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Heel to heal

New stretch relieves pain from plantar fasciitis

A new stretch is proving quite effective to help treat and potentially cure plantar fasciitis, a condition that affects nearly 2.5 million Americans each year. In a study recently published in Journal of Bone and Joint Surgery, researchers found that patients suffering from the painful heel spur syndrome had a 75 percent chance of having no pain and returning to full activity within three to six months of performing the stretch. In addition, patients have about a 75 percent chance of needing no further treatment.

The study is a two-year follow-up on 82 patients with plantar fasciitis, all of whom were part of an original clinical trial of 101 patients in 2003. The patients were taught a new stretch, specifically targeting the plantar fascia, that was developed by Benedict DiGiovanni, M.D., associate professor of orthopaedic surgery at the University of Rochester and author of the study, and Deborah Nawoczenski, P.T., Ph.D., professor of physical therapy at Ithaca College.

The stretch requires patients to sit with one leg crossed over the other, and stretch the arch of the foot by taking one hand and pulling the toes back toward the shin for a count of 10. The exercise must be repeated 10 times, and performed at least three times a day, including before taking the first step in the morning and before standing after a prolonged period of sitting. More than 90 percent of the patients were totally satisfied or satisfied with minor reservations, and noted distinct decrease in pain and activity limitations. The most common cause of heel pain, plantar fasciitis occurs when the plantar fascia, the flat band of tissue that connects your heel bone to your toes, is strained, causing weakness, inflammation and irritation. Common in middle-aged people as well as younger people who are on their feet a lot, like athletes or soldiers, people with plantar fasciitis experience extreme pain when they stand or walk. Plantar fasciitis can be a frustrating experience, as the chronic cycle of reinjury and pain can last for up to one year. DiGiovanni likens it to pulling a hamstring, and continuing to run without proper stretching. "Walking without stretching those foot tissues is just re-injuring yourself," he said.

Most physicians will recommend a non-surgical approach to treating plantar fasciitis, advising a regimen of anti-inflammatory medications, foot inserts, and stretches. Surgery occurs in about 5 percent of all cases, and has a 50 percent success rate of eliminating pain and allowing for full activity.

"Plantar fasciitis is everywhere, but we really haven't had a good handle on it," said DiGiovanni. "The condition often causes chronic symptoms and typically takes about nine to 10 months to burn itself out, and for people experiencing this pain, that's way too long to suffer through it."

DiGiovanni should know. He's experienced plantar fasciitis first-hand. Deciding to get some extra exercise on a golf outing one recent afternoon, he carried his clubs around all 18 holes instead of taking an easy-going ride in a golf cart. The next morning, he woke up with severe heel pain, which brought the topic of his study close to home.

"We need to further optimize non-operative treatments prior to considering surgical options," DiGiovanni said. "If you look at the results of the study, I think we've succeeded."

Germaine Reinhardt | EurekAlert!
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