If You Have Plantar Fasciitis, READ THIS!

"How can I help you?"

"You can fix my foot."

"What's wrong with your foot?"

"I think I have Plantar Fasciitis. It hurts near the heel and when I get up in the morning, my foot hurts a lot when it hits the floor. When I run, it hurts some too but after I finish, I have a lot of foot pain."

"How do you know you have Plantar Fasciitis?"

"Well, that's what I've been told and I kind of came to that conclusion too. From the research I did, it seems like it to me."

"So, tell me what you think it is. Plantar Fasciitis. What is it?"

"I think its when your heel gets inflamed or the tissue or stuff on the bottom of your foot is inflamed. Right?

"How long have you had this?"

"Well, let's see. I guess about two years or so."

"What have you done for your foot pain thus far?"

"I stretch it and do another stretch for my heel cord. I use ice when it's bad and take Advil. Seems to help some. Have had some massage. Tried some acupuncture too."

"Are you getting any better?"

"A little I guess. But, I still hurt a lot when I run."

"Have you tried not running?"

"Yeah. I did. But, really, I didn't notice much difference so I figured I might as well run."

"Beyond the massage and acupuncture, have you seen anyone else? Received any other type of treatment?"

"Nah. What for? Everybody says basically the same thing. Stop running, stretch, ice, try a heel lift, take these pills. I don't know. I feel like I'm just wasting my money really. No one seems to have a solution that makes sense. I've wasted a lot of time and money."

I have had that type of conversation with people, many, many times. Plantar Fasciitis is one of the most difficult foot injuries to beat. And, I believe I know why.

Have you ever been to a movie with someone and walked out saying, "Wow, what a great story!" Great movies always have great stories. The best stories are ones that keep us guessing but at the end, bring everything to a conclusion leaving you feeling good. Satisfied.

When you hear "sprained ankle", what comes to mind? Perhaps turning your foot over, landing funny on your foot, occurs with basketball frequently, swelling, ice, crutches, some type of brace? Something will be tumbling around in your head. That's because we use the phrase "sprained ankle" to define a story. An ankle sprain has a predictable story. In over 85% of ankle sprains, you injure the ligament on the outside (lateral) of your ankle. If you know the story, you will be less anxious about the injury because you know what you injured, how you injured it, what makes the injury worse, what makes it better and anything else that may be associated with it.

But, people with plantar fasciitis rarely know the story and most of what they do know is wrong. The reason Plantar Fasciitis is hard to beat is because they don't know the true story. The story they know goes something like this:

"Well, Jim, you have Plantar Fasciitis. That's inflammation of the tissue on your foot and heel and you hurt because it's inflamed. So, you'll need to stretch your foot and ankle to keep the tissue from tightening up, put ice on your foot to keep the swelling down. I'm going to write you a prescription for some medicine to bring down the inflammation. We'll get you some inserts, too. That usually helps. Now, you'll probably hurt for a while but be patient. Of course, you should stop running. Eventually, you'll get better. "

That's it.

Jim may decide to get more information on his own perhaps using the Internet but the story is the same: tissue is inflamed, stretch, ice, heel lift, inserts, etc. In fact, read what Emedicine.com has to say about Plantar Fasciitis:

"Considered a chronic inflammatory syndrome rather than a post-traumatic disorder, plantar fasciitis is common in runners and dancers who use repetitive, maximal plantarflexion of the ankle and dorsiflexion of the metatarsophalangeal joints. It is common in those who experience sudden weight gain and in overweight individuals who increase their activity level."

The biggest problem is the name "Plantar Fasciitis". What if I told you, that instead of Plantar Fasciitis, you have a torn ligament in your foot? Yikes. Torn? Are you serious? I have a torn ligament in my foot? Yep. You do because that is what happens in the misnamed and poorly told story of Plantar Fasciitis. You have torn the plantar ligament in your foot. Suddenly, it seems a bit worse somehow. Doesn't it?

