There is no evidence of this in medical literature, but I am convinced that the plantar fascia is also irritated by the foot position required by the gas pedal in an automobile.)

Amini says it can take three months to a year before "you can go through a day and realize that you haven't thought about the pain in your foot."

Treatment can include over-the-counter anti-inflammatory drugs, heel cups, arch supports, foot wraps, "night boots," orthotics, rest, ice, massage, physical therapy, ultrasound, heat, shock waves, cortisone shots and, ultimately, surgery. The sheer number of these options tells you how stubborn this injury is to treat.

I think it is a cruel and careless universe that strikes women down with an injury that can only certainly be cured by getting absolutely nothing done.

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