How to Heal Persistent Plantar Fasciitis
You notice a sharp pain at the bottom of your foot near your heel.
You dismiss it as a minor, short-term injury that will pass after a good night’s rest, but fast-forward a few weeks later and the pain doesn’t seem to be going away.
If this sounds familiar, you may be experiencing plantar fasciitis.
You’re certainly not alone: also known as jogger’s heel, plantar fasciitis is one of the most common causes of heel pain, which will nag about 1 in 10 people in their lifetime.
What is Plantar Fasciitis?
Plantar fasciitis (also known as jogger’s heel) is one of the most common causes of heel pain.
The plantar fascia is the flat bed of tissue (ligament) connecting the heel bone to the toes and supports the arch of the foot.
If the plantar fascia is strained, it gets weak, swollen and inflamed. This causes the heel or bottom of the foot to hurt when standing or walking.
Signs and Symptoms of Platar Fasciitis
Plantar fasciitis is characterized by sharp stabbing pain in the bottom of the foot near the heel. The pain worsens by bearing weight after long periods of rest.
Individuals with plantar fasciitis often report their symptoms are most intense during their first steps after getting out of bed or after long periods of sitting.
Causes of Plantar Fasciitis:
Whether you are young or old, active or sedentary, plantar fasciitis can affect a wide range of people.
Plantar fasciitis is an overuse injury to the plantar fascia.
- Age. Plantar fasciitis is most common between the ages of 40 and 60.
- Certain types of exercise. Activities placing a lot of stress on the heel and attached tissue – such as long distance running, ballet and aerobics – can contribute to an earlier onset of plantar fasciitis.
- Faulty foot mechanics. Being flat-footed, having a high arch or abnormal pattern of walking can adversely affect the way weight is distributed when standing.
- Excess weight. Being overweight puts extra stress on the plantar fascia.
- Occupations that involve a lot of standing. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.
Ignoring plantar fasciitis may result in chronic heel pain, and in some cases if the plantar fascia continues to be overused, it can rupture.
Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling and acute pain in the sole of the foot.
Diagnosing Plantar Fasciitis
Usually no tests are necessary to diagnose plantar fasciitis. The diagnosis is made based on history and physical examination.
Your physician or podiatrist, will check your feet and watch how you stand and walk.
They will also ask questions about:
- Your past health, including illnesses or injuries
- Your symptoms, such as where the pain is and what time of day your foot hurts most
- How active you are and what types of activities you do.
Plantar Fasciitis Treatment
When considering treatment options, it is important to remember what movements cause stress on the plantar fascia.
The first is when the arch drops such as when body weight is applied to the foot. The second is during toe off or when the foot is extending on the toes when you are walking or running.
The good news is there are effective ways to treat this potentially chronic condition.
Plantar fasciitis often occurs because of injuries that happen over time. With treatment, pain will reduce in a few weeks, but it may take a few months to a year for it to resolve completely.
“Being overweight or obese, standing for prolonged periods of time, and lack of full ankle flexibility can also predispose a person to develop plantar fasciitis,” says John D. Baldea, MD, a family doctor with a specialty in sports medicine who works at Indiana University Health in Indianapolis. “People with flat feet or high arches or those who wear improper footwear can also develop plantar fasciitis easier.”
Start by giving your feet a rest. Cut back on activities that make your foot hurt and try not to walk or run on hard surfaces.
Once you see a doctor and determine that plantar fasciitis is to blame for your heel pain, you’ll probably be advised to start with a treatment combo like the one Dr. Baldea gives his patients in the short-term: rest, stretching and foot exercises, and non-steroidal anti-inflammatory drugs (like aspirin or ibuprofen).
Start by giving your feet a rest. Cut back on activities that make your foot hurt and try not to walk or run on hard surfaces.
You should also do some stretches specifically for your plantar fascia:
Fortunately, there are also some effective products you can pick up online or at the pharmacy to aid in the healing process.
Here are the products that help many plantar fasciitis sufferers find relief:
Products Which Help Plantar Fasciitis
Dr. Scholl’s Custom Fit Orthotic Inserts
For starters, boost arch support with orthotics or more appropriate footwear, Dr. Baldea advises. “I usually recommend patients go to any pharmacy or general store and try the custom-fitted Dr. Scholl’s shoe inserts,” says Dr. Baldea, who has no financial disclosures with Dr. Scholl’s.
“Most stores now have the displays with force-plates that you step on, and then it recommends the proper type of orthotic.”
Recent studies show over-the-counter foot orthotics are as effective as custom-molded ones, he adds.
You can also try Dr. Scholl’s Pain Relief Orthotics for Plantar Fasciitis (pictured above), which are specifically designed with a reinforced arch and cushy heel to stop pain. They’re available for men and women.
