Do I need to see a doc for plantar fasciitis treatment?
October 18, 2012 10:59 PM   Subscribe

I know I have plantar fasciitis. I'm stretching and working to decrease my inflammation. Do I need to see a doc?

I have Crohn's disease and a lot of extra inflammation due to food allergies. The increase in inflammation has coincided with the development of plantar fasciitis.

I am doing stretches and using a foot roller several times a day. This worked initially but isn't sufficient anymore. Unfortunately, symptoms are getting worse instead of better, and I'm tired of limping all day. I often work sitting for an hour or so, then walk a moderate distance, which appears to be just enough time for the pain to set in again.

Is there anything a doctor can do for me other than recommend continued stretches, avoiding my food allergies, and continuing to take my immune suppressants? (NSAIDs are not an option.) I don't mind the visit but I'd rather avoid missing work to get "keep doing what you're doing" as an answer.
posted by gilsonal to Health & Fitness (25 answers total) 21 users marked this as a favorite
I am not a doctor but have had some exposure to the topic.

There are special shoes you can wear at night to keep the tendons extended. Do you sleep prone? If so, with your feet flattened on the bed or over the edge of the bed? A change in sleeping position could presumably accomplish the same objective.

There are also special pads/insoles you can wear in your shoes called Superfeet.

Those two things may or may not help.

If you are overweight, then that could also be a major factor.

A cortisone shot may provide relief (at the potential cost of momentary intense pain when given) but it's my understanding it's unlikely to provide permanent relief (I could be wrong about that though).
posted by Dansaman at 11:13 PM on October 18, 2012

I found that learning how to properly tape my feet really helps when my fasciitis is flaring up. There are a couple of videos on youtube that demonstrate some different methods you can try.
posted by platinum at 11:37 PM on October 18, 2012

Best answer: I asked my general practioner about my plantar fasciitis, and also went to a sports medicine doctor. I learned a lot more by watching YouTube videos. The doctors each recommended the standing calf stretch several times a day; it did help. The sports doctor cut a heel pad out of heavy cardboard and I put it in my shoe. It did help some to raise my heal a bit; being female, I found comfortable lowish-healed shoes pretty easily. The squishy gel heals seemed to make the pain worse; I needed something firm.

One very good thing I learned from YouTube was how to tape my foot. The taping helped a lot, I guess because it compressed the foot and limited swelling. Here's one method and another.

I bought a pair of walking shoes built for stability, and they helped a lot. My shoe was the Brooks Addiction Walker.

Another excellent thing was this boot-like contraption that kept my foot flexed while I slept or sat around. I got used to it pretty quickly.

You'll find a lot more stretches on line -- trust the ones from physical therapists. If you feel the need to consult a pro, I'd recommend a physical therapist over a doctor.

When seated, I'd flex my foot slowly and constantly to keep it from hurting once I stood up. While your foot is motionless and unflexed, it starts healing in that position. Stand up, and those healing areas tear -- big ouch.

Try really hard not to change your gait. I made the mistake of shortening my stride and not bending my ankle enough and not following through onto my toes. This resulted in an Achilles tendon injury in addition to the PF.

Feel free to send me a MeMail if you have questions.
posted by wryly at 11:39 PM on October 18, 2012 [3 favorites]

custom pediatric inserts did wonders for me. Eliminated the problem in about two weeks.

They were covered by my insurance, required reference form my doctor.

Good luck, it hurts!!!
posted by chapps at 11:49 PM on October 18, 2012

I would recommend seeing a physical therapist (you may need a prescription from your doctor to go see them). There are different causes of plantar fasciitis, and they can tailor the exercises to address whatever specific problems you have. There are also treatments that they can provide that you can't do yourself, such as ultrasound, TENS, and iontophoresis. Plus they can advise you on shoes and inserts.

