Notes From a Therapist

I hope that you’re off to a great start to the summer and have some fun and exciting things planned for the upcoming months. I retired as a physical therapist last year after practicing for more than 30 years and now work in the wellness and fitness world assisting people with various conditions and situations to accomplish and reach their goals for a healthier lifestyle. In this article I would like to address two common summer conditions that many people have asked me about recently, and also that I would frequently see in the PT clinic.

Issue #1 — PLANTAR FASCIITIS

Definition: An irritation or inflammation of the dense and thick tissue called plantar fascia on the bottom of the foot that connects the heel bone (calcaneus) to the toes. Symptoms and Reports The most common report with this condition is new or ongoing foot or heel pain. At times the patient could pinpoint the cause or origin of the pain; at other times they could not. They would complain of pain, often sharp or stabbing, in the heel or bottom of the foot when arising in the morning and bearing weight on the foot. The bottom of the foot is often tender to deep pressure or touch especially near the heel. They also report pain during the day with prolonged standing or walking or upon bearing weight after sitting for a period of time. With mild cases, the pain would often reduce in intensity or go away after taking several steps as the tissue loosens up. With more severe or chronic cases the pain could continue during the day and possibly increase with more walking or weight-bearing activities. The pain usually subsides when weight is off of the foot (for example when lying down or sitting).

Common Causes

Runners, athletes where repetitive pounding of the foot is required for their sport, people whose job requires them to stand for long periods of time (especially on a hard surface), or those who have poor support in their shoes or footwear can suffer from plantar fasciitis. During the summer months, another contributing factor can be walking barefoot or with sandals that do not support the foot well.

Treatment and Suggestions

With mild to moderate cases, an x-ray or imaging diagnostics are not usually needed; imaging reports are used to rule out stress fractures, heel spurs (which generally are not painful in themselves), or other more serious conditions. Initially it is wise to rest the foot and stop the painful activity or exercise. Ice often is quite beneficial, either during the day for pain and/or immediately after an activity. You can rest the foot directly on an ice pack wrapped in a towel for 15-20 minutes each session, several times per day. You can also freeze water in a plastic water bottle and roll your foot over it as an ice massage. Proper warm-up activity first thing in the morning or before exercise is important (e.g. ankle pumps or circles, or just pulling your toes up to stretch the calf), as well as gentle and prolonged standing calf stretching during the day. A gentle rubbing or massage to the bottom of the foot can also help loosen the tissue. Stretching is most important as part of your cooldown after exercise or an activity, or at the end of the day. Proper shoes and footwear are also important. It is beneficial to have a shoe or sandal with good arch support, good shock absorption and that fits your foot well. The material for the shoe and sole, as well as the shape of the sole (also known as the last of the shoe) is an important aspect of finding the right shoe for you and your activity. For more severe or chronic cases of plantar fasciitis, your medical provider may issue a night splint to stretch the calf or an orthotic to place in your shoes. Cross training is also recommended for runners to avoid repetitive pounding; good alternatives are bicycling and swimming. You may want to consult with your medical provider or physical therapist for instruction and proper guidance in management and exercises f or this condition.

Issue #2 — SHIN SPLINTS

Definition: An irritation or inflammation of the connective tissue along the shin bone or tibia (usually on the inside or medial aspect of the bone) that attaches the muscles to the bone.

Symptoms and Reports

The patient will report sudden or gradual onset of pain along the shin(s) during and/or after an activity that most likely requires repetitive stress and impact like running and jumping. The shins will be tender to touch and may be painful with walking. The pain will often increase in intensity over days and weeks.

Common Causes

Shin splints are quite common with long-distance runners, dancers, or people who are training for a race for the first time. The high-impact activity, repetitive stress and pounding, long hours of training, and worn-out shoes/shoes without adequate support can contribute to the irritation. At times people who suffer from shin splints have tight calf muscles or a tight Achilles tendon.

Treatment and Suggestions

Most cases of shin splints respond well to rest (reducing or stopping the high-impact activity), ice, proper stretching, and purchasing the right shoe or footwear for you and your activity. Again, cross training is recommended to avoid high-impact and painful weight-bearing activities. You can use ice packs wrapped in a towel directly on the shin(s) for 15-20 minutes each session; you can ice 4-6 times per day as needed until the pain subsides. Ice is also recommended after the activity once you are able to resume. It is wise to wait until the shins are completely healed or pain-free before returning to your training to avoid re-injuring the tissue. Proper cooldown after your activity with an adequate amount of prolonged and gentle stretching of the calf muscles and legs is important and recommended. Some lower-body strengthening may also be beneficial. Again, consulting with your medical provider or physical therapist for proper guidance and exercises may be beneficial. Choose the correct and best shoes for your activity and your feet that fit well, support your feet, and offer adequate shock absorption. If the shin pain does not improve with conservative measures or treatment, a medical provider may order an imaging test to rule out a stress fracture. It is a great time of year to be active, to enjoy the outdoors in our beautiful stateline region, and to participate in local events and races. However, please be mindful of your body and use good judgment in your activities and training. I hope this information and these suggestions have been helpful to you.