The plantar fascia has many functions. It provides support and structure to the longitudinal arch of the foot. It provides an attachment for the intrinsic foot musculature. It integrates skin and toe mobility into the gait cycle. And, it protects the distal neurovascular bundle, tendons and muscles from the metatarsal heads during gait.

Inflammation of the plantar fascia is termed plantar fasciitis. This inflammation can be the result of excessive stretch of the plantar fascia resulting in microtrauma, which can become repetitive and chronic resulting in inflammation and degeneration of the fibers. It is very common for persons with plantar fasciitis to also have a heel spur. Barrett & O’Malley state “there is no correlation between heel pain and the presence or absence of exostoses,” or heel spur. Plantar fasciitis is a common problem and can be the result of one or more of the following factors: errors in exercise training, a sudden increase or change in physical activity, unsupportive or highly flexible footwear, exercising or prolonged activity on a hard surface, obesity or sudden weight gain as with pregnancy, occupational influences, pes cavus deformity, pes planus deformity, excessive pronation of the foot, lower extremity malalignments particularly in the foot and/or ankle, biomechanical faults, previous trauma to the foot, avascularity, and decreased plantarflexion strength or flexibility. When plantar fasciitis is caused by excessive pronation, there is a flexible rearfoot varus, the talus plantarflexes and adducts during weight bearing, and then the calcaneus everts, causing pronation and tension on the plantar fascia. Other conditions that can cause pronation are tibia vara, ankle equines, forefoot varus, compensated forefoot valgus, and limb length discrepancies.

The plantar fascia is a strong, thick sheet of connective tissue in the sole of the foot. It incorporates itself into the muscles of the plantar aspect of the foot. Plantar fascia has superficial and deep components. The superficial fascia is thick, it contains significant amounts of fat which helps it to provide padding for the sole of the foot, and it contains the retinacula cutis, securing itself to the skin. The deep fascia is made up of the plantar aponeurosis, which has medial, lateral, central, and transverse components. It has extensions which become the medial and lateral intermuscular septa. It also has superficial and deep transverse metatarsal ligaments. The plantar fascia attaches to the medial process of the calcaneal tuberosity posteriorly, and it divides into fives slips attaching to each of the metatarsal heads anteriorly. Other structures that attach to the calcaneal tuberosity are the abductor hallucis (medially), flexor digitorum brevis (dorsally), and abductor digiti minimi (laterally). The quadratus plantae muscle lies dorsal to the flexor digitorum brevis.

As you pack for college, the University of Illinois at Urbana-Champaign told all its students in a recent e-mail message, don’t forget a thermometer, some over-the-counter cold remedies and a week’s worth of food.

But the real plan in case of a major swine flu outbreak on campus, said the head of the university’s health center, is simple: Don’t try to sweat it out in your dormitory room. Go home. Let Mom and Dad take care of you.

“About 80 percent of our students live within a two-, two-and-a-half-hour drive of here,” said Dr. Robert D. Palinkas, director of the McKinley Health Center on campus.

“We’re hoping the parents will have high-enough anxiety about their kids having swine flu that they’ll come get them.”

All across the country, universities are making plans in the expectation that dozens or hundreds of their students will fall ill with the new H1N1 flu as classes start over the next few weeks.

“This is a virus that disproportionately affects folks in our demographic,” said Dr. Anita L. Barkin, director of student health services at Carnegie Mellon University in Pittsburgh and chairwoman of the American College Health Association’s pandemic planning committee.

The new flu infects young people more often than it does older ones; people born before 1957 have an added advantage, because a similar H1N1 flu that was circulating then provides some immunity. The rapid ricochet of the new flu can create high absenteeism, disrupting college calendars.

Also, administrators worry that any surge in serious cases among students and staff members who are pregnant, obese or have asthma or other conditions that seem to make this flu worse could overwhelm local hospitals, so they are eager to slow down transmission.

While there has been talk of filling gymnasiums with cots and handing out Tamiflu on demand, most are making more modest plans.

Many have positioned dozens of hand sanitizers, made dormitory resident assistants aware of the symptoms, ordered seasonal flu shots and drafted plans to offer swine flu shots if they are approved.

