Plantar fasciitis is a “mechanical problem,” podiatrist Raymond A. DiPretoro says. Over time, the position of your joints shifts. In your foot, those changes include an inflammation of the tissue called the plantar fascia, which connects the heel bone and toes and gives you cause to yelp when you step out of bed in the morning. As you begin to walk, the pain may subside, but the condition can sometimes become severe enough to cause bone spurs.
The goal is to break up scar tissue in that swollen tissue. That can be accomplished by a regimen of stretching, sometimes guided by a physical therapist, or injection of the steroid Cortisone. Non-invasive procedural corrections include shock-wave therapy.
Stretching is an effective preventive technique, especially for weekend-warrior athletes. Over-the-counter shoe inserts raise the arch and remove pressure from the plantar fascia.
“I see five a week in the summer,” DiPretoro says. “They can be anything from a twist when stepping off the curb or a total roll,” which can also break a bone. A sprain is an unusual stretching of the ligaments (elastic tissues) or, in severe cases, a tearing that destabilizes the joint.
Mild sprains can be corrected with the kind of ankle sleeves found at any pharmacy, combined with rest, icing and elevation. Gentle stretching, started two or three days after the injury, speeds healing. The worst cases will require reconstructive surgery.
“Don’t let it happen,” DiPretoro says. In other words, be aware of your surroundings to reduce the risk of accidents. Stretch before and after an activity to loosen ligaments and tendons. Brace the joint while active.
Stress fractures are mild cracks in the five long bones, or metatarsals. Activities such as hiking or running on uneven surfaces like rocks or roots make one prone to such damage by putting extra stress on the ball of the foot, where the metatarsals join the toes. As with plantar fasciitis, DiPretoro sees a rise in fractures during mild weather months, when people are most active outdoors.
Minor stress fractures will see you shod with stiff soles or a removable cast to immobilize your foot for four to six weeks. Severe fractures earn you a full cast and a doctor’s order to stay off your feet.
Wear good shoes with adequate cushioning. If you have pain, avoid anti-inflammatory medications. “They inhibit healing,” DiPretoro says. Take Tylenol instead and rest with your bad foot elevated.
“Plantar warts are very common in kids and adults,” DiPretoro says. They occur when one of any number of viral particles gets under the skin on the bottom of your feet through a small abrasion. “Your body doesn’t even know it’s there,” DiPretoro says. The particles infect the local skin cells, resulting in the growth of a small mass with its own blood supply. And because the masses also grow nerves, they can be painful. Plantar warts can also manifest as small holes in the bottom of the foot. As warts or holes, they can spread locally, via the blood stream.
Topical medications such as salicylic acid stimulate an immune response to promote healing. Some cases may require freezing the lesion with liquid nitrogen, surgical excision or vaporization with a laser.
“Anywhere you have dirt, you have viruses,” DiPretoro says, “so avoid dirty environments.” Wash your feet, and keep them covered with shoes.
Bunions are a genetic deformity of the big toe. As a tendon on the top of the toe drifts outward over time, the attached metatarsal moves inward. The pressure buckles the joint and wears away the cartilage that protects the bone ends. Ouch.
A custom orthosis—a shoe insert molded to your foot—stabilizes the metatarsal and corrects the position of your joint. “It won’t reverse the problem,” DiPretoro says, “but it will halt its progress.” Re-aligning the joint is accomplished through an outpatient surgery. Recovery requires some physical therapy.
The condition is genetic, so preventive measures are few. The best: Wear shoes that fit correctly. They should be wide enough, with a little extra space beyond your longest toe. Ladies, think twice about buying those stiletto heels.