Plantar Fascitis (Read 1293 times)

I can't think of a better exercise for strengthening the foot than this: Stand in bare or stocking feet (depending on surface). Lean ever so slightly forward (You'll figure it out). Press your toes into the ground and pull yourself forward by toe power.

Interesting Conversation - I developed a case and could hardly walk - I went to my local podiatrist - We switched shoes - Added Superfeet Green inserts for about 2 weeks, and I was pain free, and still am (2 months later) - Incidently, my podiatrist writes for a local sports magazine - Here is the article he wrote - Might be helpful - might not http://www.vtsports.com/magazine/content.cfm?storyID=297 Plantar Fascitis Prevention Recently I attended a sports medicine and surgical seminar and would like to report to all of you the most up-to-date information on plantar fascitis. This debilitating condition is often misunderstood, misdiagnosed, and poorly treated. The unfortunate result is chronic athletic disability and even depression. Plantar fascitis affects runners more than participants of any other sport. Signs and Symptoms The plantar fascia is the thick connective tissue that supports the foot’s arch. It runs from the tuberosity of the calcaneus (heel) forward to the heads of the metatarsal bones (balls of the foot). In most cases, especially with runners, plantar fascitis is caused by repetitive over-pronation. Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing, as with over-pronation, can cause the fascia to become irritated or inflamed. The hallmark of plantar fiscitis is pain in the heel, which usually occurs after rest. The first step out of bed or after being seated for several hours will always be the most painful one. The pain usually dissipates partially or completely after a few steps, however, it may return after long hours of standing or activity. An active day will magnify subsequent “after rest” symptoms. Chronic plantar fascitis may produce pain beginning in the heel but extending through the entire bottom surface of the foot. It will often result in compensating gait patterns, which could cause Achilles tendonitis or knee pain. Walking with bare feet will exacerbate symptoms, and it is not unusual for athletes to express that they feel greatly improved when wearing running shoes. At best, plantar fascitis is painful, at worst it is disabling. Serious attention and research addressing the cause and treatment of plantar fascitis is recent and ongoing. Current Treatment Regimens Concerning plantar fascitis, the depth of understanding in the medical community at large still leaves room for improvement. For this reason, I feel it is important that the problem be treated by professionals who commonly see and care for plantar fascitis in their practices. Confusion exists about treatment, mainly because of early responses to treatments that do not address the root cause of the problem. Rest is a good example. Rest will always make the condition feel better, however, if the problem of faulty biomechanics is not addressed, symptoms will quickly return as activity is increased. Pain blocking drugs fit in the same category. The use of oral steroid drugs will create reduced symptoms, but the treatment fails when dosing is completed and activity resumes. There is no reasonable indication for taking oral steroids for plantar fascitis. This medication’s associated risks grossly outweigh any possible outcome of treatment. Non-steroidal anti-inflammatory medications may have some beneficial affect, but neither will they alter the biomechanical causes of the problem. Nor will night splints, which usually help control the early morning painful symptoms, but fail to solve the problems on a long-term basis. Evidence continues to rise against the use of steroid injections as they can weaken the soft tissue structures that make up the plantar fascia. Literature, however, still supports the use of injection therapy in those cases that are complicated with bursitis on the plantar aspect of the heel bone or the entrapment and compression of the nerves that pass though this area. Steroid injection may be the most common form of early treatment of plantar fascitis, however, it should be used judiciously. Massage therapy, ultra-sound, and acupuncture all may offer temporary relief, but they do not address the cause of plantar fascitis. Within the past few years there has been a growing popularity in the use of shock wave therapy. When this first arrived on the medical scene it did appear to be an answer to disabling plantar fascitis. Now that the dust has settled and numerous scientific-based studies have been conducted, the evidence gathered does not support treatment or cost. Evidence-based medicine are key words to building treatment programs, and shock wave treatment has failed to pass the test. In the same vein, radio frequency surgery has yet to have enough clinical exposure or studies to determine its usefulness for plantar fascitis. The most current entry into the treatment regimen programs is cryosurgery and as with radio frequency, the jury is still deliberating. Successful Treatments Study after study demonstrates that conservative therapy consisting of a biomechanical examination, gait studies, and x-rays that establish an individual’s biomechanical and functional profile will result in recommendations for supportive shoes. However, sometimes footwear alone will not solve the problem. This often leads to the recommendation for orthotics. Combining proper shoes with functional orthotics can produce excellent results up to 85 percent of the time. Success depends first on the knowledge of footwear and then the combination of footwear and orthotics. For this reason I feel the need to emphasize that plantar fascitis should be treated by professionals who are accustomed to seeing the problem. When conservative treatment with shoes and/or orthotics fails, surgical intervention is indicated. Plantar fascitomy offers the most successful outcomes. The plantar fascia is composed of three distinct bands and preservation of the most lateral band is necessary to the optimal outcome. The bands can be easily identified with endoscopic surgery, and for this reason I would recommend only endoscopic procedures. If you have been told that surgery is indicated for treatment of chronic plantar fascitis, ask these two critical questions: Can the procedure be done endoscopically? How many times has the surgeon performed endoscopic plantar fascitomy? If the answer is yes to the first, and the surgeon has performed the procedure numerous times, you should feel confident in going forward with the surgery. Robert Rinaldi is a podiatrist and a podiatric surgeon at Gifford Medical Center in Randolph, VT. He is a fellow and a founding member of the American Academy of Podiatric Sports Medicine and a consultant to the Dartmouth College Cross-Country and Track teams. He is a former nationally ranked long-distance runner, having completed 25 world-class marathons. You may reach him at Gifford Sports Medicine and Surgery Clinics, 802-728-2490 or rrinaldi@giffordmed.org.