Some are creating separate “flu waiting rooms” in their health centers so students with sprained ankles will not have to sit next to sneezers. Very few are asking students to arrive with extra food, as the University of Illinois did, but most say their dining halls will deliver to the sick.

“We have to-go packs with soup, Tylenol and Gatorade,” said Dr. Mary Covington, director of student health at the University of North Carolina, Chapel Hill, “and we could do boxes with meals-ready-to-eat that could be put in a microwave.”

By following guidelines on www.flu.gov, most universities hope to avoid shutting down.

The first priority will be, as one administrator put it, “to thin out the herd.” Sick students will be encouraged to go home, visit other relatives, even impose on kindly family friends.

Because most dormitories are full, some universities will offer healthy students cots so they can sleep elsewhere while their roommates recover.

Instructors may be asked to ease up.

“We have faculty who usually say, ‘I don’t care if you’re half-dead, I expect you to be in class,’ ” Dr. Palinkas said. “We’re asking them to bend the rules a little.”

And though talk of online classes is common, few universities are fully ready. Computer science professors are a lot readier than social science professors are, one administrator grumbled privately.

Stephanie Hanenberg, director of student health at the University of Colorado, Colorado Springs, said she had discussed flu-fighting with every campus department.

The cleaning staff, Ms. Hanenberg said, will concentrate on “doorknobs and railings in classrooms and housing, keyboards in the computer labs and restrooms everywhere.” The athletic department, she said, will figure out how to isolate players who fall ill on the road.

“They should not be put back on the bus,” she said. “You don’t want to take out the whole team.”

Colorado’s nursing students, she said, are likely to have the biggest problems making up classes. While federal guidelines suggest that ill students stay out of class until 24 hours after their last fever, nurses must stay away from patients for that long or for seven days, whichever is longer.

One university with no plan to ship students home is the United States Military Academy.

All 4,300 West Point cadets got medical exams when they arrived for summer training, said Col. Michael A. Deaton, commander of the base hospital. Anyone with symptoms or recent contact with a flu patient would have been given a nasal swab flu test, and a positive result would have put the cadet in quarantine barracks.

“Because they’re military, we can tell them what to do,” Colonel Deaton said. “It’s less like herding cats than it is on the average college campus.”

But no one arrived with symptoms. Despite the base’s proximity to New York’s outbreak, only six cadets and nine other West Point soldiers have had the flu since it emerged in April.

Students were told to take precautions “and no one was shaking hands here for a while — everyone was either tapping or bumping elbows,” Colonel Deaton said.

“I really think that’s how we dodged a bullet,” he continued.

At the University of Utah in Salt Lake City, two previous events helped prepare officials, said Marty Shaub, the university’s director of environmental health and safety.

The first was the 2002 Winter Olympics, for which students had to vacate dormitories for up to six weeks and officials had to deal with assorted disruptions. Then, this summer, a flu outbreak among campers who use university grounds spread to the housing staff, which had 30 percent absenteeism.

“So we’ve been down the road where you define what is absolutely mission-critical and what can be interrupted,” Ms. Shaub said.

Although she would like to offer free flu shots, she said, almost 90 percent of the university’s students do not join the optional student health service.

Dr. Palinkas, of the University of Illinois, by contrast, said he had an annual flu-shot program so well financed that he not only offered dining-hall vaccinations, but also had students cajoling others in food lines to get a shot; up to 12,000 of the 41,000 students do each year.

“If you just have a nurse standing next to a poster, you have a much lower acceptance rate,” he said.

And Dr. Covington said her health center at the University of North Carolina had such good electronic medical records that she hoped to send e-mail messages to each student with asthma or diabetes to suggest a shot.

But on the flu front, British universities seem to have American ones beat.

In Britain, where childhood vaccination rates are lower, campus outbreaks of flu, meningitis and mumps are so common that they are collectively referred to as “fresher’s flu.”

This year, many universities started “flu-buddy schemes.” Students officially register to use each others’ ID to pick up an extra meal or Tamiflu from the campus pharmacy.

