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How Can I Treat My Plantar Fasciitis?

Updated on Jun 30, 2022 | Orthopedics, Your Health

man doing flatfoot correction self massage at home

Plantar fasciitis (pronounced PLAN-taar-fa-shee-AY-tus) is one of the most common causes of heel pain. According to the American Academy of Orthopedic Surgeons, about two million people are diagnosed with the condition every year. Fortunately, you can often address the pesky heel pain associated with the condition in the comfort of your own home.

In this Q & A, Meghan Kelly, MD, Assistant Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai, provides at-home stretching tips that treat heel pain in more than 90 percent of plantar fasciitis patients and advises on how to prevent developing the painful condition.

How do I make my heel stop hurting?

To immediately deal with the pain associated with plantar fasciitis, you can use ibuprofen (ex. Advil) or naproxen (Aleve). In addition, rolling a frozen water bottle under the arch of your foot can also relieve the pain.

What can I do to treat plantar fasciitis?

The way to treat about 95 percent of plantar fasciitis cases is by stretching. There are two main stretches which, if done well every day, should make the condition go away in about a month. This method worked for me and every one of my patients.

On the left, Dr. Kelly shows how patients can stretch their plantar fascia and, on the right, she demonstrates an Achilles tendon stretch.

Attend to your plantar fascia.

Plantar fasciitis is an inflammation of the plantar fascia—a thick band of tissue at the bottom of the foot. You can address this inflammation by stretching that tissue. Do this by putting your leg in a “figure four” position with the ankle over the opposite knee. Then, grab your toes and pull them toward your shin and massage the plantar fascia for 5 minutes. You should do this stretch two or three times a day.

Your Achilles tendon is tight. Loosen it.

Almost everyone has a tight Achilles—it’s just the way we’re built—and a tight Achilles tendon can affect the plantar fascia. There are a couple of stretches that can help. The one I like, and that I show my patients, involves standing on a stair or curb with both heels facing out. Hold onto the railing, then move the heel that is painful off the edge of the stair or curb and let it drop. Allow your other foot to relax. Hold this position for five minutes. I know that’s a really long time, but the Achilles tendon is a very large tendon and it takes time to stretch it. Do this twice a day. It doesn’t always feel great at the time, but it really does help.

The hardest part about treating this condition is being diligent about doing these stretches twice a day, every single day. I often recommend taping a reminder on your refrigerator, or some place you can’t avoid seeing. If your heel hurts after you stretch, that’s normal. That’s when you can ice it and/or take a painkiller.

Should I try to stay off my feet? Do I need to wear special shoes in the house or outside?

You can walk as much as you want with plantar fasciitis. If it starts to hurt, you can stop—but you aren’t damaging anything if you keep walking.

In terms of footwear, the best shoes for plantar fasciitis are ones that fit correctly—both in length and width—and provide arch support. You can also use removable inserts (called orthotics) to “fix” a pair of shoes that does not have the support you need. I recommend trying over-the-counter orthotics first, to see if they help as custom-made ones can be very expensive. If you have really flat feet or very high arches, you can get over-the-counter orthotics that are designed to help with that.

I don’t routinely recommend wearing shoes inside—I’m a big fan of bare feet—but, if you’re having pain from plantar fasciitis, wearing supportive shoes in the house can sometimes help. Try it and see if it works for you.

Should I use a foot brace or splint, or a boot?

There are splints available at your local pharmacy that hold your foot at a right angle while you sleep. This will keep your plantar fascia stretched out overnight, and then, when you get up in the morning, you won’t have heel pain as you step out of bed. Some people swear by this method. The majority, however, tell me that they tried an overnight splint but woke up in the middle of the night to take it off because it was uncomfortable. If you want to try using a splint, that’s fine; it won’t do any damage. But, there are no research studies that prove its effectiveness.

Occasionally, I prescribe a walking boot for plantar fasciitis patients as it can take some pressure off the heel. But that can backfire. If you’re wearing the boot all the time and not doing the stretching exercises, your calf muscles may weaken. That won’t help with the pain. Sometimes, I give patients a walking boot for about a week, just to get them walking until the pain becomes bearable. During that time, I urge them to continue doing their stretches and, as soon as they can, I encourage them to stop using the boot altogether.

All in all, the best—and most effective—treatment for plantar fasciitis is stretching.

What if I’ve tried all this and am still having pain?

If none of this works, you might try formal physical therapy. A physical therapist may be able to help you do your stretches more effectively. Sometimes they have equipment in the physical therapy suite that you don’t have at home and can be beneficial.