If you really don't want to, or while you wait for your appointment, I would definitely try a night split (the boot-like contraption linked above), that helped me a lot. Icing is good too, you can use an ice pack (attach it to the sole of your foot with an ace bandage) or freeze a plastic bottle of water and use that as a foot roller. If you've been sitting for a while, or in the morning before you get up, stretch or massage your foot before you put any weight on it.
posted by loop at 1:58 AM on October 19, 2012

Massage therapist here. I see lots of people with plantar fasciitis and here are some thoughts:

Although plantar fasciitis ends in "itis" which would suggest it is inflammatory, the current thinking on it is that it may not be. You could Google for recent research to that effect (while ignoring, say, the Wiki entry on it). PF may be caused by improper positioning of the foot, particularly in shoes that restrict the movement of the toes. It can also be exacerbated by walking or running on hard surfaces. I've read that it can be caused by over-pronation of the foot (i.e. not enough arch support), but I've also read of people who find relief by not wearing shoes at all (so, no arch support). Go figure.

The best stretch I know of is done first thing each day before getting out of bed: loop a belt around the ball of your foot, and gently pull back, flattening the arch of your foot. Hang out there for a good long while, a minute or more, gently trying for more stretch. This stretch is better than ones where you are placing your body weight on your feet, because while the muscles are working to support your body weight, they are also tensing. Stretching while lying down gives you a better stretch.

You can get a rubber ball of an inch or an inch and a half of diameter and stand on it (try to put half your body weight on if you can), then roll it to another spot and stand on it again. Cover the entire bottom surface of your foot.

Get a massage! Professional if possible, but amateur may help as well. Massage the bottom of the foot toward the heel, with firm strokes. Massage the entire calf as well.
You can place a heating pad or microwavable beanie bag on your calf muscles. Warming the muscles will also loosen them, thus reducing the tug of the calf muscles on the achilles tendon.

If you run, you may have to take a break, possibly quite a long break. First you can try reducing the amount you run, using different shoes (or no shoes), and/or running on a softer surface (say track instead of concrete). But some people find they absolutely must take a good long break from running in order to heal.

I've read that trigger points in the tibialis anterior or soleus muscles can also play a role in plantar fasciitis, but I've never personally encountered it. If nothing else works, you could either visit a trigger point therapist, or learn about it yourself and explore your lower leg for trigger points.
posted by parrot_person at 3:13 AM on October 19, 2012 [3 favorites]

Oh, and: even though it looks like plantar fasciitis is probably not inflammatory, for the IBS... there are natural herbs and spices you can take that act as anti-inflammatories. Ginger and turmeric and hot peppers/ topical capsaicin come to mind. I recall seeing promising studies about ginger on PubMed, you could search it for gingerol if you're skeptical.

If you try the natural route, really push it. Do it every day faithfully for AT LEAST a month, preferably more. Natural remedies tend to take longer to show their effects, and many people give up too soon, possibly because they are used to taking a pill and having the effects show up right away or close to it. Try to build the changes into your routine, for example every morning you have a cup of ginger tea made with fresh ginger, and every evening you sprinkle turmeric on your food, and keep a shaker of it on the dinner table.
posted by parrot_person at 3:20 AM on October 19, 2012

I used the same taping technique in wryly's first youtube link and the pain disappeared the instant I stood up.

I'm not saying it will cure it but it will get you through the day.
posted by TWinbrook8 at 5:02 AM on October 19, 2012

I went to the podiatrist for this and xrays revealed a spur.

My doc recommended Crocs. And so now I have about six different pairs.
Also rolling a golf ball around under your foot seemed to really help.

I have not had any pain for some time. It seems as though the spongy heel prevents the spur from aggravating the tendon.
posted by AuntieRuth at 5:19 AM on October 19, 2012

Other than the passage of time, what has worked for me is to freeze a small plastic bottle of water, and use this as a roller, before and after exercise.

nthing SuperFeet, also.
posted by Danf at 5:57 AM on October 19, 2012

HTP heel inserts for my shoes is what finally helped me get my PF under control. I also did many of the same things recommended above. All helped but the heel inserts are what finally did it for me.
posted by eleslie at 6:25 AM on October 19, 2012

I don't know what your doctor will say but my GP said "rest, exercise," and offered no other treatment. A physiotherapist is be a better choice, offering specific advice plus actual treatment that can speed healing, like ultrasound and TENS and taping your foot.
posted by looli at 6:56 AM on October 19, 2012

When in doubt it is always best to see a doctor but there are things you can do if you'd rather not.

