Plantar Fasciitis

[John Lindsey]

Looks like my bad feet and age have caught up with me. About 3 months ago I started to to come down with this, but it has gotten worse over the past 3 weeks, due to lots of running (thanks to Uncle Sam).

My Doctor is part of an HMO and the treatment options are rather sparse. Heel cup, drugs, and rest are my current treatment. If that doesn't work, then cortisol shots, orthotics, and maybe surgery.

Well, I have done some searching on the net, and there seems to be a lot more options out there. I am strongly considering going to some other kind of doctor outside of my hmo coverage.


Does anyone have any experience with Plantar Fasciitis and budo? I suspect many of us do.

[Juan Perez]

Hi John:

I had the same problem develop shortly after Ranger School. It seemed to get worse week after week. I stopped "ruck" marching and increased my running to long distances. I also began to massage my feet often after exercise. I would, for instance put an old shaving cream can on the floor and roll my arch over it for a while. To strengthen the arch I would do an exercise where I would put a towel (or newspaper) on the ground and roll it up using my toes. Stretching was also a big thing. I also consulted a doctor about the right kind of running shoe. "New Balance" generally makes running shoes with excellent arch support. The results:

I have been training for SFAS for the last few months and just on Saturday (28 APR 01) I did a 12 mile ruck march with a 75 lb ruck and felt no pain in the arch. Nothing. I should add that I always use rigid arch support like the ones made by "Spenco". I get better results when the arch support is not so soft that it just flattens when I put weight on it. Spenco's arch support has a rigid plastic arch which is cushioned with some neoprene. It worked great! Especially for that foot march. I didn't even feel a hint of pain... well, at least not from my feet :). Take care, and good luck.

[nikkodojo]

John, I too suffer from Plantar Fasciitis. I found that my doctor was little help. He basically told me to make sure I stretch my arches regularly, take lots of ibuprofen for inflammation, and wear shoes with good arches. The doctor also recommended some gel type shoe inserts. I tried the inserts that he recommended, and they helped, but they wore-out pretty quickly (about 3 months). Considering that the inserts were rather expensive, I started looking for other alternatives.

For the last several years I have had good success with wearing high quality hiking/trekking boots (Italian made boots have worked best for me) with "Superfeet" inserts. I have been getting about 3 years of wear out of the boots, and have been replacing the inserts every 9 to 12 months.

In addition the trekking boots and inserts, I also massage my feet and apply Dit Da Jow (sp) lineament. This really helps, especially on days that I spend a lot of time on the mats barefoot.

Hope this helps.

Tom

[MarkF]

John,
Well, first is not to panic and allow surgery. It is still in the inflammation stage so any kind of anti-inflammatories which work for you (ointments, PO herbals, ibuprofen, or aspirin) generally provide relief but no cure. Rest is good medicine from any side of the isle. Sometimes underwater ultrasound has good results.

Personally, acupressure or shiatsu massage followed by acupuncture treatment has shown remarkable results. HMO docs are limited, because they don't know what else to do and cannot do some things they would like to do, and anything short of surgery should be attempted.

Plantar's fasciitis is a muscle cramp, similar to night cramps in the legs and to muscle spasms in the back.

Try anything you wish, but go to the store and by a quantity of Tonic Water. This contains Cinchona (Quinine) and I've taken that for my bad back with very quick results. It ain't called "Tonic" for nothing.

And for the Homepathy-directed, there are Homeopathic tablets which can be swallowed or placed under the tongue. Taste is terrible but you should know the results within a few seconds to a few minutes. Personally, I like the Tonic Water best, and capsules can be prescribed or bought over the counter (they were always available OTC, but recently were removed from the shelves. I've been told they are coming back so ask a pharmacist (homeo or otherwise).

Mark

[Rob Alvelais]

Hi,
I too, suffer from plantar fasciaitis.
What I did, seemed to help IMMENSELY. In fact, I have very little discomfort any more, whereas I used to be in quite a bit of pain. I couldn't even train karate.

