Heel Health

Recover from Plantar Fasciitis On Step at a Time

Treatment

A Cheat Sheet for Healing Plantar Fasciitis

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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 >>

 

Plantar Fasciitis Exercises.

 

Listening to your Body

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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.

Listening to your Body 1In 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?

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How long for plantar fasciitis to heal?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

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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

Icing Plantar Fasciitis 2Personally, 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

Icing Plantar Fasciitis 3Some 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

Icing Plantar Fasciitis. Photo © HeelHealth.com

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

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

Heel Pain Remedies 4Although 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 >>

 

Arch Support with Shoe Inserts

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Arch Support with Shoe Inserts 5

The inner soles (insoles) that come with most normal running shoes or walking shoes, are usually very thin and offer little or no arch support or heel stabilization. Lucky for us, they are often easily removable, and can be replaced with better ones. For the replacements you can either get over the counter shoe inserts or custom orthotics.

  • Over the Counter Inserts

    Of the many inserts available, I chose Superfeet because my doctor recommended them and because they are widely available. You should note that there are different kinds, all indicated by different colors, from green to pink. You can see all the choices on the Superfeet site. I wanted the most support plus the cushiest bottom and that was the green style, though I’m looking now at the women’s berry, since that seems to actually have more forefoot padding. I don’t have experience with other insoles and would welcome comments from anyone who prefers another brand.

    A helpful tip that I picked up at the shoe store was that you don’t necessarily want to buy the exact size to fit your shoe size. For example, I wear a size 10 shoe, but I was advised to buy a size 11 Superfeet insert and cut it off to fit my length. This was because the arch area of a size 11 insert fits my arch better than a size 10. Your arch might be different and fit perfectly with a size of insert that matches your shoe size. This is the kind of thing that a good shoe consultation can really help with. I don’t know that I would know how to determine the right one on my own.

    One thing you should know is that the inserts definitely feel uncomfortable and all wrong at first, like there is a big, hard lump in your arch. It only took a while for me to get used to it, and there is no doubt in my mind that the insert really helps my feet feel better over all. My Superfeet run from $30 to $40 U.S..  I have two pair of the green type, so that I don’t have to switch out the insoles on all my shoes, which is a big pain.

  • Custom Orthotics

    You may prefer to get custom orthotics — inserts which are custom built to support and stabilize your feet. These are often available at the same stores you can get your shoe consultation, or perhaps through your health care provider. I see that the Superfeet site also offers some sort of custom service at designated store.

    Though I would love to, I have not used custom orthotics yet, mostly because I am still too cheap to shell out the bigger bucks needed to buy custom-made ones. (I’m not sure but I think they can run at least $400 U.S..)  Well, that plus the fact that my feet are improving with just over- the-counter inserts. And, as I understand it from my online research, it may well be that most people with PF do as well with over the counter arch supports as they do with custom orthotics.

    The main thing I am interested in at this point is having a bit more cushion under the balls of my feet, which are often sore. Although I didn’t talk to my podiatrist about this, I did talk about it at one of the shoe consultations I did, and was told that it is likely metatarsalgia caused by my tight calves. Even though I usually wear my Brooks’ sports shoes with an insert, and my heels feel generally okay with this, I feel like I could use some cushioning under the balls of my feet. I could get more cushiony inserts, but this all gets tricky, since I want the arch to still be supported.

    Since there are so many factors, I feel like I need to so more research before diving into the time and expense of custom orthotics. Meantime, if you all have experience with them, please write a comment and let me know your experience, especially about how they compare with off-the-shelf inserts like Superfeet.

Action Items

  • In consultation with your podiatrist and sports injury specialist, you need to decide if you can go with over-the-counter inserts, or if you need the more expensive custom orthotics.

Best Shoes for Plantar Fasciitis: Getting Advice with a Shoe Consultation

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Walking for a shoe consultation. Photo © HeelHealth.com.
Walking for a shoe consultation. Photo © HeelHealth.com.

 

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.

LaFoot in Berkeley, California.
LaFoot in Berkeley, California.

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.

Medical Treatment for your Heel Spur or Plantar Fasciitis

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Medical Treatment Doctor

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.