Heel Health

Recover from Plantar Fasciitis On Step at a Time

heelhealth

Heel Hurts? Start Here to Feel Better

by heelhealth

Massaging your foot

If you’re on this page, it’s likely that your heel hurts, maybe even both heels hurt. It hurts a lot to walk, maybe so bad that it keeps you awake at night. And you’re worried and scared.

I hope I can help. My name is Yolanda O’Bannon, and I’m not a doctor or any kind of medical professional, just a person like you who is recovering from a sore heel caused by plantar fasciitis and who wants to share with you what is working for me on my journey of recovery.

If you are like I was when this first happened to me, you have a bunch of questions.

Treatment – What can I do NOW to start getting better?

What is Plantar Fasciitis – Is that what I have?

Symptoms – What’s wrong with my heel? Do I have a heel spur? Plantar Fasciitis?

Causes – Why do I have this problem? Did I do something wrong?

I don’t have any magic bullets, and it’s not quick, but I would love to share with you what I have learned about what’s wrong with my heel, and how to feel better.

In a Hurry? Get a Cheat Sheet for Healing from Plantar Fasciitis

A Cheat Sheet for Healing Plantar Fasciitis

by heelhealth

If you’ve got a case of plantar fasciitis (PF), then you probably want to know how to relieve it as soon as possible.

Here’s a quick and dirty list for all the things that have helped me personally recover, plus two treatment methods I investigated and avoided, and one that by all accounts seems to help.

  • Get a real diagnosis from a podiatrist, instead of guessing what is wrong with your heel. 
  • REST! Especially at the beginning, seriously get off your feet as much as humanly possible. 
  • Find out what kind of shoes might work best with your specific condition and anatomy with a shoe consultation at a good sports injury store.
  • Get the right shoes. For a whole lot of us with PF, those are athletic shoes.
  • Get some decent arch support in your shoes with over the counter inserts or custom orthotics.
  • Start a regular routine of stretching your calf muscles, Achilles tendon and plantar fascia.
  • Consider getting a night splint to prevent re-injuring your plantar fascia. (I have not done this but from research, this appears to help quite a lot of people.)
  • Research whether you need surgery or cortisone shots. You very well may not – I haven’t, at least so far.
  • Explore herbal treatments if you are so inclined. I get great help from arnica montana cream.
  • Ice your foot in the acute phases.
  • Listen to your body, both during any acute phases and as you heal.

To get more detail on all of these methods, check out the Heel Pain Treatment page >>

 

 

What is Plantar Fasciitis?

by heelhealth

Here’s a summary of the various definitions of plantar fasciitis given by online sources that I believe are reputable. (Along with About.com and Wikipedia, which can be good but are not always correct.)

You’ll find a lot of differences in the definitions, but together they help build a useful view of our condition.

Foot anatomy showing the plantar fascia from “Cunningham’s Text-Book of Anatomy” 1914 edition.

Plantar fasciitis (PLAN-tur fas-e-I-tis) involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. Plantar fasciitis is one of the most common causes of heel pain.

From WebMD

Plantar fasciitis (say “PLAN-ter fash-ee-EYE-tus”) is the most common cause of heel pain. The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.

From Sportsinjuryclinic.net

The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot.

Plantar fasciitis can also be known as a heel spur although they are not strictly the same. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus). A heel spur can be present (through repetitive pulling of the plantar fascia) on a foot with no symptoms at all and a painful heel does not always have a heel spur present.

Plantar fasciitis is traditionally thought to be an inflammatory condition. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain and dysfunction is now thought to be degeneration of the collagen fibres close to the attachment to the calcaneus (heel bone).

From the NY Times Health Guide

Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot. This tissue is called the plantar fascia. It connects the heel bone to the toes and creates the arch of the foot.

From About.com’s Orthopedic Section

Plantar fasciitis is a common, painful foot condition. Patients, and sometimes doctors often confuse the terms plantar fasciitis and heel spurs. Plantar fasciitis refers to the syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot; a heel spur is a hook of bone that can form on the heel bone (calcaneus). About 70% of patients with plantar fasciitis have been noted to have a heel spur that can be seen on X-Ray.