I saw a podiatrist. He confirmed my diagnosis ;-)

For me, YMMV, he recommended a motion control shoe and gave me a prescription for orthotics, shold the shoe not do the trick. The shoe helped a lot, your podiatrist should be able to recommend some brands and models.
It still wasn't enough, so I decided to do the orthotic route. I wish I had done that earlier. I'm just about pain free! I can train again. The pain level, that I do have is on the order of a minor annoyance, that I can easily ignore, and it's getting better.

I got my orthotics from:
http://www.activefeetorthotics.com/index.html

I like them a lot and they were about half of the price that I would have paid at the brick and mortar store.


Rob

[Joseph Svinth]

I've worn orthotics for 20 years, and they resolved a number of knee and ankle problems. Shop carefully; the doctors charge between $250 and $600 for them, but they all come from the same labs.

Since your choice of footware is limited, note that orthotics fit inside your boots, and so long as you don't tell the folks running the APFT, they'll never know the difference.

BTW, the issue boot is decent footwear, but seriously consider the uninsulated Gore-Tex boot instead, as I found it gave considerable lateral support.

[Michael Becker]

I have had the problem in the past. Change your footware to good shoes or boots and avoid training shoes. My feet cleared up completely after I started wearing good quality boots instead of training shoes. Before I changed they used to hurt like hell-burning along with shooting pain.

Shell out on some Rocky boots and I can say from experience you wont regret it. Well worth the extra money and a lot more supporting that training shoes

I have read somewhere that reducing the intake of processed carbohydrates ( bread, chips, soda's,candy, etc ) and increasing protein consumption can help. I would also go along with this.

I can remember when I started school, the old fashioned teachers would not allow training shoes to be worn-not because of fashion trends ( It wasnt a big issue then compared to now ), but because it was believed that they were bad for the feet. They may have had a point.

Personally, I wear boots for any prolonged walking, and not training shoes.

[John Lindsey]

Thanks to everyone for the replies. Now, if I can find orthotics made for tabi, I will be all set. :)

[Emily]

Originally posted by John Lindsey
Thanks to everyone for the replies. Now, if I can find orthotics made for tabi, I will be all set. :)

(laughing)
I got a mild case of plantar fasciitis in my left foot after an ankle injury left me unable to stretch my calf or sole of my foot past the angle of the damaged cartilage in my ankle.

Since I'm a massage person (this was before I was practicing) I rubbed the fascia to stretch it for a couple months and have not had a problem since.

You might check out a qualified myotherapist, I recommend those who know the names Travell and Simons over those who don't.
Go here to find them:
http://www.abmp.com/
http://www.amtamassage.org/

Should you decide to try this yourself, use dry hands on a dry foot, use your thumbs and strong pressure (almost "too much") to alternately stretch the fascia below the skin in opposite lengthwise directions as well as horizontal.
Do this after a hot soak or shower, your feet will smell better and the tissue will be more pliable.

A footrub beats surgery, says I...
:-)

(ps, I do wear orthotics in my "mat shoes" because my second toe is longer than my big toe and causes probs - these orthotics are cheap and can be made out of old mouse pads and Dr. Scholls Air-Pillo insoles)

[John Lindsey]

The best treatment so far is the following:

Take a six pack of ice cold beer. But two beers flat on the floor. Roll your feet over the cans. Drink the beer. Seems to work for me, because I always feel better afterwards :).

Thanks for all the advice!

[Budo00]

Being a massage therapist also, I fully agree with Emily. I am sure there are a lot of alternative therapies out there that could do the trick also.

I specifically work on plantar fasciitis problems in my practice (amongst many other things.) I see it a LOT in runners and people with high arches.

Good luck with your feet....

Excuse me; I have to go rub my own feet now;)

Dean Nelson

[nicholas]

OH PLEASE PLEASE PLEASE TELL ME THE URLS FOR MORE INFO!!!

I cannot stand in one position for more than 1-2 minutes because of my plantar facitis. Orthotics have not done a lick of good and last year I spent about six months on crutches! I HATE this. I cannot do one tenth of the things that I used to and would give anything to make this go away. Doctors (VA doctors) just tell me to use crutches and sit down all of the time and that won't even work.

Recently I got lucky though. I discovered the new Dr. Scholls inserts. For a long time doctors have been telling me that I need a more rigid surface to help my foot. They were VERY wrong. The ONLY time that I feel no pain in my feet is when I put the Dr. Scholls inserts into a pair of Tabi. It is truly like a miracle!

