My spikeless golf shoes cause me pain

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Published 24/05/2011 07:19:00
 

Question:

I recently bought a pair of spikeless shoes after years of wearing very comfortable steel-spiked shoes. The new shoes produced tremendous pain in my heels, which spread to my back. I traded them in for spikeless shoes -- the same brand as my old steel-spiked shoes -- which produced the same result. Now I can barely walk around the golf course, and after a round I limp for hours. Is this because of the spikeless design or something else? Are there shoes with softer heels and soles that might alleviate this problem?

 

Answer:

You may have a condition (somewhat unrelated to your shoes) known as plantar fasciitis -- commonly referred to as heel spur syndrome. Individuals suffering from plantar fasciitis often experience pain and stiffness when taking the first steps in the morning or after long periods of inactivity. Symptoms include pain at the bottom of the heel with standing, walking, and running.

 

The plantar fascia is a flat tendon, which attaches to the heel on the bottom of the foot. When constant overload stresses are applied to the foot (common in golf), it causes a degeneration and ultimate loss of blood supply to the tendon attachment. Occasionally, a bone spur may form where the tendon attaches to the heel. This condition of tissue degeneration with reduced blood supply has been called a ¿heart attack of the tendon.¿ Golfers are particularly prone to this condition due to the prolonged low load stress caused by walking long distances on grass and the uneven terrain. High demand athletes and overweight individuals are at a higher risk as well as people with abnormal foot postures (high arched or flatfooted).

 

Interestingly, our research demonstrates no inflammatory cells in the injured tissue; therefore, the name fasciitis in our opinion should be changed to plantar tendinosis or fasciosis due to the nature of the condition. This point is important since this malady is commonly treated by rest and anti-inflammatory medication, including cortisone injections, which have no known curative potential. Note also that cortisone use should only be used with the proper indication because this drug can have a tissue-weakening effect, making the problem even more painful. These cautions also apply to other tendon injuries such as the rotator cuff, tennis elbow, and the Achilles tendon.

 

Weakness and loss of flexibility in the leg and hip muscles commonly accompany plantar tendinosis. Therefore, a quality rehabilitation program must restore strength, endurance, and flexibility to all areas of the leg to be effective. The key elements should include strength training, and flexibility exercises to all the deficient areas of the lower leg, foot, thigh, hip, and back. A night stretching splint may help restore flexibility and decrease the incidences of morning foot pain. Protective aides may also be used to help reduce stress on the tendon, and decrease pain during rehabilitation. These include foot/arch taping, corrective custom orthotics, or in many instances a more effective and in-expensive aid is the counter-force foot brace. Additionally, proper shoes with reasonable mid-foot flexibility are always in order.

 

Since the cause of heel pain in this specific problem is not due to high impact but by repetitive stress with overuse, heel cups are usually less effective and can lead to increased muscular tightness down the road.

 

For a minority of cases, rehabilitation fails and surgery may be indicated. Remember that the abnormal tissue is not inflammatory, although many surgeons may not be aware of this recent research. This point is extremely important, however, as standard surgical techniques of total tissue release are based on the erroneous, outdated premise of presumed inflammation. Older surgical concepts release the entire plantar fascia (tendon) and, on occasion, remove the heel spur if present. Full surgical release increases post-operative pain and, more importantly, may unnecessarily weaken the foot support mechanism. If foot weakening occurs, the risks of injury to other areas of the foot and leg tend to increase. To avoid these potential problems, the advanced surgical concept is not plantar fascia release but very select removal of the painful tendinosis tissue which is usually located in the inside (medial) third of the plantar fascia near its attachment to the heel.

 

Finally, with or without surgery, the decision to return to golf is best accomplished with objective criteria. The goal is restoration of strength, endurance, and flexibility. This requires appropriate and adequate rehabilitation and accurate strength and flexibility measurements.

 

We recommend active participation in a meaningful rehabilitation program, along with proper analysis of the foot's structure as the most effective approach.





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