If none of that works, there are also some procedures available. Extracorporeal shock wave therapy is a noninvasive method of stretching the plantar fascia that involves applying waves of electricity to the tissue. Another option is the Tenex FAST procedure. With this approach, we poke tiny holes in the plantar fascia with a needle. perform these procedures and those who do will likely only try them if everything else has failed.

How can I prevent plantar fasciitis?

The best way to prevent the condition is to avoid unsupportive shoes and to stretch before and after you exercise. But sometimes you do everything right and still end up with plantar fasciitis. That’s why it’s good to know what stretches can treat it.

Make an appointment with Dr. Kelly

Learn more about Orthopedics at Mount Sinai

Should I Change My Skin Care Routine With the Seasons?

Updated on Jun 30, 2022 | Skin Health, Your Health

Mature African American woman using a cotton pad to clean her face while looking in a bathroom mirror in the morning

Going from hot, humid summers to cold, dry winters can mean more than just a wardrobe change. Temperature fluctuations may also prompt a change to your skin. For some, winter brings dry skin and exacerbates conditions like eczema and psoriasis, while the humidity of summer can make skin look very oily.

Angela J. Lamb, MD, Associate Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, shares what you need to know about protecting your skin and how to have healthy, glowing skin year-round.

Why does the weather have an effect on your skin?

When the weather is hot and humid outside, your skin ramps up its oil production, which can produce an oily sheen. Alternatively, when the weather is cooler, and maybe the radiators are on more, the low air humidity causes moisture in your skin to evaporate faster, making skin drier.

Should you change your skin care routine as the seasons change?

There are definitely considerations you have to take into account with seasonal change.

For the summer, you want to use a gel-based cleanser and then moisturizers that are a bit lighter—typically products that have hyaluronic acid in them—to avoid clogging your pores.

For the winter, you want to use a thicker, cream-based moisturizer, which will fuse moisture into your skin and not strip it of the oils that are being made naturally. Look for products that contain a humectant—which traps water—like glycerin or glycol. These ingredients will prevent moisture from evaporating off the skin’s surface.

Is there a general rule to a good skin care routine?

I always say that a good skincare routine is simple, simple, simple. Often people are doing far too much to their skin. They come in to my office with bags of 10 different products, and I always say: try to simplify.

I recommend having a cleanser, what I call a ‘power product’—which can be something like a serum or an eye cream—and then a moisturizer. You want to do the same thing morning and night, even if you use slightly different products.

Most people should wash their face twice a day. So, for oily or acne prone skin, you want to use a cleanser with salicylic acid or glycolic acid to help with skin cell turnover and a moisturizer that is a light oil or hyaluronic acid based. For dry skin, you want to use a cleanser that is cream based, which does not have anything in it that’s like a detergent, and a thick moisturizer. So, you should avoid products that have sulfates and look for moisturizers with oils and thick emollients like petrolatum or dimethicone.

How should I change my routine from daytime to nighttime?

Sunscreen is fundamental for a daytime routine, even if you’re not going to be outside for a long time. It is one of the main things you can do for your skin to combat advanced aging, brown spots, wrinkles—all the things people do not want to see on their skin.

A simple daytime routine includes a cleanser, a ‘power product’ for daytime could be a serum with vitamin C or a cream for around the eyes that makes them look less puffy, a sunscreen, and a moisturizer.

You want to do some things that are very similar at night, but—obviously—you will not need a sunscreen. Additionally, in the evening, you may want to use a moisturizer that absorbs oil.

A simple nighttime routine includes a cleanser, a ‘power product’ for nighttime could be a retinol or some type of vitamin A derivative, and a moisturizer.

While sunscreen is the best thing for skin cancer prevention and anti-aging, retinols can almost turn back the clock on fine lines, and wrinkles. They also help build up collagen and can even the tone and texture of skin. I think everyone should be using retinol at night.

How important is it to incorporate sunscreen in your daily routine, particularly for Black women and women of color?

Sunscreen is foundational for anti-aging. While it is true that people who have more pigment in their skin are at a decreased risk of skin cancer—which people often think of as the main reason for using sunscreen—it is also essential for preventing wrinkles. The sun’s rays increase aging. Using sunscreen daily helps to ward off that aging, regardless of your complexion.

And then, of course, the skin cancer prevention is important. It’s very difficult to prevent skin cancer if you’re not wearing sunscreen.

To sum up, use a good cleanser based on your skin type, a good moisturizer based on your skin type, and everyone should be using something—be it a serum or a moisturizer—that has retinol at night.

