Plantar fasciitis progression and recovery?
August 30, 2013 12:15 AM   Subscribe

I have plantar fasciitis in my right foot. I've read about it on the web, and it feels like either everyone else is understating the pain and mobility limitations or mine is much worse than everyone else. Help me manage my expectations for my recovery.

I went to the zoo a week last Tuesday and my right foot hurt a bit after walking round all day. By Thursday evening I couldn't take a step without pain. I then rested my foot Friday through Monday - mostly lying on the sofa and only getting up to go to the bathroom or get food or drink. On Tuesday I went to the walk-in centre in town to be told by a nurse that I have plantar fasciitis. She suggested rest, cushioned shoes and gave me a printed explanation and suggested self-care treatments.

Since Tuesday, I feel it is improving slowly. I can now walk about 10-15 metres with tolerable discomfort (say 2-3 out of 10 for pain). Walking 500m to the bus stop to get to work is painful (about 4-5 out of 10) and takes 15-20 minutes resting for the pain to subside. In the evenings after work the pain doesn't subside and varies from 1 to 4, and makes it very challenging to fall asleep. After 3 hours sleep I am woken by pain, which has now extended to my calf which is very sore.

Current self-care involves walking as little as possible, wearing trail shoes outside and cushioned sandals walking in the house, soaking my feet in cold water in the evenings, heated rice bag on my calf if that is painful, and calf and foot stretches. I have randomly taken ibuprofen which doesn't appear to affect the pain.

YANMD. Does this level of pain sound normal-ish? How long should it take before I can walk further? Have you got any suggestions for improving my ability to sleep? Is there any other self-care I should try, particularly for my calf? Finally, I have no car and my (NHS) doctor's surgery is beyond my current walking distance so I'm loathe to go there unless absolutely necessary - when should I seek further medical attention and who from?
posted by plonkee to Health & Fitness (34 answers total) 18 users marked this as a favorite
Best answer: Cushioned shoes were the worst things for me when I had plantar fasciitis--it's very strange to me that they recommended it. I started wearing shoes with a lot of arch support (Danskos) and that helped immeasurably, to a point where I think I'm completely healed about 8 months later and felt relief almost immediately.

Acupuncture, especially with points done on my hands rather than my actual feet, helped a lot. Rolling your foot on a water bottle filled with ice will help with swelling. Don't overdo the calf and foot stretches because it will make things worse. What dosage of ibu are you taking? It should hopefully help with pain at a clinical dose (like 600-800 mg), though that's not to be taken every day.

Really, better shoes with a lot of support, don't strain your foot too much with the stretching (which I found exacerbated symptoms if I did it while experiencing pain), and taking time. Sorry you have to deal with this. There are a bunch of other threads on the topic here if you search for them.
posted by c'mon sea legs at 12:21 AM on August 30, 2013 [1 favorite]

Oh, and yes that amount of pain sounds normal. And manage your expectations about recovery time: while I'm sure some people get just a touch of plantar fasciitis, I and most people I know have had pretty long recovery periods.
posted by c'mon sea legs at 12:23 AM on August 30, 2013

Best answer: I agree, cushioned shoes don't necessarily seem like they would be helpful. Depends - if cushioned means extra padding/support in the arches, maybe they would. But that's pretty much what you need. Also good shoes - are you wearing crappy runners with no support? It's worth investing in good, supportive shoes.

Apart from good shoes, the single best thing for my plantar fasciitis was to do some simple stretches before getting out of bed in the morning. You sit with your legs over the edge of the bed, feet on the floor. Put one foot up on the opposite knee (eg right foot on left knee). Grasp your toes and pull them back gently so your foot and the fascia along the bottom of the foot are flexed. Hold the stretch for at least 30 seconds. If the other foot is also affected, swap feet. Ideally do it again. In practice, it may depend how much you've had to drink and how badly you need the loo in the morning.

The theory behind this is the stretching encourages your fascia's flexibility first thing after resting, and that if you can avoid pain early on, you're reducing the impact of later stresses throughout the day. It makes sense to me.

The bad news is that this will not instantly fix things. Probably a month or two before you find it making long-term difference.

Other things: opinions differ as to the usefulness of cold/heat. Personally, I think cold after immediate injury and heat for prolonged strain. You may not think anti-inflammatories are working, but they probably do help. Be careful with ibuprofen, make sure you don't take it without having eaten something first. Lower-dose anti-inflams like Voltaren are also useful.