The correct term or name for the story, to be consistent with other body areas (have you ever heard of a Lateral Ankle Fasciitis for an ankle sprain or a Medial Collateral Fasciitis for a Medial Collateral Ligament Sprain?), is a Plantar Ligament Sprain. A sprain is a tear in a ligament. And, as with all sprains, it is either a Grade I, II, or III. Grade I is mild, Grade II moderate and Grade III severe.

Now that we know it is a sprain, what should you do? Well, what do you do with an ankle sprain? Do you stretch an ankle sprain? Never. Do you use crutches? Yes, if you cannot walk without a limp. Do you wrap the ankle creating a graduated compression from toes to calf? Yes. Do you consult a professional for advice and rehab to prevent further injury? Yes. Do you run on a sprained ankle? Not if you're smart. Do you gradually put more weight on your foot and ankle respecting what you feel and how your foot and ankle responds? Yes.

A sprained Plantar Ligament story is not much different from an Ankle Sprain story. But, for many reasons, the Plantar Ligament Sprain has managed to become one of the worst stories in health care. Practitioners are taught the story in school or on a clinical rotation (as I was). They're told about the characteristics of Plantar Fasciitis (heel pain, hurts first thing in the morning when the foot hits the floor, starts usually from overuse), and the treatment which is largely symptom based (ice, stretch, NSAIDs, heel lifts, inserts, massage). So, practitioners learn the story, recognize it in their patients and follow the suggestions to bring the story to a conclusion. Unfortunately, just like a bad movie, this story leaves you feeling dissatisfied.

A better, more satisfying Plantar Ligament Sprain story would go something like this:

"Well, Jim, you have a Plantar Ligament Sprain. This is a tough tissue on the bottom of your foot. A sprain is a tear of this tissue and from your history and examination, I suspect it is a Grade II, which is a moderate type of tear. Right now, your ligament is inflamed which means that the tissue is very sensitive to load and motion. Inflammation is a normal healing response and there are some things you can do to help.  Ligament sprains heal the best when you keep the tissue at its ideal length, keep the area compressed with a graduated compression garment, and gradually increase the load placed on your foot. When you sleep at night, you may need a special sock or brace to keep your ligament from healing in a shortened position since your foot will tend to fall into a relaxed position allowing the ligament to shorten. You may need some additional padding in your shoes to help absorb the load. And, you will need to use crutches, probably for the next 2-3 weeks or until you feel like you can walk normally and have very little discomfort.

What will make this sprain worse and potentially turn into a chronic problem is if you place too much load on your foot too fast. This can cause your tissue to stay inflamed and become gradually weaker and weaker. So, for now, use the crutches, the special sock at night, wear the compression garment. As your tissue heals, you will have less pain and stiffness. We have other exercises for you later, but for now, we need to help your body work its way through the inflammation. Control the load, move your foot a little, and use the crutches."

This story makes sense and, it is consistent with other "Sprain" stories. If you have an ankle sprain, the first phase of recovery will sound very similar to the above. Can you see how something simple, like a Plantar Ligament Sprain, becomes a complicated and complex problem later? Because it is not viewed as a tear, the tissue is easily and rapidly overloaded leading to a chronic, low grade inflammatory state resulting in weaker and more easily damaged tissue. All because of a bad story.

Success with "Plantar Fasciitis" starts with first understanding the nature of the problem and having the correct story. From this, you will make good choices, help your body heal and go back into an active and fun life.

Get your story straight first.

Make today count.

Doug Kelsey
Author. Teacher. Therapist.

P.S. If you are a clinician who works with injured athletes and would like to learn how we work with disc and joint disease in the spine, join us for our first professional seminar in 2005 entitled "The Spine: Diagnosis and Treatment of Lumbar Degenerative Disc and Joint Disease". Come to our training facility in Austin on April 28th-29th, 2005 for this cutting edge seminar for physical therapists and athletic trainers who want simple, powerful solutions for their active clients. Learn proven examination techniques and specific drills for back pain that you can execute with confidence on Monday morning. Seating is very limited and already filling. Call Angie Francis at 512-206-0433 to sign up today.

