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A strange experience at the Mall

Posted by Kathy G on 4/12/05 at 17:15 (173073)

I went to the mall today and was mall walking when a young, college-aged fellow stopped me and said, very respectfully, if I would answer some questions for a survey he was doing for a college math course. I said sure. First he asked how old I was and I told him that I was 55. He then asked my height and I said 5'5 1/2'. I laughed and told him that extra half inch was important to me. He was near a fountain and walked over to where he had leaned a yardstick. He then said he needed to measure 'how far it was from the floor to my bellybutton.' I told him, 'Not a chance!'

I turned around and started toward the mall office and was looking for mall security when a guard went rushing down the other side of the mall, in his direction. I assume it was because of him.

I am going to call the mall and see if I can speak to a living person to report this but I was aching so much when I came home, I had to take a pill and relax.

Can you imagine? Why would he stop someone with white hair? It's not like I'm a stunning beauty and he was probably twenty at the most, younger than both my children. I'm still amazed.

The only thing I thought of, as I came home, was that it was a sociology course of some sort, and the goal was to see how much a woman would reveal, depending on her age, but I swear he said it was a math course. And that doesn't make much sense because my daughter who just turned 24 wouldn't have let him measure that or anything else. Strange people in the world! Good thing I'm so normal.

Re: A strange experience at the Mall

Carole C in NOLA on 4/12/05 at 17:23 (173074)

Kathy, that was really peculiar. Good thing you left. That guy sounds like he's got a screw loose!

Carole C

Re: A strange experience at the Mall

Suzanne D. on 4/12/05 at 21:05 (173097)

That certainly was weird, Kathy. It seems it is hard to 'be nice' to strangers these days. We want to be trusting and helpful, and yet there are so many 'with a screw loose' as Carole said!

Perhaps he asked you on a dare or for some initiation of sorts. But I am sure the whole situation was unsettling to you. I enjoy shopping with my daughters (actually with either daughter, but not as much with both of them at the same time!), but I also enjoy shopping alone. Sometimes I just need that time to myself. But experiences like you described make me a little more hesitant, and I don't like that feeling.

Hope you rest well tonight and have a good day tomorrow! I also hope someone who has experience/knowledge will reply to your other recent post about hand surgery.

Suzanne :)

Re: A strange experience at the Mall

Suzanne D. on 4/12/05 at 21:07 (173099)

Two minutes after I posted and hoped someone would reply to your hand surgery post, Dr. Ed replied. Good!

Suzanne :)

Re: A strange experience at the Mall

Susan on 4/12/05 at 22:20 (173105)

That's so strange. Maybe he said it was a math course to deflect suspicion about why he was asking the questions. It does sound like a sociology project. Or maybe he's a nut.

Re: not so strange

Scott R on 4/13/05 at 10:09 (173115)

The ratio of your height to your belly button height is not so strange. Combined with your age, the data could be used to determine if the shortening due to age is primarily due to a change in the distance between the vertebre. This is just one off-hand guess. I could make use of the data myself: if the ratio is larger in women, then it would explain why woman get plantar fasciitis twice as much as men. If the belly button (approximate center of gravity) is lower (a higher height/belly ratio) in women for a given weight (i.e. height), then it's harder for women to 'tip over' than men which would cause more stress in the plantar fasciitis unless there is not also more felxibility in the calf muscles. The subject is a little complex for non-engineers, but my reasoning is absolutely solid. It's the only explanation i know of for why women get PF more often.

Re: not so strange

John H on 4/13/05 at 10:18 (173117)

How about hormones scottr or better yet footware. You got to believe that those 5' narrow heels is not very conducive to healthy feet.

Re: not so strange

elliott on 4/13/05 at 10:39 (173120)

Scott, before getting too carried away with what significance total height has to belly height, one should keep in mind there can be coincidental correlation without it being explanatory, e.g., women are just built different, but that may not have to do with why they have a higher incidence of PF. As John said, shoes are one possibility for PF.

I was thinking of a different explanation of the mall incident. Perhaps the math exercise was to see how much one variable (belly height) changes (e.g., by calculating the mean and variance for a large sample) when the first (total height) is held fixed or at least in a given height bracket.

I presume the guy didn't ask Kathy G to lift up her blouse; if he did, give the nut theory more credence. OTOH, to get an accurate reading, it would be almost mandatory to ask to remove one's shoes; otherwise, the height would be in bare feet and the belly height in shoes whose heights of course vary.

