Hello Spring, Hello Heel Pain??

By: Lowell Weil, Jr., DPM

The baseball season, which marks the unofficial start of spring, is finally here.  Actually, this year in Chicago, spring has started very early with unprecedented great weather in March.  Usually we are still hunkered down with frigid temperatures, hoping and wishing for just a glimpse of spring to arrive.  Spring means many things to different people, but to those who take care of feet at the Weil Foot & Ankle Institute, it means the beginning of PLANTAR FASCIITIS SEASON.

Plantar Fasciitis is that annoying pain to the bottom of our feet, particularly in the heels, that grabs us when we get out of bed in the morning or get up from a rested or seated position.  Oh, it starts out slowly and we think we just have a heel bruise that will go away, but a month or two later we realize not only has it not gone away, your heel pain has actually gotten slightly worse.  Now we are limping a bit in the morning and have cut back on exercise, which is annoying because we know how important exercise is for our overall health.

Why is the onset of plantar fasciitis so prominent in the spring, you ask? The primary reason is that as the weather gets nicer, people want to get out and enjoy it.  Gardeners will take to their gardens for priming, pruning, and planting. Runners and walkers will begin more intense workouts embarking on faster times and longer distances. Golfers will hit the links with more vigor, and many of us will simply get out those sandals that we love, which, by the way, don’t offer much support for our feet.

But why do those things cause heel pain?  Well, heel pain/plantar fasciitis is most frequently caused from tight calf muscles and heel cords.  We get tight calf muscles for several reasons.  One reason is that as we get older, we inevitably get less flexible.  Another reason is that we rarely stretch regularly, even those of us who do yoga. The tight pull of the calf muscles and heel cords causes stress to the plantar fascia, a tissue on the bottom of the foot that connects to the heel bone.  This irritation to the plantar fascia may cause very small tears that result in pain and swelling. When our calf muscles are too tight and we increase our activities, this all results.  Soft surfaces such as grass or sand make heel pain/plantar fasciitis worse by causing our heels to sink downward and putting more stress on the tissues.  To some degree sandals, flip-flops and bare feet do the same thing and do not provide much support.

So now the question you've been waiting for: What do you do if you start getting heel pain?  There are some easy steps you can take to alleviate your heel pain and prevent it from worsening. 

1. Wear shoes that give more support.  A running shoe (I said running shoe, NOT just gym shoe) will provide excellent support and slightly raise the heel to relax the calf muscle.  Wearing shoes with a slight heel can really help.  Look for something that has 1-1.5 inches of heel.
2. Avoid bare feet, slippers, sandals and flats…until your condition gets better.  There are some good sandals, here, that have support that you may want to try out. There are also arch supports (Orthoheel and Powerstep) that can be purchased on line that are better than what is offered in the pharmacy.
3. Increase your stretching. Start stretching your calf muscle 3-4 times a day. See this site for useful stretches.
4. Use conservative treatment to alleviate symptoms. Take over-the-counter anti-inflammatory medicines (Ibuprofen, Aleve, etc.) as directed on the bottle consistently for a week or so.  Putting ice on the area for ten minutes at a time, once or twice a day will also help.

So what happens if your heel pain persists?  If your pain does not subside within a week or two, you face the possibility of having a chronic problem.  That is where physicians from the Weil Foot & Ankle Institute come in.  Physicians at the Weil Foot & Ankle Institute are renown for their treatment of heel pain.  The doctors here have done many studies, published papers and books and lectured around the world on heel pain and plantar fasciitis.  They have treated professional athletes from the Chicago Bulls, Chicago White Sox, Chicago Bears and other professional organizations, and Olympic and collegiate athletes from around the country for plantar fasciitis.Weil Foot & Ankle Institute Physicians have pioneered non-invasive and minimally invasive treatments for the treatment of plantar fasciitis. (See treatment options here and here).  They can create a specialized treatment regimen to meet your daily needs and successfully rid you of heel pain.

So as spring creates optimism for our typically disappointing baseball teams, don’t let your heel pain get you down. Protect your heels with the steps we’ve mentioned, and if that heel pain persists, come see one of our doctors at the Weil Foot & Ankle Institute. They’ll have you out and enjoying the weather, free of heel pain, before you know it!

