Dear Dr. Garner,

I am a 45 year old in good condition. I am having a problem and I need your advice.

My right foot is acting up.

I am a policeman and sometimes I have to stand for long periods of time.  

After standing a while, my right foot feels like it is being stabbed by a knife. It has been going on for about a month, gradually getting worse with unbearable pain. The pain goes away when I sleep but comes back when I get up.

I am afraid I will not be able to continue to do my job.

Should I go for an X-ray?  Should I rest it? Should I tough it out? I appreciate any advice.

Heel Pain that
Won’t Heal in Hollis

Dear Heel Pain,

The description of your problems sound very much like plantar fasciitis (PLAN-tar fashee-EYE-tiss). One of the most difficult parts of your problem is the pronunciation of the disorder.

I’m sorry to hear about the difficulty you’re having. Unfortunately, for people who must stand for prolonged periods of time, such as athletes and soldiers, pain often develops in the heels and feet.

While there are several possible causes for foot pain, such as a stress fracture or nerve impingement, plantar fasciitis is a strong possibility in your case. The plantar fascia is the supporting tissue that connects the heel and toes on the bottom of the foot. Plantar fasciitis occurs when the fascia becomes strained. Repeated strain can cause actual tears in the ligaments or supporting structures. This leads to pain and swelling — symptoms you are experiencing.

Upon visiting your podiatrist, a diagnosis can be made, ruling out other conditions that mimic the process. An X-ray of the foot is often obtained to help evaluate for possible stress fracture of the toes.

Plantar Fasciitis
(PLAN-tar  fashee-EYE-tiss)

Occurs when connective tissue on the bottom of the foot becomes strained, causing heel pain and swelling.

Plantar fasciitis occurs most commonly in people 40-60 years of age. It can occur from an injury or may be related to a generalized arthritis that affects other joints of the body as well. Sometimes the cause is never found.

Factors that increase the risk for plantar fasciitis:
1. Women between the ages of 40 and 60 are most likely to develop this condition.
2. Activities that place a lot of stress on the heel and surrounding tissue, such as ballet dancing and long distance running.
3. Flat feet, or high arches, or even an abnormal way of walking can lead to the condition.
4. People who are obese are more likely to develop plantar fasciitis.
No single treatment works for everyone with plantar fasciitis. There are many things you can do to get relief:
1. Give your feet a rest. I realize that in your profession this may not be practical.
2. Try not to walk or run on hard surfaces.
3. Put ice on your heel to reduce pain and swelling. Anti-inflammatory medications, such as Motrin, Aleve or aspirin, may help as well.
4. Stretching your calves several times a day, especially when you first get up in the morning, is beneficial.
5. I suggest you look carefully for shoes that provide good arch support and cushioning in the sole.  Consult with your podiatrist.
6. Your podiatrist may give you heel cups or shoe inserts.
7. Sometimes the doctor may give you splints to wear at night, and shots of steroids into the heel to reduce inflammation.
8. Most people do not require surgery.
9. Patience is necessary as the healing process may take six-12 months.

Unfortunately, heel pain can affect other parts of the body, such as the knee, hip, or back, due to the change in one’s gait. Regular ice massages may help reduce pain and inflammation. Low impact exercises, such as swimming or bicycling, are preferable to  running or even walking, and help you to stay in shape without further aggravating your condition.

For those who do not have this condition, the following can help prevent the onset:
1. Maintain a healthy weight.
2. Choose supportive shoes.
3. Do not wear worn athletic shoes. It is wise to purchase new shoes every 500 miles.

I wish you well and hope you take comfort in the fact that this is fairly common, particularly among athletes and police officers and can be successfully treated.

The condition will most likely resolve after six months to a year, so I urge you not to panic.

It is important to visit a podiatrist – a physician who specializes in this condition.

I would like to take this opportunity to wish all our loyal Tablet readers and NET viewers a very Happy Thanksgiving as we take this time to count our blessings.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.