Planter fasciitis

[Missy1965]

I was just wondering if anyone had some ideas for planter fasciitis. It's hard for me to get in walking when my heel hurts so much to walk and stand on. I've used ice, taken ibuprofen, taped my heal and arch and I've also had cortisone injected in it.

[tealily]

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@Gershon wrote:

Missy,

You used heel in the singular. I'm assuming you only have the problem in one foot. If so, you can use crutches for awhile, too. 

I'm not a doctor or any kind of sports medicine expert. I've noticed this is one injury that seems to be chronic for people, especially if they go to doctors. I haven't been to a doctor in 21 years as I consider them to be irrelevant.

If it were me, I'd use the crutches as much as possible for a month and take Ibuprophen to control inflammation. Do not use the lack of pain from the Ibuprophen to indicate the injury is healed. 

Meanwhile, I would suggest swimming if it's convenient. If not, you can work on upper body strength or core strength. Avoid any squats or activity where you stand on the balls of your foot. That will stretch the tendon.

When you resume exercise the musles connected to the tendon and the muscles that protect the tendon will be atrophied. Don't get excited. Most people have atrophied muscles everywhere. It will take time to strengthen these muscles and I mean LOTS of time.

Here is why, in my opinion.

You can't really start to build muscles in the critical areas like the feet, ankles and knees until you can walk without any pain. The reason is most people will feel the pain before they get tired. The proof of this is people walk and run through injuries. Therefore, it's not possible to strengthen the  muscles before experiencing pain and damaging injuries.

I've walked over 2,200 miles since February, and it has only been recently where I no longer need days off for minor pains (1 out of 10).  Now I can't walk into pain before my muscles get tired and progress is rapid.

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(also not a doctor but effectively works in 'sports medicine' industry)

*** disclaimer: best treatments always come from individualised diagnosis - make sure you see a good clinician and not self-diagnose or self-treat over the internet ❤️

When I got PF for the first time I thought it was all over as it seems to be that one injury that keeps people down forever. Had recently amped up from walking --> interval training. Went to see my usual - awesome - physiotherapist, who pointed out that I had epic Tib Post issues (a muscle that inserts into the plantar fascia).

The foot is a pretty awesome device. It's rigid, then it goes soft to absorb shock, then it goes stiff again so you actually have something solid to push off the ground with (windlass effect). Overgeneralising here, but if you can imagine certain muscles not working hard enough for that final stiff moment --> ouchies x lots and lots.

Typical first-line treatments involve ice (my friend likes to roll a frozen bottle of water underneath her foot), massage, orthotics, taping etc. Traditional therapy usually involves lots of rest, a period of regaining muscle, then rehabilitation into activity... however modern therapy is now shifting to a model of preventing atrophy wherever possible and getting people back into whatever activity they can safely and painlessly perform ASAP as this decreases downtime, preserves muscle bulk and physiological function - eg cardiovascular function - and massively increases a client's sense of well-being and happiness (hence why physiotherapists mobilise total knee and hip replacement patients day of or day after surgery, and are beginning to be brought into ICU departments to commence mobilisation even when clients are strapped up to oxygen tanks and heart monitors etc).

Though I do find orthotics and taping help give me a bit more time before the pain kicks in, the more recognised 'treatment' (as opposed to acute pain relief) is actually foot exercises to strengthen both the intrinsic muscles and Tib Post. Don't assume doing these exercises will make things worse or that they can only be performed when the patient is pain-free (but check with your health clinician) - everybody's different and certainly in my case, doing exercises actually makes the pain go away within seconds, and keeps it away. I've been doing them almost daily now as a preventative for months and had no reoccurrence of the PF 🙂 ❤️ To be fair, I also stopped the interval training and if I ever go back, will have to go back slowly.

Tib Post acts as a medial-lateral stabiliser (also a plantar flexor, but that's less important here), so most strengthening exercises are just balance exercises. Depending on how good your proprioception is, you could try these (start at the top and if you don't notice any effect, go down. If it HURTS, you're pushing too much):

1) Standing hip width apart, rise up on balls of feet SLIGHTLY

2) Stand on affected leg, foot flat on floor.
3) Stand on affected leg, foot flat on floor. Slowly rise up on ball of foot slightly. Balance. Then lower back down slowly.
4) Repeat as for (3) but on a towel/foam mat

[Jenniferx2]

I also had extremely painful PF and as a last resort before surgery, I tried extracorporeal shockwave therapy (ESWT) and it worked!  I did two treatments of the low energy and my PF only hurts now when I've been on my feet for an extended amount of time.  Before, I couldn't even walk my kids to the bus stop!  Most insurances dont cover ESWT but it wasn't too terribly priced.

[Jarede]

I started physical therapy about two weeks ago. I was offered a cortisone shot into my heel but I politly declined.
My PT rubs my tendons and soft tissue deeply and hard - uses her knuckles.
I wanted to copy this movement since it helps so well with easing up the pain and getting the tightness out of my foot.
So...you know those felt circle pads you put on the bottom of stuff so your floor/wooden furniture doesn't get scratched? Can get them at Home Depot or lowes. I took the big ones and cut them in half. Put them in the heel of my shoe. It raises my heel up and provides space where the spur is and massages the bottom of my foot while I walk all at the same time. Yesterday I added another level. It's something to try.

[alyss05]

I've had PF for the last 4.5 months and it hasnt really eased. Ive carried on playing sports through it but cant do long distance running anymore. 

It will improve on resting but I found going to a running shop and getting trainers for me based on my gait and arch etc helps a lot. I spend most of my free time in them.

Other than that, there is little you can do medically. It's more of a waiting game but I find massaging/stretching helps a lot (google for examples).

I hope it resolves quickly! 

