WHAT IS IT? Plantar Fasciitis is a micro-tear in the Plantar Fascia, usually at the point where it connects to the heel bone. The Plantar Fascia is the very strong tissue that connects to several bones just behind your toes, and stretches across the entire bottom of your foot attaching to the heel bone (ie. See picture above). The Plantar Fascia is pulled taut each time that you put weight on it, and can become overworked and overstretched. Plantar Fasciitis describes tears that occur in the Plantar Fascia. It IS an injury and should be treated as such.
· Plantar (bottom)
· Fascia (tissue that stretches across the entire bottom of foot, attached to the heel bone and the metatarsal bones of the forefoot, and aids in walking and standing)
· -Itis (inflammation)
I see it every day, and it’s no wonder with the type of footwear people are wearing. Flip-flops and Crocs are on the rise. People wear dress shoes for eight hour shifts almost every single day, without the consideration of how much foot damage is just over the horizon for them.
You’ve probably heard of Plantar Fasciitis. It’s becoming more and more common, even among teenagers.
Some people get it as soon as their foot structure is finished developing, and others get it seventy+ years later. It all seems to depend on foot flexibility and lifestyle.
If you understand the cause of Plantar Fasciitis, it’s easy to understand what must be done to both prevent and heal it.
The Plantar Fascia is the connective tissue that extends across the entire bottom of the foot. It is a crucial part of the foot.
Depending on how flexible your feet are, over time the Plantar Fascia becomes lengthened and stretched to the max. Once it gets to that point, it doesn’t take much for it to tear. One morning you’ll step out of bed and think you’ve stepped on a nail, or you step off the side of the curb and feel a sharp sting. Once this initial tear has occurred, it very easily reoccurs with almost any amount of stress put on the feet… i.e. walking, running, or even just every day chores. You’re going to have a really rough time getting rid of Plantar Fasciitis if you’re up and down ladders all day. But other than that, if you are willing to make a few changes in your footwear and lifestyle, it shouldn’t be too difficult to get under control.
You wouldn’t think that walking is so stressful on the feet. If you are walking or standing on flat, hard surfaces (tile, hardwood, pavement, sidewalk, even carpeting) you are putting a lot of unneeded stress on the feet and obstructing the natural biomechanics of the body. The feet (no matter what your arch height) are designed to walk on natural, uneven surfaces (dirt, rocks, sand, grass).
Your body is like a car. Can you imagine driving a Camry through the woods? It’d break down pretty quick, because it’s not designed to operate in that environment. The same way, your body isn’t designed for hard-flat surfaces.
It doesn’t take a doctor to understand that when you mess with the function of the body that a large variety of things start going wrong. A large number of knee, hip and back problems are associated with improper gait and poor foot function. Poor posture is almost always associated with the feet and ankles. With that said, when you restore function to the body, it has a tendency to snap back. That is, so long as you havn’t had an injury or surgery that prevents you from reaching full function again. Going back to the car analogy… If you start to fuse parts of a car, or even worse, take parts off… that car will never run the same again. Can’t.
So, ideally your prescription would read “Move to the beach, relax, and get plenty of fluids.” Not likely, right?! They more likely read “Custom Orthotics, stable footwear, and calf stretches.” Hopefully you don’t have a doctor whose first suggestion is surgery. There are very good, and very successful, NON-surgical procedures for Plantar Fasciitis.
My experience is that THE RIGHT ARCH SUPPORT for YOUR body and foot type, in combination with LOTS OF CALF STRETCHES is the most successful treatment for Plantar Fasciitis, along with many other foot and joint disorders. The right arch support will provide your body better alignment, which affects all your joints.
To sum up, what causes PF is lack of support, a hard-flat environment, and mooshy-soft-cheap footwear.
There are varieties of solutions for Heel pain:
- Heel Lifts - Not recommended for more than 2 weeks. A very short-term solution. If worn more than a couple of weeks, it will cause your Achilles tendon to become shorter, which will in turn tug even harder on the plantar fascia and become inflamed again.
- Heel Cups - Also a short-term solution. If built into an arch support device, very effective, though.
- Stretches – Keeping the Achilles loose and long are key to preventing and healing Plantar Fasciitis statistically. A variety of calf-muscle stretches are provided below.
- Night Splints – A boot-like device that is worn while you sleep in order to keep the Achilles from shortening during the night.
- Ice - You can find various products to freeze and roll your feet over to help decrease the inflammation.
- Higher heeled shoes – Obviously a worse-case scenario. If you REALLY want to shorten your calf-muscles and throw your entire alignment off, help yourself to some heels.