But both the British pick-a-buddy tactic and the American call-Mom plan are different from what was discussed in previous pandemic planning, Dr. Covington said.

“Three years ago, we were talking about bird flu,” she said. “Then, the talk was at what point do you just close the whole university and go home?”

(CNN) — Matthew Sanchez had rarely seen his father cry. But when Rudjard Hayes looked at the X-rays of his son’s spine after a high school football accident, he held his wife close and broke down, not knowing that his son could see him.

Matthew Sanchez, now 20, relearned how to walk at Shepherd Center using the parallel bars.

Hayes was used to watching Sanchez get knocked to the ground during games and then get back up, but that game in 2004 was different: After getting knocked down, Sanchez, then 15, could not move.

“I knew it was serious, but it didn’t really sink in until I saw the X-rays for myself,” said Hayes, who lived with his family in Sharpsburg, Georgia, at the time.

Sanchez’s C5 vertebra (in his neck) was fractured.

“I knew the chances of him recovering were basically zero. But I hoped and prayed 24-7,” Hayes said. “We are a very faith-based family and believe that you trust the people that are there for you, and things are going to be OK. God will see you through it.”

Doctors at Shepherd Center in Atlanta, Georgia, operated on Sanchez’s neck, putting in a plate, screws, cables and a piece of bone from his leg.

According to Dr. Donald Peck Leslie, medical director of Shepherd Center, less than 1 percent of people with this type of spinal cord injury regain full physical abilities.

But Matthew Sanchez was destined and determined to be in that elite group. Days later — and much sooner than anyone thought possible — Sanchez started regaining some movement.

House Call with Dr. Sanjay Gupta

Watch Matthew Sanchez’s story this week on House Call.
Saturday and Sunday, 7:30-8 a.m. ET

see full schedule »

Moving on

Five weeks later, after intensive therapy, Sanchez walked out of Shepherd Center. After six more months of therapy, his sense of normalcy returned. Two years later, he could be a competitive athlete again.

“I just think some people are a little bit more motivated. Matt was an athlete, so he knew how to work hard,” Cathi Dugger, Sanchez’s physical therapist, told Dr. Sanjay Gupta, CNN’s chief medical correspondent. Watch more on Matthew Sanchez’s odyssey »

Today, five years after his injury, Sanchez has seven triathlons under his belt.

Twist of fate

Sanchez’s extraordinary recovery was made possible by an unlikely stranger. When the teen was knocked to the ground, the doctor for the opposing team, Dr. John Henderson, rushed to his aid. Knee-deep in mud, Henderson held Sanchez’s head in traction for 45 minutes, preventing anyone from moving him. Henderson also insisted Sanchez be transported by helicopter instead of ambulance.

Sanchez’s mother credits Henderson, in part, for the favorable outcome.

“Our family believes that Dr. Henderson was our angel that night. Our high school did not have a team physician, and I feel certain Matthew could have been moved had Dr. Henderson not prevented anyone from touching him until he could be properly transferred,” Lorraine Sanchez Hayes said in an e-mail to CNN.

Had he been moved, his mother believes, his injury would have been made worse.

One year after the accident, the family learned that Henderson’s son, Army Ranger John Henderson Jr., had been killed in Afghanistan.

“This man had been instrumental in saving our son’s life, only to have his own [son's life] taken,” Sanchez Hayes wrote.

Giving back

While most college students spend their summers relaxing, taking extra classes or working to earn money, Sanchez, now 20, chose to spend the past 2½ months giving back to the doctors who put him back together in the best way he knew how: a 4,350-mile fundraising bike ride. See photos from the bike ride »

In part to memorialize Henderson’s son, and in part to raise money for Shepherd Center, Sanchez and three friends — Anthony Orig, Marina Fleming and Jonny Cromwell — set out in May on a cross-country expedition to benefit the SHARE initiative, as the We Ride For Shepherd team.

Shepherd Center is home to SHARE — a partnership between the military health care benefits program, philanthropist Bernie Marcus and private donations. Through SHARE, veterans of the wars in Iraq and Afghanistan with brain injuries, spinal cord injuries and chronic pain can get specialized, cutting-edge treatment at Shepherd Center, and receive housing assistance for themselves and their families.

