ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, July 30, 1996 TAG: 9607300012
SECTION: EXTRA PAGE: 3 EDITION: METRO
SOURCE: JANE BRODY
Angelica Divinagracia of Van Nuys, Calif., tapes her foot every night before bed and again before teaching her thrice-weekly step classes. Richard Erde of Brooklyn got custom-made orthotic devices for his tennis shoes and sleeps on his stomach with his feet hanging over the end of the bed.
Both are trying to reduce the strain on a much-talked-about tissue in the foot - the plantar fascia - that few Americans had even heard of before being bitten by the fitness bug. The painful problem that Angelica, Richard and many thousands of runners and others share is called plantar fasciitis (faa-she-EYE-tis).
Like tennis elbow and shin splints, plantar fasciitis is most often an overuse injury that afflicts those who use their feet extensively for running, walking, stepping or even prolonged standing. It is a classic repetitive-stress injury that, if recognized and treated early, can be readily overcome, but if ignored will only get worse until it becomes completely disabling.
The plantar fascia is a ligament, a tough, fibrous structure, on the bottom of the foot, connected at one end to the heel bone. It fans out along the plantar surface, or sole, of the foot to attach at its other end to the five metatarsal bones of the toes.
In the process, the plantar fascia helps maintain the arch and hold the foot rigid as you push off with each step. Ligaments stretch little, if at all, but they can tear and become inflamed. Repeated stress or pressure on the fascia where it attaches to the heel bone can cause microtears and painful inflammation in the arch near the heel.
If not corrected in time, the inflammation and tension on the fascia can tug on the membrane surrounding the heel bone. That stress, in turn, prompts the body to lay down additional bone to form a spur, which can add to the discomfort.
But while plantar fasciitis is sometimes referred to as heel spur syndrome, bone spurs on the heel are actually a result, not the cause, of the problem. Surgery to remove a spur neither solves the problem nor is likely to relieve the disabling pain.
Plantar fasciitis can afflict anyone who participates in weight-bearing activities. The people who have a higher risk of getting the disorder are those who have either highly arched or flat feet; who are overweight; who have feet that pronate, or turn in, excessively, causing the arch to collapse with each step; or who have inflexible calf muscles and a tight Achilles tendon, which both place extra stress on the fascia.
The factors that may precipitate the problem include switching from working out on a resilient surface to one made of concrete or hardwood; wearing poorly cushioned or worn-out shoes or shoes not designed for the activity, and suddenly increasing training intensity.
Dr. Jeff Bronson, an orthopedic surgeon in San Diego, Calif., points out that while people who run or do high-impact aerobics are more likely than others to overstress the plantar fascia, anyone who begins an exercise program - even walking - and does too much too soon is at risk.
This is one athletic injury that a layperson is likely to be able to diagnose. It feels worse after resting. Its classic symptom is pain in the forward part of the heel that is most severe in the morning, with the first steps taken after getting out of bed and after prolonged sitting, probably because of the tearing of scar tissue that had begun to form during the period of rest. The pain usually eases during activity and becomes worse again afterward.
Those with plantar fasciitis are also likely to feel intense pain when pressure is applied to the front of the heel bone, where the fascia attaches.
Sports medicine specialists say that self-treatment is likely to be helpful if the problem is intercepted in its early stages. The recommended measures start before getting out of bed.
Lightly stretch and warm your calf muscles by pointing your toes toward the ceiling and making circles with your feet. Never go barefoot or wear slippers or shoes without a raised heel. Replace worn-out exercise shoes and fit all your shoes with orthotics (over-the-counter ones will do if the problem is not advanced) that support the arch and elevate the heel, or use heel lifts in your shoes to take some of the pressure off the fascia. If it hurts too much to step on the injured part of your heel, cut a hole in the lift at that point.
The regular use of an over-the-counter anti-inflammatory pain medication, like ibuprofen or aspirin, is almost universally recommended, especially before performing an activity that stresses the fascia.
Before and after your activity, stretch your calf muscles and Achilles tendons, and repeat the stretches several times during the day. Reduce the intensity, frequency and duration of your workouts.
If you are a runner, avoid hills and speed work. If you are accustomed to doing one long workout, break it up into two shorter ones. Better yet, give your injury time to heal properly by substituting temporarily an activity that does not stress the fascia, like swimming, cycling or working out on a cross-country ski machine or exercise bike.
Tape your foot with an elastic bandage before going to bed to hold it at a right angle with your leg, which will keep the tissues in the back of the calf from shortening while you sleep. Or adopt Richard's sleep position. Taping can also help support the arch during activity.
Ice the bottom of your foot after every activity that stresses the fascia. Some experts recommend massaging the area for five to 10 minutes at a time, or until the injured area is numb, with ice frozen inside a paper cup.
Or freeze water in an empty tennis-ball can and roll your foot back and forth over it, which will strengthen the muscles that help to maintain a strong arch while you ice the injured area. Another way to strengthen these muscles is by curling your toes around an object on the floor - a towel, for example - and trying to lift it using only your toes.
If such measures do not bring adequate relief, see a physician, preferably one who specializes in sports medicine, or a podiatrist. You may need the assistance of a physical therapist or custom-made orthotics for your shoes.
Those with debilitating pain that makes it difficult to perform required daily activities may benefit from an injection of water-soluble cortisone into the inflamed area. The injection is momentarily very painful, and it should not be done more than two or three times because overusing the drug can damage the fascia.
If everything above fails to relieve life-disrupting pain, surgery to ``release'' the fascia is the treatment of last resort. The surgery, which can be done on an outpatient basis under local anesthesia, involves snipping away part of the fascia where it is being pulled. Heel-spur surgery, on the other hand, is not recommended.
LENGTH: Long : 117 linesby CNB