2008-06-06 / Columnists

Eye On Physical Therapy

Commentary By Dr. Tim Rohrs, DPT

Knees, shoulders and low backs steal most of the spotlight in the physical therapy world. If you were to wander around an outpatient physical therapy office you would probably find that those three body parts account for 80 percent of the patients receiving therapy that day, Those suffering with foot and ankle pain, in comparison, make up a smaller percentage of our patient population. If you have ever suffered with a heel spur or plantar fasciitis, you know the intense pain and how debilitating those conditions can be.

Each foot is composed of 26 bones, which account for 25 percent of the bones of the human body. The human foot combines mechanical complexity and structural strength. The ankle serves as foundation, shock absorber and propulsion engine. The foot can sustain enormous pressure (several tons over the course of a one-mile run) and provides flexibility and resiliency. The feet have more than 100 muscles, tendons (fibrous tissues that connect muscles to bones), and ligaments (fibrous tissues that connect bones to other bones).

All those bones, ligaments and muscles work together to provide support, balance and locomotion. Any abnormality can throw the whole system out of alignment and cause pain. The plantar fascia is a thick band of ligaments on the sole of the foot that connect the heel bone with the bones of the forefoot. This ligament is responsible for the foot's arch. Stereotypically, the symptoms include severe pain in the heel, or the arch of the foot, upon waking up with the first few steps of the day, or after sitting for prolonged periods of time. After "walking it off" the pain actually lessens and may disappear until the next time you sit for 30 or more minutes, only to rear its ugly head once again. This set of symptoms if left untreated may progress to more serious conditions. With repetitive damage and inflammation in this ligament, the site where the ligament inserts into the heel bone may start to calcify and the progression to having a heel spur has begun. The heel spur is a hook shaped extension of the bone and can be visualized on an x-ray.

An accurate diagnosis may be made by a podiatrist, orthopedist or family physician. Conservative treatments include orthotic inserts for your footwear, physical therapy, local cortisone injections and anti-inflammatory medications. Few people need surgery for correction. Physical therapy treatment may include local modalities to decreased inflammation and pain such as electric stimulation, ultrasound and ice applications. The mainstay of effective rehabilitation is stretching the Achilles and the plantar fascia itself. Without an almost obsessive devotion to stretching these structures, long term relief may be elusive.

As one who suffered through the pain of plantar fasciitis for 3 months, I can attest to the incapacitating nature of this condition, the need for commitment to the stretching program, and have sighed with relief when I was able to get out of bed pain free and not afraid of that first step.

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