From Emedicinehealth.com

The fibrous tissue that surrounds muscle and separates various tissues of the body is referred to as the fascia. The bottom, or plantar, surface of the foot has a strip of this tough tissue, referred to as the plantar fascia, stretching from the heel to the front of the bottom of the foot. This “bowstring-like” plantar fascia that stretches underneath the sole that attaches at the heel can become inflamed by disease or injury. Inflammation of the plantar fascia is referred to as plantar fasciitis.

From Elrofeet.com

Plantar fasciitis is that pain in the bottom of your foot usually felt around your heel. That pain is especially strong with the first few steps in the morning as you are getting out of bed and standing on your feet, or after sitting and resting for awhile.

The name Plantar fasciitis comes from: “Plantar” which means something that belongs to the foot, “fascia” which is a band or ligament or a connective tissue, and “itis” which means inflammation…. The band connects the heel bone to the bones of the toes. The pain is caused by injuring this tough band on the bottom of the foot.

The plantar fascia is a strong, relatively inflexible, fibrous ligament band that runs through the bottom of the foot. That band helps to keep the complex arch system of the foot, absorb shock, plays a role in body balance and in the various phases of gait. The band transmits your weight across the bottom of the foot with each step you take. When the heel of the trailing leg starts to get off the ground, the band bears tension that is approximately twice the body weight. The tension on the band at this moment is even greater if the calf muscles are not flexible enough.

… Plantar fasciitis will usually be close to the heel but it can happen anywhere along the band. If the band gets bruised or stretched, the inflammation causes the pain. In more severe cases the band can also get a little detached from the heel bone or a bony growth can form a heel spur.

Plantar fasciitis is sometimes mixed up with a heel spur although they are not the same. A heel spur is a calcium deposit that occurs where the plantar fascia is attached to the heel bone (calcaneus). In many cases a heel spur is found on a foot with no pain or other symptoms at all. And in many painful heels there is no sign for a heel spur. Heel spur and painful heal does not necessarily go together.

For many years plantar fasciitis was believed to be an inflammatory condition. It is thought now to be inaccurate because there were many cases of the disorder with no inflammatory signs observed within the fascia. The heel pain cause is now believed to be damage to the collagen fibers of the fascia. This damage, caused by stress injury, sometimes may include inflammatory cells.

From Wikipedia

Plantar fasciitis (PF) is a painful inflammatory process of the plantar fascia, the connective tissue on the sole (bottom surface) of the foot. It is often caused by overuse of the plantar fascia or arch tendon of the foot. It is a very common condition and can be difficult to treat if not looked after properly. Another common term for the affliction is “policeman’s heel”.[1]

Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis.[2] The suffix “osis” implies a pathology of chronic degeneration without inflammation. Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed. Instead, injury to the tendon is usually the result of an accumulation over time of microscopic tears at the cellular level.

The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. It has been reported that plantar fasciitis occurs in two million Americans a year and in 10% of the U.S. population over a lifetime.[3] It is commonly associated with long periods of weight bearing. Among non-athletic populations, it is associated with a high body mass index.[4] The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pains, especially among runners.

 Now that you have some idea what plantar fasciitis is, you may want to check out:

Treatment – What can I do NOW to start getting better?

Symptoms – What’s wrong with my heel? Do I have a heel spur? Plantar Fasciitis?

Causes – Why do I have this problem? Did I do something wrong?

Listening to your Body

by heelhealth

Each of us is going to have a different experience with plantar fasciitis in terms of what is happening on a daily basis. Plantar fasciitis is quite a democratic disease — striking a huge range of people.

Some of us are runners. Some like to hike and walk. Others are more stay-at-home types. We have all different kinds of body types and weights and tolerance of pain. And we have vastly different daily routines. Some have to work standing up all day. Others sit at computers most of the day and then go for a run.

