"I can’t stand getting out of bed in the morning," said Nancy, the
petite patient sitting in the treatment chair. Sharing her distaste for early mornings I
was thinking "Well, yes, but what’s your point?" Instead I said something
more doctorly like "Tell me more."
Nancy told me that she is a nurse at a local hospital and needs to be on the floor at
6:30 a.m. For the last few months she has experienced a sharp pain in the inside of her
heels when she put her feet on the floor. The first few steps are extremely painful. After
a bit of walking the pain seems to ease up a little. Around noon she is doing pretty well,
as long as she does not stop to rest. Weight bearing after resting is almost always
painful. Late in the afternoon, just about the time she gets off from work, the heels hurt
no matter what she does. She said that the pain is wearing her down.
After an examination I determined that Nancy had inflamed a ligament-like band of
tissue that stretches from the toes to her heels. The ligament goes by the name of the plantar
fascia and its inflammation is called plantar fasciitis. This is a common
athletic injury and seems to affect a lot of nurses as well. Over stretching the ligament
is the direct cause of the inflammation. It can be overstretched by extra weight, overuse
and even the hormones released in the latter stages of pregnancy.
I explained to Nancy that we could direct treatment either toward the pain, itself, or
toward the cause, the over-stretching of the plantar fascia. Pain control can take the
form of oral or injected medication, physical therapy and even surgery. A better long term
aid might be to control the over-stretching. This is easily done in the office with a
special orthopedic taping that prevents the foot from stretching. Most people with heal
pain get this taping on their first visit to a foot doctor and cannot believe how
comfortable their feet feel. Nancy was no exception.
To achieve a more long term correction I plan on making a little device called an
orthotic that she can slip into her shoe that will hold her foot like the tape. The
orthotic is a bit more hygienic and a lot easier to use. With that I expect to give her
long lasting relief.
On her return visit after the first taping I told her how delighted I was with her lack
of morning foot pain. I apologized, however, for not being able to help the pain of the
early morning alarm clock.
