7 Things You Need to Know About Plantar Fasciitis

Plantar fasciitis is one of the most common and painful foot conditions. It is treatable but the longer you go without taking care of it, the harder it is to get back to normal. Here is a list of seven things you should know if you think you have plantar fasciitis.

  1. What is plantar fasciitis? Anatomists use plantar to refer to the sole of the foot. Fascia is a thin sheath of connective tissue that encases and connects structures in the body. The plantar fascia is located in the sole of the foot and connects the front of the foot to the heel and accommodates them to form the longitudinal arch of the foot. Basically, it is a web-like ligament that provides shock absorption and supports the arch while walking. Whenever “-itis” is added to a word it indicates inflammation. So, plantar fasciitis is inflammation of the plantar fascia.
  2. Stretch the calves! The fascia that surrounds the Achilles tendon and the calf muscles above it connect to the plantar fascia. Stretching the the calves is vital in treating plantar fasciitis. To properly stretch these muscles stand close to a wall with one leg forward and one leg back. Plant the rear heel to the ground with the knee bent. Lean forward with your hands against the wall until you feel a nice stretch in the back of your leg. It is important to perform this stretch at least once a day and to hold for longer than 30 seconds.
  3. Break up scar tissue. Plantar fasciitis occurs when there are microtears in the tissue. These tears are usually the result of repetitive stress and/or a decrease in elasticity. Age, weight, activity, nutrition, injury, and foot shape and function are all contributing factors. When tissue tears, a scar forms which is less elastic and prone to reoccurring tearing. Breaking up this scar tissue is important. To do so I recommend firmly rubbing the sole of the foot over a soft corner of a coffee table or on a frozen knobby water bottle. I will often strip the plantar fascia with my thumb on a willing, if not masochistic, patient. Massage therapists are often happy to oblige in this particular form of torture/treatment, as well.
  4. Ice your foot. Speaking of frozen water bottles, as this is an inflammatory issue, icing it will reduce the inflammation and arrest further tissue damage from this process. As mentioned above, rubbing your foot on a frozen water bottle will not only break up scar tissue but will also ice the sole of the foot. If that doesn’t take care of the inflammation it may be necessary to use an ice bucket. This is its own form of torture but quite effective. You can find more information on that here.
  5. The arch of the foot needs to be addressed. In my practice I often adjust feet. If the joints of the feet are not moving properly, it can put a strain on the plantar fascia and it can overwork the calf muscles. Sole inserts can also assist in correcting the proper mechanics of the foot and reduce the stress placed on the plantar fascia. I recommend trying a non-custom insole that has sufficient arch support and a decent heel cup. I like Superfeet that you can buy at REI or Kaiser but I am also trying out a new company that I will write a product review for if I like them. You can also get a great product from The Good Feet Store but it is an expensive product. If none of those options work, a podiatrist and some chiropractors can fit you for a custom orthotic. I have strong opinions about these and really prefer ones that correct gait. I really do not like posts that only correct the foot while standing. Unfortunately, the vast majority of orthotics are the latter.
  6. Podiatrists can help. A good podiatrist, or foot doctor, can make a big difference in difficult cases of plantar fasciitis. If you have done everything I mentioned above and you are still struggling, you made need more invasive intervention. If a podiatrist tells you to wear a boot for six weeks, I recommend getting a second opinion. This usually just means that they don’t think it is bad enough to do something more invasive and they are too busy to tell you to do more of the above. If it is severe enough, the first aggressive step is to get a cortisone injection. This is not without risk. Cortisone is very effective in reducing inflammation and can be what is needed to put the foot on a healing course. However, it also dries out tissue. As dehydration leads to a decrease in elasticity, cortisone can worsen the problem. At the very extreme, surgery is the last option. Typically the podiatric surgeon will cut the plantar fascia and release the tension placed on it. Yes, it is the last resort but there are times when it has to be done. By the way, I know some really good podiatrists in the area.
  7. Is it really plantar fasciitis? Finally, just because you have foot pain and your GP diagnosed it as plantar fasciitis doesn’t mean that is what you have. I cannot tell you how many times people have told me they have plantar fasciitis and I rub my fingers along the sole of the foot eliciting zero pain. It will absolutely be painful with tiny bumps on the sole of the foot if you have plantar fasciitis. Often times the real problem is that the foot is maladjusted. Getting it adjusted enough can remedy the problem in this case. Sometimes it is an Achilles or calf issue. In that case, stretching and massaging the calf can help. Occasionally, a heel spur is the culprit. Most people have heel spurs and they are rarely the cause. But, I have had patients where it made a huge difference to have surgery to remove them. Lastly, the heel has a fat pad that provides cushion while walking. If it gets injured it is extremely painful. There is not much but rest and maybe cortisone that will help with that.

***Photo by Imani Bahati on Unsplash

How to Treat Sprained Ankles.

Whenever I get several patients who come in with the same ailment, I always feel like the universe is telling me to write about it. When that same ailment happens to me, the hint is as subtle as a two by four to the head. Such is the case with this article.