In my experience, no matter who you are and what you do, your body will tell you fairly precisely how you are doing in your recovery.

Every day is different, and every day I have to trust my body to tell me what is going on. Usually, these days, I don’t have to ice my foot, but sometimes, for no apparent reason, my heel is quite sore, and out of the blue I need to ice again.

If I forget that standing around, like at a party, is one of the worse things on my feet, my foot will let me know right away, as I’m standing there. These days, I pay attention, and even if it makes me feel like an old lady, I find a chair and sit down.

Sometimes, I want to take a longer walk, so I walk, even knowing that my foot may be sore, and I ice it when I get home. If it’s quite bad, I take some ibuprofen, though I pretty much hate doing that.

Some things I do no matter how my foot is feeling, like stretching my calves and Achilles tendons multiple times a day, and before I get out of bed in the morning, and wearing good shoes, but for everything else I pay attention to what my body is telling me on a daily basis.

Action Item

  • Listen to your body, and respond!

How Long for Plantar Fasciitis to Heal?

by heelhealth

I have read that it will take at least as long to heal from plantar fasciitis as the amount of time you have had it before starting treatment. Clearly, this is in no way a scientifically viable theory, but it is a useful way to begin to think about the problem. 

Basically, the earlier you begin treatments the shorter your recovery time is likely to be. This really can’t help most of us with painful heels, who are little too far down this road already, but it can help us to spread the word among our friends and family about awareness of the symptoms of plantar fasciitis.

For the majority of us, recovery is going to be a long term process. No one with a badly sore heel wants to hear this but it is clear that it usually takes months or years to heal from plantar fasciitis.

I don’t know why this is and will explore it more in future posts — maybe because we have to use our feet so that it is hard to truly rest them, maybe because we tend to push too hard as soon as we feel a bit better, or maybe because there is a conflict of interest between wanting to be generally healthy physically and needing to rest your foot.

It is common for the pain to lessen in a few weeks, with treatment, but in my experience, it was only the acute pain that toned down after those first weeks of complete rest, multiple daily icing and stretching, ibuprofen, arch supports, etc. I have been treating my plantar fasciitis, earnestly, since June 2012, for about five months now, and things are much better than they were. I can hike a couple of hours now, and I am back to walking 30 minutes or so from work each day on hard city streets (with great shoes), but I am not “healed.” I can feel it improving very slowly, but I have the feeling this will take a year or more to really resolve, which is quite common. Unfortunately, some people keep the problem chronically, for years on end. I hope to avoid that, and to help you avoid that!

Action Item

  • Start treatments as soon as you can.
  • Be as patient as you possibly can. For the great majority of us, this is going to take a while.

Icing Plantar Fasciitis

by heelhealth

Icing plantar fasciitis is a cheap and easy treatment for the inflammation in your plantar fascia ligament. My podiatrist recommended this and I don’t think I’ve ever read a plantar fasciitis treatment plan that did not include it. I found that it helped a lot at the beginning, when my pain and swelling were more constant and acute. But I’m also using it as a sort of maintenance tool, as my foot begins to feel better and I use it more. So on days I walk the 40 minutes home from work, I ice it when I get home, and when I hiked a few miles recently, I iced it right away when I got home.

Icing Methods

When using any of the methods below, you want to avoid the risk of frostbite. So don’t let the ice come in direct contact with your skin with the methods used below, and don’t apply the ice for longer than 15 or 20 minutes at a time. Basically, ice as soon as possible after exercise or standing for longer periods, or anything that is hard on your feet.

Ice pack

Personally, I prefer using an ice pack for icing. As soon as my heel pain got really bad and I realized I had plantar fasciitis, I started icing my foot at least a couple of times a day. I’m not a fan of being cold, but this helped so much with the pain and swelling that it actually felt good to do it. I freeze one of those reusable ice packs — mine is called Tech Pack, but you could use any ice pack.  The Tech Pack has a thin paper cover, but to avoid over-cooling, I still cover it in a thin hand towel, or wear a sock,  and rest my feet on it for 20 minutes. (In the photo we didn’t cover it, to show the ice pack better.) You can ice while you’re doing something else so it doesn’t feel burdensome. I usually ice my feet while on the computer. By the way, I ice both feet even though I seem to have the problem in my left foot, as a preventative measure.