Get one of the boots to sleep in.
Stretch your foot each morning with a belt, like already suggested.
Do stretches during the day religiously.
If you can't take anti inflamatories then ice, ice and more ice. Fill a drinking bottle with water and freeze it and then use it as a roller under your foot and arch.
Tape your foot I found support hose/socks helped too.
When sitting make sure to keep your foot flexed and move and stretch it regularly, set a timer on your computer to go off every ten mins or so and do a few little stretches.

Get inserts or a good pair of shoes, I recommend a pair of crocs, no you don't have to get those ugly croc clogs there are all sorts and styles of crocs out there now a days even ones you can wear to an office and no one will know. Crocs made walking almost pain free for me when I had PF, except for the few minutes in a morning until I'd stretched and gotten them on. Once I could walk without pain I walked properly and that helped things stretch and heal faster too.
posted by wwax at 7:26 AM on October 19, 2012

I have a lot of experience with plantar fasciitis -- I'm one of the unlucky few for whom nothing else worked for my chronic case, and I had to have surgery, an endoscopic plantar fasciotomy. Don't worry, there's like a less than 5% chance that you'll end up in that situation. (Fortunately, the surgery was successful for me, as well, so even if this does happen it doesn't have to be catastrophic.)

I'll second parrot_person. Inflammation is not really the issue, so the "itis" is sort of a misnomer. The problem is that you have microtears in the soft tissue (fascia) along the arch of your foot. Soft tissue takes a lot longer to heal than a ligament or a bone. So the best thing to do is to stay off of your foot as much as possible to give it a chance to heal.

In your case, if the pain lasts for longer than a couple of weeks, I would see a podiatrist. I think custom orthotics can really help a lot. They're expensive if your insurance doesn't cover them, but it can be worth it -- they helped me for a while and who knows, I may have avoided surgery if I had gotten them sooner.

Unfortunately I found a lot of podiatrists don't really know what they're doing when it comes to treating plantar fasciitis, so don't be afraid to go to a couple docs if the first gives you the run-around.
posted by Asparagus at 7:32 AM on October 19, 2012

Best answer: I had a bad case once upon a time and between wearing Birkenstocks and strapping up my arch, things got better. For my arch strap, I wrap a piece of gauze around the arch of my foot all around. This is basically to keep the tape sticky from icking up my foot. Then I use athletic tape and follow around a couple times. Just snug. Don't want to cut off circulation but want it snug enough to keep the facia up. I also had a friend who took an empty frozen juice concentrate can, filled it with water, froze it, then used it to roll his arch and heel over it a couple times a day to keep the inflamation down. Good luck, it does get better.
posted by PJMoore at 8:13 AM on October 19, 2012

Lots of good advice here (stretching, carrying the least amount of weight as possible when walking, good foot insoles, the right kind of shoes, etc). I'd like to add one small thing that made a huge difference in my PF: loose socks. Oddly enough, wearing socks that barely touch my feet really helps. Socks that really didn't seem all that tight were making it worse.

And of course: get that inflammation under control with lots of ginger (I'm a big fan of creamy ginger turmeric tea) and whatever else works for you. Even if it's not an inflammation per se, the body takes longer to heal when it's on self-attack mode, but you must know all this already.

PS: it might last way, way more than just a few weeks.
posted by Neekee at 9:40 AM on October 19, 2012

I kept a firm ball (about 4" diameter) under my desk at work and at home and rolled my foot on it periodically during the day and evening, really stretching my heel out as I did so. The pain went away in a couple of weeks.

