Ask Well: Healing Plantar Fasciitis

Plantar fasciitis, or pain in the foot, especially near the heel or arch, is sadly familiar to many of us who run, walk, play basketball or tennis or otherwise are active. An irritation of the long, skinny rope of tissue that runs along the bottom of the foot, it’s one of the most frequent overuse injuries, especially as we age.

Until recently, scientists believed that it was an inflammatory condition. But when they microscopically examined tissue from sore heels, they found little evidence of inflammation. Instead, the injury seems to involve degeneration of the tissue; small tears in the fascia accumulate and become a constant, debilitating ache.

Because there’s little inflammation, anti-inflammatory drugs, like ibuprofen, are unlikely to aid in healing the problem. A better response, says Dr. Terrence M. Philbin, a orthopedic surgeon at the Orthopedic Foot and Ankle Center in Westerville, Ohio, is ‘‘first, to back off training,’’ allowing the slight tears in the tissue to heal. If you run every day, drop to twice a week or walk for a while.

Meanwhile, stretch. While stretching may be of equivocal value among the healthy, it aids in recovery from sore feet.

“Stretching the calves and Achilles’ tendon is important,” Dr. Philbin says. For a full program of stretches, consult a physical therapist, he says. But a simple, effective calf stretch, according to the American Academy of Orthopedic Surgeons, involves leaning forward against a wall with one leg behind you, heel on the ground, and the other leg ahead and bent, as if you were taking a step. Push your hips toward the wall to fully stretch the calf of the back leg. Hold for 10 seconds, and repeat 20 times on each leg.

And be patient. Recovery from plantar fasciitis typically requires months, Dr. Philbin says, but for most people, it does happen, and without surgery or other invasive treatment.

To learn more, read my earlier column “No Consensus on a Common Cause of Foot Pain.”

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A Step-by-Step Executive Workout

Even the most health-conscious corporate executive sometimes struggles to balance professional and social commitments with a regular exercise regimen. The bottom line is this: The healthier you are, the more productive you will be; the fitter you become, the fewer work days you will miss, the less susceptible to stress you will be, and the better you will sleep.

So how do you make time for a workout when you are at your desk before a foreign market opens or at the office long after the gym closes? I recommend what I call the Corporate Workout: a time-efficient, flexible routine that can be done at any time of day . . . no equipment, no gym membership and no weight room necessary. All you need is a stairwell and some guts, which should not be a problem for people who routinely close multimillion-dollar deals. Your body is the equipment, the stairs are the cardiovascular machines and each landing in the stairwell is the weight room. Oh, and you'll want some sweat duds and access to a shower later. This is definitely not a regimen meant for your business suit.

The program is simple, at least to describe: Climb a flight of stairs. Perform an exercise on the landing. Take the next flight up. Do another exercise. And so on. On the road and don't have access to a stairwell? Skip the stairs and do the same exercises in your hotel room.

Try the following sequence of exercises, each targeting multiple muscles and joints; the first in each set focuses on the upper body, the second on the lower body and the third on core muscles. (Follow the same concept for a shorter sequence.)

· Push-ups: as many as you can get with proper form.

· Split squats: Put one foot forward, one foot back, splitting the legs broadly enough so that when the back knee is lowered toward the floor, the front knee is directly over the front heel; do eight to 15 on one leg, then switch legs and repeat.

· Bicycle sit-ups: Lying on your back with the legs moving in a bicycle motion, first move one elbow to the opposite knee, then the other elbow to the opposite knee; do as many as you can in 60 seconds.

· One-arm fliers: Begin in a push-up position and slowly raise one straight arm away from the body while keeping the shoulders and hips square to the floor; slowly return the arm to the start position, then raise the other arm in the same fashion; do eight to 15 on each side.

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Quick Study: Using sunscreen may reduce risk of deadly skin cancer

THE QUESTION Can the most deadly form of skin cancer, melanoma, be prevented with sunscreen use?

THIS STUDY randomly assigned 1,621 adults who lived in a sunny climate to use sunscreen daily or whenever they wanted to for at least four years. Daily users were to put sunscreen with a sun protection factor (SPF) of 16 on their head, neck, arms and hands every morning and reapply it after heavy sweating, bathing or spending a long time in the sun. The others could use a sunscreen with any SPF; about 35 percent used it once or twice a week at most, and 38 percent never used it. Participants also took either a beta-carotene supplement or a placebo daily, to test whether the supplement might enhance protection. Sun exposure was found to be similar between the groups, as was their use of other means of sun protection, such as wearing a hat or seeking shade. Nearly 15 years after the start of the study, 11 melanomas had been detected among the daily sunscreen users, compared with 22 among the others, for a 50 percent reduction. Invasive melanomas were 73 percent less common in the daily-use group. Beta carotene showed no beneficial or harmful effect.

WHO MAY BE AFFECTED? Adults who spend time in the sun. Harmful exposure can occur in any season and at any temperature, wintertime included. The sun's ultraviolet rays penetrate the skin and damage cells, which can lead to skin cancer over the long term. Basal cell and squamous cell are the most common types of skin cancer, but melanoma is the most dangerous and is reportedly occurring with increasing frequency. Melanoma accounts for about 75 percent of skin cancer deaths.

CAVEATS Results might have been different if sunscreen users had been compared with those who never used it; the authors wrote, however, that asking a group to use a fake sunscreen would have been unethical. The effect on children was not tested.

FIND THIS STUDY Dec. 6 online issue of the Journal of Clinical Oncology (jco.ascopubs.org).

LEARN MORE ABOUT melanoma at www.cancer.gov and www.skincancer.org.

- Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.

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