Bag of frozen peas

Some people like to use a bag of frozen peas as an ice pack, and I tried this, but preferred my ice pack in the end, only because the ice pack has developed a general shape that sort of fits my foot at this point.  Do what you like!

 

 


Frozen water bottle

One popular method is to roll your foot on a plastic water bottle full of frozen water, which gives you a double treatment of massage and icing. This sounds like such a great idea, but honestly this never worked for me. First of all, the bottle wouldn’t stay round when I froze water inside it, so it didn’t really “roll.” Also, I didn’t like any of the massage methods besides using my hand on my feet at the beginning, when they really hurt. It just hurt too much to roll anything on it. Now, when it doesn’t hurt much or at all on most days, I still don’t like the feeling of rolling a tennis ball or frozen bottle along my foot. But you should give this a try if you are inclined as a lot of people really like it and find it useful.

 

Action Items

  • When your plantar fascia is inflamed and painful, apply ice to the bottom of your feet for 15-20 minute periods, with an ice pack, bag of frozen peas or frozen water bottle. (Don’t put the ice directly on your skin.)
  • Continue to ice your foot until your plantar fasciitis resolves, anytime that you might overuse your plantar fascia ligament, when exercising or standing for longer periods.

 

 

Heel Pain Remedies

by heelhealth

Some people may wish to use herbal or natural treatments instead of or in addition to the standard medical treatments. I have used only one of these types of heel pain remedies — an arnica montana cream — but have listed a few of the better-known herbal treatments as well.

 

Arnica Montana, in Riffelberg, Zermatt, Switzerland, at 2500 m. Photo by Barbara Studer.

 

For External Use

Arnica Montana

Arnica Montana is a flowering plant extract used in herbal medicine, both as a little pill you take internally and as a topical cream or ointment. Both forms are used for bruising and inflammation. I started using the topical form – an Arnica Montana cream called Penetrex – on the strong recommendation of a friend who used to have plantar fasciitis. (Don’t you love hearing that people “used to” have plantar fasciitis? 🙂

Penetrex cream with Arnica Montana. Click image to read reviews on Amazon.

Although the results of scientific studies on the efficacy of Arnica are mixed*, I have to say I was impressed with the results. Using the Penetrex cream as directed, my foot started feeling significantly better in a few days. I guess I will never know if my foot had healed a lot just at the point I started applying the cream 2-3 times a day, or if the Arnica itself was really effective, but my foot did feel better. I’m still using it now, on a daily basis, and there are days when my feet don’t feel great, so I think it is clear that by itself the cream cannot “cure” your plantar fasciitis. However, my personal opinion is that it is a useful tool in plantar fasciitis “recovery toolkit.” I think the action of massaging the cream into the bottom of my foot is in itself useful.

One note. I used to use an Arnica Montana gel called  Arniflora, for repetitive stress problems with my arms, and I like it, but I personally prefer the Penetrex as it seems to me to be more effective. Also, I prefer the way the Penetrix feels to put on – it’s a white cream – compared to Arniflora’s clear thin gel that. But that’s just me.

 

For Internal Use

I have not tried any of the herbal remedies that one takes internally. We will explore these further, but for now, here are the names of four that some people use for pain relief:

  • Ginger
  • Turmeric
  • Bromelain (pineapple extract)
  • Willow

Also, I can’t really vouch for the websites below until further investigation, but they have a bit more information on herbal pain remedies:

 As Heel Health learns more, we will explore other options. Also, please let us know your experience with any herbal treatments.

Action Items

  • Consider adding Arnica Montana cream to your recovery regimen. With the one I use, Penetrex, I massage it into all the painful areas at the bottom of my foot once a day (after the first week, when the frequency was 2-3 times a day.)
  • If you are interested, check out some other herbal remedies, like willow, bromelain, ginger and turmeric. As always, please use all medicines, traditional or alternative, responsibly. Research what you plan to take, and speak to your doctor first.