Lowell Weil, Jr., DPM, MBA, FACFAS Fellowship Director, Weil Foot & Ankle Institute

Team Podiatrist, Chicago White Sox 
Dr. Weil Jr. has been on the staff of Weil Foot & Ankle Institute since 1996. His special areas of interest are reconstructive foot and ankle surgery, tendon and ligament reconstruction, radiofrequency techniques, Extracorporeal Shock Wave Therapy and sports medicine.

Save Your Soles: A Guide to Foot Pain

Treat your feet right and they'll return the favor. Our experts reveal ways to kick the bad habits that can lead to serious foot pain.

By Dorothy Foltz-Gray

Preventing and Soothing Problems

Maybe you were born with problem feet -- feet that turn in or out, arches that are too high or too low. Or you're dealing with foot pain that's self-inflicted, caused by tight shoes or high heels. Whatever the cause, foot pain is overwhelmingly a female problem: Experts say that 80 percent of foot surgery is performed on women. Foot doctors frown on teetery slingbacks, backless sandals and sky-high heels -- a disappointment for anyone who's ever coveted sexy stilettos or loves to lounge in flip-flops. If a shoe isn't supportive or fits poorly , say podiatrists, it's best not to wear it. Easier said than done, we know, but to avoid developing a foot problem or making one you already have worse, resist heels higher than 2 inches -- at least most of the time -- and tight squeezes (there should be about half an inch of space between your longest toe and the tip of the shoe).

"Try several sizes whenever you buy shoes," says Leslie Campbell, DPM, a foot and ankle surgeon at Presbyterian Hospital, in Allen, Texas. "Feet can change a half size in length, and also in width, at any time during adulthood -- from age, weight gain or loss, or pregnancy. And buy in the afternoon when feet tend to be the most swollen." Even if your feet mostly feel fine, our guide will help you pinpoint potential problem areas so you can stop bad habits that could lead to future foot trouble. If it's too late for preventive measures, you'll find the latest ways to soothe sore toes, heels, and soles

Pain Problem: Achilles Tendinitis

What It Is: Inflammation of the Achilles tendon (heel cord), causing pain and swelling at the back of your heel and ankle.

Cause: Some people are born with shortened muscles and tendons. But many women get what's called adaptive Achilles tendinitis by wearing high heels all day long -- which shortens those muscles and tendons -- and then going barefoot at night, making them suddenly lengthen. "Such shifts stress the Achilles tendon, which leads to inflammation," says Dr. Campbell.

Foot Fix: A heel insert can lift and cushion your heel, relieving tension on the tendon. An ice pack several times a day and over-the-counter anti-inflammatories such as ibuprofen can help reduce swelling. Extracorporeal shock wave therapy, which uses sound waves, may help. And try this stretch several times a day: Stand with both feet on the same staircase step, holding the banister. Let one heel drop below step edge; hold for 30 seconds. Do on other foot. Repeat three to four times.

Pain Problem: Plantar Fasciitis

What It Is: An inflammation of the plantar fascia, the tough band of tissue that runs along the bottom of your foot between the heel bone and the base of your toes. It's one of the most common causes of foot pain and can make you feel as if you're walking on a knife, especially in the morning (the fascia tightens overnight).

Cause: Feet over-pronate, stressing the plantar fasciae. Open-backed or flimsy shoes can strain the area. So can weight gain, which may thin the fat pad beneath the heel, flattening the arch and straining the bottom of the foot. Dancers, runners, and people who stand a lot often develop this problem.

Foot Fix: Add cushioned insoles or heel pads to supportive shoes with a 1- to 2-inch heel or use custom-made orthotics. Over-the-counter anti-inflammatories, such as ibuprofen and naproxen, and cortisone injections may also help. Other approaches your doctor may suggest include extracorporeal shock wave therapy. There's also radiofrequency therapy -- electrical signals are sent through a probe inserted through small punctures in the heel area -- which is more likely to be covered by insurance, says Chicago-area podiatric surgeon Lowell Weil, Jr., DPM. Another option is surgery on the fascia itself. Stretching in the morning, evening, and before exercise also helps. Try this: Stand arm's length from a wall, one foot behind the other, legs straight, heels on the floor. Place your hands on the wall and lean in, stretching the calf muscles. Do 10 repetitions; switch legs and repeat.

Pain Problem: Corns and Calluses

What They Are: Corns are balls of thickened skin, usually on the tops, sides, or tips of your toes; calluses are rough, thickened patches of skin on the heels and soles of the feet.

Cause: When your shoes pinch and press on your feet, your skin reacts to the friction and pressure by getting thicker.