Triathletes, walkers, and workers alike review them highly on drscholls.com:
“These inserts are the best,” writes one buyer. “I wouldn’t know what I would do without them. These are the only ones that I would ever buy because [they] really give with your foot. It’s like walking on air.”
Dr. Scholl’s Comfort Heel Cushions
Along with some form of arch support, Dr. Baldea recommends trying these gel cups (available for men and women), which can help center the heel and unload pressure on the plantar fascia and Achilles tendon.
This pair of Comfort Heel Cushions for women has a tapered design that can fit into all types of shoes, and its massaging gel absorbs shock while you walk to ease heel pain. Better yet, Dr. Scholl’s has a money-back guarantee if they don’t work for you.
Heel That Pain Original Heel Seats
Here’s another heel support option that comes with a Seal of Acceptance from the American Podiatric Medical Association, meaning it’s been officially assessed by a committee of podiatrists to ensure it promotes foot health and does what it promises.
These flexible but durable Original Heel Seats are designed to lift the plantar fascia into proper alignment and cushion your aching heels from daily impact. And users swear by them:
“I NEED THESE for my Plantar Fasciitis,” insists one Amazon customer. “I Haven’t found anything else that works as well.”
Master of Muscle Mauler Ball
Though a frozen water bottle or golf ball also works, it’s even more convenient to have a massage ball on hand to roll out the stressed bottoms of your feet.
This best-selling mauler ball by Master of Muscle is made from dense rubber, so its spikes won’t bend as you press into it, meaning you’ll get a deep massage that will release tension in the plantar fascia.
It also has an excellent rating and hundreds of positive reviews:
“I have very flat feet and [plantar fasciitis], which means my feet are sore just about every night,” one customer writes. “The rubber spikes are awesome! You can locate specific spots instead of just surface area like the golf ball I’ve used in the past.”
The Strassburg Sock
“If patients are not responding to our more traditional conservative therapies, and have tried our prior recommendations for shoe inserts and gel heel cups, I will recommend a plantar fascia night splint or a Strassburg Sock,” Dr. Baldea says. “These devices are not as well tolerated by many patients, but I have seen good results in some cases.”
Though Dr. Baldea did not recommend a specific brand of Strassburg sock, he usually tells patients to Google what it looks like first, so they know what to expect.
The long sock, to be worn while sleeping, has a strap that extends from the toes to below the knee, where you secure it through a ring to keep your toes pulled slightly up.
This position prevents the plantar fascia from contracting while you rest. Strassburg Medical’s Strassburg Sock (pictured above) is an affordable and well-reviewed option:
“I was so skeptical, but this really worked!” writes one wearer. “Yes, it was uncomfortable sometimes, but it was worth it. It took about four weeks to cure my heel pain. Sometimes the elastic around my calf was annoying, and sometimes my toes were really uncomfortable, but I’m glad I pushed through and used it consistently.”
Plantar Fasciitis Tension Night Splints
In a randomized study to evaluate the efficacy of a tension night splint, 15 patients assigned to a Night Splint treatment protocol were cured or found significant improvement to pain, plantar fascial tenderness and/or ankle range of motion in an average of 12.5 weeks.
Upon conclusion of the study, it was determined that a tension night splint, in conjunction with Ibuprofen, stretching and heel cushions, proved effective in treating plantar fasciitis.
…15 patients assigned to a Night Splint treatment protocol were cured or found significant improvement to pain.
In another study performed by the University of Pittsburgh, three control groups of 30 persons each were set up to determine the efficacy of using either 1) only Night Splints, 2) using only Arch Supports, or 3) the use of both in treating plantar fasciitis.
It was concluded that, the use of both, a night splint and arch supports, might be a more effective treatment than the use of either individually as a sole treatment option.
Benefits Of Wearing Night Splint
Positions the foot in a 90-degree dorsiflexion, which stretches the fascia and, in many cases, relieves that striking “first step.”
Sustains stretch to the Achilles tendon and Calf muscles, which have been thought to play a role in plantar fasciitis.
The drawback to wearing a night splint, of course, is the cumbersome effect it may have on some people. It has been compared to wearing a snow boot to bed.
Those willing to stick out the protocol, however, open the potential to see definite improvements from their heel pain.
Different Types Of Night Splints
There are two primary types of splints for dealing with plantar fasciitis – the dorsal and the boot. The visible difference is that they are constructed on opposite sides of the foot.
The Dorsal splint has a hard plastic support that rides along the shin and top of the foot to keep the foot firmly in a 90-degree angle, while leaving the heel and arch free to breathe.
The Boot splint looks just as it sounds. The spine of the brace is on the back of the leg and calf and runs under the foot. It is generally a larger brace than the dorsal style.
