TORONTO - The orthopedic surgeon pressed his thumb into her heel — and Bev Greenwood saw stars.
Greenwood had spent the latter half of her 40-year nursing career at St. Joseph's Healthcare Hamilton in orthopedics. She became the head charge nurse in the orthopedic clinic, teaching hip and knee classes to patients about to undergo surgery. But the Dundas, Ont., resident would soon find herself facing a physical ailment of her own.
Greenwood was diagnosed with plantar fasciitis, one of the most common causes of heel pain. The condition typically involves pain and inflammation of a thick band of tissue that runs across the bottom of the foot and connects the heel bone to one's toes.
"I found that my feet were starting to bother me at work," recalled the now-retired RN and Ontario Nurses' Association member.
"I remember one time, I bet you 12 years ago, I put a cane beside my bed. My husband would say, `What's that for?' And I said 'Well, I get up in the morning, it hurts me so much I can't weight-bear on that foot, so I've got to walk with a cane to go to the bathroom."
Greenwood started wearing orthotics and also had her left foot injected with cortisone in a bid to help alleviate the pain, which she said helped for about five to six years. However, in the last three years, the pain resurfaced, and a subsequent injection didn't work.
Greenwood said many nurses experience knee problems by virtue of pounding on the hard floors typically found in hospitals. But beyond the health-care field, retail and food service employees are among the countless workers required to spend extended hours standing or walking on the job — likely putting them at heightened risk to experience some form of foot pain.
Prior to her plantar fasciitis diagnosis, the 65-year-old started to find foot aches setting in as the work week progressed, with initial shooting pain earlier in the day giving way to more of a "gnawing pain."
"You'd kind of be twisting your foot in your shoe thinking: `If I could just turn my foot one way and get that away from me...'" said Greenwood, former president of the Canadian Orthopaedic Nurses Association.
"It's something that you want to move and try to get away from it but you can't — you're locked in your shoe. The only thing you could do is change your shoe or take your orthotic out for a while and see if that change would take away some of the pain."
Foot pain is usually a postural alignment or impact issue, said Sandra Messenger, owner of Bedford-Sackville Physiotherapy Clinic in Lower Sackville, N.B. Whether it's due to standing for prolonged periods, someone's who's started running or changing their exercise routine, Messenger said it can create wear and tear.
Dr. Richard Mandal with The Foot Institute in Edmonton said while people come in with various types of foot pain, the most predominant form is in the arch or heel.
He suggests individuals start off by trying over-the-counter insoles.
"They're not moulded to your feet, nor are they made with any sort of specific pathology; but if it cushions your feet and keeps you in good shape, generally, that's fine," said Mandal. "And generally, running shoes with some sort of support are better."
But even the most supportive and well-cushioned shoes have a shelf life. Messenger said if individuals are wearing their pair frequently for 12-hour shifts as well as at home, they may need to be replaced every six months to a year.
"Usually, (if) the sole pattern is going flat, that usually means the cushioning on the inside probably has had a lot of impact too and it's not as good as it used to be."
If store-bought insoles don't help and symptoms persist, Mandal recommends having custom-moulded orthotics made. If individuals still experience problems, Mandal said they'll then modify the orthotic or send patients to physiotherapy where they do ultrasound electrical stimulation.
For a persistent nagging spot, Mandal said it's OK to try a mild corticosteroid injection. But for general fatigue, over-the-counter insoles and better shoes should do the trick.
Messenger said taping the foot creates a false arch support, but it's not as hard or restrictive as orthotics, which are more beneficial to those with structural issues with their feet or have very high or rigid arches.
"Some people have pretty good alignment — it's just that the tissues are strained and they need to heal," she said. "Just like if you sprained your ankle you wouldn't necessarily wear an ankle brace forever ..which is why taping works."
Messenger said it's important to stretch out the arches of the foot to help ease aches. But exercises can also be a preventative measure to help stave off pain in the first place.
Creating circles with the ankle can help increase circulation which is often a problem with foot pain. Another good exercise is to roll the foot over a tennis ball. This helps the fascia in the arch of the foot to relax it if it's tight, as well as stretching out the calf muscles, she noted.
Messenger said pacing yourself during the day, taking breaks and trying, where possible, to perform tasks seated is also beneficial. Standing on anti-fatigue mats can also offer some additional cushioning.
Above all, it's key to be prudent in addressing the problem, she noted.
"If people are starting to notice symptoms, seek help sooner rather than later because if they've been living with it for six months it's harder to get rid of it," Messenger said.
Bedford-Sackville Physiotherapy Clinic:www.bedfordsackvillephysio.com
The Foot Institute: http://www.footinstitute.com