Re: Apparently I was the only one!

Kathy G on 4/13/05 at 13:02 (173132)

Well, either this guy approached just me or I was the only one who thought it was strange. I called Mall Security and they had no other reports. I, too, thought he might be doing it on a dare, Suzanne. My daughter, Scott, thought that I should have asked him why he wanted to do it, before I refused. And you're right, it could have been legitimate but as she said, he should have explained before saying it. She also said there was no way in the the world that she'd let a stranger see her navel!

The more I think about it, the more I think it was a dare because if someone had a 'navel fetish' if there is such a thing, there were a lot of young pretty things around who would have been far more appealing.

Mall Security did file a report and get a description of the guy so I'm glad they're on the ball.

Re: not so strange

marie on 4/13/05 at 20:19 (173143)

I'm in favor of the hormone theory. Never wore 5' heels and wasn't overweight when I first began having foot problems. I sure can stand to drop 20. I say this every spring and I drop it. somehow it comes back over the winter months.........but I read somewhere (don't have a source) that women have higher hormone levels in the spring, even after menopause.

marie

Re: not so strange

john h on 4/13/05 at 22:10 (173146)

If he appeared to be of college age he could have been on some project as a pledge. I would not put into writing the things I had to do during hell week.

Re: more thoughts on the female-PF connection

elliott on 4/14/05 at 09:45 (173168)

Marie, but you're a counter-example of size 1. :-)

After looking into this a little, here's some more thoughts:

In the following link,

http://www.emedicine.com/emerg/topic429.htm

it says,

'Plantar fasciitis is more common in middle-aged women and young male runners. Obesity is present in 90% of affected females and 40% of affected males.'

The male athletes thing is confirmed here

http://www.north-wales-sports-physiotherapy-clinic.co.uk/ankle1.htm

'Common to the 30-50 year age group, affecting males more commonly than females'

and here (the reference source is a European chiro journal)

http://www.coachr.org/planfasc.htm

'There is a greater incidence of plantar fasciitis in males than females (Ambrosius 1992). While no direct cause could be found it could be argued that males are generally heavier which, when combined with the greater speeds, increased ground contact forces, and less flexibility, may explain the greater injury predisposition.'

But the opposite, 'Plantar fasciitis is more common in adults and in female athletes,'

is stated here:

http://www.podiatrytoday.com/podtd/displayArticleaa.cfm?articleID=article2015

The obesity statement appears in numerous google hits. So one might speculate that obesity is more prevalent among (middle-aged) women than men, but one would be wrong. In fact, men have slightly higher obesity rates; see figure 6.2 in this link:

http://www.cdc.gov/nchs/data/nhis/earlyrelease/200503_06.pdf

Two theories for the female-PF connection (assuming there is one) come immediately to my head:

1) Obese women tend to have the extra pounds in their rear (as opposed to men who tend to have it in their gut), putting more strain on the heel

2) The PF-obesity relationship is the same in men and women, it's just that women are more likely to seek treatment than men.

Scott, you see, there's a lot of possibilities, probably all wrong. :-)

elliott

Re: more thoughts on the female-PF connection

Susan on 4/14/05 at 11:37 (173185)

I was 115 pounds and 5' 6.5' when I first got PF. I now weigh a little less than 120 and still have it. It's been almost 3 years now. A woman at a doctor's office I go to has it, and she is very slender.

Re: more thoughts on the female-PF connection

elliott on 4/14/05 at 12:03 (173187)

Susan, you're not a runner by any chance, are you? :-)

Again, a sample size of 1. I wonder if people are missing my point. One doesn't have to wear high heels or be obese to get PF, even if these features make it *more* likely to get PF. It is not surprising either to see people on these boards who do not have such features, especially if they all find the need to post that they are a counter-example. :-)

Re: more thoughts on the female-PF connection

Susan on 4/14/05 at 13:58 (173198)

No, I'm not a runner and never wore high heels. I know that's a sample size of one, but there's also the gal at the doctor's office. And there's a man in my office with it as well. He's a health nut of a sort, and has no excess body fat. Those are the only people I know with it (outside the boards).

