By Dr. Jackie Sutera
Plantar fasciitis is when the fascia on the bottom of the foot, which attaches to the heel bone, becomes inflamed, thick, and painful. It usually presents with symptoms of pain after periods of rest and with the first step in the morning. Plantar fasciitis is a localized skeletal inflammation that can be caused by and aggravated by:
- a sudden increase in activity
- increased body weight
- improper or old, thin, flat, worn-out shoes
- limb length discrepancy
- fat pad atrophy
- tight achilles tendons
What are some ways to treat plantar fasciitis?
Calf stretches 4 x a day (minimum) for 15 seconds at a time. Ways to do it include:
- Runners stretch against the wall,
- Downward dog yoga pose, and
- Calf stretch – This is the most important stretch to do first thing in the morning before getting out of bed. You can perform a calf stretch by extending your leg, locking your knee, and using a belt or tee shirt looped around your ball of foot to pull your foot back to stretch your calf, which also stretches your plantar fascia.
This is most important because after periods of rest, the PF and achilles tighten up and when you put weight down without warming up, it starts the inflammation cycle all over again, so super important to stretch before putting weight on it. (YouTube or Google some of these stretches).
It is very important to massage the arch, achilles and calf. This works best after shower, so everything is soft and warmed up. The arch: think of a tic tac toe board and massage going up and down the arch vertically, then across horizontally from the ball of the heel, do this for one minute and use a body oil or moisturizer and medium/deep pressure. You can also use a golf ball but remember to go up, up, up then across, across, across like you are drawing a tic tac toe board. This does provide a fascial release which can be very helpful in relieving pain and inflammation. Don’t forget to ice! You should be icing for at least 15 min at a time, at least 4 times a day.
Ensure you have the proper footwear
–Avoid being barefoot for long periods of standing and walking. Over time, the fat pad on the balls and bottom of the foot can become thin. This is called fat pad atrophy. Often, elderly people will have little to no fat on the bottom of their foot and are basically walking on skin and bone. This symptom can start to present and cause pain as early as people in their 30’s. Wearing cushioned shoes and slippers is a great way to slow down the progression of fat pad atrophy.
–No old or worn out shoes! Replace shoes as soon as they show signs of wear, even if they are “comfortable”. Old shoes force your feet to land at an abnormal angle and your body weight then gets transfered abnormally which can cause pain, inflammation, and even injury.
–Make sure your shoes and slippers have arch support like styles from Vionic. Vionic also has deep seated heel cups and cushioning, which are also key in treating and preventing Plantar fasciitis.
–Avoid platform shoes and flat shoes. If you have plantar fasciitis, a “heel to toe drop” is most comfortable, where the heel of the shoe is even slightly thicker/higher than the front of the shoe.
–Have a “shoe wardrobe”.
- Do not wear the same shoes everyday all day.
- Alternate between different styles and types depending on activities. Thinking ahead helps, just like you would think ahead for the weather.
- If it’s raining, you should use an umbrella.
- If you are going to be on your feet walking, you should have shoes made for walking that are supportive.
–Insoles, arch support and orthotics can also help people with plantar fasciitis and overpronation.
- Adding OTC insoles or buying shoes, like Vionic, which already have arch support built in is recommended to alleviate, treat and prevent symptoms of PF.
- In more severe cases that are resistant, or if the patient also has a limb length discrepancy, where one leg is or functions as if it is longer than the other- a custom molded orthotic may be made by their podiatrist. This is a prescription device that is made to go into shoes.
When To Seek Medical Help For Your Plantar Fasciitis
–Rest. This is not the time to be doing high impact workouts or walking a lot for exercise… do lower impact workouts until you get better then slowly get back into it and increase intensity. Make sure your sneakers are in good shape, and you should only use work out sneakers for workouts- don’t use the same pairs for errands, they should be separate. Workouts vs. daily walking have different wear patterns.
-If your symptoms persist or worsen after about 10 days/2 weeks of trying some home remedies, it would be a good idea to see a podiatrist for a definitive diagnosis, evaluation. They may take an Xray, or order ultrasound or MRI. Some possible treatments for more persistent and severe cases of plantar fasciitis include: cortisone injection, physical therapy, custom orthotics, prescription anti inflammatories, etc..
-In cases where all conservative treatments have failed, or if there is a tear in the fascia, surgery may be recommended and necessary.
What Products Should You Look For When Treating Plantar Fasciitis?
-OTC motrin (if you can take it) 600mg up to 3 times a day with food, this is the equivalent of prescription strength versions.
-Voltaren gel is now over the counter. It is a topical anti-inflammatory which works so nicely for foot aches. 3 times a day, the size of a quarter. rub into the foot after massage.
About the Author:
Dr. Jacqueline Sutera is a surgically trained doctor of podiatric medicine specializing in the prevention and treatment of foot pathology. She graduated from Fordham University with a Bachelor of Science degree in Biology and Philosophy. She later attended the New York College of Podiatric Medicine where she earned the degree of Doctor of Podiatric Medicine (DPM). Dr. Sutera received her postgraduate residency training at the busy level-one trauma center at Jamaica Hospital in Queens, NY and Brookdale Hospital in Brooklyn, NY. During her time there, she served as chief surgical resident and received and completed training in all aspects of podiatric medicine and surgery. Dr. Sutera is Board Certified in Foot Surgery and is a Fellow of the American College of Foot & Ankle Surgeons. She is also a proud member and spokesperson for the American Podiatric Medical Association and the New York State Podiatric Medical Society. As one of NYC’s premier podiatric physicians, she is a caring, conscientious and extremely personable doctor who prides herself on being holistic in her approach to foot care. Where other doctors treat feet only locally, she has a unique gift of being able to link some foot problems to other underlying conditions taking place in the body.