YOUR HEALTH
Plantar Fasciitis is a pain in the foot
DR. DONOHUE

DEAR DR. DONOHUE: I would like information on plantar fasciitis. We know two people who suffer greatly from it. Their pain is excruciating. -- D.M.

DEAR DR. DONOHUE: I am a 42-year-old woman who started using a treadmill. I used it for 25 minutes daily. After four to five months I started feeling pain in my feet. The doctor says it's plantar fasciitis. Neither the medicine that was prescribed nor the exercises I was told to do have done anything. Please help. - - M.

ANSWER: The plantar fascia is a band of dense tissue running on the bottom of the foot from the front of the heel to the toes. It provides support to the foot's arch. Inflammation of that tissue is plantar (PLAN-tur) fasciitis (FASH-ee-EYE-tiss). Overuse --running, jumping -- is the prime cause of such inflammation.

Pain on the bottom of the heel is the hallmark symptom. The pain is worse in the morning or after sitting for any amount of time.

Treatment requires curtailing exercise that puts pressure on the heel. Don't run for at least two weeks, perhaps more. Don't be completely inactive, however. Inactivity causes the fascia to shrink, and that brings on more pain. Anti-inflammatory drugs like Advil or Aleve lessen pain and calm inflammation. Icing the bottom of the heel for 15 minutes three times a day can dull the pain. Silicone heel pads relieve heel pressure.

At night, when in bed, put a splint on the bottom of your foot that keeps the toes pointed upward and slightly toward your head. That prevents the fascia from shrinking. Shrinkage during the night makes the first step in the morning a step that produces horrible pain. You can make your own splint.

Stretching the fascia is important. With the involved foot resting on the knee of the opposite leg, use your hand to pull the front part of the foot toward the shin. When you feel the stretch, hold that position for 10 seconds. Repeat the stretch and hold 10 times, and repeat this exercise three times a day.

If things aren't progressing in a week or so, your doctor can inject the area with cortisone, which usually eliminates the inflammation quickly. When all else fails, surgery might be considered. That's a last resort and not often necessary.

DEAR DR. DONOHUE: My husband exercises in a gym every day. When his T-shirts dry from his sweat, they have a crust of salt on them. I have four brothers, and I was our family's washerwoman. My brothers were active, but they didn't have shirts like my husband has. He says he's always been this way. He sweats a lot. Is this normal? -- C.N.

ANSWER: Does your husband say exercise tires him quickly? Does he complain of muscle cramps? If either question gets a yes, he might be a "salty" sweater. About 10 percent of the population is. They put out more salt in their sweat than does the average person. If these people have any symptoms like muscle cramping, they need to increase their salt intake. They can do so by drinking sports drinks, adding more salt to their food or eating salty snacks like pretzels.

DEAR DR. DONOHUE: I have a teenage boy who is a skateboarder. About three weeks ago, he tried a new stunt that catapulted him into the air, and he came down, landing on his right foot on cement. He couldn't put any weight on that foot afterward.

We took him to the emergency room. X-rays were normal. However, his foot continued to swell and hurt, so we took him to an orthopedic doctor, who made a diagnosis of a Frank injury. What is it? -- R.J.

ANSWER: I'm sure the doctor said Lisfranc injury. Dr. Lisfranc was a French physician who described a particularly vulnerable foot joint that is prone to dislocation and separation. It's the joint where the foot's metatarsal bones join bones in front of the heel. The metatarsals are like the hand's metacarpals, the long bones in the palms.

Your son has a separation of the Lisfranc joint. If the separation isn't great, a cast allows for healing. If the separation is great, then the joint requires surgical correction.

DEAR DR. DONOHUE: I underwent a complete and thorough CT body scan, which indicated no evidence of cancer. However, this line on the report confuses me: "There is calcification of the coronary arteries, mostly involving the left anterior descending artery and to a lesser degree the right coronary and circumflex arteries. Atherosclerotic calcifications of the abdominal aorta is also noted." This is all news to me. I have no aches, pains or blood pressure problems. What is my prognosis? Should I be concerned? I am past 75. -- D.D.

ANSWER: What kind of CT scan did you have? If it was an ordinary one, what was mentioned on the report could be said of most people in their 70s. Just about everyone at that age has some calcification of their heart arteries and of their aorta. It happens with age.

If the scan was an ultrafast CT scan (an electron beam or helical scan), the amount of calcification in arteries is quantified by using the Agatston score. Calcium is part of artery plaque -- the buildup of cholesterol, fat and many other materials clinging to and invading artery walls. It's the stuff that can lead to obstruction of blood flow to heart muscle and a heart attack. An Agatston score of less than 10 indicates minimal calcium; one of 11 to 99, moderate calcium; 100 to 399, "increased" calcium; one of more than 400, extensive calcium.

Only a few people with calcium in their arteries actually have a heart attack. Furthermore, the scan doesn't disclose "vulnerable" plaque, the kind that's easily shattered and brings on an artery blockage.

You paid good money to have the scan. That money entitles you to question the doctor who wrote the report and demand to know exactly what was meant by the description given on your report.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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