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Straight Talk About Injuries


What can we say about the feet without waxing poetic? You may have the whole world on you shoulders, but your shoulders are on your feet. As with the knee, the feet can have any number of a thousand problems and we haven't the expertise or time to go into everything. Although we do see some common problems, and we can talk about those.

Plantar Fasciitis

Plantar fasciitis is characterized by pain anywhere from the ball of the foot to back by the heel. Initially, the pain may not come on until after you have been walking or running for a time. A sign of the condition worsening is when the pain comes on sooner and lasts longer. If left untreated, the pain can become so severe that you have to reduce your activity level or stop activity altogether. The pain is often very severe in the morning and decreases after walking, stretching or massaging the foot for a few minutes.

Plantar fasciitis literally translates into inflammation of the plantar fascia and is quite common and quite treatable. The plantar fascia is a piece of connective tissue that connects the ball of the foot to the heel. The pain of plantar fasciitis comes from damage to that connective tissue which has resulted in an inflammatory response. One characteristic of damage to contractile tissues (tissues which can contract like muscles and tendons) is that they contract in response to the damage to prevent further aggravation. This is great for other areas of the body, but not so for the plantar fascia. It is this characteristic shortening to damage that explains why the pain is often more severe in the morning, because while we sleep our feet drop, shortening the distance between the ball of the foot and the heel, allowing the fascia to contract and shorten in response to the damage. When we then stand in the morning we force that fascia to stretch out again and experience the characteristic pain.

Despite the debilitating effect the pain of plantar fasciitis can have, the treatment is relatively simple. There are three cardinal rules when dealing with any type of inflammatory problem: rest, ice and anti-inflammatory medication. Rest is often the most difficult aspect because, lets face it, we half to walk. So, rather than stay off your feet for a week (granted that might seem like a great idea) you lift the heel. Lifting the heel reduces the stress transferred to the plantar fascia, reducing the amount of aggravation caused. This way, even though you are on your feet, the plantar fascia is getting a break. The heel lift doesn't have to be very high, _" to _" is all that is needed to provide some significant pain relief. The Sports Medicine Shop has several varieties to choose from. Visit the foot section on the web site to check prices and descriptions.

Athletic trainer's go to school for four years to learn that if something swells, put ice on it. (I'm a certified athletic trainer, so I can say that. In good humor of course.) Ice is so simple a treatment, people forget that it is also a tremendously useful tool. While ice doesn't reduce the inflammation that's already there, it will prevent more from accumulating. While the inflammatory response is necessary for healing and the body is excellent at getting it geared up, it's not so good at stopping it or getting rid of it once it's there. Ice prevents the inflammation from getting too out of hand. Wrap the bottom of the foot in ice for twenty to thirty minutes every two hours, or as close to that as you can get. Even once or twice a day for half an hour is better than nothing, and will provide some excellent benefits. If ice is too inconvenient, get a gel cold pack, not the instant kind. There is a common misconception that the gel ice packs are not as cold as ice. The truth is just the opposite. Since gel doesn't freeze solid until extremely low temperatures, it is able to absorb more cold energy and get colder than ice, which is able to reach only 32 degrees. However, since the gel packs get so cold, you need to remember to put a small cloth between the pack and your skin, or you may find yourself with a nasty ice burn. A pillowcase is an excellent cover for the gel ice packs.

Anti-inflammatory medications may be helpful, but should be taken under the direction of a physician. Talk to your physician about the possible benefits these medications could provide.

To prevent the shortening of the plantar fascia while you sleep, we recommend using a night splint. This is a device that is worn while you sleep that keeps the foot from dropping. Thus the plantar fascia remains stretched while you sleep allowing healing to take place with your foot in a functional position and preventing the drastic morning pain. We have found the night splint to be one of the most effective tools in treating plantar fasciitis and we highly recommend using it until the condition is completely healed. The night splint appears somewhat bulky, but is easily adapted to and people generally prefer wearing the splint to waking with pain.

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