Ask the Flight Surgeon / By CPT Frank Stafford, D.O: Q: The bottom of my feet, especially my heels, have really been hurting. The pain is the worst when I first get up in the morning. It can get so bad that it makes it difficult to walk or stand for a long time let alone go for a run. I read on the internet that this could be plantar fasciitis. What is that?
FS: Plantar fasciitis is when the fascia, a thick, wide band of tissue that runs from the base of your toes to your heel, becomes inflamed and painful. This tissue acts as a shock absorber and supports the arch of the foot. Too much pressure on your feet can irritate or even tear the fascia causing pain and stiffness in the foot. Pain is typically worse after you have been off your feet and the fascia has not been stretched out for a while. The presentation of plantar fasciitis is a stabbing pain in your heel when you first get out of bed in the morning or when standing after a long car ride or flight. Plantar fasciitis usually starts off with minor irritation and can be tolerated reasonably well. However, as time progresses, the tears, inflammation and associated pain often increase to the point where running, jumping, or any impact on the foot becomes intolerable. This could prevent you from being physically active and may affect your ability to operate an aircraft safely. Safety of flight can be jeopardized by distraction from pain, physical limitations due to pain, inability to properly pre-flight or inability to safely egress.
Treatment
Diagnosis can be made by your aeromedical provider using the history of your symptoms and a physical exam in the office. All forms of treatment involve rest (but not inactivity) and allowing the tissue to heal from the tears. Initially, you will need to limit the pressure applied to the feet and not perform any activities that cause pain. Anti-inflammatory medicines such as ibuprofen or naproxen can be used to reduce pain and swelling. Additional therapies such as ice baths for the feet, rolling a tennis ball or frozen plastic bottle of water under the arch of the foot may reduce inflammation and promote healing. A lower leg stretching routine as well as the nightly use of a foot brace may prevent the painful tightening of the fascia. Orthotics such as heel lifts and arch supports are additional options. X-rays are not required to diagnosis plantar fasciitis but may be used to identify other causes of foot pain like stress fractures or abnormal boney outgrowths called spurs that have their own treatment regimens.
As the pain decreases, you can begin increasing your activity levels. Examples are slowly jogging short distances and then adding distance and speed over 2-3 months. If you experience any worsening of the pain at any level, you should return to the previous comfortable level of activity. If given enough time, most cases of plantar fasciitis will resolve on their own without further treatment. If conservative therapies are not successful, then injections typically using steroids or even foot surgery may be considered. Same day surgery is generally considered after all other methods have been unsuccessful. Recovery time requires a few weeks and physical therapy is often initiated about two weeks after the surgery.
Prevention
Certain interventions can help prevent the occurrence or recurrence of plantar fasciitis. Extra body weight increases the stress on the arches of the feet and increases your chances of irritating the plantar fascia. In addition, quality footwear that provides proper arch support should a part of your prevention regimen. Shoes should support your arch and protect your heel or allow the use of properly fitted inserts. Even the best shoes wear out, losing their ability to support your arch and should be changed periodically. This is especially true if they get heavy use like running or other athletic shoes. A physical therapist is a great source of stretches and their proper execution. These stretches can include the “Achilles Stretch,” “Stair Stretch,” toe stretch and several others. Recent studies have shown that muscle strengthening of the foot and ankle may have a role in returning the injured back to physical activity sooner and help prevent the return of the problem. Please see your aeromedical provider for assistance with the right prevention and treatment plan for you.
Flight Status
This condition does not usually limit your ability to fly unless the pain interferes with flight activities. If pain and stiffness limit your ability to work the pedals or to safely egress the aircraft, then a period of grounding will be necessary as you work through the concern. Properly fitted orthotics can be used while flying without concern. Steroid injections only limit you from flying the day that you get the injection, otherwise you can fly. The surgery will keep you out of the cockpit until the surgical wound is healed, your pain is well-controlled, and you are able to safely perform your duties.
Stay safe!
Questions for the Flight Surgeon?
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The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated.
CPT (Dr.) Frank C. Stafford is a flight surgeon at the School of Army Aviation Medicine, Fort Rucker, AL.
