Plantar fasciitis is by far, the most common foot condition we see in our clinic. More often it is an injury of overuse, and symptoms are typically insidious in onset(they just creep up on you). And it is a frustratingly tenacious affliction that can become the bane of an otherwise enjoyable summer of activity. It affects any foot type; young or old; athletic or non; overweight or fit; and can last weeks or years. The most important factor in treatment is that both patients and clinicians must realize that it is a condition that often cannot be cured but controlled.

I liken fascia to thick plastic food wrap. And it functions either like a bag around our muscles or, in the case of the foot, like a hammock for your foot bones.

My patient will typically complain of:

  • Pain at the plantar medial calcaneal tubercle, which is the center of the underside of the heel bone
  • Pain that is most exquisite on initial weight bearing, either worse when they first get up in the morning or after they’ve been sitting for long periods of time; likely a result of the calf muscle, Achilles tendon and plantar fascia tightening up during rest  – to me the “trademark” of plantar fasciitis
  • The feeling of a bruised heel that is worsened with activity

TREATMENT

Initiating treatment within a couple weeks of onset is key to more successful resolution with conservative efforts. But there is no absolute intervention that works for all people.

Stretching: Flexibility is paramount. As a pedorthist, I take a comprehensive look at pelvic and lower limb mobility to determine what tissues need to be stretched, from the hip flexors, hamstrings gastroc/soleus muscle group and the plantar fascia itself; and demonstrate the proper stretching techniques, frequency and duration.

Strengthening: More evidence is giving credence to strengthening of the intrinsic and extrinsic muscles of the foot as equally important to stretching, to promote healing. Exercises are provided at our clinic through an effective home program.Check the orthokinetics web page for a copy for yourself.

Ice therapy: In most cases, ice provides symptomatic relief. Reduce the pain and inflammation through application of an ice pack 2 or 3 times a day with duration of 10-15 minutes per application and never before activity.

Taping: Taping provides some temporary relief by supporting the medial arch, thus reducing the symptoms. Great for very acute situations or while awaiting custom foot orthoses to be manufactured. This is a service provided at Ortho-Kinetics.

Custom foot orthotics: Orthotics created from a 3 dimensional cast or scan, improve foot and lower limb biomechanics, ensure proper stabilization of the medial arch and optimal support of the soft tissue of the heel pad, reducing the excessive strain on the plantar fascia, allowing for healing to take place. Our orthotics are made from 3D casting and are manufactured in house.

Night splints: Wearing a night splint at rest prevents the gastroc/soleus muscle complex and plantar fascia from shortening through the night and healing in a shortened position; a couple options are available at our clinic including the Strassburg sock.

Footwear: Unsupportive, inappropriate or worn out shoes can be a cause, and avoiding barefoot in the home is essential. As a Pedorthist, I am a shoe expert, providing proper advice on the right type of shoe for in home, work and recreational activity.

Rest: Modifying or reducing activity allows the damaged tissue time to repair and ultimately heal;

Remember, at Ortho-Kinetics, we treat every patient like a puzzle, with the goal of discovering lower limb pain and dysfunction

Foot Comfort In Motion turned 1 today!

Reflections of a Foot Care Professional

True story. My first week on the job, back in early 1988, an elderly gentleman walking with a cane came into the clinic and sat down with his wife. I introduced myself and asked how I could help him. He promptly removed his left lower leg and handed it to me, saying with a curt and abrasive tone

 “I need shoes to fit this.”

Working in the back room, out of sight of the client, I broke into a mild sweat as I struggled to remove the existing shoe from the prosthesis and fought to fit the leg into the new shoe. Cursing and laughing at the same time, I wrestled for what seemed an eternity as the leg flipped, banged and slid around, falling to the floor several times from the work bench before I was able to casually(or so I pretended) bring it back out for his inspection.

Ahh, the humble beginnings of a future pedorthist.

What a strange and beautiful profession pedorthics is.

On the one hand, I steel myself to react professionally, when in reality, I am tempted to run from the gnarly and near psyche-destroying vision of something akin to the Crypt Keeper’s feet, which she calmly releases from each tomb-like, ill-fitting, mangled and horrifyingly rank smelling sarcophagus for a shoe, ironically named something that conjures up the opposite image, Munro. But I don’t run away.

I approach the older gentleman who I instantly like, with open, sincere compassion and concern, while secretly doing mental cartwheels at the prospect of treating such a challenging, complicated and profitable misfortune of having been run over by a tow motor some 25 years ago. The compassion wins out and the gentleman walks from my clinic in comfort.

I feign surprise and yet with true concern, stifle a yawn, when the factory worker describes how his heels feel like someone is driving red hot pokers into the bottoms of them when he first gets out of bed. With well rehearsed authority in my voice, I address him with “It’s known as plantar fasciitis and I can help you.” The exercise advice and foot orthotics I fit him with immediately reduce his pain.

Yet how can I forget the moment when I fit the young man, who lost all the toes of both his feet to frostbite, with rigid rockered footwear and orthotics that make him exclaim with raw emotional ecstasy as he walks the hallway of my office, that I “have given him his toes back.” I am truly moved by this moment.

These are true examples in a long line of unforgettable and irreplaceable moments of learning and character building in my career as a pedorthist, and frankly, as a person. I absolutely love what I do and daily, I embrace the opportunity to practice a truly wonderful profession.

Ortho-Kinetics - 22 years and counting

This is my first blog so it seems a good time to reflect.

I have to say that these last 22 years have gone by much faster than I would have imagined. In the beginning, I ran the entire show by myself - no staff. From answering the phone, looking after my patients, making their foot orthotics and all the clerical and custodial tasks.

What’s changed since then?

For starters, I have over 24 years experience as a pedorthist. And I now have a tremendous staff, 2 locations, including Oakville, and we’re possibly the busiest foot orthotics business in Cambridge.

And we still make all our professionally designed and high quality orthotics right in our lab in our Cambridge building on King Street.

We still use our highly developed and experienced skill set to design and construct custom made foot orthotic devices from a plaster or foam cast.

And through all these past 22 years I have had hundreds of loyal patients return for new foot orthotics, footwear and advice. I have had dozens of family physicians, specialists, physiotherapists and other members of the healthcare community support me with their trust in my services. And for this I am very grateful.

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