As for the normalcy of your pain levels? YMMV, everyone has different experiences of pain. I currently have a wonky achilles tendon which is about a 5 when I stand up, but subsides to a mere 2 after walking a bit. The thing is that I have adjusted to that so now 5 feels manageable because I am used to it. 2 feels like it almost doesn't hurt at all anymore. So maybe the pain is actually 6 upon standing and 3 after walking? I don't know. Anyway, don't stress over whether it's normal, just work out whether or not you can handle it and act accordingly.
posted by Athanassiel at 12:30 AM on August 30, 2013 [2 favorites]

Forgot two of your questions: re sleeping, try taking the anti-inflammatory about half an hour before you go to bed. Might help. Also non-weight bearing activity that stretches things out is good. I actually lashed out and bought a recumbent exercise bike because I knew I wouldn't make it to the gym or similar. Stretches fascia, tendons and calf muscles without you actually putting weight on them. Also strengthens these bits, making it easier when you do have to put weight on them.

And yes, what c'mon sea legs said - no quick fixes in my experience either.
posted by Athanassiel at 12:35 AM on August 30, 2013

A friend of mine who had plantar fasciitis issues swears by sleeping in a Strassburg sock (keeps you from pointing your toes at night, so things don't tighten up as much).
posted by ktkt at 12:37 AM on August 30, 2013

Roll a tennis ball around under the arch of your foot.
posted by humboldt32 at 12:49 AM on August 30, 2013

After suffering with this for over a year I finally said "Give me the damn shot, doc!" It was the only thing that made it go away. I had done stretches, slept in the boot that kept my foot stretched, took pills, got massages, everything. I have had it twice, and both times it went away only after I got a shot of cortisone in my foot. It's not the easiest shot in the world and I had a sore bruise for a few days afterwards, but by God the plantar fasciitis went away! So...I feel your pain. See about getting some deep tissue foot massages...that can help break up the scar tissue that keeps things tight. The frozen water bottle felt good too.

But the, that is worth it's weight in gold.
posted by MultiFaceted at 1:38 AM on August 30, 2013

I had it really bad for a while. One night I went to dinner with a friend and had to excuse myself because I thought the pain was going to make me throw-up and/or pass out. I didn't go to work the next which was the first time in my life (20+ years of working) that I missed a day of work for illness/injury. The "cure", as such, was good shoes. I hadn't had a decent pair of shoes in like 20 years up to that point (always the $3/$14 shoes from Target). Now that I have really good shoes (those fancy hiking/trail type shoes) the problem in the foot has gone away. Unfortunately it migrated to my Achilles but it's not so bad (say a 1 or a 2 at worse) and only flares up some of the time (I do long 2-8 mile walks almost daily) and goes away pretty quickly.

When it was really bad the only thing that helped was to keep walking on it. If I stopped for anything more than a minute the pain would cripple me. When it was at its worst sleeping was a nightmare. While asleep if I accidentally turned my foot the wrong way the pain would wake me up. I took whatever OTC sleep medicine I could to get me through those worst couple of nights.

Pain medicine never seemed to help nor did any topical treatments. It was the shoes with padding and good support that did it and it still took time. Stretching did help some. But it took several weeks to a month before I felt it was 95% healed.

It really sucks and I hope you feel better soon. If the pain reaches the point you feel like you're going to be sick or pass-out and stays like that or happens more than once or twice then I'm guessing you'd probably need to seek serious medical help. Unfortunately I do not know what that entails (being an uninsured American means that I have to tough it out no matter what the problem is so I don't know what the actual procedures are for this issue).
posted by bfootdav at 1:54 AM on August 30, 2013

Best answer: c'mon sea legs is right that you don't want cushioning per se but arch support arch support arch support. If your trail shoes have a solid buildup under the arch they might be adequate, but I suspect they're like most running shoes and just have a thin foam insole and a fairly flat foodbed underneath. You can keep wearing them, but switch out the factory insole for something with a rigid support under the arch and a deep heel cup--Dr. Scholls is ok for right now, but hunt down spenco, superfeet green, powerstep pinnacle, or orthaheel. And either wear shoes with said orthotic insole around the house (you can swap your insoles into different shoes if you want a little variety in life) or else slip them into your slippers.

Night splints help some people, although the general opinion is that a rigid splint is more effective than the Strasbourg sock.

If you're having pain in your calf as well, you might try out trigger point massage on your calf trigger points--google plantar fasciitis trigger point massage and you will pull up several articles and some videos. For me, VERY FIRM (ow that hurts like a mutherfucker firm) massage using an electric massager on the most painful point of the heel also helped for a half-day or so. That may be the "bang your head on the wall and it feels so good when you stop" school of pain relief.

Give ibuprofen another shot, at regular rather than random intervals. 400 mg every 4-6 hours. Also try icing--a plastic water bottle in the freezer (with the lid off) makes great ice for PF--you can massage and ice at the same time.