Re: more thoughts on the female-PF connection

Scott R on 4/14/05 at 14:28 (173199)

That's the first reference i have ever heard of that claimed it was more common in men. It's from a european chiropractic journal that's not listed in medline. In any event I am only concerned about the visitors to heelspurs.com and my survey of 5,000 clearly indicates it's more common in women than men, and more common in overweight women than overweight men. In the BMI 15-20 group, women were 4.4 times more likely to have PF. In the BMI 20-25 group, women were 2.3 times more likely. In the BMI 25-30 group, women were 1.55 times more likely. In the BMI 30-35 women were 3.6 times more likely. In the BMI 35-40 range women were 5.3 times more likely. In the 40-45 group, women were 6.9 times more likely. To plot this:

15-20) xxxx-
20-25) xx
25-30) x-
30-35) xxx-
35-40) xxxxx
40-45) xxxxxxx

Now, some meaning is lost if we don't also know the weight distribution of men and women in the general (control) population. But I'm sure more women than men are in the 15-25 range which could help account for why more women than men in that range have PF. But in the higher weight categories, I think men are at least as likely as women to have a high BMI, so it's striking that women in the 35-45 range are 6 times more likely than men in the same BMI range to answer our survey and therefore presumably be representative of the general PF population. With 5,000 respondents, statistical significance is no problem. I don't think there is any other 'study' of PF that is so large. One could argue things like 'maybe overweight women are just 6 times more likely than overweight men to find and answer the survey', but i think that's getting a little absurd.

Elliott's first possible explanation is the same as my previous explanation: that center of mass is lower and places more stress on the plantar fascia.

Definitely the hormone theory is possible: weight increases estrogen. I don't believe the 'high heels' theory since that theoretically decreases tension on the fascia and there has not been any research confirming that heels cause PF. Besides, high heels are more likely to be worn by thin women which contradicts the evidence. But difference in footwear is definitely possible, but do overwieght women and men really wear shoes that are that much different? The last possibility mentioned was by elliott: that overweight women are more likely than overweight men to seek treatment (or fill out the survey). If this is true, then i would suggest that it could also be caused by hormones triggered by weight since average weight women and men are more equally likely to seek treatment (if elliott's theory is correct). But i think the lower center of gravity theory has by far the most merit. It proposes a simple and direct mode of action without having to resort to accusing people of having different mental states or behavior. Occam's razor is still useful in science.

Re: more thoughts on the female-PF connection

elliott on 4/14/05 at 14:31 (173200)

OK, a sample size of 3 is different. :-)

The purpose of this sub-thread was to figure out why women are more likely to have PF (assuming they are); the reasons admittedly are guesses. Regarding that a correlation to obesity exists, I was not making anything up myself, rather relying on sources. Here are some:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12728038

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15134611

This one is cited very frequently in journal articles on PF:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2731839&dopt=Abstract

Here is a source that both ill-fitting shoes and obesity play a role:

http://www.orthojournalhms.org/volume5/manuscripts/ms13.htm

[]

Re: more thoughts on the female-PF connection

Dr. Zuckerman on 4/14/05 at 14:33 (173201)

Scott,
I just heard a lecture on weight distribution difference's in woman vs man. The apple shape vs the pear shape. It may not be the amount of weight but where the weight distribution is .Woman have more weight in the thigh and buttock region as opposed to the abdominal area with men This could account for the pf being greater in man then woman

Re: more thoughts on the female-PF connection

Susan on 4/14/05 at 14:52 (173202)

I thought that would be convincing. :)

I haven't read your articles yet, so don't know if this is in there. What about hormones and/or auto-immune issues?

Re: more thoughts on the female-PF connection

elliott on 4/14/05 at 15:04 (173203)

Scott,

Thanks for posting those stats. It may be true, as you say, that PF is more common in females than males. But if you re-read my post and links carefully, the reference that PF is more common in men, whether reliable or not, I believe is talking only about male *athletes*, while other sources I listed debate even that, claiming it's actually more common in *female* athletes.

Regarding extra weight in the rear, I was suggesting this to explain why obese women are more at risk, but not necessarily the general population of women who are not obese. I'm also not sure about whether the weight in the rear theory correlates with your lower cetner of mass (belly height) theory; in fact, I believe women are known to have on average a LARGER legs-to-torso ratio than men (that's why they have had a tough time fitting on even small-size men's bikes--the top tube is too long for the given seat tube--and why women-specific bikes are now made by many companies), suggesting their bellies and center of gravity would be proportionately *higher*, the exact opposite of what you are claiming.

