COVID-19 has even ruined our feet

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Stuck at home and out of work because of the pandemic, Timothy Hudson decided to tackle a new project: lose weight and get in shape.

Between September 2020 and May 2021, the 32-year-old dropped 100 pounds by changing his eating habits, working out more, playing basketball with friends, and running up to five miles a day.

Hudson, who lives in Chester, Pennsylvania, said he'd never felt better—except for his feet.

"It was like a burning, pulling feeling," Hudson said. "Any type of strenuous activity, I'd be out for at least three days."

Foot has been on the rise during the pandemic, as people working from home kicked off their supportive shoes in favor of flimsy slippers and flip-flops, while others, including Hudson, used the time to become more active, which put new strain on their feet.

"In March 2020 I said … 'Oh, my goodness, everyone is going to have plantar fasciitis and Achilles tendinitis," recalled Laura Virtue-Delayo, the president of the Pennsylvania Podiatric Medical Association.

Her prediction panned out: Podiatrists, orthopedic surgeons and say they're seeing more cases of plantar fasciitis and Achilles tendinitis—two common foot-pain conditions—than ever before.

Virtue-Delayo, a Scranton-based podiatrist, said her caseload of foot pain patients peaked over the summer, when she was treating about 35% more people for foot pain than usual. The number of new patients with foot pain has gone down but remains above prepandemic levels, she said.

What causes plantar fasciitis?

Plantar fasciitis is inflammation of the thick band of tissue that connects the heel bone to the toes, which causes a stabbing heel pain. Unsupportive shoes or going barefoot, a dramatic increase in physical activity, exercise that puts lots of pressure on your heels (such as running or dancing) and obesity can all contribute to plantar fasciitis.

Achilles tendinitis occurs when the tendon that runs down the back of the leg between the calf and heel is overused. The injury is common among runners and athletes, but can affect anyone who dramatically and suddenly changes activity level.

Plantar fasciitis and Achilles tendinitis were already top causes of heel and foot pain, and the sequestered pandemic lifestyle many people have adopted has worsened the problem.

Normally, taking your shoes off when you get home at the end of the day isn't a big deal. But during the pandemic, many people's entire workday has been spent at home. That means a lot more people wearing slippers or flip-flops without any arch support or, worse, walking around barefoot, said Rachel Shakked, an orthopedic surgeon who specializes in foot and ankle surgery at Rothman Orthopaedic Institute in Philadelphia.

For many people, less physical activity during the pandemic has contributed to weight gain and stiff muscles, which in turn can lead to foot pain.

"The obvious answer is put shoes on," Shakked said. "Nobody really loves wearing shoes in the house. [But] especially if you have hardwood floors or tile, walking and standing on hard surfaces can cause that discomfort in your heel."

Supportive shoes and , such as maintaining a healthy weight, are the best bets for keeping foot pain at bay, said Richard K. Rettig, chief of the division of podiatry at Einstein Healthcare. Sneakers are always a good choice, but if you insist on slippers or sandals at home, choose a pair with arch support.

"If someone can change their lifestyle—lose the weight, not go barefoot, not wear sandals," they may be able to live foot-pain-free for years, said Rettig, who has not seen an increase in foot pain patients during the pandemic. Most people, however, don't change their habits and return for treatment when the pain flares up again, he said.

Other ways to treat foot pain include heel cups that stabilize the foot, ice, and cortisone shots.

People who don't find relief with those techniques may need surgery.

When Zachary Bauermaster, an elementary school principal in Lancaster County, first started working remotely in March 2020, the plantar fasciitis that had bothered him since 2019 subsided. At home, he wore sneakers with orthotic inserts instead of the stiff and unsupportive dress shoes he normally wore to work, and had more time for stretching and low-impact exercise.

But by the time his school returned to in-person teaching that fall, the pain in his heel was worse than ever. Being on his feet less during the workday had allowed his heel to recover, but also led to stiffer calf muscles, his doctor told him.

By 2021, the pain was so bad—and unchanged by stretching, massage and cortisone injections—that Bauermaster's doctor recommended surgery to release the tension in his heel caused by the plantar fasciitis and tarsal tunnel syndrome (a pinched heel nerve).

"I wasn't able to do activities with my three kids," said Bauermaster, 35. "They'd talk about activities but then say, 'Oh, wait, Dad can't do that. He can't run."

Bauermaster had the surgery in mid-January and has to keep weight off the for several weeks. But he hopes to develop a plan for stretching and exercise with lower impact on his feet that will get him back to chasing his kids around.

Too much activity can also lead to foot pain

Shakked's caseload of patients is up about 25% compared with before the pandemic. In addition to people damaging their feet by going barefoot, she's seen an increase in patients with problems related to too much physical activity. Abruptly becoming more active can lead to inflamed tendons and ligaments—especially if you're wearing the wrong shoes.

Other patients have suffered stress fractures from overzealous neighborhood walking routines. (She's also treated at least four people who fractured their ankle tripping over a pet—being home all the time creates more opportunities for dogs and cats to get under our feet.)

Hudson had never done much running before setting out on his weight-loss journey.

But after doing a double take at the number on the scale, he decided to get moving. Hudson works at a school as a one-on-one aide for children with special needs—a job that wasn't needed when his school went virtual.

"It gave me that time of self-reflection—I can do this and I don't have a choice but to be outside," he said. "Had I been at work, would I ever have had the time to actually go through and do it?"

Hudson started with walking, then transitioned to running. At the same time, he starting taking freelance photography jobs, which kept him on his feet for hours at a time.

By summer 2021, Hudson had added basketball with friends to his routine, and the pain in his feet got bad enough to see a doctor, who diagnosed .

Daily stretches, a more moderate exercise routine, and knowing to call it quits when he feels even a twinge of pain have helped significantly, he said.

Hudson is back at work now, and figuring out how to balance his old school routine with his newly active lifestyle.

"It's been a little bit of an adjustment, getting up at the crack of dawn to work out," he said. "But it's fun."

That may not be many people's idea of a good time, but for Hudson, starting his day with a workout is a reminder of what he gained during the pandemic—a new sense of pride and confidence that he can do things he never thought he could.

©2022 The Philadelphia Inquirer, LLC.
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