And, you really shouldn’t be using more than five or six products on your face. I find that people are stressing themselves out trying to do too many things which can cause problems, like irritation or allergic reactions. I encourage people to keep it simple.

Make an appointment with Dr. Lamb

Learn more about Dermatology at Mount Sinai

Vaccine Facts: No, the COVID-19 Vaccines Were Not Made Too Quickly

Aug 12, 2021 | COVID-19, Vaccines, Your Health

One of the many misconceptions that some have about the COVID-19 vaccines is that they were developed too quickly. In fact, all of the normal safety steps were followed in developing the vaccines, and they are helping to bring the pandemic to an end. In a roundtable talk, experts from Mount Sinai answer some frequently asked questions.

Did scientists and the government take short cuts and develop the vaccines too quickly?

Scientists followed all of the normal safety steps that are taken when we create new vaccines. No safety steps were skipped. The Pfizer-BioNTech and Moderna vaccines were made with technology that has been studied for many years, and the Johnson & Johnson vaccine was made using traditional methods.

So how did we produce and test these vaccines as quickly as we did?

COVID-19 vaccines became the priority for everyone. Researchers around the world dedicated themselves at the same time to finding solutions. We quickly understood how well the vaccines worked because COVID-19 spread so rapidly. It became clear that people who were vaccinated weren’t getting hospitalized, weren’t in ICUs, and weren’t dying of COVID-19.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

How do we know the vaccines are safe?

In the United States alone, nearly 200 million people have safely received the COVID-19 vaccines—twice as many as the flu vaccine. If you haven’t yet, we encourage you to get vaccinated.

Get more information from Mount Sinai about COVID-19 vaccines

Is It Safe to Eat That? — Debunking Pregnancy Dietary Myths

Updated on Jun 30, 2022 | Diet and Nutrition, OB/GYN, Women's Health, Your Health

Cropped side view portrait of pregnant African-American woman buying groceries while shopping in supermarket

Old wives’ tales about pregnancy have been around for centuries. While some myths vary from the lighthearted—carrying high? You’re having a girl—to those of a serious nature—spicy foods causes blindness in babies. Not true!—, we wanted to debunk some of those rumors.

Valerie D. Lewis-Morris, MD, Assistant Professor of the Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, gives us the facts on what to eat and what to avoid to ensure a healthy pregnancy.

If I didn’t eat a healthy diet before becoming pregnant, is it too late to start while I’m pregnant?

It’s never too late to change your dietary habits. And once you find out that you are pregnant, it’s really important to begin eating nutritious food for the health of you and your baby. If you need help with healthy meal planning, Mount Sinai nutritionists are available to answer your questions.

Can I drink coffee while I am pregnant?

Yes, but pregnant women should not consume more than 200 milligrams of caffeine each day—that’s about two, eight ounce cups of brewed coffee. Caffeine can increase your blood pressure and can cause unusual heart rhythms, so energy drinks, energy boosters, and too much coffee should be avoided.

Is alcohol okay to drink on special occasions while I am pregnant?

Not drinking alcohol is the safest choice. However, a glass of wine—which means a six to eight ounce glass—, a beer, or a toast of champagne a couple of times during pregnancy should not harm your baby, especially if you’re not in the first trimester.

If you are in your first trimester, then abstaining from alcohol is the best, safest choice and you should avoid hard liquor.

Can eating nuts during pregnancy prevent my baby from developing a peanut allergy?

This is an old wives’ tale with absolutely no truth to it. Nuts are a nutritious snack and an excellent source of protein, but consuming them while you’re pregnant will not have an impact on whether your baby will have allergies in the future.

Is it true that you should avoid cheese while pregnant?

Not exactly. The goal here is not to avoid all cheese and dairy, but you should not consume raw cheese or unpasteurized milk as these foods may contain bacteria that is harmful to your baby. All of the dairy you consume should have been pasteurized.

Avoid raw goat cheese, or cheese that has been mold ripened such as gorgonzola, or Roquefort. Hard cheeses, such as cheddar cheese or Swiss, are a safer option. And make sure that you read your food labels to make sure that all of your dairy has been pasteurized.

In addition to dairy, make sure that eggs are completely cooked before you eat them. So, save the runny yolks for after pregnancy.

Is it safe to eat fish?

Yes, as long as it is not raw or high in mercury.

Fish is an excellent food that is low in fat and contains high-quality proteins in omega three fatty acids, which are very important for your baby’s brain development. You want to avoid fish that are high in mercury as it can interfere with your baby’s brain and spinal cord development. These are fish such as shark, swordfish, towel fish, and king mackerel. However, fish that are low in mercury are safe to consume and those are fish like salmon, tilapia, and flounder. Enjoy those as much as you want a couple of times a week.