I've had two bouts of plantar fasciitis, and to be honest your pain level sounds much worse than I ever had. In my most recent bout I tried a lot of things without much progress for 4-5 months, but then doubled up on the arch support to 1 firm + 1 cushioned insert (powerstep pinnacle or my birkenstocks which have built-in firm support as the firm base + dr scholls 3/4 length gel insert for more lift and support on top) and 4 hours of walking around like that and I was a changed woman! So that's my "1 weird trick to get rid of plantar fasciitis" for the thread.
posted by drlith at 3:16 AM on August 30, 2013 [2 favorites]

My plantar fasciitis pain was extreme (it's often comorbid with psoriatic arthritis, so I don't know if that makes a difference, but I also couldn't walk a few feet without pain in the mornings). I would echo the stretches (and naproxen) before you get out of bed, rolling on frozen water bottles, and more stretches.
posted by Pax at 4:14 AM on August 30, 2013

My wife struggled with this for a year until I talked her into a pair of Dansko clogs.

My father struggled with this for multiple years, even going so far as to have custom orthotics made, until he tried a pair of Mephistos for a month, after which he replaced all of his shoes with Mephistos.

For immediate relief, IMO, you just can't beat Dansko clogs. There's a reason they're favored by waitstaff, cooks and bartenders.
posted by slkinsey at 5:11 AM on August 30, 2013

I self-diagnosed planar, so take this for what its worth, but it took a solid 6 months or a little more for mine to go away.
posted by jpe at 5:13 AM on August 30, 2013

Try this foot taping technique. I did it with duct tape when I had a (mild) recurrence and it helped immediately.
posted by TWinbrook8 at 5:24 AM on August 30, 2013 [1 favorite]

Seconding Multifaceted. I had an outbreak so bad I hobbled to the podiatrist, and practically leaped through the ceiling when he touched my heel. He gave me a shot that took the pain away for about a week. It was a blend of a steroid, an anti-inflammatory and I think an immediate numbing agent like novocaine. He implied it was some kind of secret blend, but I bet other doctors also use it.

After the immediate relief of the injection, it took at least a month for it feel substantially better, and many months before it was almost pain free. In the meantime, I got myself a pair of supportive shoes (Saucony Trabajos, if you're interested) and a pair of Spenco Polysorb insoles, which seemed like they really helped. I stretched and rolled my foot on a ball, which provided some relief, but can't really say it reduced recovery time or prohibited a recurrence.
posted by mollweide at 5:24 AM on August 30, 2013

Better than rolling a tennis ball under your foot - chill a can of soda in the fridge until it's almost icy, and roll that under the arch and ball of your foot - cools AND stretches. Do it until your foot is aching with the cold and you just can't bear it any more.

I'm dealing with PF right now as well, and I sleep with a pillow under my calf so that my foot hangs off of the edge and the heel doesn't actually make any contact with the mattress surface. That stops me waking up in pain, after the paracetamol and the anti-inflammatory have put me to sleep!
The special socks and braces that keep your foot flat are also a good idea.

Gel insoles for sure - particularly for the heels.

Buy or rent a forearm crutch - the sort with an elbow brace. I bought mine at a medical supply shop for USD$15. It gave my foot the rest it needed to get me back to walking again.

If/When you can bear any pain on your foot, my physio has me doing the two following stretches:

Achilles Tendon Stretch and one that specifically targets the plantar fascia.


And Physio, physio physio, if you possibly can. This is going to be around for a while....
posted by tabubilgirl at 5:33 AM on August 30, 2013 [1 favorite]

The number one thing that helps whenever I'm afflicted with plantar fasciitis is wearing Crocs. There are some pretty decent women's styles these days.

I know lots of people get freaked out about Crocs, but seriously, nothing aside from plain old rest ever helped as much as the Crocs.
posted by EXISTENZ IS PAUSED at 5:40 AM on August 30, 2013 [2 favorites]

Response by poster: The shoes I'm wearing at the moment are North Face Hedgehogs. They are by far the most comfortable of the shoes I already own.

I guess I'm managing ok with the pain during the day but not at all well in the evenings or at night. Any other suggestions for then would be gratefully received.
posted by plonkee at 5:48 AM on August 30, 2013

Best answer: Get some crocs. Honestly my PF was so bad I was crawling to the bathroom at night instead of walking as I didn't want my feet to touch the ground (it was in both feet). Gel insoles are not worth the money enough, ugly clog crocs are the best for walking around on, but you can get dressier ones you can wear to work that are indistinguishable from "normal" shoes. I spent 500 bucks looking for shoes that I would wear when my PF was at it's worst and these were a life saver, why do you think they still sell so well today? Don't get the cheap knock offs they don't have the arch support. If they don't work for you, go to a good walking shoes store and keep trying on shoes until you find a pair that help.

