February 4th, 2011

Every day I speak with customers and patients searching for solutions to manage the pain in their heels or arches of their feet.

Plantar Fasciitis. A couple of words that make those who've experienced it say: OUCH!
One estimate puts the number of affected Americans at approximately 2 million annually.[1]

There is hope! It is rare that I can't find a way to make you more comfortable and better able to go about your daily life without constantly thinking about your feet and whether they will limit what you want to do.

Plantar fasciitis (Plan-tar Fash-ee-eye-tiss), commonly called "heel pain syndrome" or "heel spur syndrome", is a medical term used to describe the common and sometimes debilitating foot condition characterized by acute discomfort under the heel or in the arch when standing or walking.  The Plantar Fascia is a thick band of connective tissue that provides support for the soft tissue that makes up the arches of the feet. Plantar fasciitis describes damage to this connective tissue and may include inflammation of the surrounding soft tissue on the bottom or sides of the foot during the initial acute phase of the injury. Plantar fasciitis can be the result of overuse when activity level or duration of activity is suddenly increased as when beginning a new exercise regimen, a rapid weight increase or brought on by biomechanical factors that allow an abnormal amount of pronation in the feet while walking or running. Age can also play a role, as the connective tissues can degrade over the years into a condition called Plantar fasciopathy (more on that in a future post).

Some symptoms of Plantar Fasciitis?
    •    Pain in the heel or arch  first thing in the morning or after periods of extended rest
    •    Persistent sharp pain under the heel
    •    Pulling or tearing sensations along the inside arch of the foot
    •    Pain is reduced after the plantar fascia has been stretched out or massaged

The pain from plantar fasciitis often changes from an intense pain under the heel to a dull, constant pain during periods of long weight bearing. You may have the feeling of walking on a pebble under your heel when walking barefooted and occasionally a burning sensation along the arch and even into the toes. Relief is often sought through softer, more cushioned shoes or inserts which can have the effect of making the symptoms worse because the added cushion does not provide support and pronation control.

Semi Rigid Arch Support

Studies have shown that the use of a good over the counter, semi-rigid arch support or a custom made foot orthotic are more likely to reduce the acute symptoms of plantar fasciitis that the use of a softer cushioned insert.[2] I see this played out regularly when bags of inserts and orthotics are presented to me as 'the ones that didn't work'. These outcasts are almost always nothing more than glorified pillows for the feet and lack the supportive value that is needed to alter the time your feet spend over-pronated. 

Replace your shoes

The insert is just part of the puzzle. Simply adding a high quality preformed insert or a prescription foot orthotic to an existing shoe may not do the trick! With excessive pronation, and extended wear prior to adding the insert, your shoes may have become misshapen toward the inside, or medial arch, and may allow yur feet to spend too much time in the pronated position even with your new insert or orthotic! A recent study on running shoes indicated that there is natural degradation of the midsole materials after 1 to 2 years even on shoes that have yet to be worn.[2]  So just because you haven't worn those running shoes frequently doesn't mean they are still in good shape. To get the best results from the insert or prescription foot orthotic, I recommend starting the therapy with a new pair of shoes when you begin wearing the insert.

Tips

You may find the pain of plantar fasciitis to be a very limiting factor in your life, but there are some relatively easy steps that can make a big difference in getting you back on your feet.


What increases your risk of developing Plantar fasciitis?                           What can you do?
  •  Wearing poorly designed footwear with little or no arch support.
  •  Wear shoes that are properly fitted and support your arches.
  • Add a good quality, firm pre-made arch support to your shoes.
  • Custom made, prescription foot orthotics have been shown to          quickly reduce the pain of Plantar Fasciitis.
  •  Walking barefoot on hard surfaces.
  • Weear a supportive sandal such as a Birkenstock, Naot or Orthaheel instead of going barefoot.
  •  Excessive weight gain.
  •  Maintain or work toward a healthy weight.
  •  Sudden increases or duration of physical activity.
  •  Strecth your toes, feet and calves prior to standing or excercising to warm up the tissue and muscles.



Take care of your feet in 2011 and get back to doing the things you want to do!

{The information presented here is for informational purposes only and is in no way intended to replace the medical advice of your doctor. If you have experienced discomfort in your feet that has lasted for longer than 3 weeks, seek the advice of a Podiatrist or Orthopedist.}

[1] Cleland JA, Abbott JH, Kidd MO, et al. Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther 2009;39(8):573–585.
[2] Asplund CA, Brown DL. The running shoe prescription: fit for performance. Phys Sportsmed 2005;33(1):17-24.

Stephen Sadler, C.Ped
Board Certified Pedorthist
InStep the Birkenstock Store, Austin, TX