Why Flats Are Hurting You More Than Heels

unnamedIllustrated by Sydney Hass.
Let's talk about heel pain. Are there sexier topics? Sure. Maybe "Benedict Cumberbatch's Heel Pain" would make for a better headline, but if there's one thing we've learned from recent comments, it's that few escape the vengeful scourge of plantar fasciitis.
If you're unfamiliar with the term, you're likely acquainted with the feeling. Ever step out of bed in the morning feeling like you've been punched in the heel? Ever have to spend vacation holed up in the hotel, watching foreign soap operas because your dumb foot hurts too much to walk around Paris? We've been there. It's a cranky place. So, let's never, ever go back.
Plantar fasciitis has come into the public eye recently, "because big-name athletes have been sidelined by this seemingly innocuous problem," says Dr. Ron Noy, MD, an orthopedic surgeon who's currently developing a treatment device specifically for PF. "The plantar fascia is a fibrous band of tissue on the bottom of the foot that connects the heel bone to the forefoot and toes." Any number of things can cause inflammation of this area: A quick pull, or repetitive stress such as jogging, or even extended walking might be the culprit. Sometimes, the fascia is simply strained; other times, PF includes tiny tears in the tissue (eek). "The common thread is that every step can be debilitating," Dr. Noy explains.
NO KIDDING. We got Dr. Noy to walk us through the causes, treatments, and prevention of this nasty, nagging, life-ruining injury — so no one will live in service to their heel pain any longer. This is for everyone who spent last summer in orthotic sandals. This is for everyone who sat one the sidelines, weeping bitter tears while everyone else got drunk and danced to "Vogue" at their sister's wedding. This is for me and you and Benedict Cumberbatch. We will not be silenced by heel pain. Not anymore.
unnamed-4Illustrated by Sydney Hass.
Causes & Symptoms:
PF is the most common cause of foot pain. It's so common, in fact, that almost everyone will deal with a case in his or her lifetime. But, certain factors may put you at a higher risk. Among common causes, Dr. Noy lists repetitive stressful exercises (running, dancing, aerobics), over-training, tight calf muscles, flat feet, high arches, weight gain, or jobs that require long periods of standing.
Middle-aged people are more likely to get PF, but it's an easy affliction to acquire, no matter how old you are. It typically shows up in one foot, but it's absolutely possible to get it in both feet at once. (You double-foot people — you're the real heroes.) The pain can present as sharp, dull, aching, or burning. Here are some classic symptoms to look out for:

- Notable heel pain or stiffness in the morning that recedes during the day.
- Pain that goes away when you exercise (as the muscles and ligaments get warm and stretchy) but comes back when you’re done working out.
- Increased pain when you climb stairs or stand on your toes.
- Pain after sitting or standing for an extended period.

unnamed-2Illustrated by Sydney Hass.
Here's the bad news: Getting rid of PF takes a long time. At a minimum, you're looking at six to 12 weeks of traditional treatment, says Dr. Noy. "Although, often it can take up to a year...and some cases never go away."
Here's the good news: Most cases of PF are sub-clinical and can be treated without a doctor. However, it won't hurt to go if you can, especially if your heel pain has lingered for months or is particularly intense. You don't want to wind up limping grumpily around Vienna before you realize just how bad it's gotten, like certain writers of this article. If it's bad enough to ruin your vacation, it's worth the doctor co-pay.
More often than not, the first course of action is "stretching, stretching, and more stretching." Dr. Noy recommends "30-second stretches, five times a day." Foot stretches may help, but it's far more important to stretch your calf. Give these simple, doctor-recommended stretches a try. In addition to stretching, you should also consider these basic treatments to expedite the process:

- Wear an over-the-counter sleep splint, which gently holds your foot in position overnight.
- Roll the foot over a tennis ball or frozen bottle of water, to reduce pain and inflammation.
- Lay a towel on the floor. Then, grab and release it with your toes for 10 minutes, to stretch and strengthen the supportive muscles.
- Wear over-the-counter orthotic inserts in your shoes. It's crucial to support the arch, so avoid flats or inflexible shoes.

If traditional treatment fails, there are more drastic measures. If you're still in serious pain after six months of stretching, rolling, and taking it easy on your bum foot, then it may be time to start talking about surgery or cortisone shots. But these, warns Dr. Noy, should be considered a last resort.
unnamed-1Illustrated by Sydney Hass.
As ever, prevention is better than any cure. If you've already escaped the hellish grip of heel pain, you're probably wearing orthotics right this very second. But, even if you've never had a case of PF, you should do what you can to keep that beast at bay.
If you have tight calf or foot muscles, Dr. Noy advocates a preventative stretching routine. You may want to consider a night splint as well. These splints prevent your foot from resting in the plantar-flexed position (toes pointing down). It's the natural position for sleep, but the plantar fascia "will get tight in this position during the night, and then hurt when you stretch it in the morning."
For gym-goers (runners in particular) "proper shoes are important," as is consistent shoe rotation, explains Dr. Noy. Always buy a supportive / orthotic-friendly gym shoe and switch it out as soon as the tread starts to wear down. If you can, it's worth it to go to a specialty store that can assess your running style and find the right shoe for you.
Runner or not, here are some easy tips to prevent PF before it's too late:

- Always stretch your feet, calves, and achilles after a workout (or a long day on your feet).
- When going for distance, walk or run on soft surfaces.
- Alternate activities to prevent over-stressing the plantar fascia.
- Ice at the first hint of pain.
- Take rest days!
- Always wear supportive shoes (or OTC orthotics in your non-supportive shoes), whether or not you're working out.
- Avoid long periods of barefoot walking or standing. Even at home, try slippers or comfy shoes.
- If you've recently gained weight, gotten pregnant, or started a new fitness routine, take extra care to support your feet. Sudden changes like these can increase your risk of PF.

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