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In the United States, up to 10% of adults will have heel pain in their lifetime (1) and plantar fasciitis is one of the more common causes of heel pain in adults. It is among the top 5 diagnoses of foot and ankle pain in runners (2, 3) as well as in professional football, baseball, and basketball players (4). Per year, plantar fasciitis affects 2 million people in the United States and results in approximately 1 000 000 visits to physicians, 62% of which are to primary care physicians (5). The annual cost of treatments for this disorder is between $192 and $376 million (6).
Figure 1. Palpation of the medial tubercle of the calcaneus. The borders of the plantar fascia are drawn on the bottom of the foot.
Figure 2. Calf and arch stretch using a towel.
Figure 3. Cross-friction massage.
Figure 4a. Wall stretches. With the knee in extension.
Figure 4b. With the knee in slight flexion.
Figure 5a. Stretching healing tissue. Using a can for a dynamic rolling stretch of the arch.
Figure 5b. Manually stretching the plantar fascia.
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Plantar Fasciitis is a common problem evaluated in the primary care setting. Your recent January 3rd article concerning that condition is informative and your recommendations for prevention and therapy are realistic. You should add, however, one more very important bit of advice: Stop walking around in bare feet on hard surfaces. Fifteen years ago I used to send several patients a year to the podiatrist for plantar that did not respond to conservative therapy, but since I started to advise patients to stay off the hard surfaces in bare feet I cannot remember the last time I sent someone to the podiatrist. This country has experienced a significant change in its interior flooring over the pst twenty or so years transitioning from thick shag or plush carpeting to tile or hardwood floors. This transition in flooring led to, in my opinion, a significant increase in plantar fascial complaints. It is my experience that just about every patients this problem admits to walking around their tile and wood floors in bare feet. We need to support our arches. Thick grass, soft sand, and 1960's style shag carpeting are all fine for bare feet, but not our hard floors. It is simple common sense advice and it works for just about every patient with this difficulty. Timothy Hunter, MD. Myrtle Beach, SC. 29572
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