“Our goal is to educate the VA about what we have available,” said Dr. Darryl Kaelin, the Shepherd Center physician who oversees the SHARE initiative. He said that many of the smaller Veterans Affairs hospitals might not be aware of the resources available at Shepherd Center.

Kaelin said one of Shepherd Center’s main focuses is to help people move on with their lives after a catastrophic injury and regain their independence.

That’s what brought U.S. Army Spc. Dillon Cannon to Shepherd Center as a SHARE patient. Cannon had been in Iraq for about a month when he was shot by a sniper in 2006.

He admires Sanchez’s fundraising effort. “Why military personnel? Out of the kindness of his [Sanchez's] heart. It shows that people like that go above what they have to do. I mean he could be working — making money for himself — but he’s trying to help out people like me,” Cannon said.

Moving forward

Hayes said that he is proud of his son for completing the cross-country journey, but he’s even prouder that Sanchez wants to give something back.

Sanchez said he couldn’t think of a better way to show his appreciation. “These men and women are over there… risking their lives every day, and we feel like they deserve the best treatment possible,” he said after completing his 78-day bike trek.

A review of the literature demonstrates the effectiveness of various treatment options. Oztas, Turan, Bora and Karakaya (1998) studied the effectiveness of continuous ultrasound. It was discovered that there was no improvement in subjective symptoms, but there was a negative effect on motor nerve velocity, implying that ultrasound has a deleterious effect on carpal tunnel syndrome. On the other hand, Ebenbichler et al. (1998) found that pulsed ultrasound resulted in significant improvement with subjective symptoms and nerve conduction studies. These improvements continued after six months. Akalin et al. (2002) studied the effects of nerve and tendon gliding exercises on carpal tunnel syndrome symptoms. They found that performing these exercises combined with wearing wrist resting splint provided significant relief of symptoms. Their control group only wore the splints and they also reported decreased symptoms, but the extent of their relief was not as significant as the exercise group. Carter, Hall, Aspy and Mold (2002) studied the effects of magnetic therapy. They did not find any positive effects with their study. Yoga was studied as a possible treatment option by Garfinkel et al. (1998). They found that yoga allowed improvement of grip strength, pain reduction and the Phalen sign. They found no changes with sleep disturbance, Tinel sign, or nerve conduction studies. Therapeutic touch was tested by Blankfield et al. (2001). Their subjects received thirty minutes of therapeutic touch as compared to sham therapy. There was no relief of the carpal tunnel syndrome symptoms.

Medical interventions for carpal tunnel syndrome include prescription of NSAIDs, cortisone injections, and surgery. Further literature review was performed on medical interventions available for the treatment of carpal tunnel syndrome. Gerritsen, deVet, Scholten and Bertelsmann (2002) compared the effects of splinting with surgery. They found that after three months, patients who wore wrist splints reported 54% improvement, while the patients who had received surgery reported 80% improvement. After 18 months, the splinting group had 75% improvement and the surgical group had 90% improvement in symptoms. Tudiver, Johnson and Brown (2003) performed a literature review study and found that 33% of cases respond to splinting alone while surgery has a 90% success rate. They also compared the outcomes of open carpal tunnel release compared with endoscopy and found that they are equally effective, but the endoscopy patients have a faster return to function. Steroid injections were studied by Graham, Hudson, Solomons and Singer (2004). They gave their patients three betamethasone injections along with wrist splinting over the span of nine weeks. They found that these patients only had temporary relief of symptoms. Ten percent had long term relief and the remaining patients required open release surgery. Katz and Simmons (2002) noted 80% relief with wrist splinting. They stated that NSAIDs, diuretics and vitamin B6 were ineffective. Injections can be effective in 75% of cases, but recommend no more than three per year to avoid tendon rupture or nerve irritation. They recommend surgery if symptoms persist for greater than one year. They report 70-90% improvement with surgery, and also note some documented effectiveness with yoga and chiropractic treatment. Chung, Walters, Greenfield and Chernew (1998) studied the cost-effectiveness of endoscopy as compared to an open release. They found that endoscopy was more cost-effective, not because of the actual cost of surgery, but because of the decreased chance of complications, creating sociological costs. These complications were listed as median nerve transection and/or transient hand numbness. Trumble, Diao, Abrams and Gilbert-Anderson (2002) compared endoscopy with open release for effectiveness. They found that both surgeries were equally effective, but the endoscopy group demonstrated less scar tenderness and a quicker return to work. Lee and Jackson (1996) performed carposcopies, which is an open procedure, but the incision is smaller and is performed in a transverse manner. They reported that their patients had 86% relief in symptoms with no major complications. The fourteen percent that did not experience relief reported residual weakness and pain. They underwent open releases.