Of course, you can't (well, you probably shouldn't) wear Tabi outside of the house or Dojo so I'm screwed there.

My first Reiki master had plantar facitis and gave herself Reiki treatments every day for it. After a few weeks she didn't have it anymore. I don't feel comfortable using Reiki on myself though so I can't make any claims.

Definately get the Scholls inserts and stop running if you can. You'll strip the cartillage out of your knees and hips and maybe screw up your back if you keep running with plantar facitis (lord knows that I did). Deep massage can keep the tendons from going too crazy also, if you can find someone to deep tissue massage your feet!

And PLEASE let me know where I can go on the web for more info on anything that can help!

Thanks,

Nicholas Trammell

[John Lindsey]

What about Rolfing? Is it possible to get just a foot treatment and not the whole package?

[Budo00]

From my perspective, a nice foot massage would probably help.

Do not take advice off of the internet in place of your doctor and do this all at your own risk. What works for me and my clients may not work for you. Massage therapists can not diagnose any ailments, only a doctor can. Be aware of your body and trust your gut if you think your have a more severe problem (like gout for example) get a second opinion.

Some ‘basic’ pointers for doing it your self or getting some one to do it that is not trained in massage but has good hands:

1) Smooth gliding strokes with out any lotion on a clean, warm feet (fresh out of the shower or bath is best)

2) Cross fiber friction. Do this by taking your thumbs in 2 different directions. You’re going to try to loosen the fascial tissue and other tissues in the foot. Go from top to bottom or bottom to top. Be careful because if done too intrusively, this can have a burning feeling.

3) Once the tissues of the foot is feeling looser (feeling looser for the person massaging), you can work deeper in. At this point, I would apply a little oil or lotion but not too much, you just want a nice glide. Remember: when working deeper go much slower. When applying deeper pressure, stop on each point where you feel a 'ropey' feeling. With out easing up the pressure much, you can move your fingers in a small circular motion or in a cross fiber motion.

The goal of working deeper is to hit on all of the painful points and apply enough pressure that the receiver of the massage is feeling a tolerable pain. You should notice that when pressure is applied to the ropey, painful area, if the pressure remains steady, the receiver should start to feel the pain subside, even though the person giving the massage did not ease up on his/her pressure.

4) An other way to do some treatment is to ‘walk’ with your thumbs in very tiny pressing motions all over the foot, slowly with tolerable pressure. Both parties may feel (or even hear) some crunching sounds of the lactic acid crystals and other toxins being crunched up.

Remember, the feet are at the lowest end of our gravity. All of the heavy toxins in our body that we eat, inhale and accumulate in our lifetime have a tendency of settling to the bottom of the feet. You should drink plenty of water after the massage so your body can flush out all of these toxins.

Hope this helps,

Dean Nelson

[Tami]

John,

As for getting only a certain area rolfed, it might depend on the rolfer, but mine will work only a problem area if that is your preference. I have been through the whole series plus. My rolfer is willing to work just one area, but she has found that once people discover the benefits they tend to go for the whole series:)

My husband has had problems with a slipped disk for many years. Jan said she could probably help him even if he only wanted that worked on. He was resistant to try rolfing so I paid for a visit for him for Father's Day and he went. He ended up doing the whole series.

If you have a good rolfer at your disposal I recommend you give it a try even if it is just for the feet, but all the better if you can do the whole series.

Best regards,

[Manny Aragon]

John-
Get Rolfed. Do the entire series. There is more going on in your body than what you can presently feel in your feet. If cost is an issue than you can do the series more slowly. This will give you greater longevity in budo and you will also injure yourself less than before the work. Check out this website: http://www.rolfguild.org . You will find a description of the art and also listing of practitioners. You can always call the Guild ( owner of the website) for additional info. They are more than helpful.

-A. Rolfer

[John Lindsey]

Went to the doctor again today. I got a cortisone shot in the tendon. Now, I have felt pain before but this has to be one of the WORSE kinds. OUCH!! The doc did say that the tendon was very inflamed and that the shot would help...maybe. I am still shaking...

[John Lindsey]

Sure did. I drank the whole thing.