Should I be eating for two?

Eating for two is a very common myth, but the reality is that you should not be consuming double the portions of every meal and snack. You only need about an additional 350 calories per day and that can be easily achieved by adding two or three small healthy snacks like: a banana with a couple of tablespoons of peanut butter or three to five wheat crackers with about an ounce and a half of cheddar cheese cubes. You don’t have to eat a lot of extra food while you’re pregnant; don’t feel that you have to splurge.

Is it safe to exercise?

If you’re healthy and you have a low risk pregnancy, then the risk of moderate intensity exercise is safe. Consistent exercise during pregnancy can minimize constipation as well as decrease the risk of gestational diabetes and depression. If you incorporate aerobic exercises, such as brisk walking two to three times a week for 20 to 30 minutes or flexibility and strength workouts like yoga, that is all you need.

If you have a high-risk pregnancy, you should discuss adding exercise or continuing the exercises you are doing with your provider to make sure it is safe for you and your baby.

Finally, ignore the old wives’ tales and the misinformation that’s out there. When you’re in doubt, reach out to your obstetrician or midwife to get the most accurate and up-to-date information about your pregnancy and nutritional needs.

Make an appointment with Dr. Lewis-Morris

Learn more about OB/GYN Services at Mount Sinai

My Heel Hurts. Is It Plantar Fasciitis?

Updated on Jun 30, 2022 | Orthopedics, Your Health

cropped shot of man sitting on bed and suffering from foot pain

Each year, approximately two million patients in the United States are treated for an irritating heel pain caused by a condition with a difficult-to-pronounce name. Plantar fasciitis (pronounced PLAN-taar-fa-shee-AY-tus) is an inflammation of the plantar fascia—a thick band of tissue at the bottom of the foot—which connects your heel bone to your toes and helps support your arch.

This very common condition is the most frequent cause of heel pain and can affect just about anyone, though it’s pretty rare among kids. If left untreated, the pain can last for weeks, months, or even years.

Meghan Kelly, MD, Assistant Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai, explains why we experience this condition and when you should see a doctor.

What does it feel like to have plantar fasciitis?

You will probably feel pain in your heel, though it may also spread to your arch and along the bottom of your foot, all the way across to where your toes begin. Sometimes you’ll experience a slow burn, sometimes it really fires up. It’s usually most tender on the inside of the heel.

The pain usually starts first thing in the morning. You get out of bed, put your foot on the floor, and you feel pain on the bottom of the foot when you try to put your heel down. You may find you want to tiptoe around a little bit until things start to settle. Once your plantar fascia stretches out, it becomes more tolerable to walk on your whole foot.

Plantar fasciitis pain usually comes and goes throughout the day. It might feel better after walking a bit, then painful again if you’ve been sitting then stand up to walk, or if you’ve been on your feet for an extended period. That’s the unusual part about plantar fasciitis. While other conditions, like arthritis and Achilles tendonitis, get progressively worse throughout the day, the pain with plantar fasciitis waxes and wanes.

What causes plantar fasciitis?

This condition can occur for a variety of reasons, but is usually due to a change in the way your foot hits the ground. It can also stem from tightness in your foot and ankle muscles.

Often, people experience plantar fasciitis after a change in activity. Personally, I had that experience a few years ago, when I started wearing a pair of shoes with a really hard insole. Plantar fasciitis can also affect athletes when they change up their exercise routine. Occasionally we don’t know what caused the pain.

I saw a lot of plantar fasciitis as the world began opening back up after the COVID-19 lockdowns of 2020. All of a sudden, people traded in their flip flops and sneakers for hard-bottomed shoes and heels. They started going back to the gym, commuting to the office, and walking around the city after having not done so for more than a year. And, their feet were not happy about it.

How is the condition diagnosed? Is it chronic?

Most of the time, plantar fasciitis is diagnosed by taking a patient’s medical history, going over a list of their symptoms, and pressing on the “magic spot” that really hurts. Typically, for plantar fasciitis patients, that spot is on the bottom of the heel, close to the instep. Sometimes doctors take X-rays to rule out other issues, such as bone spurs or a foot shape that might make you more prone to problems.

Thankfully, if treated completely, plantar fasciitis goes away and does not come back. If it does come back, that means you never really got a hold of the condition the first time around.

Do I need to see a doctor?

There’s a good chance you can address plantar fasciitis on your own. But, if you find the condition is affecting your daily activities, you should consider going to the orthopedist. A doctor can make sure you do have plantar fasciitis, not something else, and can give you some simple stretches to treat it.