One thing you can't deny: there are far more regular female PF sufferers posting on heelspurs than regular male PF sufferers; the women tend to feel at home here, whereas this guy (who, BTW, doesn't even have PF) would rather be elsewhere if his feet weren't so decrepit, and certainly wouldn't feel inclined to fill out some silly survey. :-)

elliott

Re: more thoughts on the female-PF connection

elliott on 4/14/05 at 15:08 (173204)

Dr. Z, I think you're actually supporting something I said. :-)

[]

Re: more thoughts on the female-PF connection

elliott on 4/14/05 at 15:43 (173205)

Regarding women and shoes, this link

http://www.mdmercy.com/news/docbios/lebow_article.html

seems to support the shoe theory crowd and my speculations somewhat and even link the two, while appearing to disagree with Scott:

'Are women more prone to this?
Plantar fasciitis occurs in both men and women to a similar degree. Women tend to seek treatment earlier and more often due to symptoms/discomfort worsening with the use of non-supportive shoes. Men tend to wear laced supportive shoes more often which helps slow progression/decrease symptoms/begin effective treatment.'

Regarding hormones, the same link actually claims the opposite! Namely,

'Relaxin (a hormone causing ligamentous laxity during pregnancy) should help protect plantar fascia from injury of overstretch/strain caused by increased pronation due to change in center of gravity and external rotation legs/feet due to weight gain. Plantar fasciitis can occur with mothers who experience a more rapid recent weight gain or an inability to wear supportive shoes due to fluid retention.'

It seems that hormones are also a good thing when it comes to cortisone shots:

http://www.zfootdoc.com/serv02.htm

'How does cortisone work and is there a danger to cortisone?
The cortisone that I use for injection is a synthetic version of one of the body's own hormones produced by the adrenal gland. This is an important hormone and essential to a life able to cope with the stress of living. I inject a very small quantity of this hormone, mixed with local anesthesia, into the heel area. It produces a nearly universal reduction in pain anywhere from a few days to a few years.'

So at least some anecdotal evidence against the hormone theory.

This so much fun!

elliott

Re: not so strange -one more issue

Ed Davis, DPM on 4/14/05 at 17:59 (173216)

ScottR:

Interesting observation on your part. Math and physics are not the forte of most in the medical profession although podiatry has made the biggest effort to study biomechanics of the lower extremity. I think that your observation is publishable as a letter in a journal like the Journal of the American Podiatric Medical Association or maybe, better yet, a journal called 'Biomechanics' which attempts to take more of a multidisciplinary approach to the issue of biomechanics.

Another issue to add to the mix. Women who wear high heels in their 20s and 30's start to develop forefoot problems in their 40s such that they must go to lower heeled shoes. Many women who have been avid high heel wearers develop a shortening of the heel cord (functional equinus). As we know from the Heel Pain Book, a tight achilles (therefore the night splint) is a factor ind the development of plantar fasciitis.
Ed

Re: more thoughts on the female-PF connection

Ed Davis, DPM on 4/14/05 at 19:17 (173219)

Elliott:
The weight issue definitely needs more attention, research wise, due to the fairly modest number of slender people with PF. It is a dilemna that seems to fight the physics that ScottR explains; a bit like trying to figure out why modest number of people with low cholesterol readings get heart attacks. At this point we can make some educated assumptions, due to lack of data, and acknowledge that extra weight must mean more plantar fascial tension as the physics require it. Why do a number of heavy people not get it and a number of slender people do? The implication is that we still don't have a good handle on how much weight to apply to the various etiologies. My assumption is that tissue quality deserves more weight than we assign it, in part, because it is so difficult to measure.
We also are unsure on how to treat tissue quality issues other than with ESWT when the pathology is already there.