Jack Smith, head of the Pentagon’s office of clinical and program policy, says he will recommend that Gates adopt proposals by a federal study that cites rising tobacco use and higher costs for the Pentagon and Department of Veterans Affairs as reasons for the ban.

The study by the Institute of Medicine, requested by the VA and Pentagon, calls for a phased-in ban over a period of years, perhaps up to 20. “We’ll certainly be taking that recommendation forward,” Smith says.

A tobacco ban would confront a military culture, the report says, in which “the image of the battle-weary soldier in fatigues and helmet, fighting for his country, has frequently included his lit cigarette.”

Also, the report said, troops worn out by repeated deployments often rely on cigarettes as a “stress reliever.” The study found that tobacco use in the military increased after the wars in Iraq and Afghanistan began.

Pentagon spokeswoman Cynthia Smith said the department supports a smoke-free military “and believes it is achievable.” She declined to elaborate on any possible ban.

One in three servicemembers use tobacco, the report says, compared with one in five adult Americans. The heaviest smokers are soldiers and Marines, who have done most of the fighting in Iraq and Afghanistan, the study says. About 37% of soldiers use tobacco and 36% of Marines. Combat veterans are 50% more likely to use tobacco than troops who haven’t seen combat.

Tobacco use costs the Pentagon $846 million a year in medical care and lost productivity, says the report, which used older data. The Department of Veterans Affairs spends up to $6 billion in treatments for tobacco-related illnesses, says the study, which was released late last month.

Along with a phased-in ban, the report recommends requiring new officers and enlisted personnel to be tobacco-free, eliminating tobacco use on military installations, ships and aircraft, expanding treatment programs and eliminating the sale of tobacco on military property. “Any tobacco use while in uniform should be prohibited,” the study says.

The military complicates attempts to curb tobacco use by subsidizing tobacco products for troops who buy them at base exchanges and commissaries, says Kenneth Kizer, a committee member and architect of California’s anti-tobacco program.

Seventy percent of profits from tobacco sales — $88 million in 2005 — pays for recreation and family support programs, the study stays.

Strong leadership could make the military tobacco-free in five to 10 years, Kizer says. President Obama, he says, could set an example for the military by ending his own smoking habit once and for all. Last month, Obama said he is “95% cured” but “there are times when I mess up” and smoke.

Ideally it must take at least six months or up to one year for women to shed the weight they put on in pregnancy. Trying to do so in weeks will not only result in failure, but also harm the health of the new-born and the mother.

“Often, the extra effort women have to make to look after a new baby and breastfeed after giving birth means the kilos just melt away without effort,” said Professor Peter Sawicki, the director of the Institute. “But for about half of all women, the weight will not go away as quickly.”

Celebrities like Nicole Kidman and Victoria “Posh” Beckham were back in skinny jeans just weeks after giving birth. However this is not at all feasible, the Institute warned women who take up crash diets and vigorous exercise

to shed the pounds.

“It is not a good idea to ‘eat for two’ in pregnancy and forget about your weight until after the baby is born if you are at all overweight - or prone to overweight - already,” Professor Sawicki said, adding that most weight problems can be avoided by a sensible diet during pregnancy

.

Source-Medindia
RAS

FRIDAY, June 5 (HealthDay News) — Most people, especially children, love to be out in the summer sun, but parents should remember that no tan is a good tan.

