Archives for October 2012

 

After you’ve seen a podiatrist, and know what is actually wrong with your foot, the natural next step is to make sure you are wearing the right kind of shoes. Most of us don’t have the best shoes for plantar fasciitis, which is partly why a lot of us are here in the first place, and we have no idea how to find out. Lucky for us, it is fairly easy to get a shoe consultation, either in person or online.

Here’s my experience with two different shoe consultations.

Consult #1: Fleet Feet Sports

I never even knew you could get semi-professional advice about the right shoe to wear until I walked into the Fleet Feet Sports  in Pleasant Hill, California, looking for flip flops with arch support, and started talking to the sales guy, Spencer about my plantar fasciitis. (This was in July 2012).

Honestly, the consultation at Fleet Feet in Pleasant Hill was one of the most useful things I’ve done.  He measured my feet, and had me walk through the store barefoot and noted that my arches are not all that low, that I do tend to pronate and that my feet are on the narrow side. He showed me what kind of shoes he thought I needed in general, based also on these three factors, and brought out two or three different brands for me to try. Different shoes are recommended for you if you have wider or narrower feet.

My doctor had recommended that I use off the shelf inserts like Superfeet, so Spencer helped my figure out the right type for my situation. More helpfully, he suggested that I get the next largest size, and cut down the inserts, so that the arch would better fit mine. When I put the recommended shoes, with the inserts, on my feet, my feet sort of breathed a sigh of relief. Seriously, it was clear immediately that this was the right combo to support my feet, which at that point were hurting pretty badly. (For more information on what was recommended, see the posts on shoes for plantar fasciitis and inserts for arch support.)

While my podiatrist had been great, I had learned a lot more about my particular situation and how to deal with it at the shoe store!

I think it made a big difference that I had a helpful and experienced person like Spencer to consult. It would be easy to go to a place where the consultants are not very helpful or knowledgeable, and there could be a big difference between different salespeople at the same store.

Since Yelp is so great, I would personally recommend looking up “sports medicine” or “orthotics” or “shoe fitting” or “physical therapy” on Yelp.com or somewhere in your area, and seeing what place other people in your area found helpful, and specifically, who at that store helped them.

If you can, you may want to try several different sports or shoe stores that will evaluate your feet, as you can learn a lot from different people.

Consult #2: LaFoot Plus

In October I checked out another sports shoes store — LaFoot Plus on Elmwood in Berkeley, CA, which calls itself a “sports health and wellness center,” and was also great.

A salesperson called Afsanah at LaFoot worked with me for a solid 40 minutes, assessing my walk when I asked her to, and recommending a different style of Brooks’ sports shoe than the one I had (Adrenaline) for my overpronation and plantar fasciitis, noting the one I had was fine, but that the new rec, the Addiction, was even stiffer and would be better. She wasn’t trying to sell me the Addictions – I had specifically asked what shoes she recommended – and by the end of the visit I realized that her strongest recommendation was that I focus on stretching my calf muscles.

When I asked her about the ball of my foot hurting, she said it was probably metatarsalgia and described to me how my tight calves would cause both the metatarsalgia and plantar fasciitis. She showed me on my foot how the tightness in the calf basically puts pressure on both the plantar fascia and the ball of the foot, and how my toes arch up a bit and how they should lay more flat.

She recommended that I add some stick-on heel lifts to the bottom of my Superfeet, to take some of the pressure caused by my tight calves off my feet, but warned that this was a temporary measure and that the stretching was what would help in the long run. The heel lifts were something like $1.50 each and she stuck them on and trimmed them for me.

When I asked if there are other shoes she would recommend, she said for my problem she would recommend either the Saucony Stabile or the New Balance 1012 except that both of those run a bit wide and my foot is on the narrow side, so that she would go with the Brooks Addiction. And that she thought my current Brooks were fine, especially with the inserts I wear.

In the end, I got a pair of the Brooks Addictions, to the salesperson’s surprise  Since I wear my sports shoes almost literally all the time, and since it sounded like they were even better for my condition, I figured it was a good shot.

Final Report Card

At the end of the day, I was sad to find that my feet felt a bit worse after I wore the Addictions with the heel inserts, and they are not quite as comfy as my other Brooks. There are a million factors with plantar fasciitis, so I’m not honestly quite sure if either the shoes or the heel lifts are the problem, or something entirely different – more walks, etc. But my instinct was too lose the heel lifts, which I have now removed, and to only wear the Addictions at home rather than on walks or to work.

