[music playing] Rameen: Meeting the ever changing in healthcare needs of our communities.

Paris Community Hospital/Family Medical Center is now Horizon Health, with the same ownership, management, providers and employees.

Horizon Health provides patient care and promotes wellness to the communities of East Central Illinois.

Jeff: At HSHS St. Anthony's Memorial Hospital we are at work transforming heart care, rebuilding knees and hips, delivering new generations, and focused on providing healthcare to you.

We are HSHS St. Anthony's Memorial Hospital.

Lori: Sarah Bush Lincoln Health System supporting healthy lifestyles, eating heart-healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Rameen: At Carle, we dedicate ourselves to helping you be great.

And we have the expertise and inspiration to help you stay that way.

Ke'an: Hi, I'm Ke'an Armstrong and I'm the host of Being Well and today we are going to be talking about feet.

We're going to be talking about foot problems, foot pain, and more specifically, plantar fasciitis.

And joining me today is, Doctor Joseph Borreggine and he is a podiatrist affiliated and on staff with Sarah Bush Lincoln and HSHS St. Anthony's.

So, welcome and thank you for joining us.

Joseph: Thank you.

Thank you very much.

Ke'an: So, we all have feet problems and we all want to take care of our feet.

So, let's talk a little bit generally about plantar fasciitis.

Let's start with that.

Joseph: Well, plantar fasciitis is probably one of the most common foot problems that we see in the office.

A lot of people will come into the office complaining of a misnomer called heel spur syndrome.

And they say, well, this doctor told me I had heel spur syndrome, and I must be standing on a bone.

And the reality is, it's really not.

It's more of a tendonitis issue where a patient will be experiencing pain because they've actually had micro tears of this structure called fascia.

Fascia surrounds muscular tissue.

It's kind of like a Saran wrap.

So when it gets torn, it creates pain.

So the classic symptoms will be pain, getting out of bed in the morning, getting up from a rest position and decreased pain with activity.

Ke'an: Okay.

I've been diagnosed with that in the past- Joseph: Sure.

Ke'an: ... and it's very painful- Joseph: Yes, it is.

Ke'an: ... and it really does feel like there's a bone problem.

Joseph: Correct.

Ke'an: So what does a person do if they feel like this is something is an issue with them?

Joseph: They can certainly try to treat it themselves with over-the-counter medications, nonsteroidal anti-inflammatories.

Sometimes people will Google plantar fasciitis.

It can be a dangerous thing.

Sometimes too much knowledge can create problems.

But the bottom line is, is it can be treated simply by icing, stretching, those sorts of things.

Then they may want to seek the care of a podiatrist.

Then a podiatrist can basically do a much more thorough examination of the condition, rule out other things that might be causing the heel pain, because heel pain can be caused by other issues.

But the podiatrist will take X-rays, examine the foot, take a history from the patient, find out how long they've had the problem.

If it's the classic symptoms I just mentioned, then most likely it's plantar fasciitis and then a treatment plan can be formulated with the podiatrist.

Ke'an: Okay.

So how does a person get plantar fasciitis?

Is it something that they did to injure themselves?

Something they can be aware of to prevent it?

Joseph: Well, the fact is is that this injury is what it is.

It's an injury and it's an injury to that fascial tissue.

That band of tissue runs across the bottom of the foot and a patient could overuse their foot, in a manner of speaking.

A weekend warrior, for example, has gone out and done a little too much, whether it be exercise activity, outdoor activity, and then they tear that little structure right at the heel attachment.

Patient may not feel it right away, but it's usually something that arrives, you know, the symptoms arrive usually the next day and that patient will experience that pain.

So it's a micro tear of that fascial tissue.

That's actually what it is and it can be related to activity, foot structure, and/or shoe gear.

Ke'an: Hm, okay.

So kind of give a little bit of a picture of the foot.

You said that it's the fascia, but it's also heel pain.

So do you get the pain also like in the middle of the foot and up near the toes?

Joseph: You can.

You can get radiating pain that goes from the heel, the bottom of the foot, stretching across into the arch and then into the toes.

That pain is actually more or less cramping of the musculature on the bottom of the foot, because your body is splinting those muscles to keep you from moving that part of your foot.

So that pain could be related to that.

It could be nerve pain because the swelling can cause pressure on the nerves, the sensory nerves in the bottom of the heel.

So that can cause the pain, radiating sometimes up the ankle.

So plantar fasciitis can have other symptoms, but majority of the time, it's in the heel.

