That First Step Is A Doozy!

Isn't it funny how diagnoses seem to come in waves in primary care practice? Two weeks ago was nothing but rashes. However, this week’s wave was a topic that is near and dear to my heart (or foot rather!) I have personal experience with plantar fasciitis and was searching for information about the subject for a patient and decided to write about it.

The toes are grasped and dorsiflexed with one hand, while the other hand palpates the plantar aspect of the foot, particularly the bands compressing the plantar fascia. Courtesy of Robert P Sheon, MD and Uptodate.com

Plantar fasciitis is an extremely painful condition that causes severe pain to one's heel area due to a bone spur that pushes on the tendon in your foot. It is important to make sure that you have an x-ray to confirm this condition because other conditions can mimic it like stress fractures and arthritis. Patients who walk or stand for long periods of time are usually the ones who show up in the office with this complaint. The first words out of their mouths is usually "That first step is a doozy!"

Nurses and waitresses are particularly prone to this condition due to the sheer volume of walking that we do. If fact, I often felt like a waitress while working in the hospital setting as a floor nurse! What would baffle me is the family members standing at the doorways watching us run up and down the hallways taking care of patients and still ask me to go get the patient a drink of water. I often felt like asking if their fingers were broken. Standing there tapping your feet and fingers does NOT make us want to move faster. It also used to boggle my mind when patient’s family members would walk behind the areas and get sodas for themselves without asking. Wonder why health care is so expensive? Misuse of resources as simple as cans of soda really add up. But, I digress!

There are a few different ways to treat this condition. The first line is NSAIDS like Ibuprofen, Aleve or Naproxen and stretching exercises. For most, this helps a little but you have to be careful with irritation to your stomach which can cause ulcers. The second way to help is to see a good podiatrist or orthopedist who will inject steroids into the area. Some patients tell me that this is a very painful method and sometimes get results lasting from a few days to several months if they get lucky. I received an injection in my R heel and didn’t feel a thing! Of course, I was under anesthesia for my knee surgery so I was cheating a bit! The last resort is a surgical procedure releasing the fascia from the spur which can lead to a weakening of the arch in your foot. My mother had this done with great results. I would have to think long and hard before I went to that extreme.

The only way that I have found to control my plantar pain is to wear a running type shoe rather than the typical nursing type.  My patients often ask me why I don’t wear dress shoes in the office and after I explain my condition and the fact that wearing Nike running shoes in all white helps keep me moving, they understand. I am also not a “foofy” person and am pretty down to earth so it matches my personality to wear sneakers all the time.

How many of you have developed this condition as nurses? What is the best way that you've found to relieve pain? Chime in!