I had it for almost 8 months before I was able to get rid of it. Had to actually go to a podiatrist and get physical therapy for about 1 month. I had to do the strengthening and stretching thing, and this did help. But the thing that really helped, I believe, was the massage therapy I received while doing PT. I will first tell you that it hurts like hell (I almost puked during one PT session), but I strongly think this is what finally got me through this. You can do the same thing at home by rolling your arch over a tennis or golf ball. I would actually stand and put almost full pressure on it. Again, it hurts but it effective. Just be sure to ice your foot afterwards. Another thing that helped was a night splint prescribed by my Dr. Kept my arch flexed during the night. Foot was more loose in the morning (before I started treatment I had to hop to the bathroom in the morning the pain was so bad). Good luck!

On the recommendation of our own Jgoldsborough, resident shoe expert, I tried the Superfeet. The girl at Fleet Feet had tried to talk me into them, and I'd balked. After almost 10 months of dealing with PF, nothing much helped. In ONE week, those Superfeet inserts have almost entirely eliminated the problem. It's like a freakin' miracle. I've either been in pain every morning or run in pain for months and months ... after one week, it's almost all gone. I just ran 2 60 mile weeks in a row, and my feet feel human for the first time since April. I swear, I don't own stock in the company. But I may have to buy some.

Ok, I have to try these. Nothing else is working. Do you use them only in your running shoes? Or do you move them around to whatever shoes you are wearing?

I had a bout of PF about this time last year. My wife is a PT so she gave me a program, here's what I did: - Iced my feet in a tub of ice water a couple times a day - Stretched my achilles (very tight calves was a contributing factor in mine, I think) - Stretched my tib anterior (front of the lower leg) - Cut my running mileage back by about 50% for two weeks - Only ran in the evening, after the PF had a chance to loosen up through the day. I started reading up on PF a lot and looking through the ultra list archives to see what's worked for others. People (and societies) who go barefoot a lot seem to have less issues with foot proplems, so I figured I'd give it a try... nothing to lose at this point. My feet were very weak and the intrinsic muscles and tendons leading to my toes were EXTREMELY tight... I couldn't move my toes AT ALL when I started doing this... not one bit. I figured this weakness and tightness in the foot intrinsics probably were a major contributing factor, since there was very little flex anywhere in my foot. After the condition started to clear up I went completely against my wife's (PT's) advice and started walking barefoot. I bought some Vibram FiveFingers and started walking the dog a for 2-3 miles every other night while wearing them. After a few weeks I started to incorporate some light running on grass while wearing them. I also bought some Inov-8 trail shoes w/ a very low heel (similar to the Nike Free shoes). I ran trails in these 1-2 times a week to stretch the achilles and work the foot intrinsics more. Long story short, that cleared up my PF completely and it hasn't come back at all. In the last 12 months I've more than doubled my training mileage without suffering a recurrence. Your results may vary, but it's a pretty cheap experiment... don't have to buy anything to walk barefoot! (Although the FiveFingers are nice in case you step on glass or rocks). One thing I'd caution: It's probably best to resolve (or at least nearly resolve) your PF before starting a barefoot regimen. Best of luck, it's an awful condition. - Chris