This foot condition is the new back pain — it’s everywhere

Updated 10/22/2018
Plantar Fasciitis, the Boston Globe, Dr Bob Baravarian

Written by Beth Teitell, Globe Staff


A spokesman for the American Podiatric Medical Association says the condition has reached “almost epidemic” levels.


The chief of podiatric reconstructive foot surgery at New England Baptist Hospital goes further: “It’s an epidemic.”


It’s become so common — with millions of sufferers — that it’s safe to call it the new bad back.


And yet, as medical conditions go, plantar fasciitis has no cachet. Many hear the name and think “plantar wart,” not “what are these intense stabbing pains in my heel?” or “why does my arch feel bruised?” or “how come I’m limping?” Alleged “remedies” — like the toe spreader, or the Strassburg sock (don’t ask) — make you feel like a dork. There’s no celebrity spokesperson.


There certainly aren’t any big fund-raising walks.


If plantar fasciitis has come for you — or a loved one or friend or colleague — you know this to be true: It’s persistent (attacks can stretch on for a year, and be so painful walking feels nearly impossible). And not unlike Taylor Swift, the affliction has a wide and diverse base; it afflicts skinny runners and plump couch potatoes alike.


If you want to start a passionate conversation, mention the malady in a crowded room and prepare to be overwhelmed with tales of woe — and advice.


“Everyone has some remedy,” said plantar fasciitis victim Ken Johnson, 57, a retiree who lives part time in East Orleans.


Drink tart cherry juice twice a day. Don’t eat shellfish. Ice with your foot in this position. No, ice with it in this position.


Johnson tried it all, but in mid-October he was forced to cancel a long-planned trip to Antarctica. As an amateur photographer he was looking forward to seeing the emperor penguins, but as a plantar fasciitis sufferer, not looking forward to other aspects of the trip.


“I have trouble going for a walk around my neighborhood on the Cape,” he said. “The idea that I’d go to South Georgia Island and traipse about over snow and ice, carrying a 40-pound backpack of camera equipment . . .” his voice trailed off as he imagined the pain.


Before we go any further in this plantar fasciitis journey, let’s answer some basic questions.


Number one: What is it? It’s not a plantar wart. It’s the inflammation of the plantar fasci, or thick band of tissue that connects the heel bone to the toes.


Number two: Who gets it? Risk factors include being middle-aged or overweight (or both). Those with flat feet or high arches or tight Achilles’ tendons or calves are also in danger. Wearing poor shoes with thin soles or no support can doom you. So can excessive running or standing.


Number three: Why the epidemic? Blame high obesity rates, yoga, and casual Friday (and casual Monday-Thursday).


The shift from suits to casual wear in the workplace — and the attendant move from stiff, leather-soled shoes to flexible sneakers — means people are wearing shoes that provide less stability and rigidity than in the past, said Bob Baravarian, an assistant clinical professor at UCLA School of Medicine, and director of University Foot and Ankle Institute in Los Angeles.


Those mushier shoes, he said, put more strain on the fascia than other, more structured footwear.


Yoga is a culprit, too, said Kenneth M. Leavitt, chief of podiatric reconstructive foot surgery at New England Baptist Hospital. Any activity where you’re standing barefoot for a long time can cause problems, he said.


There are several ways to measure the size of the plantar fasciitis problem. One is by sheer numbers. As much as 10 percent of the general population may suffer from plantar fasciitis, according to a study published in the March issue of the Orthopaedic Journal of Sports Medicine


Another way to see it is at Podiatry Today, where November’s annual heel pain issue is among the most popular, according to publisher Jeff Cieszkowski. “This is information our readers are hungry for,” he said.


Or go on Amazon and check out the most popular night splint and its 1,041 (and counting) reviews, which make for fascinating reading for the afflicted.


Consider this page turner: “I’ve had plantar fasciitis almost all year, have tried all kinds of stretching, using crutches often, strapping my arch every day with athletic tape, massage, always looking for ways to reduce stress on it. . . . I am rather jaded about total healing at this point, but I got the most encouragement that something just might make a difference when I started using this splint.”


Plantar fasciitis has been likened to mold. “Just kind of lurks and requires daily management to keep it at bay,” one woman said.


Indeed, its ongoing nature — it’s here, it’s gone, it’s back — has desperate victims cycling through endless products and procedures.


There are orthotics and compression socks and foot rollers and foot massagers and heel cups. Acupuncture might help, or cortisone shots. Or maybe not. You can discreetly roll your foot on a frozen water bottle at work under your desk, and watch YouTube videos on the art of foot taping.


You can try one of the newer treatments, like stem cell injections, shock wave therapy, or low-level laser therapy. But it’s going to cost you, said Jason Miller, a Pennsylvania foot and ankle surgeon.


“Most often the insurance industry doesn’t pay for these because they’re considered ‘experimental,’ ” he said.


There’s surgery, too, but that’s considered a last resort.


Alas, what works for one person does not necessarily help another. As Alex Kor, the spokesman for the podiatrists’ association, and a podiatrist himself, explained in an e-mail to the Globe:


"Unfortunately, there is NOT one standard treatment protocol (provided by all podiatrists) for plantar fasciitis. To compare this condition to a toe fracture, there is little variation in the treatment of a toe fracture. Conversely, for plantar fasciitis, there are many options.”


Such is the wily nature of plantar fasciitis that even the most non-controversial-sounding advice — stretching — can be a matter of disagreement.


“It’s an urban myth,” said Leavitt, the foot surgeon. “When you stretch, you only aggravate it more.”


OK, plantar fasciitis, you win.

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