I also started taking fish oil regularly again which may have helped.
posted by Serene Empress Dork at 9:42 AM on October 19, 2012

Nthing the right insoles. I went to Disneyworld with plantar fasciitis. My doctor recommended Powerstep insoles for me. I had been sleeping in a boot and doing stretches to no avail and was quite nervous about what the 8-10 miles of walking every day were going to do to me. By the time I got home, walking around on those insoles every day had 95% cured my P.F. Not saying they're the right ones for you, but get something in your shoes, stat!
posted by Addlepated at 10:59 AM on October 19, 2012

I had plantar fasciitis for about 2 years so badly my feet clawed if I sat for even 5 minutes, I had no idea that it was something that could be treated for the longest time.

Podiatrist gave me 3 shots, 1 week apart in the heal of my foot. They were by far the most painful medical treatment I have ever received. BUT they cured my plantar fasciitis and I have not had a return of symptoms in 3 years with absolutely no other intervention or attention.
posted by dadici at 12:05 PM on October 19, 2012

Best answer: I had a lot of success treating my PF by using these Powerstep insoles (much more effective and cheaper than Superfeet!) combined with intense trigger point massage (self-myofascial release) on my arches and my calves. My calves were the real problem - I didn't even have any pain in my calves, only in my feet, but the source of the problem was definitely in my lower calves. I tried the leg splints at night too, but they were only helpful once I got my calf tightness under control; if you use them when your calves are still super-tight, my experience was that they just aggravate the problem.

Anyway, definitely look into self-myofascial release & trigger points. This site is really helpful - just look for the location of the pain (e.g. "plantar midfoot pain") and it will tell you where common latent trigger points for that location can be found. When I was dealing with mild PF, I found some trigger points in my calf muscles that were so tight and sore it took almost a month of massaging them every day to really work them out. Because those muscles were so tight, they weren't really functioning well so the rest of the muscles in my calves and feet had been compensating, creating even more tightness. Once I got my calf muscles worked out and back up to strength, my foot problems got a lot easier to deal with. If you get into the trigger point stuff, or want more detailed information about it, the Trigger Point Therapy Workbook is extremely helpful and has a ton of great information in it.
posted by dialetheia at 12:42 PM on October 19, 2012 [4 favorites]

Podiatrist gave me 3 shots, 1 week apart in the heal of my foot. They were by far the most painful medical treatment I have ever received. BUT they cured my plantar fasciitis and I have not had a return of symptoms in 3 years with absolutely no other intervention or attention.

That should be a last resort. If the injections are done in even slightly the wrong place, they can melt the fat pads on your feet. Try less risky (not to mention less expensive) options first. For a podiatrist to jump to steroid injections before trying anything else first should be malpractice IMO.
posted by parrot_person at 4:46 PM on October 19, 2012

Contrary to the misinformation on this thread, plantar fasciitis is a common symptom of the inflammatory spondyloarthritides, including enteropathic arthritis, the arthritis associated with Crohn's. Please ignore the people above who are uninformed about spondylitis and seek advice from your doctor. If you are not already on a TNF-alpha inhibitor for your Crohn's (Humira, Enbrel, Remicade, Simponi), they are the standard treatment for spondyloarthropathies and also, not coincidentally, help IBD as well. If you are already taking one of them, it may be that changing to a different one would help to control your arthritis symptoms as well as your GI symptoms.
posted by hydropsyche at 7:17 AM on October 20, 2012

What misinformation, pray tell? In this thread we have many people relating their personal experiences about what helped their plantar fasciitis, as well as up-to-date medical thinking about PF. Introducing another possibility the poster should look into can be done without snottily claiming that everyone else on the thread is "misinformed".
posted by parrot_person at 1:53 AM on October 27, 2012

People said repeatedly that PF is not inflammatory. Perhaps yours is not, but for many people who fit the profile of the OP, PF is absolutely inflammatory. I seriously doubt any doctor would look at a Crohn's patient with PF and not immediately investigate enteropathic arthritis.

Telling the OP that they are wrong to worry that their PF is inflammatory, because it can't be inflammatory, is dangerously bad advice.
posted by hydropsyche at 4:30 AM on October 27, 2012

Mod note: One comment deleted; please do not continue this back-and-forth here.
posted by LobsterMitten (staff) at 6:04 PM on November 24, 2012

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