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.