Seriously, I had rubbed some on my feet in the morning. It left a yellow stain, so I bet the doc was wondering what the heck it was :).

The shot seems to be working.

[Lionized]

I was told by the doctor two weeks ago that I have plantar faciitis, which will stay with me for quite some time. He said I should go out and purchase a pair of orthotics ($400-500 a pop), which I knew would only mask the problem anyway. I usually take what the doctor has to say and then explore.

First of all I chucked my five year old NB runners (nice, eh?) and bought a pair of Merrell hiking shoes. Exactly what I needed; stylish and practical. Second, I went to a recommended acupuncturist (10 yrs. of experience, originally from Shanghai). She's given me four sessions plus supplied me with herbs that strengthen my musculoskeletal system. Finally, I visited a friend of mine who has a business infusing Alkaline ionic water with absorbable minerals. I started taking the Sulfur water for accelerated healing and will add others as I progress.

I would say that I am now about 90% better and impatiently looking forward to training again. Hope this helps.

[EDGordon]

Went to the doctor again today. I got a cortisone shot in the tendon. Now, I have felt pain before but this has to be one of the WORSE kinds. OUCH!! The doc did say that the tendon was very inflamed and that the shot would help...maybe. I am still shaking...

Yeah, cortisone shots hurt BAD. How is it now?
You can't do it often, it softens muscle tissue too much.

Now, on that whole Rolfing thing: A good myofascial therapist can do this too. Now that I am most of the way thru my Rolfing training (can you get some R&R in Bavaria?) and have been Rolfed twice and then some in the last two years, I get it a little better. My whole body feels about 15 years younger, and I can do things I never could. I'm not perfect (my doggone knee) but I am way better. My feet were the first thing to change.

You don't just need your plantar fascia lengthened, you need work at the VERY LEAST on your lower legs. Years of abuse thicken and shorten tissues, resulting in all kinds of major and minor pathologies.

http://www.rolf.org/ a little market-y but good info.
See also http://www.somatics.de/ .

--Emily

[Brian Owens]

...He said I should go out and purchase a pair of orthotics...which I knew would only mask the problem anyway....
Actually, orthotics do more than "mask" the problem. By providing support and changing the the angles of the forces on the foot and leg they can keep the plantar fascia from being over-stretched, which can in turn reduce the over-stretch/inflammation cycle and allow the body to start healing.

In conjunction with physical/occupational/massage therapy and/or other physiotherapeutic modalities, orthotics may be just the ticket for a large percentage of sufferers.

[Rob Gassin]

Before contemplating any treatment for plantar fasciitis, consider the following.

In most cases, if left untreated, the condition will improve within 6 to 18 months.

Despite extensive scientific studies, there is little evidence of any treatment being consistently helpful. The abstract below summarises the state of play at the moment.

The Cochrane Database of Systematic Reviews 2006 Issue 1
Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Interventions for treating plantar heel pain
Crawford F, Thomson C

Main results
Nineteen randomised trials involving 1626 participants were included. Trial quality was generally poor, and pooling of data was not conducted. All trials measured heel pain as the primary outcome. Seven trials evaluated interventions against placebo/dummy or no treatment. There was limited evidence for the effectiveness of topical corticosteroid administered by iontophoresis, i.e. using an electric current, in reducing pain. There was some evidence for the effectiveness of injected corticosteroid providing temporary relief of pain. There was conflicting evidence for the effectiveness of low energy extracorporeal shock wave therapy in reducing night pain, resting pain and pressure pain in the short term (6 and 12 weeks) and therefore its effectiveness remains equivocal. In individuals with chronic pain (longer than six months), there was limited evidence for the effectiveness of dorsiflexion night splints in reducing pain. There was no evidence to support the effectiveness of therapeutic ultrasound, low-intensity laser therapy, exposure to an electron generating device or insoles with magnetic foil. No randomised trials evaluating surgery, or radiotherapy against a randomly allocated control population were identified. There was limited evidence for the superiority of corticosteroid injections over orthotic devices.

Authors' conclusions
Although there is limited evidence for the effectiveness of local corticosteroid therapy, the effectiveness of other frequently employed treatments in altering the clinical course of plantar heel pain has not been established in randomised controlled trials.