Comments

[Lainna]

Hi Doug,
I am a 39 year old woman, in the past was a collegiatic basketball player and currently still have a little competitive edge. I have had heal pain for the last 3 months and have essentially ignored it, easing up on workouts as the pain indicated. Last week while playing basketball I completely tore my planter fascia. I saw a podiatrist and he stated that the fascia was up to 9mm. I am 5 days after injury....and I am slightly sore but feel so much better than I did prior. No morning heel pain, I wear a foot splint at night. Is this common after a rupture. Are there any precautions as I began back into exercise or any other concerns?

[Owen]

I think i have plantar fasciitis. Whenever i play football/soccer my right heel really hurts sometimes. I am very scared as i have heard it takes up to 1 year to heal. My career is on the line and i don't know what to do. Please help!

[SusanJ]

Hi Doug - I have now been suffering off and on with this for almost a decade, first the right foot, then the left. Your description of how the sprain turns into a chronic problem sounds like what happened with my left foot, the tissue stays inflamed and doesn't heal properly.

I have done everything (custom orthotics, cortisone injections, taping, stretch every morning, etc.) I have not yet had surgery, acupuncture and Extracorporeal Shock Wave Therapy (ESWT), but am considering any of them now.

As I live in England and can't consult you directly, any suggestions for how to address the chronic (vs. acute) condition would be most gratefully received, and if you have any views on the ESWT or surgery treatment? Many thanks!

[lois elston]

thanks for all the information. I have suffered with Planters Fascitis on and off for several years. What is so fustrating to me is the poor care I have recieved by my HMO and Podiatrist. I work as a nurse and most of the treatment I have recieved has been intiated by me and what I have found through the internet and through colleagues, I'm glad I'm not alone.Can I order the splints omnline? Lois

[Sharlena Kuehmichel]

I'm 17 and I plan on going to college next year for dance and today I was diagnosed with Plantar Fasciitis by my chiropractor but i had a hard time really understanding what he was saying, and like most Dr's he gave me the same mis-information. He told me that I could no longer walk barefoot, I had to buy tennis shoes or shoes that have arch supports and I could no longer wear my high-heels or flip-flops, and he gave me some stretches to do. What he didn't really explain to me is the recovery. Will I fully heal and go back to a normal foot or will I always have problems with my foot? Will I always have to wear arch-supporting shoes or will I be able to go back to wearing my heels and walking barefoot? Will I always have slight pain when I move or dance or will that pain go away? Will I ever be normal again?

[tina kay]

I am a 41year old female, 20 months ago I had my second child. Not being able to lose the excess baby weight I had some mild discomfort in my heel. I went to the podiatrist, he did a series of 4 cortisone shots, and also put me on prednisons. With the extra weight I put on from the steroids, now i live with horrible pain not only when i step on it but also just when i sit.. I am supposed to start physical therapy this week. Does this usually help.

[yoshu]

hi doctor,
i am suffering with plantar fascitiis since 2yrs ihave undergone all treatments including injections it didnt releived me from pain and im one year without walking later istarted to wear HTP heels ifelt happy and doing job as faculty in university,but my doubt can we get socks which can wear anytime.
let me know
thanks

[Rebekka R]

I have had Plantar's Fascitous for 2 years, been to two different Drs. all the same, gel heels (no relief) stretches (little relief) one year ago I had ahad a bad ear infection and was given antibiotics, I tell you my feet felt like brand new feet. I told my Dr. about this, so I could get some more antibiotics and she felt it was a fluk!! I have talked to others about this and I have heard others with Plantar's Fascitous where treated with antibiotics and were healed. Has any one experienced this too?

[samantha]

Hi I was dianosed with p.f from my doctor 2weeks ago but had the pain for about 6 months my Dr gave me Voltarene gel helps a tiny bit but in the mornings my feet are killing, actually all day its like some one is squeezing the living day lights out of my heels (yes i have it both feet) The pain is terrible.

[bobp]

This story makes perfect sense, especially the comparison to a sprained ankle.