I don’t think Asfanah at La Foot gave me bad advice – far from it – but rather that each of our experience with plantar fasciitis is unique and that for my feet and my body, it’s better to wear Brooks Adrenalines without heel lifts.

I am indeed following her advice to do more plantar fasciitis exercises.

My point is that it’s worth it to get a shoe consultation at a good spot, and that it’s even better to try different places if you can, so that you can find the combination of shoes and inserts and lifts (or not) that is right for you.

I have no doubt that my feet would be in much worse shape if I had not done a shoe consult at all.

Action Items:

• Look on Yelp (or ask around) for a highly reputable “sports medicine” or “orthotics” or “shoe fitting” or “physical therapy” store in your area, especially paying attention to finding the most skilled shoe consultant at that store.
• If needed, ask them to evaluate your feet while walking.
• Keep in mind that off the shelf shoe inserts might work just fine for you instead of the much more expensive custom orthotics.
• If you can, try more than one consult.

When does your heel pain treatment (or heel spur treatment) need to move to the next level?

FIRST STEPS

Most of us will feel significantly better very soon after we seriously begin to implement the simple home remedies that we can do or get for ourselves, like rest, icing, and wearing shoes for plantar fasciitis with some additional arch support. Many people also will use over the counter drugs, specifically anti-inflammatories, to reduce the pain when it is acute.

Anti-Inflammatory Drugs

My doctor, and virtually every source about heel problems I’ve read, indicates that when your heel pain from plantar fasciitis is acute, anti-inflammatories like ibuprofen, naproxen or aspirin can help your symptoms. (This is despite the fact that there is a considerable amount of doubt about whether plantar fasciitis actually involves any inflammation.) As a group, these kinds of drugs are known as NSAIDs — non-steroidal anti-inflammatory drugs. Ibuprofen can be purchased as a generic or as Advil or Motrin, and naproxen is sold as Aleve. Of course you need to consult your health care provider about whether this is a good idea for you personally. Some people should not take ibuprofen, and there are a fair number of people who are concerned about its effect on your liver. I’m concerned about that, too, but I do take it, in 800mg doses prescribed by my doctor, when the pain is high, or when I have really pushed my foot too much one day and I know I’m going to feel it the next day.

Please note the following from the website of the  American Academy of Family Physicians :

The use of anti-inflammatory drugs in chronic inflammatory diseases is somewhat controversial. (1,17) Eleven percent of the patients in one study (3) cited NSAIDs as the treatment that worked best for them, and 79 percent of the patients using NSAIDs were in the successfully treated group. (3) Advantages of NSAIDs are the acceptability of the use of an oral medication as a treatment modality by many patients, the convenience and ease of administration, and the acceptance by medical insurance. Disadvantages of NSAIDs are many, including the risk of gastrointestinal bleeding, gastric pain and renal damage.(18) 

WHAT NEXT?

Farther down the road, other steps can include cortisone shots and in a few cases, surgery. Please read on as there are pros and cons for some of the options.

Cortisone Shots

Many doctors and podiatrists recommend or at least offer cortisone shots to their patients with plantar fasciitis. Mine did, but I had read enough to be concerned about how helpful cortisone would really be long term and suggested to her that we wait and see if things didn’t improve with the other treatments I am suggesting in this blog, which are helping, but granted, very slowly. At this point, I don’t think I will need a shot, but am open to the possibility if things get significantly worse for any reason. One problem with these shots is that they reportedly hurt like heck, but more importantly, to me anyway, is that cortisone shots carry a decent amount of risk.

If you are considering a shot, please read Phys. Ed: Do Cortisone Shots Actually Make Things Worse?  from an October 27, 2010 post on the New York Times online.

And this, again from the website of the American Academy of Family Physicians :

Corticosteroid injections, like iontophoresis, have the greatest benefit if administered early in the course of the disease but, because of the associated risks, they are usually reserved for recalcitrant cases. A plain radiograph of the foot or calcaneus should always be obtained before injecting steroids to ensure that the cause of pain is not a tumor. Steroids can be injected via plantar or medial approaches with or without ultrasound guidance. Studies (20,21) have found steroid treatments to have a success rate of 70 percent or better.

Potential risks include rupture of the plantar fascia and fat pad atrophy. (22,23) Rupture of the plantar fascia was found in almost 10 percent of patients after plantar fascia injection in one series. (22) Long-term sequelae of plantar fascia rupture were found in approximately one half of the patients with plantar fascia rupture, with longitudinal arch strain accounting for more than one half of the chronic complications. (22,23) On the other hand, one author (24) found that most individuals with rupture of the plantar fascia had resolution of symptoms with rest and rehabilitation.