It's in the bottom of the foot.

Ke'an: Huh.

Isn't that interesting when it runs along the entire foot?

So how do you really determine ...

I mean, you mentioned heel spur.

So is heel spur and plantar fasciitis connected or are they two different things?

Joseph: Well, actually, I tell patients that it's a typical finding to see a heel spur, one that's asymptomatic, which is interesting because patients will get X-rays routinely in our office and I will point out they have a heel spur and I will ask them, "Do you have heel pain?"

They say no.

Well, this is the classic example.

The spur itself is actually a traction spur, which means bone is live and any stress on that bone can cause more bone to grow in the direction of pull.

So if you look at the X-ray, the spur is actually pointing towards the front of the foot.

So that spur itself is part of an attachment of muscle which is far deeper in the foot that the actual fascial tissue.

So that spur itself is an independent entity all of its own, usually asymptomatic.

There's no pain or issue involved with that.

Some doctors will use that as a need to do further treatment.

Oh look, you have a heel spur, and the reality is that spur has nothing to do with the problem.

The issue is more related to the fascial band that's been injured or torn and it's not a complete tear, like ripping paper.

It's just micro tears in the fibers.

Ke'an: Okay.

So is ice something that a person should use on their feet?

If so, what's the protocol on what you tell a person to do?

Joseph: What I will tell patients to do is to start with the mnemonic of rest, ice, compression, and elevation, RICE.

And those four things will help immensely for this type of injury.

So you rest the foot.

Stay away from the activities that caused it.

Ice it, which basically means you do it maybe 20, 30 minutes twice a day.

And you can do it on and off, which basically means you take the ice and sometimes I'll tell patients to use a frozen bag of peas, an ice pack.

Protect the foot, of course, with some sort of washrag or towel.

Apply that for 10 to 20 minutes, give it a break for 10 to 20 minutes, and then do it again.

Do that twice a day.

Compression is basically wrapping the arch with some sort of support.

Then elevation will help reduce a lot of the swelling.

So you can combine that with the nonsteroidal anti-inflammatories, which are just basically over-the-counter anti-inflammatories that you can take to reduce those symptoms.

Ke'an: Okay.

So how long does a person need to do that?

I mean, how long does plantar fasciitis last?

Joseph: Well, it can last a long time if left untreated.

But if you start to treat it and do conservative measures, a lot of times in two or three weeks, it'll go away.

But if it doesn't, further treatments will be needed.

Ke'an: Okay.

Is there particular activities that people need to avoid if they're athletic or anything like that?

Joseph: Well, running can actually aggravate it.

Long periods of walking can aggravate it.

Anything where you're using your feet to stand up on your toes, that can aggravate it.

So any excessive pressure can aggravate.

Those types of activities have to be limited.

Ke'an: Okay.

Joseph: Not completely eliminated, but limited.

Ke'an: Limited.

So in between the activity, do this RICE method and limit the activity a little bit.

Joseph: And do some stretching beforehand.

And if those things- Ke'an: Okay, what kind of stretching?

Joseph: Well, the stretching .

..

I wish I could stand up and show you.

But it's actually a heel stretch, where you're propping your hands up against the wall, putting one leg behind the other, one foot behind the other, and just leaning into the wall, putting stress on the bottom of the foot and the back of the leg.

The other one that you can do, which I tell patients to do and everybody has steps in their home.

They can actually just put their toes on the step and then let their heels drop with full weight and just do that for, let's say, 10 to 20 seconds and then give it a rest and just keep repeating that.

That will help stretch out that fascial tissue.

Ke'an: Okay.

Now, should there be concern in someone overdoing the stretching or overdoing something like that, where they could make it even worse?

Joseph: Yes.

So that's why we provide excellent literature to our patients and the exact timeframes and periods that they should be doing it.

Ke'an: Okay.

Now, is there a particular body type of a person who maybe suffers from this problem more so than someone else?

Like does weight contribute to this at all?

Joseph: Weight can contribute to it, but not necessarily be the major reason why.

So it's all body types can suffer plantar fasciitis.

Ke'an: Okay.

So when does a person know that they need to go see a podiatrist with this type of- Joseph: When those types of things fail.

Like I said, the podiatrist may redo those things, may repeat those things.

But they're gonna do things maybe a little bit more aggressively, which may include cortisone injection, physical therapy, other things that they cannot do at home.

So those are things that the doctor can specialize in.

Ke'an: Okay.

So I'm sure people avoid going to the doctor, like oh, it'll be fine.