Foot Fix: A podiatrist can shave the dead cells from the corns and calluses and prescribe an exfoliating cream. You can also reduce skin buildup by rubbing a corn or callus daily with a pumice stone or using a foot file. Silicone pads sold in drugstores protect the areas from pressure. Acid-based corn and callus removers do work, but Dr. Campbell points out they may burn your skin.

Pain Problem: Neuroma

What It Is: A benign growth, usually between the third and fourth toes, that pinches your nerves -- causing swelling and pain between the toes and a burning sensation in the ball of your foot.

Cause: When the foot's long bones are unusually mobile and the heads of these bones lie close together at the base of the toes, they may squeeze the nerve, creating a benign growth. Both wearing high-heeled pointed-toe shoes and going barefoot can aggravate the condition.

Foot Fix: Injections of cortisone, over-the-counter or prescription anti-inflammatory pills, orthotics, and stable, roomy low-heeled shoes can all help. Or your doctor may remove the growth or use cryotreatment (a cold probe that inactivates the nerve) or surgery that releases the ligament that's compressing the nerve.

Pain Problem: Athlete's Foot and Toenail Infections

What They Are: Fungal infections of the skin or nail bed. Athlete's foot can make the skin between the toes itchy and blistered. Fungal toenail infections (nails turn thick, yellow, and brittle) are more unsightly than uncomfortable.

Cause: "Fungi are everywhere," says Deerfield Beach, Florida, podiatrist Cary M. Zinkin, DPM. Going sockless in closed shoes or barefoot at the gym ups your chance of getting a fungal infection. So does having a pedicure with unsterilized instruments.

Foot Fix: For athlete's foot, your doctor may prescribe antifungal cream. For fungal toenails, she may prescribe a paint-on medication or three months of Lamisil pills, unless you have liver or kidney problems. Also ask about Vicks VapoRub-type products. "To avoid infections, keep your feet dry and clean," says Dr. Zinkin. "Dry between your toes after you shower and then use a foot powder." Wear clean cotton socks -- not nylon socks or tights -- to make feet less welcoming to fungi. And if you get pedicures, be sure both the instruments used and the footbath you soak in have been sterilized.

Pain Problem: Hammertoes

What It Is: A condition in which one or more toes become so bent at the joint that it can look like an upside-down V. Hammertoes also cause swelling and corns -- thickened skin -- on the top of the toes, which can restrict the joint's movement.

Cause: Heredity -- but also high heels, says Dr. Campbell. "More than half of my female patients have hammertoes." Wearing unstable shoes, such as stilettos and flip-flops, can contribute to the problem by providing so little support for your foot that you bend your toes when you walk, grabbing the shoe bed for balance. Eventually you may be unable to straighten one or more of your toes.

Foot Fix: Although only surgery can straighten bent toes, there are ways to ease the pain and keep hammertoes from becoming worse. Your doctor can shave the corns and prescribe exfoliating cream to help normal skin resurface. She may prescribe an orthotic to stabilize your foot and will certainly tell you to trade your high heels for low-heeled shoes that will keep your feet from wobbling. You can also buy over-the-counter silicone pads that slip between or over the toes to reduce friction and pressure from your shoes. And try using an ice pack to reduce painful inflammation of the toes, which should help make your shoes fit better.

Originally published in Ladies' Home Journal, June 2009.

International Society for Medical Shockwave Treatment

Dr. Lowell Weil, Jr.

Lowell Weil, Jr., DPM, MBA was elected President of the International Society for Medical Shockwave Treatment (ISMST) at their annual meeting in Sorrento, Italy, this past week. He is the first podiatric physician to be elected to an executive position of this organization. His term of office will run through June of 2010 when he will host the 13th Annual ISMST2010 Meeting in Chicago, IL. This multidisciplinary meeting will not only involve ESWT for musculoskeletal disorders, but also the application of this modality in the treatment of wounds, arterial disorders, cellulite, and other cosmetic conditions. Dr. Lowell Weil, Jr.

Dr. Weil, Jr has pioneered the use of extracorporeal shockwave treatment ( ESWT) for plantar fasciitis in the United States and has been involved in three FDA studies and written several papers, as well as co-authored a book on the subject of musculoskeletal ESWT. Dr. Weil, Jr. is the Fellowship Director of the Weil Foot & Ankle Institute, Des Plaines, IL and is a team podiatrist for the Chicago White Sox.