- Accommodative Arch Supports – A good idea, but ultimately not a long-term solution, either. Accommodative orthotics are rigid and do not allow the foot muscles and tendons the normal movement they need in order to stay strong and fit. You DO want to restrict your foot from over-stretching, but if you restrict your foot biomechanics TOO much, the muscles and tendons with shorten and weaken. It’s the fine line between not-enough and too-much support.
- Functional Arch Supports – Now THIS is the best solution by far, because it supports the foot, but also allows the foot to function at its best. There is some flexibility in the orthotic, but not too much. If you can get the ones that are calibrated to your body weight and foot flexibility you'll be getting an upbeatable orthotic to date.
- ESWT (shock wave therapy) - Ask your doctor about this option.
- Supportive footwear -
should not bend
anywhere past the
ball of the shoe*
- The Most effective solution? The combination of Function Orthotics, calf stretches, and supportive footwear. Orthotics, because ultimately collapsing arches are the cause of PF. Calf-stretches, because short calves will cause PF to reoccur. Supportive footwear, because you need to be wearing a shoe that will hold up against the hard, flat surfaces you’re walking on from day to day.
Some treatments work more often than others, but no ONE treatment works for everyone. Healing can be up to double the amount of time you felt the original injury.
*You must hold these stretches for 45-60 seconds each stretch.
Do not bounce on the stretch.
Hold it nice and snug for the full 45-60 count.
Do the stretches as often as possible until you’re past the severe stages of Plantar Fasciitis. After that, continue to stretch, but it’s ok to cut back a little. Any time you feel any stress on your feet, though, stop and stretch.
*Drop your heels off the stair until you feel the calf pulled taut.
Hold stretch 45-60 seconds.
Questions and Answers
Q: Do I have to stop working out?
A: If it includes running or long amounts of walking, then YES until your feet have had time to heal a bit. Remember, this is an injury and inflammation. Once you get into your arch supports AND have had at least a few weeks of recovery, then start back into your exercise routine slowly.
Q: How long does it take to recover from Plantar Fasciitis?
A: How long have you had PF? Now take that time and divide it in two. That’s USUALLY how long it takes to recover from Plantar Fasciitis, IF you are doing your part.
Q: What’s a good shoe for Plantar Fasciitis?
A: Try the MBT or Chung Shi shoe. They are designed to lengthen and strengthen the calf muscles and the Plantar Fascia. In combination with the right arch support, these shoes will help to restore function to the body by giving you better posture, increasing your circulation, and increasing muscle activity throughout the body. This type of technology shoe is one of the best long-term ways of preventing Plantar Fasciitis as well as a myriad of other medical problems. Other than these shoes, you need to get OUT of your Crocs and flip flops and dress shoes. Get INTO a shoe that you can’t twist in half. It needs to have structure! That doesn’t mean that it’s going to be hard as a rock. Get your feet evaluated somewhere like a Foot Solutions, and they’ll help you get into a comfortable, structured shoe that will also suit your lifestyle needs.
Q: Once the pain goes away can I go back to wearing my old shoes, stop wearing my arch supports, and discontinue the stretches?
A: Absolutely NOT. Once this injury/inflammation has occurred, you can expect that when you go back to your old habits that it will come back. I’ve worked with people who’ve been struggling with PF for ten years! There’s no need for that. You MUST continue to take care of yourself. And unless you’re walking barefoot in the woods every day – all day, then you have to stay in your arch supports and supportive footwear.
Q: Can I go barefoot, even if it’s just around the house?
A: If you’re going to be on the beach or walking through the park… sure. If you’re going to be at home on your carpeted, hardwood floors… nope. You should NEVER go barefoot on flat surfaces. It might feel ok at the time, but it will only make the injury worse in the long run, and create more problems elsewhere. Remember, flat surfaces stress the feet, even when in a mooshy shoe like Crocs or flip-flops. Which is just as bad, if not worse, than going barefoot.
Q: What if I have a heel spur? Should I have surgery?
A: Please listen to your doctor. I would at least try wearing the right arch support and doing plenty of stretches before I’d recommend surgery. The MBT/Chung Shi shoes have also provided a great deal of positive results with bone spurs, from my experience. Because of the function restored to the foot (in combination with the right arch support), and the increase of blood circulation, some people have had bone spurs both relieved and reabsorbed. Like I said, Restore function to the body and it tends to heal itself.
IN CONCLUSION, the results vary case-by-case. You need to have your feet completely evaluated (gait analysis, pressure scan, foot palpation, flexibility test, footwear examination, etc). And be careful to do your OWN research. If you just trust that the sales associate or Doctor working with you knows everything, then you are going to end up spending a lot of unnecessary money. How many people have had orthotics made that didn’t work? Almost 99% of orthotics made don’t work, because they’re not put on the correct foot. There are a lot of orthotics out there; you just need to make sure that you get the right one for YOU. No ONE product works for everyone.