Footnotes

* See the Memorial Sloan Kettering Cancer Center page on Arnica >>

 

Don’t Make These Mistakes if you have Heel Pain

by heelhealth

A little learning, as they say, is a dangerous thing, and my early online research about plantar fasciitis was incomplete and led me to some wrong conclusions. Plus, I just made some assumptions early on, and you know what they say about that….

Mistakes I Made that I Hope You Don’t Need to Repeat:

  • Since I had heel pain, I (mis) diagnosed myself with having a heel spur.I then leaped to the conclusion that I was ALWAYS going to have a heel spur, and bad heel pain, and there was Jack Squat that I could do about it, for the rest of my life, all eternity, the end. This was a freaky, depressing prospect, and also happened to be just plain wrong.
  • From some stuff I read online, I thought that my heel problem could not really be healed, so I thought I was pretty much resigned to a geriatric existence, without the hiking and walking that I love like life itself. I have not disproved this yet (though I am on the path), but after more research and talk to my doctor and many friends who have had plantar fasciitis (FP), I believe this is also wrong. I hope to disprove this with you, together.
  • I realized that I should not walk 1.5 hours a day on hard city streets, as I had been, but I did not understand that my feet needed serious rest, as in total and complete rest with as little walking or standing as humanly possible, for quite a long time, maybe for months. For weeks after my feet were hurting pretty badly, I kept walking 40 minutes a day or so, on concrete, in flat shoes with no arch support. And I just didn’t understand why I wasn’t getting better!!
  • Before I saw my podiatrist in the San Francisco Bay Area, I visited my parents in East Texas, and went with them in the mornings to their great community gym with a beautiful pool looking out on the mild, green East Texas landscape. At 6:30a I had the pool to myself and I thought it would be a heel healthy idea to do some water aerobics. So I proceeded to do 40 or so minutes of jumping water aerobics every day, fully expecting the throbbing pain in my feet to decrease. News flash: it didn’t 🙁 Okay, I finally thought, maybe I should just walk in the water, so I did that a few days. Note to self — that didn’t work either.
  • Before seeing the podiatrist, and not knowing that shoes are actually really important to healing this problem, I spent a couple of weeks diligently following my regular doctor’s initial advice, which was to wear Superfeet inserts. The problem was not with the inserts, but that I was wearing the blue Superfeet, which might be fine for some people, but for me don’t have enough support. The bigger problem was that I was wearing these cute little Sketcher Mary Janes with NO support except the blue Superfeet. Dumb.
  • For some reason, even after I understood that I really should not walk much at all while the plantar fascia (the connective tissue at the bottom of my foot) was inflamed, and even though I knew that people who have jobs that involve standing for many hours are predisposed to the disease, somehow my poor wee brain could not connect that me, myself and I also should not stand up for long periods. When the pain was really bad, and even now, actually, a long period is anything over 10 or 15 minutes. A week or so after I went to the foot doctor, I went to a friend’s party and stood around on the concrete patio on and off for a couple of hours. While it didn’t hurt while I was doing it, the aftermath was brutal.
  • As soon as my doctor and the Internet said I should be stretching my calf muscles, plantar fascia and Achilles tendon, I diligently started stretching, out of desperation, usually in the morning before getting out of bed and a little bit at night while watching House or Jericho or Game of Thrones on Netflix. But I’m a restless person, a little on the lazy side, and I don’t especially enjoy stretching, so I did the bare minimum until very recently. Probably less than the minimum, like if you are supposed to hold a stretch for 30 seconds, I’ll hold for 10 and call that good to go. Recently, I’m beginning to get it into my head that I actually need to stretch a lot and for as long as I can stand if I want to seriously be healed.

I truly hope you can benefit from my experience.

More importantly, now I’ll move on to treatments that are actually working for me 🙂