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The Therapist is in...Happy feet for the summer

The Therapist is in...
Happy feet for the summer
by Shannon Murphy, MPT

So you've pushed the snowboots into the back of your closet and replaced them with your favorite summer shoes. While there is nothing wrong with letting your feet breathe in the warm weather, choosing smart shoes is important year round. Your feet bear the brunt of your body's weight, play a big role in your walking pattern, and affect how well your ankles, knees, hips and back hold up over time. One of the most common sources of foot pain, called "plantar fasciitis," can flare up in summer months when people spend more time barefoot or in sandals.
What is plantar fasciitis?
The "plantar fascia" is a dense band of fibrous tissue on the bottom of your foot - it extends from the heelbone to the base of the toe bones and helps to maintain the foot's structure. In some people, particularly those who are overweight, have flat feet, and/or spend a lot of time standing/walking, that tissue can become painful and irritated. Pain on the bottom of the foot or heel is therefore called "plantar fasciitis", although several different types of conditions or problems can be lumped into that category (inflammation, nerve entrapments, trigger points, heelspurs, etc).
How is plantar fasciitis treated?
A multi-dimensional approach is most effective. A range of treatment options are available, including anti-inflammatory medications, local injections, nighttime splints, modalities (like ultrasound, low-level laser, shockwave, etc), footwear changes, orthotics, exercises and alternative medicine (like acupuncture). Surgical intervention is rare. Physical therapy helps to identify underlying imbalances, instruct corrective exercise, decrease pain, improve posture and coordinate the selection of shoes, orthotics, and self-management strategies.
Simple Steps for Home
Direct ice is an effective way of reducing inflammation and pain in the plantar fascia. An ice cup is one easy method. Fill paper cups with water and freeze them. Then peel off the top of the cup and massage the exposed ice over the heel and arch region for 5 minutes, 2-3 times a day.
Plantar fasciitis is commonly irritated by walking and standing. Just as a bruise cannot heel if you keep bumping it, an irritated tissue cannot calm down if keeps being provoked. To the extent that you can, try to get off your feet and choose non-impact fitness activities (e.g. swimming over running) until you are feeling better.
Heel and arch support are important in helping to support the foot and decreasing strain on the plantar fascia and deep muscles of the foot. Flip-flops, most sandals, and many styles of popular shoes fail to provide this type of support. This is an area in which the saying "you get what you pay for" has some truth. Investing in good footwear (go to a reputable walking/running store with a knowledgeable staff) can pay enormous dividends. Many companies do market summer shoes that offer some support - look for a deep heelseat, contoured arch, sturdy straps, and a cushioned sole.
Inserts can also help significantly to improve a shoe's support, and can be a cheaper "first-step" than custom orthotics. As with shoes, however, it is important to select an insert with stability...not gel liners or flimsy cushions.
There is some evidence that an opposite approach (barefoot or minimalist) works for some individuals, but success with this method relies on a variety of factors and should not be undertaken without the specific guidance of a physical therapist or other qualified practitioner.
In many cases, progressive stretching to the sole of the foot and calf muscles can alleviate pain. Stretching these areas first thing in the morning, before you take your first steps, is helpful since the tissues get tight overnight. Keep a towel next to your bed. To stretch, hook it over the ball of your foot. Then, keeping the knee straight, pull back on the towel. Hold the stretch for at least 30 seconds and repeat until the intensity feels lessened. This should make your initial steps less painful.
It is important to catch symptoms early, so that you can recover more quickly, remain active, and enjoy the long summer ahead!

This series of columns are by Shannon Murphy, MPT, Owner/Director of BodySense PT. 9 Saint Paul St, 3rd Floor, Boonsboro, MD 21713. 301-432-8585 phone, 301-432-1987 fax,

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