I have had a lot of patients come in with sprained ankles lately. For me, I didn’t think it was possible to sprain my ankles anymore. The ligaments in my ankles are pretty much gone from spraining them several times playing soccer in high school and college. So much for that. I rolled it jumping on the trampoline with my kids yesterday. It usually smarts initially and that is about it. This time it continued to hurt and started swelling a little, too. So, “Doctor, heal thyself!”

Here is the protocol: First you have to remember the mnemonic PRICE. P=protect, R=rest, I=ice, C=compress, E=elevate. I stopped jumping and walked it off. I rested with it elevated. Then, I put it in an ice bucket (protocol details below). I planned on wrapping it up but it felt stable and the swelling was down when I woke up this morning so I thought I would be alright. In fact, I walked to work today and it felt just fine.

The most important thing to do if you sprain an ankle is ice it. Ice packs on an ankle are almost useless. You just don’t get enough surface contact to penetrate to the joint. If you are going to do it, be sure to leave it on for 20 minutes. However, the best way to ice the ankle is to put it in an ice bath. Here are the steps:

1.As soon as possible after a sprained ankle get a bucket big enough to fit your foot

2. Fill it with ice about 4 inches deep

3. Fill the bucket with water deep enough to reach just below the calf muscle (higher for high ankle sprains)

4. Cover the toes with a sock if needed

5. Immerse foot for 6-10 minutes until numb.

This is not exactly fun (unless you are a masochist) so, be tough. The stages of icing are intense cold followed by aching then burning then numbness. You have to get to numbness to benefit. Some people cheat a little and put on a sock covered by a baggie. This is ok as long as the sock is not too thick and there is not an air barrier in baggie. It still has to get to numb!

If you chronically sprain your ankles like I used to, you will have to rehab them. The more you sprain a joint, the worse the proprioception or the communication between the brain and the joint. In short, it becomes dull and you are much more likely to sprain it again. I recommend standing on a wobble board for several minutes each day. That will improve the proprioception and dramatically decrease the likelihood of future sprains.

Ice or Heat?

I get asked quite frequently whether to use ice or heat on an aching joint. When in doubt, use ice but use it properly. I have outlined protocols for icing below. That is not to say that there are not times when heat is appropriate, but icing is almost always beneficial if done right, whereas heat can cause problems on a new or inflamed injury.

The rule of thumb is that if the injury is acute or new within the last 6 weeks or if it is an exacerbation of an injury, use ice. Heat is good for loosening up sore muscles and stiff joints. If you need to get things moving, heating for 20 minutes can be very therapeutic. Be careful though. If you heat an inflamed joint, it will feel better while it is on but the heat will increase the inflammation and not only cause more discomfort but also prolong your healing. As a precaution, I typically recommend using heat only if you are going to be moving around (ie. never before or during bedtime). If you are going to use heat before bed, follow it up with ice. That way you won’t wake up feeling like you were hit by a train.

Icing is not as simple as just putting something cold on you for a little while. If done properly, it can be extremely beneficial. If done improperly, it will have little to no benefit. So, here are the rules to using ice properly.

1. Cover the affected area. Not using enough ice will not drive the inflammation away enough to make it worth the pain of icing. A nice big ice pack for big areas like the back, legs, and arms is critical. Conversely, for feet and hands, an ice pack might not be good at all. I usually recommend an ice bucket if the body part fits. ***I will explain those protocols below.

2. Make sure the ice penetrates. Too often, people will put a bath towel between the ice pack and the affected area. Their excuse is usually that it is too cold. They are missing the point. It is supposed to be cold! You should only use a paper towel or thin t-shirt in between.

3. Let it go numb. If the area you are icing doesn’t get numb you really haven’t done it right. When icing you should feel it get cold which should then start to burn. (Be careful not to get an actual ice burn. On rare occasion, if the ice pack is too cold and it is up against sensitive skin it can burn the skin. This shouldn’t happen with most ice packs if you have a paper towel in-between.) After the burning feeling, the area should start to ache until it goes numb. Once it is numb, you are done!

4. Never ice longer than 20 minutes. After 20 minutes the body sends out a signal that the area is developing frostbite and will send more blood to the area. As icing helps to drive blood/inflammation away, sending more blood in is a bad thing. If after 20 minutes the area never got numb, take it off and wait 40 minutes to ice again.

5. Wait 40 minutes before you can ice again. Make sure the affected area is back to regular body temperature before you shock it again with ice.

***Ice Bucket Protocol: Use an ice bucket for ankles/feet and hands/wrists. This is by far the best way to drive out inflammation from these areas.
1. Get a bucket big enough.
2. Put as much ice in it that will cover your affected extremity.
3. Fill it with water to the same level.
4. Cover fingers or toes with a sock.
5. Immerse the extremity.
6. Keep it moving gently to keep the water immediately surrounding from warming up.
7. Ice until numb (usually around 5 minutes).
8. Repeat once the limb is back to body temperature.