Archive for August 2017

Plantar Fasciitis: Signs and Symptoms, Risk Factors, and Helpful Tips

Plantar fasciitis is one of the most common foot disorders treated by health care providers. Plantar fasciitis is inflammation of the dense, fibrous connective tissue (plantar fascia) that extends along the plantar surface of your foot due to repetitive strain. This condition is best described as pain on the bottom of your heel or mid-portion of the foot. The peak population of people seeking treatment for this diagnosis is between 40 and 60 years old. Here is a quick overview of signs and symptoms, predisposing factors, and helpful tips for managing this condition.

Signs and Symptoms:
• Classic symptom: severe pain on the plantar surface (bottom) of your foot with your first few steps in the morning.
• Increased pain in the bottom of your heel with first few steps after a period of inactivity.
• Pain may decrease with increasing activity (walking), but worsens at the end of the day.
• Tenderness when pushing on the bottom of your heel or mid-foot.
• Antalgic gait (limp with walking)
• Pain with pulling your big toe up.

Risk Factors:
• Sports or occupations that require prolonged weight bearing (being on your feet a lot.)
• Weight bearing activity on hard surfaces.
• Overtraining
• Poor foot posture (both flat feet and excessively high arches)
• Muscle and flexibility imbalances.
• Inappropriate footwear.
• Increasing age.

Helpful Tips:
• Rest (activity modification).
• Ice 2-3 times a day for 15-20 minutes (try rolling a frozen water bottle or frozen golf ball under your foot).
• Massage the tender areas.
• Over the counter or custom foot orthoses (arch supports, heel pads, etc.)
• Stretch your plantar fascia (Pull your toes back towards your shin until a stretch is felt.)
• Stretch your calves.
• Wear supportive shoes (Go to a running store and have them fit you with an appropriate shoe for your foot type).

If symptoms persist after 4 weeks, contact your physician or physical therapist for consultation.
Patient education provided by Carli Heft, PT, DPT with Harlan County Health System Rehabilitation Department, Alma, NE


Nebraska Critical Access Hospital Program Receives National Recognition

Lincoln, NE – The Health Resources and Services Administration (HRSA) has recognized 10 states for outstanding quality performance of their Critical Access Hospitals (CAHs) in achieving the highest reporting rates and levels of improvement over the past year.

The 10 top-performing states – Wisconsin, Maine, Utah, Minnesota, Illinois and Pennsylvania (tied), Michigan, Nebraska, Indiana and Massachusetts – built on their previous successes by investing Federal Office of Rural Health Policy (FORHP) funds into quality improvement projects and developing technical assistance resources that improve high-quality care in their communities. States also work collaboratively with every CAH and their respective partners to share best practices and utilize data to drive quality improvement in their hospitals.
“Rural hospitals are key safety-net providers in their communities and it is important that we make every effort to provide the highest quality of care to individuals living in rural communities,” said Dr. George Sigounas, HRSA Administrator. “Critical Access Hospitals may be limited in resources, but they have strong connections to their community and a commitment to quality care for every patient that is reflected in their effort to meet higher standards.”

In 2011, FORHP, located within HRSA, created a program to promote high quality of care at rural hospitals with 25 beds or fewer. Low-volume hospitals participating in the Medicare Beneficiary Quality Improvement Project (MBQIP) voluntarily report on a set of quality measures relevant to the care they provide, share data, and take on quality improvement initiatives. Currently, 96 percent of the 1,340 CAHs in the United States are reporting rural-relevant quality measures.

Nebraska has 64 Critical Access Hospitals which serve the most rural communities in the state. The federal initiative is administered in the state by the Nebraska Office of Rural Health. For more information, contact Flex Program Manager Nancy Jo Hansen at 402-471-4616 or


Back to School Backpack Safety


It’s that time of year again when kids and parents are preparing for a new school season.   When buying school supplies, parents often overlook the impact an ill-fitting backpack can have on a child’s health.  According to a study by Boston University, approximately 85% of students from the university reported pain and discomfort associated with backpack usage.  Wearing a pack that is too heavy or one that fits incorrectly can cause low back pain, muscle soreness, shoulder pain, and poor posture.  A study in The Journal of Applied Physiology found that the pressure of heavy loads carried on the back have the potential to damage the soft tissues and nerves of the neck and shoulders causing numbness and tingling to arms and hands.

Here are some tips to consider to avoid these health issues and prevent injury and discomfort when buying, loading and wearing a backpack.

When buying a backpack:

Make sure the backpack fits appropriately with the height of the backpack extending approximately 2 inches below the shoulder blades to waist level or slightly above the waist

Look for well-padded shoulder straps so the weight of the pack is evenly distributed across both shoulders

Hip and sternum belts are helpful to disperse weight and take some of the strain off of the neck and shoulders

The bottom of the pack should rest in the curve of the lower back, never more than 4 inches below the waist

Packs should be tried on for fit, just like new shoes or clothes

If ordering online, make sure the vendor has a return policy in case the pack is not the right fit

Reflective material on packs allows kids to be seen more easily when walking to/from school

When loading a backpack:

Place heavier items like computers, tablets and large books toward the back of the pack (closest to the child’s back)

Arrange books and materials to avoid items moving around when walking

Check to see what your child carries in his or her backpack and remove unnecessary items

Utilize pockets to disperse items evenly and snuggly

When wearing a backpack:

The backpack should weigh no more than 10% of the child’s body weight.  For example, a child weighing 50lbs should not carry a back pack more than 5lbs

Adjust the straps so that the pack fits snuggly against the child’s back

Check the straps for correct fit frequently, as they can become loose over time

Two straps are better than one, dispersing the weight more evenly across the child’s shoulders

When putting the pack on, educate the child to bend at the knees vs bending over to prevent back injury

If you would like to consult an occupational therapist about an ergonomic evaluation regarding backpacks, computer use, or other learning-related issues, contact Harlan County Health System’s Rehabilitation Department at (308) 928-3002.


These tips provided by Mindy DeJonge OTD, OTR/L (