I've been re-habbing a blown knee (torn MCL, ACL, crushed LCLs) for the last two years. As part of my program I lift regularly, typically doing 10 sets of squats with up to 225lbs. I'm a 5'11', 165lb, 49 y/o male. Out of the blue one morning after a big workout I couldn't walk. The first thing I did was to grab my crutches, stay off of the foot and ice for 24 hours. The next day I was better though I still felt mild pain. I took things relatively easy (lots of stretching during exercise) and things continued to improve. Unfortunately, while playing tennis yesterday I felt it really tear. I'm now on crutches (again), will probably get the compression sock for sleeping and continue to ice and stretch

It's pretty dull to go through another long rehab. Had I fully understood this issue I would have been much more careful after the first episode. Torn ligaments are a drag...

[Julie]

I have been suffering with Plantarfacitis for over 9 months. I have tried ice, Celebrex, Orthodics, and steriod injections. I also had 4 weeks of PT which ended in more pain and caused a Posterior Tibial Tendon rupture. I have had my foot in a cast for the last 2 weeks and have been NWB. I do not have any pain relief at allin my foot and ankle. There is so much pressure in my ankle I can't sleep some nights, and if my foot is not elivated I get muscle spasm's?

[Louise Howlett]

All these stories sound very familiar, although gentle yoga helps me start the day and supportive shoes and custom orthotics are much better than not using any support, but I am still in pain most days.
After talking to a friend studying Chinese medicine, however, I wanted to add one idea that I am looking into more. She said to eat more iron-rich foods, especially red meat, to strengthen the fascial tissues that are tearing. I am looking into whole food/nutritional answers to strengthening the ligament that doesn't want to heal. Certain parts of the body won't heal or stay strong without the proper nutrients...

[Shirley Hamm]

I have Plantar Fascitis in both feet. I was measured for orthotics. They were hard to get used to and the time that they helped me was very short. I went into a local sports store and one of the guys who worked in the shoe dept told me to but De Scholl's walking shoes and I have to but a new pair about every two months. Today, a lady came into my store and she had Z-coil shoes on, we talked and now I'm looking for a location near that I can visit to see if they will help me. I live in Everett, WA. She told me that there is a great guy in Vancover, that's a long trip but I desperate! I'll be looking for some information from you hopefully. Thank You ahead on time. Shirley.

[B Jones]

I've had plantar fasciitis for over a year. Do you think it's too late for me to try your method?
I've tried stretching, anti-inflammatories, ice, rest, corisone shots, orthotics, night splint. After 9 weeks with physical therapist (exercises, ultrasound, electrical stimulation, massage) I asked about crutches and he acted like I was crazy. I'm not overweight and exercised regularly before onset of plantar fasciitis (mainly biking, walking, weight machines). The doctors/PT have told me I have flat feet and pronate when I walk.

[Maddie]

I'm 16 and I've been having pain in my arch for about 8 months now. It started during the cross country which I've read is common. I'm very active, and always have been and am now currently in soccer and volleyball.

I've been to my school trainer, an othopedic surgeon, and apediatrist. They have diagnosed me with probably having plantar fasciitis although I don't have the common heal pain, but pain in the arch. I've tried resting, iceing, medicine, orthodix, and everything else you have talked about, but it seems like nothing will work.

The pain is getting worse. I can hardly play volleyball for 10 minutes before I have to sit out because I can't stand to be on my feet anymore. I've been sitting out of my sports for 8 months now, I can't participate in gym, and it throbbs even when I'm sitting in class. Where do I start after already enduring 8 months of pain?

[Kathleen Page]

I had surgery for tarsel tunnel. After months of getting no relief, the doctor finally decided to do an MRI. Then he also found Plantar Facitis. So we started the cortisone shots. I had six of them with no relief. Then he decided to try and kill the nerve with alcohol injections. I had 5 of them --again no relief. So after a year of complete misery he finally decided that I should have a fascia release. I had that surgery about 6 weeks ago. We both thought it would be better by now but even though it is somewhat better during the day I still have problems whenever I sit for more than a few minutes and try to get up or first thing in the morning also when getting out of bed. He just says to wait a couple of more months....Was the surgery worth it? I am definitely having doubts....