It will go away.

Do you see people who should have come seen you a lot earlier?

Joseph: Yes.

Ke'an: What do you tell those folks?

Joseph: Well, I use the exact statement you said.

You should have seen me a lot earlier, because unfortunately that creates more inflammation, more pain, more swelling, and it becomes a real problem.

I had people literally come in with inability to weight-bear on that part of their foot.

Ke'an: Okay.

So once you have it, you don't want it again, because it's very painful.

Joseph: Sure.

Ke'an: I mean, I remember walking and thinking, I don't want to put any weight on this heel.

Joseph: Absolutely.

Ke'an: It hurts.

I was wearing some flat shoes that didn't have any support, but after you sort of get it taken care of and the pain goes away, what's the chances of it coming back?

Joseph: Well, it's all, again, based on foot structure and activity.

So if you have a foot structure that's prone, one that's flatter than normal, a high-arch foot can do that, we have to really think about prevention.

Prevention can include the continued stretching, but we have ... and compression and so forth.

But we have to think about some sort of arch support.

That's called an orthotic.

We've specialized in that aspect of care in our profession and we're known for providing orthotics to a lot of our patients.

So we make a product that's particularly set to that patient's foot type and then we can make a prescription that allows that patient to have the best support possible.

The device is molded to their foot.

It's not something you buy over-the-counter, but it's just something that they can wear, kind of like your eyeglasses, to keep that foot in the normal place and position that it should be.

Ke'an: All right.

Well, since you brought it up, let's talk about orthotics a little bit.

What's the deal with orthotics?

Because you see all these things on the shelf, you know, like maybe this is what I need to put in my shoe, or I can put my foot on this thing and it'll tell me what I need to get.

So let's talk about orthotics a little bit.

Joseph: Sure.

The orthotic is a name.

I actually call it a customized foot brace.

So the bottom line is is that would you .

.. and I even use this as an example.

Would you go to the big box store to buy your eyeglasses, or would you go to the optometrist or optician to get your eyeglasses?

And you know the answer to that.

The same should be said for the orthotic.

Allow the professional to provide that type of device.

Yes, those machines do have a lot of technology that are behind them, but the only thing that you don't have is that human, that doctor providing you that experience and they understand the biomechanics of the foot, a lot of the training and experience and talent that they have.

So I think you get the best type of device if you went to the podiatrist.

There are other professions that do this as well, but I still think the podiatrist has proprietary over that product and can provide the best result to that patient.

Ke'an: Okay.

Give you the best advice, really make sure that something is fitting the proper way and you're not going to ... buying something, wasting your money that's not going to help.

Joseph: Correct.

I've had that happen.

A lot of patients, they'll come in.

They've got three or four pair and nothing works and then they get the prescription product and they're very satisfied.

Ke'an: So when a person turns to the point of wearing orthotics, is that like a lifetime thing, or is it a certain amount of time that they wear them?

Joseph: It can be.

There are patients that do quite well with them.

But then there a small percentage of population that does not.

So after six months, you have to make a determination.

What's the next step?

Ke'an: Okay.

Now, what about age?

Does it come into play?

Is there a certain age that you start seeing people who have this problem?

Is it older?

Is it more athletic when they're more active?

What about younger people?

Where does all this fall into play with age?

Joseph: I see it more in the younger population, the active population.

I don't see it in the sedentary population, the elderly.

I see it more in that active, youthful population that are quite active in their daily activities, whether it be running, exercise, or whatever they're doing, but in the sedentary population, I don't see it as much.

Ke'an: Okay.

All right.

So we've talked about the RICE method, the rest, ice, compression, and elevation.

We've talked about orthotics.

What about ... Is there surgery involved ever?

Joseph: Yes, there is.

That is, unfortunately, a problem for most.

They've heard many stories about the failure of surgery in heel surgery, but the fact is the technology today allows us to do surgery in a very small-incision type procedure, just releasing that fascial band does not in any way disable the foot.

It just takes stress off that part of your foot.

It's usually done through a small, tiny incision.

We're actually doing injections now of stem cell, amniotic-type dehydrated products that allow this to heal better.

We even use blood products from the patient.

It's called platelet-rich plasma and that's a therapy that's been used quite successful post-operatively or intra-operatively, I should say, to help that patient have the best result.

Ke'an: Okay.

So those are new advances in the foot surgery?

Joseph: Yes.

Ke'an: Okay.

So what kind of recovery time is involved?

