Explainers

Foot Pain in Nursing: Plantar Fasciitis


Nurses are constantly on their feet. Besides back pain, one of the most common painful conditions that plague nurses is foot pain. While back pain can be particularly difficult to treat, foot pain isn’t that easy either.

It seems like nurses are constantly looking for the perfect pair of shoes or inserts to make their shift as well-cushioned as possible. Some nurses swear by certain brands of shoes while others stick to the method of compression stockings to help ease aching feet.

Most foot pain is caused by a common condition known as plantar fasciitis. This condition can cause crippling pain, and once you have it, it seems that no shoes or stockings are going to help. In the past, it was thought that plantar fasciitis was caused by heel spurs. While these bony outcroppings may be present, they aren’t usually the reason for the heel pain.

Explaining Plantar Fasciitis

Plantar Fasciitis
The plantar fascia originates in the medial tubercle of the calcaneus, runs the length of the foot, spanning the arch, and terminates into the transverse ligaments of the metatarsal heads. Essentially this means that the thick, fibrous ligament spans from the heel to just in front of the toes. It acts as a cantilever for the arch.

When pressure is put down on the arch with walking, the ligament stretches. The pressure then comes off the arch with retraction, and the plantar fasciitis snaps back to keep the arch from collapsing.

The problem arises when the ligament gets overused. It is very easy for the insertion point to cause small tears in the plantar fascia. These tears cause pain, inflammation and tenderness.

Many people mistake them for heel spurs because the pain originates there, but the fact is that you can have heel pain from plantar fasciitis without a spur. Similarly, a spur may be present that has nothing to do with the heel pain. The pain is caused by the ligament rubbing against the insertion point from overuse and causes minute tears, leading to painful inflammation.

Preventing Plantar Fasciitis

The shoes a nurse wears are absolutely critical to preventing plantar fasciitis and saving themselves a great deal of pain.

Appropriate shoes
Plantar fasciitis is very common in runners, which means that a certain amount of repetitive trauma may be the cause of the tears. It is interesting that nurses suffer the same problem so often because there is not as much pounding on the feet as in running.
Because this has been identified as a particular problem for nurses, your choice of shoes can help prevent the pain of plantar fasciitis. You need shoes that are cushioned and soft. Shoes that don’t provide support and cushioning are only going to lead to this problem. In addition, you should have proper heel support built into the shoe and excellent arch support as well.
If your shoes do not have these features, you can use orthotics to prevent plantar fasciitis. Orthotics are inserts that are put in the shoe to provide support. First, you want a cushioned heel to prevent the repetitive stress on the insertion point of the plantar fascia. This can help prevent microtears. Second, you will want to have solid arch support, especially if you have flat feet.

The constant downward pressure of the weight on the arch can cause tears as well, and having the arch supported prevents these from occurring. It is best to have a custom orthotic created by a podiatrist, but over-the-counter orthotics can do in a pinch or for prevention purposes.

Treatment for Plantar Fasciitis

Sometimes, no matter how careful you are or how supportive the shoe, you still manage to tear your plantar fascia. There are a number of options that may be considered in treating plantar fasciitis:

Orthotics

Orthotics are usually the first line of treatment, and this includes both heel support and arch support. The inserts will be customised to fit your feet specifically and are much more effective than anything you can get over the counter.

Splints

Splints are the next line of treatment. These are devices that hold your foot at a flexed angle to take the pressure off the tears. Usually these splints are worn at night and are used in addition to orthotics. A podiatrist will typically use these two measures for a period of time before taking any more invasive actions.

Cortisone

If neither treatment seems to ease the pain, you may need a cortisone shot directly into the heel. Although this can be uncomfortable, it does seem to reduce pain, especially when used with the other, lesser treatments.

Surgery

Very rarely is surgery needed to release the plantar fascia. This is generally frowned upon because it affects the action of the foot, but it may be necessary in the treatment of extremely resistant plantar fasciitis.

As nurses, we need to take care of our feet. It is important to understand plantar fasciitis, take every precaution you can to prevent it and to know when it is time to seek treatment if you experience heel pain.

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