How nurses can prevent and treat this common foot problem.
Nurses are on their feet all day, walking-sometimes sprinting-up and down concrete hospital hallways, bringing items to and from patient bedsides, lifting heavy equipment to free up space, and even lifting patients themselves.With every step a nurse takes, the foot absorbs 3 times his or her body weight-7 times when running. Is it any wonder that nurses often develop foot problems? The scenario described above could be considered “the perfect storm” for developing plantar fasciitis.
Heels Sound the Alarm
“If you wake up one morning and find you have an intense pain in the arch of your foot or your heel, and can’t put any weight on it, plantar fasciitis is developing,” stated Johanna Shira Youner, DPM, a podiatrist who owns a private practice in New York City and who speaks for the American Podiatric Medical Association.
The plantar fascia is the ligament that connects the heel bone to the toes and supports the arch of the foot. Under normal circumstances, this band acts as a shock absorber, supporting the arch and minimizing the impact of each step. When the plantar fascia is strained, it becomes weak, swollen and irritated. Repeated stretching can cause tiny tears in the ligament, leading to the painful condition known as plantar fasciitis.
The pain is usually most severe with the first few steps out of bed after waking, but it can also be exacerbated by prolonged standing or getting up after a long period of sitting.
Foot pain that occurs mostly at night is likely caused by a condition such as arthritis or tarsal tunnel syndrome.
A few factors can be addressed to try to avoid or reduce the symptoms of plantar fasciitis. Primary risk factors include:
- Age. Most people develop plantar fasciitis between the ages of 40 and 60. “The plantar fascia deteriorates with age; this is a degenerative process,” Youner said. “We don’t see many patients under age 40 with this condition-but after the age of 40, people start to experience foot pain.”
- Occupation. People who stand or walk for long periods on hard surfaces (teachers, factory workers, nurses) are more prone to develop plantar fasciitis.
- Excessive pronation. During walking, the foot should land on the outer side of the heel first. Body weight should then pass along the inner edge of the sole (normal pronation) and then back to the outside of the foot. If the weight stays on the inner edge of the sole of the foot, this is considered excessive pronation-the foot rolls inward too much when walking.
- High arches, flat feet, tight Achilles tendon or tight calf muscles. These can adversely affect the way weight is distributed when standing, putting added stress on the plantar fascia.
- Obesity. Excess pounds put extra stress on the plantar fascia.
- Wearing worn-out or ill-fitting shoes. “My No. 1 suggestion for people experiencing plantar fasciitis pain is to improve your shoes,” Youner advised. “If you are experiencing foot pain, you cannot wear inexpensive shoes. The money you save at the shoe store will be spent on podiatry bills, because your cheap shoes will create problems for your feet.”
The podiatrist recommends spending more than $100 for each pair of shoes. She said shoes should have a thick, rubber bottom to absorb the shock of each footstep; leather does not absorb shock.
Preventing Further Damage
No matter the shoe selection, anyone with plantar fasciitis likely requires outside arch supports inside the shoes. “Medical-grade orthotic devices and things like heel cups can help realign your feet and properly support your foot, taking the stress and strain off your plantar fascia,” Youner said. “An arch support will add a bit of depth inside the shoe and cup your foot properly, giving you more controlled footsteps.”
An appointment with a podiatrist is recommended for anyone experiencing heel or arch pain. If you think this sounds too time-consuming, consider this: Not treating it can lead to worsening-and spreading-pain. If you are unconsciously changing the way you walk to minimize plantar fasciitis pain, you might also develop other foot, knee, hip or back problems, leading to pain and discomfort in other areas of the body.
Finding Immediate Relief
Certain steps can minimize and relieve plantar fasciitis pain. Most people recover completely within a year (provided they have received the care they need to avoid further tearing of this ligament). Here are some steps you can take to bring immediate relief of plantar fasciitis symptoms:
- Pain Relievers. Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin IB, etc.) or naproxen (Aleve) reduce inflammation and can relieve some of the pain associated with plantar fasciitis. If these do not work, a podiatrist might recommend meloxicam, a prescription-strength anti-inflammatory medication.
- Ice Your Heel. “Several times a day, put ice on your heel for 10 minutes, then take it off for 10 minutes,” Youner advised. “Heating pads are not recommended for plantar fasciitis, since heat can make the area swell further and cause more pain.”
- Compression. Compression garments can be worn during the day (inside a sock) or at night to sleep. These “sleeves” offer support, improve circulation, and reduce edema and foot fatigue. Users report feeling much less pain when the garment is on, but the pain might return after it is removed, Youner said.
- Physical Therapy Exercises. Toe stretches (pulling on the toes to bend the foot back at the ankle), calf stretches (to strengthen lower leg muscles and the Achilles tendon, thereby stabilizing the ankle and heel), and towel stretches (performed by placing a towel lengthwise under the ball of the foot and pulling with both hands to bend the foot back toward the body) can increase flexibility in the ligament and strengthen the muscles that support foot arches.
- Night Splints. A splint can hold the plantar fascia and Achilles tendon in a lengthened position overnight, which facilitates the stretching of the calf and the arch of the foot.
- Avoid Going Barefoot. Put on a sturdy pair of shoes (not bedroom slippers!) the minute you get out of bed. Going barefoot can make plantar fasciitis pain worse.
“The last key to avoiding pain is to change footwear,” Youner reiterated. “Find a good foot specialist who can recommend the additional steps you should take to prevent further plantar fascia damage.”