Joseph: Well, the heel surgery is actually quite minimal.

It could be as little as two weeks.

I've seen very few patients go beyond six weeks.

So I tell patients usually in two to four weeks.

There's a small percentage of population of patients that have this surgery that do not get relief and usually that's a nerve problem, compression that is higher up in the leg and causing these painful areas in the bottom of the heel.

If that's released, it's kind of like carpal tunnel.

It's called tarsal tunnel of the foot.

So tarsal tunnel surgery can relieve that patient of that residual pain.

Ke'an: Okay.

So then after the surgery, are they able to walk?

Are they on crutches?

Do they have a special shoe or boot?

Joseph: I usually put them in a walker boot, which is basically a high boot that goes up to just below their knee.

They can weight-bear on that to tolerance and then eventually discard that, go back to the stretching exercises and gently get back into those normal daily activities, as well as the other activities like running or any other physical activities that they do.

Ke'an: Okay.

Now let's talk about shoes outside of orthotics.

Are shoes such as heels or flip-flops or a certain kind of tennis shoe with arch support ... What do you advise on shoe wear?

Joseph: I tell patients to wear the most supportive shoe as possible.

If a patient's suffering from plantar fasciitis, actually a little bit of a heel with help reduce a patient from having continual heel pain, because you're not putting so much stretch on the back of the leg, which eventually goes into the bottom of the foot.

So I try to tell patients to stay away from flip-flops, sandals, anything that's going to not provide support to that patient.

I know flip-flops are a big thing that a lot of people like to wear.

So just understand that you're going to have issues.

It's just basically like a barefoot issue that you're going to be suffering from.

I know runners sometimes will run barefoot and I've seen these shoes with the ... they look like barefoot runners.

But you really have to think about that type of shoe and how does it work for you.

If it hurts or bothers you, don't use it.

Ke'an: Okay.

So now, out on the market, without giving the names of specific shoes, there's lots of flip-flops that look like they have arch support in them.

I mean, is that something that people should look at?

Joseph: I think they're responding to the market need and sometimes there's aesthetics that are involved, that is how something looks.

So if it looks good, it must feel good.

The reality sometimes is that arch support that's in that flip-flop may not be in the right spot and that can cause some problems.

But I find those to be just a little bit better, but not something you should be wearing every day.

So if you have a support in that type of shoe, you can wear it, but it's not something that you should be wearing often or all the time.

Ke'an: All the time, all right.

So then, let's talk also about maybe the formation of the foot.

Are there other feet problems that come into play with maybe the way the foot looks or the way the foot was developed?

Joseph: Sure.

I think I talked about that a few minutes ago.

The high-arch foot, the low-arch foot, flat foot as we call it, is more prone to a plantar fasciitis.

The high-arch foot is more prone to a plantar fasciitis and the reason is is that a low-arch foot is putting a tremendous amount of stretch across the whole entire bottom aspect of the foot.

The high-arch foot has two points of contact, the front of the foot and the heel.

So those are the two spots that are most prone to injury in a high-arch foot.

So if a patient has a high-arch foot, they're going to have more problems with heels, front of their foot.

If you have a low-arch foot, you're going to have more problems with your arch, heels, and so forth.

Those two types of feet have different issues.

The flat foot is a very good adapter to the environment for which we're standing on.

Yes, we're in a concrete jungle.

We're not walking around barefoot.

But the high-arch foot is not a very good shock absorber.

So you're going to have different issues with both.

So the mechanics of that foot structure's going to relate to other problems that could occur higher up in the ankle, knee, hip, and back.

Ke'an: Okay.

So, I know, for me, I've had feet problems all my life and I've always had to pay attention to the types of shoes I wear and maybe the size of shoe I wear and things like that.

Then, when I go into a shoe store, I read pronation, overpronation.

Can you explain what that means?

Joseph: Pronation is another term.

It's a medical term for flat foot.

Supination is the other term.

It's the opposite term.

That's for a high-arch foot.

So if you're a overpronator, which just basically means you have a very flat foot through the entire gait cycle, that is through the heel contact when the foot's flat on the ground and when you toe off.

The foot's always flat.

Then the supinated foot is high-arched all through the entire gait cycle.

So when you see that, overpronation, it just means an over ... it's a foot that's overly flat.

And then a supinated, or oversupinated foot is a foot that's abnormally high-arched.

Ke'an: Okay.

So do you need to look for that specific type of shoe where- Joseph: Yes.