[joanf]

I agree. Time is really the essence. When it is better it is easier to keep it in order.

[janellybean]

My podiiatrist suggested Birkenstocks and between the shoes and their inserts, the pain has been gone for months.

[joanf]

Kind regards
Joan

[deb0266]

I have been dealing with this for over 9 months. I have spent 1000.00's of dollars on different dr's , inserts, therapy, shots, with no help. Stretching couple times a day, icing , pain pills. Nothing has helped. Thinking of PF release surgery now. 

I did my second marathon last year and that is when it started. I haven't ran since Janaury because to painful.

I feel like this is consumming my life. I want my Life back painfree.

Anyone here have the surgery ???

[shipo]

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@deb0266 wrote:

I have been dealing with this for over 9 months. I have spent 1000.00's of dollars on different dr's , inserts, therapy, shots, with no help. Stretching couple times a day, icing , pain pills. Nothing has helped. Thinking of PF release surgery now. 

I did my second marathon last year and that is when it started. I haven't ran since Janaury because to painful.

I feel like this is consumming my life. I want my Life back painfree.

Anyone here have the surgery ???

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A few years ago I had PF so bad I needed crutches to get to the bathroom in the morning.  Since then, problem solved; no surgery required.  How?  I started wearing a night split (not the most comfortable thing in the world) which holds the foot perpendicular to the shin, thus preventing the calcification and shortening of the tendons on the bottom of the foot in front of the heel.

As uncomfortable as wearing the splint was (at least at first), the very first day I wore it I noticed an improvement; within a week I was able to get up in the mornings and not limp even a little.  That said, I wore that brace for over three years because I was so afraid of having a relapse; I stopped wearing it when it finally broke.

[Heybales]

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@deb0266 wrote:

I have been dealing with this for over 9 months. I have spent 1000.00's of dollars on different dr's , inserts, therapy, shots, with no help. Stretching couple times a day, icing , pain pills. Nothing has helped. Thinking of PF release surgery now. 

I did my second marathon last year and that is when it started. I haven't ran since Janaury because to painful.

I feel like this is consumming my life. I want my Life back painfree.

Anyone here have the surgery ???

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Not needed here either, though I dragged on the recovery for years by being foolish and continuing to try to workout to same levels.

But finally got orthopedic inserts and moved between all shoes worn, then got more so I didn't have to move them around. Was even able to keep working out to some degree, biking with thinner inserts, ect.

Since it's a messed up tendon, the closer you get to non-use, the faster the repair can be. I stretched that out to 1 year about.

And repair on those tendons is slower from the achilles on down anyway, compared to elsewhere in body, so as much assistance as possible is great. Besides great night splint above, always keep it warm from calf down to encourage blood flow.

Non-use means the foot's arch is supported by another means, those inserts - and yes that means it gets weak except for the specific workouts you give it, but not even barefoot use to start with - shoes all the time.

Once the pain is gone when daily required walking, I started barefoot walking at home, making sure no pain ever started, so it was gradual increase - 1 hr daily on up.

Once that was good, removed the inserts from shoes that actually bend the way the foot wants to bend naturally to operate correctly - and got shoes that did that better, from daily shoes to running shoes with minimalist/barefoot design.

Dress shoes, biking shoes, things that just didn't bend at all - kept the inserts. Figured if the foot can't work naturally, I'll help it.

I still have them in dress shoes, and backpacking shoes (when I remember to put them in), but biking are out now.

I actually worked my way up to barefoot running, then the 5-Finger shoes, and then better Merrill trail-runners. But discovered unequal leg length so require minimalist shoes to put a full length height insert in. (that issue actually helped the PF issue develop).

So it does take time, they never saw a tear in mine that made it major, but bad enough.

But it can be recovered from, and done stronger.

[shipo]

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@Heybales wrote:

But it can be recovered from, and done stronger.

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Agreed; back when I first got PF I was in my early 40s and only running *maybe* 15-20 miles per week, max.  Now, 18 years later, I am running 50-70 miles per week with no inserts, splits, or other aids.  🙂

[brerbill]

I've had severe PF, shin splints, and compartment syndrome - and have read quite a few people's complaints about similar running type injuries over the last few years. Successful treatment for PF is so uncommon or varied, that what works for one person probably won't work for another. I tried all the normal "remedies" including night splint, taping, stretching, rest (probably not enough), blah, blah, blah. I think a  lengthy period of total rest  is probably the most successful single method for recovery, but what runner or walker wants to give up exercising? - So, we look for possible solutions.

Out of desperation, I tried walking/running barefooted - and over the course of a few months greatly strengthened my feet and overcame my PF. I built up very conservatively, and even now, I only run barefooted about 40% of my mileage, always using minimalist footwear, even at work. That was about 7 or 8 years ago, and I've had no running injuries since. At the time (and still today), I had 2 opposing bone spurs on my left heel, recurring PF, very tight achilles on both legs, hammer toes on the right foot, and high arches. A year or two later, a podiatrist saw my feet regarding a toenail issue - and immediately exclaimed that I would need surgery to correct my deficiencies, because my feet were "headed for trouble". But, in this case I knew better and kept on enjoying my running.

Here's my rant: I didn't need "motion control", "arch support", "stability", or much "cushioning" in my shoes; turns out I was born with all that stuff, but due to wearing regular shoes for decades, those particular muscles in my feet atrophied until I built them up again. This of course is just my personal and non-professional opinion, based only on one person's experience.

People too often want a "fast fix", or they try to push through injury. My "fix" took close to a year to accomplish, probably isn't for everyone with PF, and may not even work for most people for various reasons. But I'm now running twice the mileage I was before, without injury at almost 70 - and I hope others will find the solution that helps them get back on track.