Make an appointment with Dr. Kelly

Learn more about Orthopedics at Mount Sinai

Is It Normal to Have Irregular Periods?

Updated on Jun 30, 2022 | OB/GYN, Women's Health, Your Health

Young woman lies on sofa with stomach cramps

Most people know menstruation is normal vaginal bleeding that is part of the monthly cycle which prepares the body for a possible pregnancy. But you may have some questions about the regular—or irregular—ebb and flow of your cycle.

Tamara N. Kolev, MD, Assistant Professor, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, explains how mundane activities can affect your cycle and why one or two irregular periods is nothing to worry about.

Is it normal to have irregular periods? When should I worry about them?

Your menstrual cycle tells us about your overall health and hormone balance. Most people find that the time from the first day of one period to the first day of the next is about the same every month. This time span, called a cycle, can be anywhere from 22 to 35 days. Women on birth control tend to have periods that are shorter, lighter, or—depending on the birth control—disappear altogether.

If you have an irregular period once or twice, that’s probably fine. But, if you notice that you’re continually having irregular periods, it’s better to get evaluated to diagnose the underlying reason and get your body back in balance.

Why am I bleeding in between periods?

There are several reasons why some women have minor bleeding (spotting) between periods. It could be as simple as too much stress, too little sleep or certain medications. The cause could also be a physical condition, such as fibroids, cervical or uterine polyps, or a chromosomal abnormality, all of which are generally non-cancerous (benign).If you’re at all concerned, you should check in with your primary care doctor or gynecologist.

If I exercise regularly, will my period be lighter–or will I even skip a period?

Exercise can help regulate your periods. When you exercise, your body releases hormones such as endorphins and serotonin, which can also help with menstrual pain, cramps, and mood disturbance. But if you exercise too much—especially if you also don’t eat enough—you may skip a period because your body needs a certain amount of body fat to produce estrogen and maintain the hormonal balance required to have normal periods.

What about diet and weight gain, will either—or both—affect my period?

Gaining or losing a few pounds shouldn’t affect your menstrual cycle. But if your weight changes dramatically, especially if it happens quickly, it can affect your periods. Along the same lines, if you’re not getting enough calories and nutrients to maintain a healthy hormonal balance and produce enough estrogen, your periods may become irregular or may skip a month altogether.

In terms of your daily eating habits, there is growing evidence that what you eat can affect premenstrual syndrome symptoms, such as mood swings, bloating, and fatigue. It can help to eat foods that are rich in omega-3 fatty acids, vitamin D, and calcium or take vitamin D or calcium supplements. Doctors also recommend reducing your intake of fat, salt, and caffeine. Additionally, not having enough iron in your system can make your periods shorter and less regular. And if you have heavy bleeding when you menstruate, that may lower your iron level.

Alcohol use and smoking can also affect your period. While a glass or two of wine shouldn’t cause fluctuations, heavy drinking can disrupt your hormones and lead to late or irregular periods. Heavy smoking can shorten your menstrual cycle and make periods heavier and more painful.

How will stress and lack of sleep affect my period?

When your body is under stress, it can go into fight-or-flight mode, which may signal the body to overproduce certain stress hormones. This could change your overall hormonal balance. Lack of sleep, in particular, affects both stress hormones and melatonin levels. Melatonin is a hormone that helps to regulate the start of your period and the length of your cycle. For this reason, changes in melatonin levels can affect your cycle. You may find your periods delayed, or they might skip a month altogether.

When should I see a doctor?

Typically, if you often have bleeding between periods or especially heavy bleeding, you should get it checked out. For premenopausal women, if you don’t have a regular cycle, or if you miss your periods regularly or for several months, you should be evaluated, even if you think the reason is excessive diet or exercise or not getting enough sleep. In general, if you’re at all concerned, make an appointment with your gynecologist for a check-up.

Can I get pregnant during my period?

If it’s truly your period, then no, you cannot get pregnant while menstruating. However, if you’ve been having irregular bleeding between periods, you may be unsure if the bleeding is a real period or if you are bleeding during ovulation. If you are bleeding while ovulating, then you could get pregnant.

Will my period change as I get older?

Yes. After menarche (onset of menses) your period may be irregular and unpredictable. But as you get older, certainly by your 20s, it should become more regular. As you get older, and you approach menopause, your periods will likely start to spread apart and become lighter and less regular. If, instead, they get heavier or more frequent, then it’s important to have that evaluated.

Make an appointment with Dr. Kolev