The WebMD site has this to say:

Your doctor may suggest corticosteroid shots if you have tried nonsurgical treatment for several weeks without success.¹ Shots can relieve pain, but the relief is often short-term. Also, the shots themselves can be painful, and repeated shots can damage the heel pad and the plantar fascia.

Surgery

By all accounts, very few people need surgery for plantar fasciitis, as the great majority can resolve their problems within a year without it. If you are considering it, of course first consult your podiatrist. You might also have a look at WebMD’s feature on Plantar Fasciitis: Should I Have Surgery for Heel Pain?

Action Items

• In the early stages of plantar fasciitis, talk to your doctor and/or podiatrist about the use of over the counter or prescription level anti-inflammatory drugs like ibuprofen, along with your resting, icing and stretching regimens.
• If your foot is not responding to rest, icing and anti-inflammatories in the early stages, talk to your doc about a cortisone shot. But please do your research first as this really is not for everyone. 
• Consider surgery only as a last resort when all else fails.

A lot of us with plantar fasciitis wear shoes that contribute to our pain, and we may need to get some inserts and shoes for plantar fasciitis before we can heal.

Normally, I hate any kind of shopping but once getting diagnosed with plantar fasciitis, I was desperate for my feet to feel better and went on a shoe shopping extravaganza.

Here are the shoes I bought that are helping me:

You can click on the links under the images above if you want to check them out on Zappos (an online shoe store with a huge selection and free shipping both ways).

Disclosure: Heel Health gets a small commission if you purchase these shoes. The price to you is the same 🙂

I know of these versions for men:

• Brooks – Adrenaline GTS 13 (White/Obsidian/Black/Olympic/Silver) – Footwear

  

• ECCO Sport – Yucatan Sandal (Bison/Black/Black) – Footwear

  

• Brooks – Addiction 10 (Dark Denim/Primer/Grey/Silver/White) – Footwear

  

Keep in mind that these shoes are helpful for my particular situation, which includes: plantar fasciitis, slightly low arches, overpronation, and feet that are a bit narrow. Many podiatrists would probably recommend that you not wear slippers, flip flops or sandals at all if you have plantar fasciitis, but I found that there were times in real life that I needed them.

What to look for in a shoe for plantar fasciitis:

• A very stable mid-section, meaning basically the middle third of the length of the shoe. If you grab the toe and heel of the shoe and try to bend it, the whole middle and heel section of the shoe should stay stiff. It’s okay if the toe section bends up a bit, but not after the area where the ball of your foot goes.
• A bit of a heel cup to stabilize the motion of the foot. In the examples below, the slippers, sports sandals, and flip flops and especially the Mephisto Hannel sandals have a nice little heel cup integrated into the shoe. The Brooks running shoes have a heel cup formed by my inserts.
• A little bit of a heel, but not too much. (In the shoes below, the Brooks Adrenaline Running Shoes are a pretty good example.) There is a whole school of thought about “earth shoe” type of shoes and the MTB types and the finger running shoes, which we can explore together, but for now the conventional thinking is in favor of a little bit of heel.
• Usually, an insert that you can remove. Very rarely do the inserts that come in shoes work for those of us with heel problems, so best if you can remove the ones that come with the shoe, except of course for slippers or sandals.
• A wide toe box, to give the toes room to spread out. I’m not sure why this is important, honestly, but I think, for now, it is for stability. I will research this further.
• A bit of cushion. Actually no one recommended this to me, but especially when my feet were super tender in the early stages of my heel problem, shoes with a little bit of soft bottom felt a million times better than others. For that reason, I actually only wore the Brooks and the Orthoheel slippers for almost a month because those two felt the best when my feet were really hurting.

What are the best shoes for your case of plantar fasciitis?

To get the best shoes for you I recommend that you:

• Above all, consult a podiatrist to get a proper diagnosis of your condition.
• Get a shoe consultation to learn more about your particular case and recommend a good shoe. 
• Once you have a medical diagnosis, and an assessment of your arches and pronation, it can be useful to check out a very interesting online tool called OPIS, or Optimal Performance Index System, which both ranks the stability of various popular running shoes, and offers a “find your shoe” function. I strongly recommend that you only this online tool as supplement to your medical diagnosis and in-person consultation. It would be easy to make very wrong assumptions otherwise. (We do not get any commission from OPIS, it just seems to be a helpful tool :-))

Action Items

• From your podiatrist and your shoe consultation at a good “sports medicine” or “orthotics” or “physical therapy”  shoe store, determine your personal condition  — such as, for example, plantar fasciitis and/or heel spurs, flat feet, overpronation and wide feet.
• Check out the OPIS, or Optimal Performance Index System tool to get a general sense of some good sports shoes for you.
• Get shoes for daily use that fit most if not all of the criteria in the “what you should be looking for in a shoe” section:  stable mid-section, heel cup, slight heel, removable inserts, wide toe box, and maybe a bit of cushion.