Quotes: From Scott Roberts via HeelSpurs.com
**There are so many good quotes from this website I can't include them all. This guy was suffering from heel pain and started this website to help others learn about heel pain. He's not a doctor, but sometimes the most informed people are those who suffer from the condition.**
"Patients often report that the pain "moves around." The pain can be mild or debilitating. It can last a few months, become permanent, or come and go every few months or years for the rest of a patient's life with no obvious explanation.
Every year, about 1% of the population seeks medical help for this condition (one company claims it's 2.5%).
The heel may hurt when it strikes the ground, but plantar fasciitis is not caused by the heel striking the ground.
Some patients begin walking on the front of their foot because of heel pain. This may help if they have something other than plantar fasciitis, but if they have plantar fasciitis, walking on the forefoot causes more tension in the plantar fascia (which pulls more on the heel) and it can make their condition worse.
Unfortunately, it can take 12 to 36 hours after harmful activity before the pain increases, so it is not usually obvious what activity is causing an increase in pain. For example, a runner may not know if it was a recent change in shoes or changing to a terrain with hills that is causing an increase pain. But since a lack of flexibility in the calf muscles and/or excess weight are the causes of most cases, it is not usually a particular activity that can be blamed.
Despite the claims of various product manufacturers, there is no cure-all. Different treatments help different people. Patients need to be active in their treatment. Experimenting with several different treatments is often necessary before finding those that help. As in exercising and working out, actively finding a way to enjoy the daily routine that is beneficial to your feet is crucial for continued improvement. Applying ice, stretching, and taping are not inherently enjoyable, and it is not always obvious that they are helping.
The pain usually increases gradually over weeks or months before help is sought, and improvement is usually just as slow. Patients often have to be patient. Setbacks are the norm in dealing with plantar fasciitis, and simply preventing the daily minor injuries is just as important as preventing the less frequent big injuries.
A portion of a patient's lifestyle (excessive running or standing, over-eating, inactivity, or inflexible shoes) has often caused the pain, and it is that portion of their lifestyle that has to change. Desk jobs are unnatural and a very recent development, so they are probably a major cause by way of atrophy (desk jobs prevent the feet and legs from being naturally flexible and strong). Frequent stretching before walking should be emphasized for those with desk jobs."
"Trying to "walk through the pain" can cause a mild case to become long-term and debilitating."
"So, many doctors appear to use the phrases "heel spur" and "plantar fasciitis" interchangeably. Plantar fasciitis and heel spur syndrome are "waste basket" diseases: if there is pain in the heel or bottom area of the foot and the doctor has ruled out other causes, then it may be called "plantar fasciitis" or "heel spurs." This is not a completely unfortunate situation because many of the treatments for plantar fasciitis will help many different causes of heel and arch pain. "
"Out of the 1st 2,655 responses to the survey, 46% had had heel pain for over a year. The pain can range from mild to debilitating. In some cases, patients report having to quit work and crawl to get around the house. If there is little success after 9 to 12 months of proper conservative treatment, patients are often advised to have surgery. A podiatrist emailed to say that the presence of a bone spur increases the chances that surgey is required. Surgery fails 2% to 35% of the time, depending on which journal article is quoted. Some doctors may have a failure rate greater than 50%. A failed surgery can ruin the patient's ability to walk for at least a year. Some surgeries reported as "successful" by the doctor may decrease a patient's ability to walk for up to a year. Those who delay seeing a doctor, have heel spurs in both feet, or are overweight are more likely to have the condition for a long time. It is important for the patient to be active in their treatment."
"Probably the number one cause of plantar fasciitis is lack of flexibility in the calf muscles. A journal article reports that people with inflexible calf muscles are 23 times more likely to get it."
"See "Risk Factors for Plantar Fasciitis: A Matched Case-Control Study" J Bone Joint Surg Am. 2003 Jul;85-A(7):1338.
Results: Individuals with 0° of dorsiflexion had an odds ratio of 23.3 (95% confidence interval, 4.3 to 124.4) when compared with the referent group of individuals who had >10° of ankle dorsiflexion. Individuals who had a body-mass index of >30 kg/m 2 had an odds ratio of 5.6 (95% confidence interval, 1.9 to 16.6) when compared with the referent group of individuals who had a body-mass index of 25 kg/m 2 . Individuals who reported that they spent the majority of their workday on their feet had an odds ratio of 3.6 (95% confidence interval, 1.3 to 10.1) when compared with the referent group of those who did not. "
If you have any questions, please feel free to e-mail me. BethJensenCPED@yahoo.com
To reiterate, I’m not a doctor. I am a Board Certified Pedorthist, trained in foot biomechanics, foot conditions and disorders, and some preventative non-surgical foot care treatments. My goal is to point to some products and services that I personally believe are helpful and effective, and to provide some focused education about foot conditions and treaments.