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Noreen Noelle Oswell, DPM

In The News

Swept Off His Feet by Severe Heel Pain
By Jacqueline Stenson, Special to The Times

As a teacher, William Crews has spent a good deal of time on his feet. But when he began suffering from excruciating heel pain, his students weren"t the only ones who had to take a seat when the bell rang.

"Normally, I walk around the classroom and see what they"re doing, and I talk and get them involved," says Crews, 57, a special education teacher at Belmont High School in Los Angeles. "I"m used to using a lot of energy."

That changed when his feet started to hurt a couple of years ago. Discomfort that began as little more than a nuisance progressed to debilitating pain that made it impossible for him to stand for long periods.

"It got to the point where I was limping all the time," Crews says. "And I started sitting down to teach. I thought, "This is ridiculous." "

Sitting down not only put a kink in Crews" teaching style but it also caused commotion in his classroom because students had to walk to the front to show him their work. "That was a disturbance," he says.

The pain also affected other aspects of his life. Mowing the lawn was much more work than usual. And favorite activities such as riding his bike and playing golf were out of the question. Even the family pet was affected: "I quit walking the dog," Crews says.

Crews had a severe case of plantar fasciitis, an inflammation of the plantar fascia, the tough band of tissue that connects the heel bone to the ball of the foot.

Plantar fasciitis is a common cause of pain on the bottom of the heel and a frequent complaint at podiatrists" offices. Lakers star Kobe Bryant, for example, was recently diagnosed with the condition and is undergoing treatment.

People most at risk include those who are on their feet a lot, are overweight, wear unsupportive shoes or often go barefoot, have flat feet or very high arches, have a tight Achilles tendon or suddenly increase their exercise participation. High-impact activities such as running, tennis and basketball are especially likely to injure the plantar fascia.

One or both feet may be affected. Crews had it in both, though the right one was more painful.

Like many people with plantar fasciitis, he had flare-ups first thing in the morning and when standing up after extended periods of inactivity, such as the long ride to work from his home in Lancaster.

As his pain worsened and became more frequent, Crews had great difficulty walking. He began using the handicapped parking spots at school and feared he might even need crutches.

Eager for relief, Crews tried self-help measures, such as stretching his feet and applying ice and heat to them. But when those failed, he turned first to his primary care doctor and then to a podiatrist. He credits his recovery to a second podiatrist, Noreen Oswell at Cedars-Sinai Medical Center in Los Angeles, whom he began seeing last November.

To be sure, there was no quick fix. Oswell recommended several treatments to help Crews get back on his feet. He was advised to trade in his boots for supportive athletic shoes, and to wear over-the-counter heel cups for additional support while custom-designed orthotics were being made. He received a prescription for anti-inflammatory pills and got a cortisone shot in his right foot.

In addition, he went to physical therapy three times a week for a few months. Sessions included ultrasound treatments, stretching exercises and massage of his feet and calves.

Oswell also recommend night splints, boot-like devices that stretch the foot up toward the knee, but Crews found them too bothersome to wear in bed. Instead, he used them for a few hours in the evenings when working on his computer or grading papers.

Crews also used elastic braces to support his feet, and he iced them at the end of the day.

Oswell and other experts say such extensive treatment is necessary for patients such as Crews who"ve suffered many months with plantar fasciitis.

"Inflammation is a more difficult problem the longer it persists," says Oswell, a spokesperson for the American Podiatric Medical Assn. On the other hand, patients treated at the first sign of trouble usually recover much more quickly with fewer interventions, she notes.

Treatment for simple cases usually costs $200 to $300, Oswell says. More complex cases, such as Crews", can reach $2,000 to $3,000.

In either case, she says, the majority of patients improve without surgery to cut the plantar fascia away from the heel bone. Considered a treatment of last resort, it"s used in less than 5% of patients and isn"t always successful, Oswell says.

Crews says he began getting better shortly after his initial visits to Oswell, and he continued to improve steadily. "For the most part, I can say I"m pretty much back to normal," he says. "I still have some pain now and then, but it"s very manageable."

To keep his feet in good working order, Crews is vigilant about stretching in the morning, icing his feet at the first sign of pain and wearing proper footwear even at home. He buys new athletic shoes every three months so he always has good support. "It"s a bit of an expense," he says, "but it"s worth it if you can walk without pain." He has a pair of black sneakers for when he wants to dress up they may not be fashionable, but they"re foot-friendly.

Crews can once again walk around his classroom. And he"s much more mobile in his off hours too; he recently completed some repairs on his deck, he"s back to walking the dog, and he takes regular bike rides as long as 11 miles.