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Pain in the Foot

Robert Martin adventure
Robert Martin outdoor adventure

Three years ago, Robert Martin, at the age of 59, was on the brink of losing his job. As a group leader for process mechanics at a biopharmaceutical company in North Carolina’s research triangle, Robert’s job was physically demanding, keeping him on his feet 8 to 10 hours a day. For 19 years he has been working with mechanics, walking from place to place across the expanse of his company’s manufacturing facility to make sure systems stayed running efficiently. That kind of day to day physical demand on his body, combined with his love for running and the outdoors, began to cause severe foot pain. The pain became so excruciating that Robert started to find it difficult to get out of bed in the morning, let walk and stand at his job all day.

His foot pain began in 2008. Robert was an avid runner, clocking x miles per week and whose hobbies included white water kayaking, camping, wilderness trekking, and climbing. His weekends were trips into nature, enjoying life to its fullest. However, once the foot pain set in, he gave up his favorite activities but neglected to visit a doctor right away. Instead, he suffered from the pain for five years before making his first of many doctor appointments. “Everything hurt,” says Robert. “Even mowing the lawn hurt. I would come home from work, and I couldn’t do anything but sit, put my feet up, and feel them throbbing.”

The first podiatrist Robert saw was an individual in private practice; he refers to as Doctor X. Dr. X diagnosed Robert with plantar fasciitis, a common cause of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. It’s accompanied by stabbing pain that usually begins with a person’s first steps in the morning and can be exacerbated by body weight and periods of long-standing or heavy physical activity.

Howard Kashefsky, DPM
Howard Kashefsky, DPM

Doctor X initially suggested surgery. Robert declined, saying, “I prefer to have treatment without surgery because I don’t think there’s anything a knife can do to help.” Dr. X gave him injections, provided shoe recommendations and inserts, but everything seemed ineffective in the end. “I just didn’t feel like he was listening to me or answering my questions,” Robert explains, which is why he booked an appointment with Dr. Kashefsky, DPM, Associate Professor and Podiatrist in the Division of Vascular Surgery at UNC Chapel Hill.

It’s been a long road since Robert walked into the office of Dr. Kashefsky in late 2016. Dr. Kashefsky not only diagnosed him with plantar fasciitis but also found Robert suffered from neuropathy and metatarsalgia, a condition in which the ball of the foot becomes painful and inflamed. His symptoms included sharp or shooting pain, numbness, or tingling in his toes and pain that would worsen when he stood and walked — especially barefoot on hard surfaces. Although generally not serious, metatarsalgia can sideline patients, as it had done with Robert.

Robert Martin
Robert Martin Canoeing Trip

“We obtained a thorough history and physical,” Dr. Kashefsky explains. “During my examination, I talked with Robert and physically examined his foot to find out where his pain was coming from so I could see for myself where it was hurting him.” Dr. K as his patients refer to him as, made some specific recommendations to Robert. They began with new footwear. Robert purchased a pair of OOFOS recovery sandals which he used around the house, no longer able to walk around barefoot.

The next step for his life outdoors was a pair of Hoka’s, a specialty athletic sneaker. At the same time, he started to get physical therapy, and Dr. K wrote him a prescription for orthotic shoe inserts from Limbionics in Durham. “These four things eliminated 90% of the pain,” says Robert.

The next thing they did together was work on Robert’s body mechanics. Dr. K gave him some recommendations and worked with him to change his walk to put less pressure and pull on certain joints. “When I walk,” says Robert, “I stomp. Dr. K recommended I elongate my stride to distribute the weight. We discussed the mechanics of the feet and the body. Dr. K was really great at explaining and helping me understand my body and habits so that I could help myself reduce the strain I was putting on my own body.”

The final step in Robert’s treatment was receiving Extracorporeal Shock Wave Therapy (ESWT). ESWT is an 18-minute non-surgical procedure used to cure chronic plantar fasciitis, Achilles tendonitis, tennis elbow, shoulder tendonitis, and other chronic tendinopathies. “The ESWT equipment we have is not something that most practices have access to,” says Dr. K. “Unfortunately it’s not currently covered by insurance, but I have yet to have a patient sorry they spent the funds to get the treatment, in fact, the feedback I’ve gotten is that they wished they had done it sooner.”

Dr. K talked with Robert about the ESWT treatment, pros, and cons and let him decide if he wanted to move forward with it. “I decided I was willing to pay for it myself to get rid of the pain,” says Robert. “Within a month, the pain was gone, my feet don’t hurt, and I’m on them all day. It really is a lifestyle change, a complete 180 from my life before. The whole series of treatments from the ESWT to the shoes and body mechanics got me back to where I want to be. I’m no longer kayaking on class 3 or 4 rivers. Instead, I’m doing white water canoeing, paddling class 1 and 2 and doing some overnighters, once again able to have fun in the outdoors.”

Robert Martin Under the waterfall
Robert Martin Under the waterfall

Patients with foot and ankle problems don’t have to suffer with pain but can seek treatment from the UNC Podiatry Center. The caring medical professionals at UNC Health Care collaborate to improve the comfort and increase the independence of their patients. “Dr. Kashefsky cares about his patients,” says Robert. “He never mentioned surgery, at any of our appointments because he understood from the beginning it wasn’t what I wanted. The whole practice was first-rate, top tier service. Everyone I interacted with including the guy behind the reception desk at check to Dr. K, were great. It was a good experience, and I highly recommend others not wait and suffer with the pain when there are solutions out there.”