[Doug Kelsey]

Hi Mr. Doug Kelsey,
I was lucky enough to stumble upon your article dated February 20, 2005
If You Have Plantar Fascitis, READ THIS!

I am a classic example of miss information. I have gone the normal route of doctors, therapists, neurologists, acupuncture, leg braces at night, orthotics etc... Nothing worked for me. I recently thought that stretching my calfs and hamstrings would really help so I started Yoga and have been suffering. I would like to know what kind of compression socks and something to sleep with at night. I am going to get some crutches tomorrow. I always said that if i could walk on my hands for 2 months I would be cured. I would love to speak to you. I will pay for a consultation. Please, please reply for the first time in a long time someone knows what they are talking about. I have been suffering for almost 3 years.

Thanks,
Scott

***************************************************************************************************

Scott -

The socks we suggest are TED hose for compression (these are available at Walgreen's, Walmart, and other major drug stores). We typically suggest wearing these when your symptoms are more severe: your foot hurts at rest or very soon after walking on it. For sleeping, we use the Strassburg Sock (http://www.thesock.com). In terms of consultations, I am currently only conducting them in my clinic. If you would like to schedule a consult, please call 512-206-0433.

[A]

Are there good support socks to wear during the day for plantar fascitis?

[Audge]

I've been experiencing heel pain for at least 10 years on and off. I've had physical therapy, with electro wave treatment, cortisone shots which helped for about two months and then the pain returns. I have been diagnosed with plantar fascitis being the problem but I'm grasping for straws with this pain. I use custom made orthotics and several store bought orthotics and I find that it helps a little bit. However, the pain still continues and in the morning its obvious the worst. Please, help/direct what I can do next. I desparately want my full mobility back. I think my lower back is now compensating. Please advise.

[DeeAnn]

This article is exactly what I've heard for the past year. I've seen 2 different podiatrists and several doctors and I keep getting the same stories. About a month ago I pushed off my foot really fast and felt an extremely painful pop in my heel which was as painful as childbirth, for me. I had my supervisor take me to the E.R. and they saw nothing on the x-ray so guess what I was told, the same old story!!!! Imagine that!! I was off work for a few days and actually had to ASK for a doctor's note. This article has helped me a lot and is something I will be able to take to the specialist???? tomorrow.

[Stacy]

I am An emergency room nurse. I am on my feet most of my 12hr shifts. I was diagnosed with plantar facsitis a year and a half ago. I went to a podiatrist. He gave me custom orthotics which cost about $350 plus two office visits. I got no relief with the orthotics. I have tried several different shoes. I ordered night splints 2 weeks ago. I cant tell a difference yet. I just ordered heel that pain inserts off the computer. I am very frustated. My feet hurt so bad I can hardly walk at the end of my shift. I have tried stretches and ice. I would greatly appreciate any advice. I did not think the podiatrist helped me. And I wont go see him again. Can anyone recomend good shoes, inserts, treatments. I done alot of research on the internet.

[Amy]

I had plantar fasciitis 7 years ago. I did a CAM boot for 3 months- got better and even ran two marathons. After my second pregnancy my plantar fasciitis came back. It has been 18 mos now. I have been wearing a CAM boot for 3 mos and going to a physical therapist for 2 mos. I am not getting better. I work as a nurse and I have orthotics in my shoes. I need help. When will this pain end and what else can I do. I have iced, ultrasound, splint at night, and taped along with the CAM boot.

[Joan Vogel]

Hello,

My heel pain started 3 years ago and I was told I had plantar fascitis. After wearing inserts, doing exercises, ice and walking cast for a year, I received a cortisone shot which helped for about two months and then while walking on a tread mill, I felt like the bottom of my arch had fallen. MRI results showed a tear and lots of inflamation. I've been in physical therapy for 3 months but without much success. The pain is constant. What course of action should follow? Pain medication has been ineffective because it aggravates my stomach. Any help or suggestions would be greatly appreciated.

Joan

[Rhonda]

I recently had surgery for a torn tendon in my ankle. For the past 2 months I have been experiencing the symptoms of plantar fascitis, would this and the surgery have anything to do with each other?