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Arch Enemies 

Overuse, injury and ill-fitting shoes can torture your feet and cause painful plantar fasciitis, but there are simple remedies

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A flip through the fashion magazines in Dr. Todd Allain's waiting room reveals pages and pages of towering stiletto heels and 8-inch platforms. Considering it's a podiatry office, advertisements for stilt-like shoes seem a little incongruous, like ice cream coupons at a weight-loss facility.

  "That just looks torturous," Allain says, glancing at a sky-high platform boot. "It's along the same lines of foot-binding (a tradition in which women's and girls' feet were tightly tied, deforming the bones, to make their feet appear small, practiced in China for 1,000 years before it waned in the early 20th century). All the pressure is going to the ankle joint. Yep, that's crazy."

  Though patients can predispose themselves to foot problems by wearing pointed-toe, high-heeled or ill-fitting shoes, Allain says most of the conditions he treats are genetic. Plantar fasciitis, a painful swelling in the heel, is brought on either by genetics, repetitive stress or a combination of the two. The plantar fascia, a thick band of connective tissue extending from the heel to the toe, supports the arch of the foot. When that band is damaged, often with micro-tears, it causes inflammation and pain.

  Like a flaw in the foundation of a house, even a small injury in the tissue of the foot radiates upwards, eventually affecting the whole body. Untreated, plantar fasciitis is painful and often causes people to favor their unaffected foot. This unequal distribution of weight can lead to knee, hip and back pain and raises the risk of developing plantar faciitis in both feet, says Dr. Edward Lang of Uptown Podiatry.

  Approximately 2 million people a year suffer from plantar fasciitis in the United States, and 10 percent of Americans will experience the condition at some point in their lives, according to a 2003 survey published in The Journal of Bone and Joint Surgery.

  The way people walk and the structure of their feet is a factor in developing the condition, says Lang: "Everyone has a different gait. Some have a pounding gait or a high arch, and they walk more on their heels. Those types of patients tend to have plantar fasciitis more often."

  Allain adds flat feet to the genetic risk factors. "[In flat-footed patients] the heel everts (rolls outward), and that puts increased strain on the band of fascia," he says.

  Repetitive activities and prolonged stress on the feet from wearing shoes without proper support or being overweight also can trigger plantar fasciitis. "The total anti-Christ is walking barefoot on a concrete floor," Allain says. "Walking in flats and flip-flops is going to tear [the plantar fascia] even more."

  In many cases, plantar fasciitis improves quickly with conservative treatments like stretching and over-the-counter anti-inflammatories. Allain recommends taking naproxen in the early-morning hours to ward off the severe pain that often accompanies the first steps out of bed. He also prescribes a regimen of stretches to start the day.

  "Take a towel, loop it around your toes and pull it toward you for 45 to 60 seconds before you get out of bed," Allain advises. "You can also pigeon-toe your feet and lean in with your feet to the wall; that stretches your Achilles tendon and plantar fascia. Icing is good for the pain and inflammation: Take a frozen bottle of water and roll it in the arch for 15 minutes or so."

  If those treatments don't work, Allain prescribes steroids, with 60-70 percent of his patients improving after the first injection, he says. He also fits them with customized orthotic insoles using a digital pressure scan of their feet. The orthotics are placed in their shoes to properly align the 26 bones in the foot and alleviate pain.

  Orthotics are good for more than treating plantar fasciitis, Allain says. He recommends them for people with flat feet and for athletes to prevent problems down the road. "Runners need to be in an orthotic, especially if they are doing distance," he says. "You need to support the structures and the tendons in your foot. ... [The orthotic] basically helps correct your gait to give a proper stride from heel to toe."

  Orthotics and medications are effective for the majority of plantar fasciitis cases, but occasionally surgical intervention is necessary. Allain performs an endoscopic plantar fasciotomy, a minimally invasive procedure in which he makes small incisions in the plantar fascia to release the tension. Recovery time is three to four weeks, and in rare cases, calcaneal cuboid joint syndrome may develop as a complication, causing lateral foot pain and the need for physical therapy.

There are simple steps you can take to remain, quite literally, well-heeled. "A shoe that fits properly is probably the key to good health," Lang says, adding that supportive shoes are essential.

  "It is worth it to spend extra for a shoe that is better quality and layered with support," says Evie Poitevent, owner and buyer for shoe store Feet First, which features comfort lines and over-the-counter orthotics for customers with foot conditions. She adds that shoe maintenance is equally important. "Get shoes re-heeled properly. Most people pronate (roll in) or supinate (roll out) when they walk, and heel caps are plastic so they wear out on a diagonal according to the direction your foot falls. If the cap is worn out on one side, you will favor the muscles on that side, so it is going to upset the way you walk. Keep the caps smooth and level and new."

  Lang says he often sees patients who wear shoes that are too small, a problem particularly common among the older population. "As we get older, nerve endings die off a little," he says. "Some patients go with a small shoe because they can't feel their feet. Also, some women feel they look better in a smaller shoe."

  When in doubt about your shoe size, go to the larger size, Poitevent recommends. "It's better to go big and have your toes spread out properly, which is better for balance and comfort, than to go small and be in pain and ruining your feet."

  This doesn't mean fashionable stilettos should be hauled off to Goodwill, Lang says, but like any vice, they must be enjoyed in moderation. "Any shoe you wear for a short period of time isn't bad," Lang says. "Wear the heels for a short time, a few hours."

  Ultimately, the best preventative techniques for plantar fasciitis and other foot conditions are simple ones: Wear sensible shoes and seek early treatment for problems.

  "Just pay attention to your feet," Lang advises. "They do carry you a long way."

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