At the moment there is limited evidence upon which to base clinical practice. Treatments that are used to reduce heel pain seem to bring only marginal gains over no treatment and control therapies such as stretching exercises. Steroid injections are a popular method of treating the condition but only seem to be useful in the short term and only to a small degree. Orthoses should be cautiously prescribed for those patients who stand for long periods; there is limited evidence that stretching exercises and heel pads are associated with better outcomes than custom made orthoses in people who stand for more than eight hours per day.

The Cochrane Collaboration is a highly respected international institution that gathers all the scientific data and endeavours to make sense of it. It's findings are highly respected by medical and non-medical colleges alike.

So my initial advice to sufferes of this condition.

1. If possible avoid, or at least decrease the triggering factor.
2. Use shock-absorbing insoles if you have to weight-bear a lot.
3. Try to lose weight if you are overweight.
4. massage your feet by rolling it on a plastic bottle.
5. Stretch the sole and calf gently.

Review in 1 month, or earlier if pain increases.

[gmanry]

I am not a doctor, nor do I play one on TV.

When I had a run in with PF, I was told to get a soup can (unopened) and put it on the floor, role your foot over it back and forth. It felt really good, and sure enough in about 2-3 weeks the symptoms vanished and have not returned.

Mine was not absolutely excrutiating though. So, your mileage may vary with this suggestion.

I still do it from time to time. It does feel good, massages the feet and stretches everything on the bottom in a gental fashion.

[mews]

the soup can/ soda bottle idea seems to work. or at least it f-e-e-e-l-s good :)

my neice, a dancer, used night splints. she said that she wasn't sure they helped her actually heal faster, but they reduced the pain when getting out of bed in the morning.

I think reduced pain is a good thing.

mew

[EDGordon]

In most cases, if left untreated, the condition will improve within 6 to 18 months.

<snip research>

Review in 1 month, or earlier if pain increases.

This is true of most things.
They said that about my knee for 20 years.

Now I'm looking at an MRI and possibly surgery, and a doc who is asking me why I didn't get sent for an MRI earlier.

That said, PF can be treated with splints and rest.

It just depends on what you have time for. Steroids can cause weakening of the tissue, and are only symptomatic treatment.

A more aggressive and long-sighted treatment can be appropriate for those who are not willing to just "cool their heels".

Treating the tightness in the entire system is a better answer, but then, I am a Rolfer and soft tissue expert (okay, talented beginner) and that's how I look at things. In absence of someone like me, heel lifts, ice, and massage with a golf ball or something, can be very helpful.

Lots of times, PF is just too much, too fast, and the body needs a rest. Mine was from an injury which kept me from stretching my Achilles tendon and had damaged the inner bones and ligaments of my foot. No real prob these days, just burns a bit on rainy days.

"When all you know how to use is a hammer, the whole world looks like a nail" (Maslow) I try to think of that whenever I think I know the Answer.

People need to know how to help themselves. They need to ask questions. This is part of an honest and conscientious health professional's job, helping people to take care of themselves and ask questions.

-Emily
(often hands out used squash or golf balls for self-treatment)

[EDGordon]

Before contemplating any treatment for plantar fasciitis, consider the following.

Despite extensive scientific studies, there is little evidence of any treatment being consistently helpful. The abstract below summarises the state of play at the moment.


More research (tripped over while researching knee stuff)

http://www.nata.org/jat/readers/archives/39.1/i1062-6050-039-01-0077.pdf

-Emily

[tsunamiflood]

-tonic water (quinine)
-rolling the soup can (prefer progresso, but whatever works)
-pulling in newspaper or towel with toes to work arch muscles
-calf stretch & heel raise - hang your heel off the edge of a stair or step to stretch, push yourself up and let yourself down to work it (calf often seems impacted by this problem too)
-increase calcium intake (yogurt or non-fat milk)
-increase potassium intake
-consider your hydration - balance fluid intake so you are never overhydrated and never underhydrated
-phase 4 orthotics (cheap alternative to expensive orthotics, and better than nothing)
-postural exercises for hip over pelvis alignment when standing still and moving
-ibuprofin 30 minutes before sleep, then elevate feet above heart until bedtime

your mileage may vary, but i think we'll all agree that it is always best to attack a problem from a lot of different angles for best results