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Q: My feet are always hurting. The podiatrist has given me orthotics to help support my high arch, but they are hard plastic, and when I use them the pain is severe.

I am 52 and walk like a 90-year-old. I don't get much help from my doctor or the orthotics people. They've given me anti-inflammatory drugs and pain pills, which do nothing to alleviate the situation. Help!

-- S.M.
A: Based on the information you have provided, it sounds like you may have a condition called plantar fasciitis, which is an inflammation of the fascia in you feet.

Fascia are fibrous bands or sheets of tissue that hold many other tissues in place. The fascia in the feet are called plantar fascia and they support the arch of the foot. But when fascia are stretched too far or too fast, they can become inflamed. This is called plantar fasciitis and is more likely to occur in people who are out of condition or older.

Diagnosing this condition is usually straightforward, and is based on having pain over the inner and bottom side of the heel. The pain is typically worse after periods of inactivity, such as the first step in the morning.

During a medical examination, stretching of the fascia by bending the foot and toes backward will increase the pain. In more severe cases, direct pressure on the soles of the foot will also increase the pain.

Sometimes one can feel a bone spur on the bottom of the heel where the fascia are connected. A bone spur is usually detected when an X-ray is done while trying to make sure there aren't other explanations for the heel pain.

When the heel spur is large, it may cause heel pain, but studies have shown that most people with spurs do not have heel pain and most people with heel pain do not have spurs. Consequently, in most cases, the treatment of heel pain is not surgery, but rather to treat the inflammation and to relieve the excessive stress on the plantar fascia.

First, try to relieve the stress by avoiding standing for long periods of time. Arch supports or orthotics help some people if they are fitted properly. I'm concerned that your orthotics are causing you pain and suspect that as a result you're wearing them sparingly. I suggest you ask for softer orthotics that do not cause you pain so that you wear them all the time.

Applying ice immediately following any rigorous activity will also help. In addition, gentle stretching of the sole of your foot and the Achilles tendon (the large tendon on the back of the ankle) several times a day may relieve some of the pain over time. Talk with your podiatrist about how to best do stretching exercises.

As with any inflammatory problem, non-steroidal anti-inflammatory drugs can be useful in controlling the pain as well as decreasing the inflammation. Whether you take aspirin, ibuprofen or other over-the-counter or prescription drugs is a matter of personal choice. All probably work equally well in proper doses.

A new approach has recently been approved by the FDA that uses shock wave therapy to break up the scar tissue and to stimulate growth of blood vessels.

Write to Dr. Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611; or contact him at This column is not intended to take the place of consultation with a health-care provider.

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