Plantar Fasciitis and Foot Pain in Nursing
Published: 18 April 2018
Published: 18 April 2018
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.
One of the most common causes of foot pain, found often in athletes, is plantar fasciitis - though you don’t have to exercise to acquire this ailment. Contributors can include obesity or regularly wearing shoes with inadequate support.
Plantar fasciitis can cause crippling pain, and once you have it, it seems that no shoes or stockings are going to help.
Plantar fasciitis is an overuse injury like carpal tunnel syndrome.
Commonly presenting as a stabbing pain in the sole of the foot, plantar fasciitis is a much more complex beast than it seems on paper.
While other overuse injuries result from the thickening or degeneration of tendons, plantar fasciitis does not. The plantar fascia is not really a tendon - it’s a sheet of connective tissue, more similar in structure to a ligament.
The plantar fascia originates in the medial tubercle of the calcaneus, runs the length of the foot, spanning the arch, and then 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 the tears for heel spurs because of where the pain originates, 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.
‘Degenerative fasciosis without inflammation' is probably the most accurate way to describe plantar fasciitis. The fascia on the plantar surface of the foot is dying - it’s necrotic - and that’s why it hurts.
This sounds extreme, but this death is at a cellular level. Plantar fasciitis is the loss of healthy connective tissue and the development of scar tissue. Understanding this is key to treating it.
The shoes a nurse wears are absolutely critical to preventing plantar fasciitis and saving themselves a great deal of pain.
Plantar fasciitis is very common in runners, which means that a certain amount of repetitive trauma may be the cause of the tears.
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 cause problems.
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.
Firstly, you want a cushioned heel to prevent repetitive stress on the insertion point of the plantar fascia. This can help prevent microtears.
Secondly, 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.
There are many treatment options available for plantar foot pain, all with varying effectiveness, but efficacy is not the only factor you might want to keep in mind when considering your options.
Different medications and procedures are going to work with different patient outlooks, volumes of function and recovery times. Some options simply mask symptoms, which might be okay for some, while other treatments are more curative and will address the problem at its root.
Sometimes, no matter how careful you are or how supportive the shoe is, you might still manage to tear your plantar fascia. There are a number of options that may be considered in treating plantar fasciitis:
Medicines are usually the first option when it comes to any illness, as they are easy to acquire and hold much less risk for complications than surgery.
Non-steroidal anti-inflammatory medicines (NSAIDS) are used to manage almost any condition that causes symptomatic pain. One of the most commonly known NSAIDs is ibuprofen.
NSAIDs are not a solution to plantar foot pain, but they are likely to provide you with some relief. It is important to remember that plantar fasciitis is not actually caused by inflammation - this is only a symptom.
Steroid injections are another method of pain reduction - not a treatment. They involve directly injecting synthetic cortisone into the plantar fascia.
Cortisone is a powerful anti-inflammatory substance that can act to reduce pain in the area, but as mentioned, inflammation is not the source of plantar fasciitis.
Platelet activation plays a key role in all sorts of tissue healing throughout the body, and repair of the plantar fascia is no exception to the rule.
PRPs are composed of a portion of the patient’s own blood, extracted and modified so that the platelet concentration within it is above baseline.
When injected into regions of injury such as tendons, ligaments, muscles and joints, increased platelet concentration can be directly linked to improved function and decreased pain in the treated area.
Side effects of these infections are often limited as the patient is utilising their own blood.
PRPs are not enough to be curative in and of themselves, however, and it is important to follow a program of rest, progressive stretching and strengthening to complement the procedure.
Surgical interventions are a more invasive measure, with extended recovery times and, as with all surgery, the added risks of potential infections and complications.
Plantar fasciitis can often settle with rest alone, so there needs to be thorough consideration and consultation with your medical professional before these options are considered.
Surgery is usually the last resort for severe, debilitating plantar fasciitis pain.
Whilst you can return home the same day as your procedure, you are likely to need a splint or boot and must refrain from placing weight on your foot for an extended length of time.
Very rarely is surgery needed to release the plantar fascia.
An alternative to invasive surgery is a Tenex procedure, carried out while conscious. Ultrasound allows the exact location of pain to be targeted and the system emits ultrasonic waves to break down scar tissue without disturbing healthy tissue.
Therapies are likely to be your best option when it comes to addressing plantar fasciitis. These are not as extreme as surgery, nor are they simply treating the symptoms. Physical therapies address the root of the problem.
Stay off your feet for a few days, avoid high impact activities and give it some time. It might seem frustrating to wait around and do nothing, but that time spent taking it easy can be a huge investment in a foot pain-free future.
Exercises to stretch and strengthen your plantar fascia, Achilles tendon and lower leg muscles have been found to be essential in the treatment of many cases of plantar fasciitis.
Physical therapists might also offer massage, contrast baths or ultrasonography to help with long-term healing.
Orthotics to place inside your shoes and provide extra support for the arch of your foot are (theoretically) perfect in preventing plantar foot pain and are often the first line of treatment.
Strain is placed on your plantar fascia to keep the shape of your heel arch. So, if you can place something under your foot to keep it in a neutral arch position, you’ll be putting less strain on the fascia.
Orthotic inserts can be customised to fit your feet specifically and are generally more effective than over-the-counter options.
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 both splints and orthotics for a period of time before taking any more invasive actions.
Barefoot running is great for conditioning the tissues of the foot if you’re already healthy – but this same process can exaggerate the pain of plantar fasciitis.
It also stresses degenerative tissue, only exacerbating the problem. Get healthy before you strengthen the foot!
There are many options out there to assist you if you find yourself suffering from plantar foot pain - but a limited number of them should be labelled as treatments.
The best options are to avoid symptom masking and work on resting and addressing the over-strained plantar fascia naturally.