 

When the pain in your heel is up, like 5 or higher on a scale of 10, the most important thing to do is to get off your feet, and to lie down with your feet elevated as often as humanly possible. The inflammation and pain cycle need time to be allowed to chill out, which is exponentially harder when you’re on your feet.

This means:

• No unnecessary walking. For me, that meant no little stroll after dinner and no 15 walk to the burger joint I love at lunch. I literally did not walk unless I had to. (This is not so hard when your heel is really letting you know it is not happy.)
• No standing around for longer than strictly necessary. Oddly enough, standing up actually seems to be harder on my feet than walking, so standing around, in any context, whether at work or at a party or doing dishes, is not so good. If you have a job that involves standing, which I’m sure many readers do, you will need to do whatever you can to stand as little as possible when you are not on the job and, if your circumstances allow, consider taking some time off.
• No water aerobics that involves walking or jumping. (Deep water aerobics and swimming are good.)
• No running
• No biking (There are different theories about when you can start biking but definitely when the pain is acute, you just need to be off your foot.)
• No hiking

To seriously rest your foot, you won’t be able to hike or run or bike, for as long as it takes to let your foot get pretty far down the path of healing. If you are a runner, you will need to stop running for a while. I completely stopped hiking and taking long walks, my favorite forms of physical exercise, for several months. This was hands down the biggest drag of having plantar fasciitis. Not everyone will choose to stop hiking or running all together, but for me it was worth it to give my inflamed heel a chance to almost totally calm down before slowly adding back some walks and hikes.

As I write this, five months into my recovery, I do take 30 minute to 1 hour walks and light hikes, but still don’t go on the 3-4 hour (or more) hikes I have always loved. It’s a slow journey, and it’s especially challenging not to push the exercise too hard when you begin to feel better.

At the beginning, needing to lounge around with your feet up may be a pleasure for some, but tough for others. I had to do battle with my internal critic calling me a lazy a** and a big loser.

I felt embarrassed a lot, asking my husband to bring me the laundry from the dryer or to do the dishes so that I didn’t need to stand up. (He’s the main cook in our family, so was doing double duty.) I couldn’t stand lying down for very long, but I did it as often as I could stand, and for most other things, I have learned to turn everything into a sit-down task, even now when my feet are considerably better.

I put the cutting board on the kitchen table and chopped veggies over there. Pull a chair up to clean the work bench in the garage. Sit down when chatting with a friend at work instead of standing by her desk. All those little moments, and ten-minute segments, add up over the course of a day.

Action Items: 

• As you go through your day, find 3 things you can do sitting or lying down instead of standing up.
• When you’re resting at home, elevate your feet.

 

You need to get an actual diagnosis from a podiatrist, a foot doctor, to know what is wrong with your heel.

I really can’t say this strongly enough. If you’re like me, self diagnosis can totally lead you down the wrong road.

In my case, I diagnosed my own heel pain by talking by phone to my mother, who is a retired nurse, and researching on the Internet. And I was just plain wrong. I completely believed that I had heel spurs, but when I consulted a podiatrist I found that actually I don’t have heel spurs. I have plain old fashioned plantar fasciitis (PF).

In my case, I emailed my regular Kaiser doctor and asked for her advice. She sent in an order for a foot x-ray to have done before seeing the podiatrist, and this saved me a couple of extra doctors visits.

Even my regular doctor, who I love, got it wrong. When she saw the x-rays that were going to the podiatrist, my physician wrote me that I had “mild arthritis,” and said that I did not need to see the podiatrist unless I wanted to for an injection. I followed up and asked for a referral to the podiatrist, because I had a million questions, and I’m glad I did. When I saw the foot doctor, she told me that I don’t actually have “mild arthritis” either, and that normal docs often misread the x-rays that way. Instead, she said, I have plantar fasciitis.

One thing I will note is that my podiatrist offered me a shot, which I did not take. That’s a whole topic on it’s own, which I will write about soon.

Action Item

• Make an appointment with a podiatrist to get your heel problem diagnosed.