Common Complaints With The DORSAL Brace
Design flaw causes foot slippage, thus not holding the stretch
Added pressure on the toes causes toes to tingle and/or fall asleep
Larger straps cause sweating
Common Complaints With The BOOT Brace
Large and uncomfortable
Toes go numb
Can’t walk in them if you have to get up
There does not seem to be a consensus on which type of brace is better, so you’ll have to determine which is more likely to be of benefit to you.
Recommended Night Splints
Bird and Cronin PF Night Splint
The Bird and Cronin Night Splint was designed to provide relief from the morning pains associated with plantar fasciitis. A lightweight design and slip-resistant sole adds to the benefit of keeping your foot stretched all night in a dorsiflexed position.
Pros: Relieves that “first step” morning pain – Soft padding to prevent irritation – Fits on both feet – Available in multiple sizes
Cons: Foot goes numb if strapped too tight – May be uncomfortable to sleep in – Difficult to move around in – May need to get one size up
Alpha Medical PF Night Splint – Heel and Foot Pain
Much like the Bird and Cronin, the Alpha Medical Night Splint for plantar fasciitis (Alphabrace) promises simple engineering that delivers results. Their lightweight profile, padded straps and foot breathability all provide convenience to an otherwise cumbersome sleep device.
Keeping your fascia stretched and feeling relaxed first thing in the morning, however, is why this boot is just as promising as the Bird and Cronin.
Pros: Alleviates that morning pain – Comes with optional wedge for toe support – Comfortable padding with velcro straps – Multiple size options – Fits on both feet
Cons: Foot may go numb if not strapped correctly – May be uncomfortable to get used to – Design concerns that the middle strap may not lock firmly into place
Futuro Plantar Fasciitis Sleep Support
Unlike boot braces, Futuro produces the less-bulky, dorsal-style brace for plantar fasciitis sufferers. Breathable, soft foam enhances comfort while also holding the foot in a 90-degree angle while you sleep or lounge around the house. Futuro also has an adjustable foot strap version.
Pros: Works to alleviate morning heel pain – Not as large as wearing a boot to bed – Easy on-and-off – Small enough for travel
Cons: Adjusting issues to get the right fit – May cut off circulation – Foot slippage in the brace – Takes getting used to
Active Ankle DNS Dorsal Night Splint
Like the Futuro, the DNS Active Ankle Night Splint is a dorsal-style brace, which allows it more breathability and less bulk overall. It’s constructed to hold your foot in a neutral position and provide relief from that excruciating morning heel pain.
Pros: Works as specified – Sufficient cushioning – Non-irritating – Slightly more favorable reviews vs. the Futuro foot splint
Cons: Some adjustment needed to find the optimal fit – Foot can go to sleep if too tight – May slip at night – May not be for small feet
Mars Wellness Comfort Soft Night Splint
The Comfort Soft Night Splint is just as you might imagine it to be… comfortable and soft! It’s a boot brace with plenty of padding to prevent irritability during sleep, yet has the full functionality that a posterior brace provides.
Touted as the most comfortable splint on the market, you can see why just by looking at it.
Pros: Most comfortable plantar fasciitis boot – Effective in morning pain relief – Comes with optional foot-flex wedge
Cons: Large and bulky – Might have to size down – Takes time to get used to – Hard to walk in – Velcro wears quickly
Thermoskin Night Time Relief FXT
The Thermoskin FXT night splint is hailed as a more comfortable and user-friendly version of the larger boot brace and the equally-restricting dorsal brace.
A softer profile gives this splint more of a sock feel as the material is less binding than hard plastic and pulls the toes up, much like the Strassburg Sock.
Pros: Less intrusive than a brace or larger sock for plantar fasciitis – Works in stretching fascia ligament – Small and easy to use
Cons: Material heat technology causes sweating – Pulls back on toes causing discomfort
Medical Treatments for Plantar Fasciitis
“For more severe pain that is causing a patient to limp and limit their work or recreational activities, I will recommend a steroid injection to the painful area to calm down inflammation,” Dr. Baldea says.
“This usually provides at least a few weeks of significant relief, which allows us to make more progress with the patient using conservative therapies.” If basic treatments fail, you may need formal physical therapy.
But here’s some good news:
Surgery to release tension in the plantar fascia is rarely needed, Baldea says, adding that “75 to 80 percent of plantar fasciitis cases will resolve within one year of initial diagnosis.”
The prognosis for plantar fasciitis is usually very good. Plantar fasciitis generally resolves with the conservative measures described above.
If you tend to have foot problems, you can be proactive by:
- treating any underlying associated inflammatory disease and
- wearing optimal footwear,
- picking and using some orthotic shoe inserts, and
- using a mauler ball
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