Obviously, we are not going to get away with an experiment where we go around biopsying (taking tissue samples) people in large numbers so some other biological marker will have to be found. The only thing we have in PF to measure tissue quality is the sonographic or MRI measure of its thickness and, in the case of sonpgraphy we look for fibers than appear to be 'disorderly' or not parallel to each other and also for hypoechogenicity which is indicative of tissue fiber breakdown or fluid within the fascia which can be a marker of inflammation.
Ed

Re: not so strange

Ed Davis, DPM on 4/14/05 at 19:27 (173220)

Marie:
You actually, in my opinion are closer to the root cause of things than you may imagine. I feel that tissue quality (see my post below) is a factor that needs much more weight assigned to it. Tissue quality is affected by hormones. This is anectdotal (and controversial) but I am familiar with a doctor who would suggest that injections of growth hormone would be a prime means to increase tissue quality and that hormone, in adulthood, becomes a big factor in tissue repair and it is a hormone, the level of which, really plummets as we course into middle age.
Ed

Re: not so strange

Ed Davis, DPM on 4/14/05 at 19:29 (173221)

Marie:
Actually, I should have said, 'see my post above' as it falls in line under Elliott's post.
Ed

Re: not so strange

Ed Davis, DPM on 4/14/05 at 19:39 (173222)

Elliott:
I would consider the physics of plantar fascial tension to be the main item to get from ScottR's explaination and think that that is as far as he expected us to carry it. Plantar fascial tension invariably is a root cause of plantar fasciitis with the other half the equation being the manner in which we respond (tissue response) to plantar fascial tension. This is an area that we don't understand very well in the medical community and I suspect, will be a misunderstood area for some time to come.

Ed

Re: more thoughts on the female-PF connection

Scott R on 4/14/05 at 21:00 (173229)

Dr Z, the weight distribution difference is what i am talking about because in each statement i am comparing OBESE women to OBESE men and theorizing the women's group is 6 times more likely to get PF because of weight distribution. I first published this 4 years ago in the online booklet. Someday someone will publish 'discovering' this with their own smaller set of data and not make a reference to heelspurs.com. It's an interesting explanation, but it doesn't change treatment advice other than to emphasize the two standard pieces of advice which have always been to lose weight and stretch.

Re: more thoughts on the female-PF connection

Scott R on 4/14/05 at 21:26 (173230)

Dr Ed, although an increase in weight does cause the same percentage increase in PF tension, that's not my point. My point has to do with flexibility of the calf muscles since a lower center of gravity in overweight women requires more flexibility. That skinny men also get PF is not a mystery or suggesting a different root cause than my theory. Skinny men are also most likely to have inadequate calf muscle flexibility. It's just that overweight women need even more flexibility. As the first link elliott posted today says, the greatest risk factor for PF was lack of flexibility in the calf muscles (23.3 times more likely to get PF if you do not have adequate flexibility) followed in importance by weight (5.6 times more likely to cause it) which may also be more of a flexibility issue than weight issue if my theory is correct. The third most important thing was time on their feet at work (3.6 times) which would be of great interest to all those Canadian insurance guys who have called me over the years desperate for a journal article indicating that a claimants job was the cause.

Strangely, the 2nd article elliott links to (which was published by 2 of the same authors who published the first one) states that the amount of pain had no effect on disability. That seems absurb.

Re: more thoughts on the female-PF connection

Scott R on 4/14/05 at 22:11 (173231)

Elliott, now that you mention it, there is indeed a difference in the leg-length to height ratio in men and women: women's ratio is smaller. But more to the point, there are many web sites that say a woman's center of gravity is lower for a given height, adding support to my theory. In particular, men's upper-body muscle is dense and therefore has a greater effect than boobs. But now i am wondering if women with small boobs are predisposed to PF, or if a good boob job could be a cure. I'm not kidding, but now I'll start. Dr Z has volunteered to conduct a study in order to gain scientific validity for his new mobile silicon unit. We need a perfectly random sample, so we've chosen a local mall to gather recruits for testing in a new mercedes RV with 'Boobs for PF-USA' written in bold on the side. The FDA is looking into it, insisting that he remove the 'for PF' part until his study is complete.

Re: more thoughts on the female-PF connection

John H on 4/15/05 at 11:10 (173251)

Add this to your mix. Men are more apt to engage in activities that may induce PF such as sports, climbing ladders, working on roofs, heavy lifting,etc.

Re: more thoughts on the female-PF connection

Ed Davis, DPM on 4/15/05 at 21:10 (173278)

Scott:
Understood. Flexibility, to a large extent is a tissue quality issue. For an extreme example take someone with Marfan's syndrome (Abe Lincoln had this). That is a diease of hyperextesiblity of the connective tissue. I have never had a pateint with Marfans syndrome and plantar fasciitis.
Ed

Re: more thoughts on the female-PF connection

Pay Pay B on 6/13/05 at 12:02 (176666)

What exactly is marfans disease and what does it come from?