Eventually, the feet rebel

Scientists estimate that the average person will walk what amounts to three trips around the Earth in a lifetime, based on mathematical calculations too complicated to explain here.

The plantar part of the foot is the soft tissue on the bottom

Scientists estimate that the average person will walk what amounts to three trips around the Earth in a lifetime, based on mathematical calculations too complicated to explain here.

Nobody, however, has ever called Chad Worthen average.

The 35-year-old Worthen routinely runs far more than 160 km a week, rarely taking a day off. Extrapolate that over his lifetime and . . . well, it’s got to add up to a lot of distance.

Is it any wonder, then, that Worthen’s feet once staged a rebellion so prolonged and painful that he almost gave up the sport he loves?

Worthen, like an estimated 10 per cent of the adult population, had suffered through a nasty bout of plantar fasciitis — what podiatrists say is the most common of myriad ailments that can develop in the intricate 26-bone, 33-joint, 100-tendon design of the foot.

The plantar fascia is a fibrous tissue that runs from the heel to the ball of the foot, providing cushioning and support to the arch and serving as a connective buffer between the foot and the Achilles tendon. When it gets stressed, microtears and inflammation cause sharp pain and can make weight-bearing and flexion unbearable.

The Achilles tendon may have had Greek mythology to boost its profile, but plantar fasciitis can be equally painful and debilitating.

Just ask Worthen, who tried numerous treatments over 14 months before custom-made orthotics — insoles of hard plastic and leather specifically molded to a person’s foot — eased the condition.

He since has won the 2008 San Francisco Marathon and placed 22nd in the 2008 California International Marathon.

“I tried everything,” recalls Worthen, who first started experiencing heel pain in 2006 after a marathon in Kentucky. “I rolled my foot over a frozen water bottle. I tried rolling a golf ball over it. Massage. Stretching. I even got cortisone injections, which were extremely painful.

“I’d take, like, a month off of running, then start again, and it was back. I guess you can treat the symptoms as much as you want. But until you treat the actual problem, find out what’s causing (plantar fasciitis), it’s not going to go away.”

In many respects, Worthen was lucky he felt pain for only 14 months.

Orthopedic foot surgeons and podiatrists say plantar fasciitis can be difficult to treat and unpredictable to cure, not to mention nearly impossible to prevent. The underlying cause remains a matter of debate among specialists.

The majority of plantar fasciitis sufferers are not endurance runners such as Worthen but simply aging baby boomers who perhaps have packed on some pounds, stand for long periods in their occupation and perhaps have structural abnormalities such as flat feet or high arches.

Or not.

Foot experts can only speculate.

“When inflammation occurs, it doesn’t always have a rhyme or a reason,” says Dr. Eric Giza, chief of foot and ankle surgery at University of California at Davis Medical Center.

“Most of the time, it’s associated with overuse, which sets off an inflammatory pathway. Incidence of (plantar fasciitis) in kids is almost nonexistent. So we know, in some way, it’s associated with degenerative tissue process. That’s all I can tell you. It’s very vague.”

Researchers posit that repetitive trauma to the fascia can lead to irritation that, in time, leads to degeneration of the tissue itself. Podiatrists such as Kevin Kirby, who treated Worthen’s case, says degeneration is the biggest obstacle to overcoming the condition.

“When you’re 10 years old, (the fascia) are like rubber bands, they stretch and go back,” Kirby says. “With an older person, it’s like paper. You pull on them and they rip. Maybe not that dramatic, but that’s what happens. When (fascia) are put under a load and stretched repeatedly for years and years, they are more likely to get these little tears.”

Excess weight worsens the problem. Each step puts a force on your feet of 120 per cent of your weight.

“Most of the people we see for plantar typically have gained weight in the past six to eight months,” says Kirsten Van Voris, a podiatrist for Kaiser Permanente in Sacramento. “And they tend to experience symptoms multiple months before they come to us.”

Delaying treatment can turn a temporary condition chronic, says UC Davis’ Giza.

“After eight months, the tissue down there no longer responds to things like anti-inflammatory medicines,” he says. “But if it’s recognized early and (the patient can) get a good cushioning device, respond to anti-inflammatories and stretch (the Achilles, calf and foot) out, 85 percent can go away within the first six months.”

The first line of attack for plantar fasciitis often combines rest, ice and ibuprofen. But most important is stretching the Achilles tendon and calf muscles, which has proved effective in early treatment, according to a study in the Journal of Bone and Joint Surgery.

“I find something as simple as hanging from a stairway in a good pair of shoes for five minutes, two times a day, helps,” Giza says. “The balls of your feet are hanging over the edge of the stair. You get more stretch than pushing against the wall.”

Kaiser’s Van Voris says her patients are advised to stretch both the Achilles and hamstring 10 times a day for a month.

“Pain will actually increase in the first two weeks,” she says, “but once they push through that period, they should gain motion and have decreased pain.”

If simple stretching doesn’t work, some plantar patients turn to wearing night splints that force the foot to dorsiflex — angle toward the shin — while they are sleeping. Studies have been mixed as to whether it helps promote healing.

Van Voris calls splints a “nice adjunct. … My honest opinion is that it’s for the person who won’t stretch during the day.”

Van Voris says most of her patients seek cortisone injections or surgery on a first visit. But the next stage after stretching, doctors say, is the use of an arch support (also called an orthotic).

Custom-made orthotics, molded to a specific foot, usually cost between $300 and $400. Many podiatrists will first prescribe prefabricated orthotics available at stores.

From the Sacramento Bee

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