Ke'an: ... how much of an- Joseph: Yeah, there are shoe companies that specialize in those types of foot problems.

So if you go to a shoe store and you look at a shoe company brand name and hopefully you can go to a place that has a little bit better sales person.

Those sales people can be trained or not.

Then there's the pedorthist that knows a little bit about feet.

They can provide good shoe advice.

So try to go to a place that has that type of customer service, especially if you have difficulty finding shoes.

Ke'an: Okay, all right.

What other kinds of problems or things have we not discussed that comes to plantar fasciitis?

That may be questions you get asked or that we haven't covered so far.

Does anything come to mind?

Joseph: Yes.

The first one is Achilles tendonitis.

That can be a precursor.

The Achilles tendonitis is nothing more than a tendonitis of the Achilles tendon.

That's the tendon that inserts in the back of the heel, can cause pain up the back of the leg.

If that's overly tight, that can cause problems on the bottom of the foot.

If a person has arthritis in their big toe, if you have limited motion at your big toe, you're going cause strain across the bottom of the foot and that can be related to plantar fasciitis.

If you have a high-arch foot, low-arch foot, those all can come into play as well.

Ke'an: All right.

So does the stretching and different things like that with the tendon ... What did you call it again?

Joseph: The Achilles tendon, yes, yes.

Ke'an: Achilles tendon.

Is that something- Joseph: That stretching exercise I explained where you put your hands up against the wall stretches not only the Achilles tendon, but the plantar fascia as well.

Ke'an: Our producer's practicing the stretch right now.

Good job, Fred.

Joseph: There you go.

You're doing it right.

Ke'an: So is this something that maybe if you have an office job and you sit a lot, maybe getting up, walking around, doing some stretches.

Will that help?

Joseph: Yes.

The fact is the sitting is a new form of smoking.

Ke'an: Okay.

Joseph: That's what I tell patients.

We do a lot of sitting.

And because of that sitting, the flexors of our body, that is, the things that contract us, get tighter.

If we continue to sit in a position as we are, all day, every day, those muscles go into contraction.

So when we go to stand up, they're under stress.

When they're under stress, they create problems.

Most of our fascial problems are on our backside.

Our neck, our back, our low back, our hips, into our heels if you really stand up on your toes.

That's actually that back of your body.

So all that fascial tissue that's being basically contracted as you sit all day is being under stress when you go vertical or stand.

So stretching is an important part of any, I think, any day activity, but it should be something that's done all the time.

Ke'an: Yeah.

Get up, move around.

Don't just sit and be still.

Joseph: I remember years ago watching things on TV.

They used to have people that do stretches and we don't see that much anymore.

But there's YouTube and other things that you can go on and find those different types of stretches that will help you.

Ke'an: Yeah, absolutely.

Okay, we only have about one minute left.

Joseph: Sure.

Ke'an: Should people pay attention to how much sugar or salt they're getting into their bodies?

Does that affect anything?

Joseph: I don't know if it affects the foot health, but high amounts of sugar or high amounts of salt can certainly affect you metabolically through your entire body.

Blood pressure, diabetes, and so forth, so those certainly can play a role in those things.

Ke'an: The only reason I brought it up is because you hear a lot about people intaking salt and their feet swelling and things like that.

Joseph: Sure.

Ke'an: So I didn't know if that came- Joseph: That can certainly come into play minorly, but it certainly can be an issue.

Ke'an: All right.

Well, Dr. Borreggine, we've learned a lot today.

Joseph: Thank you.

Ke'an: Lots of information about plantar fasciitis- Joseph: Thank you.

Ke'an: ... and feet problems, so thank you so much for joining us.

Joseph: You're very welcome.

Ke'an: And thank you for tuning in to this episode of Being Well.

For more information, visit our website, weiu.net.

Thanks for watching.

Lori: Sarah Bush Lincoln Health System supporting healthy lifestyles, eating heart-healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Rameen: At Carle, we dedicate ourselves to helping you be great.

And we have the expertise and inspiration to help you stay that way.

Rameen: Meeting the ever changing in healthcare needs of our communities.

Paris Community Hospital/Family Medical Center is now Horizon Health, with the same ownership, management, providers and employees.

Horizon Health provides patient care and promotes wellness to the communities of East Central Illinois.

Jeff: At HSHS St. Anthony's Memorial Hospital we are at work transforming heart care, rebuilding knees and hips, delivering new generations, and focused on providing healthcare to you.

We are HSHS St. Anthony's Memorial Hospital.

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