“Remember that if you form a tan, you will have ultraviolet radiation damage,” Dr. Alfred Lane, a pediatrician and researcher at Lucile Packard Children’s Hospital, said in a news release from the northern California facility. “Unfortunately, the body really doesn’t forget this damage. It accumulates from childhood through adolescence and adulthood, and this can lead to skin cancer.”

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Lane, who is also a professor of dermatology and pediatrics at the Stanford University School of Medicine, offers tips to help protect young and old from sun damage:

• Always use a waterproof sunscreen with at least a 30 SPF (sun protection factor) — the higher, the better for protection from ultraviolet damage and skin cancer — before going outside in the daylight.
• Wear clothing with high SPF. Even then, don’t forget to put sunscreen on all exposed skin.
• The format of the sunscreen — stick, lotion or spray — doesn’t matter as long as it is used. However, to avoid getting sunscreen in the eyes and mouth, a stick might be best to use around those areas.
• Because sunscreens are not recommended for children younger than 6 months, dress infants in a hat, long sleeves and long pants and keep them in the shade whenever possible. Carefully applying a little sunscreen on their exposed face or hands should be fine.

By Elizabeth Quinn, About.com

Updated: April 03, 2009

About.com Health’s Disease and Condition content is reviewed by the Medical Review Board

Stretching is a fundamental way to improve your overall health and fitness. By incorporating a regular flexibility program into your exercise routine you will:

• improve circulation
• improve range of motion
• improve posture
• decrease joint stiffness
• decrease muscle tension
• improve performance (there is limited evidence to support this)
• improve your ability to relax
• allow time for mental training, such as visualization

A complete stretching routine can take as little as 10 minutes. The best time to stretch is after you have warmed up and the muscles are warm. The best time to perform your flexibility routine is after exercise. This is when the muscle is the warmest and when you can use the relaxation. Focus on stretching the muscles you use the most during your specific exercise or sport.

Proper Stretching Technique

• Perform balanced stretching. This means you should always stretch the muscles on both sides of your body evenly. Don’t stretch one side more than the other side.
• Avoid over-stretching. Never stretch to the point of pain or discomfort. You will feel slight tension or a pull on the muscle at the peak of the stretch.
• Go slow! Always stretch slowly and evenly. Hold the stretch for about fifteen seconds and release slowly as well.
• Never bounce or jerk while stretching. This can cause injury as a muscle is pushed beyond it’s ability. All stretches should be smooth, and slow.
• Don’t forget to breathe. Flexibility exercises should be relaxing. Deep easy, even breathing is key to relaxation. Never hold your breath while you stretch.

Recommended Stretches
Hamstrings Stretch Sit on the floor with one leg straight in front of you and the other leg bent (with the sole of the foot touching the inside thigh of the outstretched leg). Keep your back straight and lean forward from the hips. Slide your arms forward toward your outstretched foot. Stop when you feel a pull in the hamstring. Hold for 15 seconds and repeat with the other leg extended.

Hip Flexor - Psoas Stretch Lie on your back. Bend your left leg and bring it toward you. Grasp your left knee gently with your right hand and pull it slightly down and to the right until you feel a stretch. Turn your head to the left. Your right leg should stay flat on the floor. Hold for 10 seconds and repeat with the other leg.

Low back: Lay flat on the floor with knees bent. Use your hands to pull them toward your chest. Lift your head and shoulders off the floor until your head is approximately six inches from your knees. Cross your ankles. Gently rock yourself back and forth in this position for 30 seconds.

Standing Quad Stretch Lie on your right side with your right knee bent at a 90-degree angle. Bend your left leg and hold onto the ankle with your left hand. Gently pull your left heel in toward the left side of your butt. As soon as you feel a stretch in your left quad, slowly lower your left knee toward the floor behind your right knee. Hold for 15 seconds and repeat with the other leg.

Standing Calf Stretch Stand an arm’s length away from a wall with your feet shoulder-width apart. Slide the left foot back approximately 18 inches, keeping the knee straight and both heels flat on the floor. Bend your right knee and slowly move your pelvis forward until you feel a stretch in the calf and Achilles of the left leg. Hold for 15 seconds and repeat with the other leg.