Like others have said, ice that baby up good. I used a 600ml coke bottle full of water that I froze and rolled under my foot, and also an ice pack I used to sit with my foot on when the pain was too bad as it would have a nice analgesic effect. See if you can keep an icepack at work (assuming you have a desk job) so you can ice your foot up during the day too. I also took ibuprofen pretty much all the time, don't wait until you are in pain every six hours take one or 2, as it helps with the swelling.

Stretching exercises in bed before you get up in the morning can help with that early morning pain of everything popping and tearing after a night of healing. Keep doing these throughout the day there are a huge lot of videos on Youtube showing how to do these.

It took me 3 months before I could walk more than 100 metres without wanting to cry, 6 months until I could walk my dogs again (about this point I found crocs) and 2 years before I could walk around barefoot on any sort of regular basis. Don't assume the shoes you have are the best without going out and trying a lot of others, I had Birkenstocks, Danskos and several other big name brand shoes I would have sworn were the most comfortable shoes in the world, until this happened. Not every brand is right for every person so going to a walking shoe shop and maybe trying on a few other brands might help, if nothing else you will be reassured you have the best shoes for your situation. This is the one thing I wish I had done earlier when I got PF.

The best pain management too I found was ice and strapping my foot during the day for extra support so things wouldn't hurt so much at night (again videos on Youtube on how to do this).
posted by wwax at 5:58 AM on August 30, 2013 [2 favorites]

Nthing stretching, rolling, and arch support. Get shoes with good support, or supportive orthotics to put in your shoes, and wear them regularly. Wear arch support sleeves to bed or if you'll be hanging around the house barefoot for a while.

There are a couple exercises you can do to strengthen the plantar fascia:

- Lay a towel on the floor underneath your foot and scrunch it up underneath your arch.
- Practice picking things up with your feet. Marbles are good because they don't have any annoying points or corners, but anything around that size will do in a pinch. Put about twenty on the ground and, one by one, pick them up and put them in a bowl about a foot away. Try to pick them up in the space between the toes and the ball of the foot - this works your feet better than grasping between your first and second toe.

Don't do either of these if they hurt, but if they don't, try to do them daily.

Plantar fasciitis can stick around for months, and it can be easy to get discouraged and assume nothing's working, but you can beat it.
posted by Metroid Baby at 6:06 AM on August 30, 2013

take a towel or physical therapy rubber band and put it around your toes and pull towards you is usually the best stretch. doing those is what gets this fixed.
posted by Ironmouth at 6:12 AM on August 30, 2013

It took months for my plantar fasciitis to improve significantly, and even now it can flare up if I'm lax about wearing good shoes. The pieces that helped me were being pro-active about pain relief (basically I took as much ibuprofen as my doctor said was safe, along with prilosec every day to protect my stomach, for months); doing stretching exercises during the day; sleeping with one of the braces that keeps you from pointing your toes; and eventually, when all of that wasn't quite enough, getting custom orthotics.

I think a long recovery time is common.
posted by not that girl at 6:25 AM on August 30, 2013

Ah, my dear, old friend PF. How I do not miss you. I suffered for over three years, in varying degrees of pain, your levels sound similar to mine. What made it tolerable (barely) was: orthotics (custom), walking with a cane (for two years), never (ever!)going barefoot, and finally, massage and super hard water jet massage. Oh, I also tried tens therapy, and sleeping in various splint things, mostly to no avail. I really don't know what caused it to go away, I like to think it was the massage, but various docs and PT's tell me that this condition often takes its own sweet time getting better. Best of luck.
posted by dbmcd at 6:58 AM on August 30, 2013

I had plantar fasciitis last winter. I treated it myself using stretch and massage, and wore these orthotics for about a month. Youtube is a great resource for different stretch and massage techniques, and I found this video especially helpful. I'm sure every case will differ, but I began to see results within the first week of self-treatment, was about 75% better after a month, and the condition was completely resolved in about 3 months. Since then, I've kept on top of it by doing regular calf and foot stretches, and I'll occasionally do the heel massages.
posted by gimli at 7:05 AM on August 30, 2013 [1 favorite]

I'm astonished that so many posters seem to be dealing with PF without physical therapy.

Mine resolved quickly with PT, prescribed by my orthopedist, which consisted of (painful) manual manipulation of the foot -- she basically stretched the fascia by hand. I keep it under control with golf ball self massage and the other things that people have suggested here, but I doubt I could have ever gotten to the maintenance point without the PT.
posted by fingersandtoes at 7:19 AM on August 30, 2013

Your pain does sound more severe than mine, but for what it's worth, a rigid split at night really helped a lot with night pain, much more than even the soft sock-type splints. It looks like FootSmart isn't carrying the model I ended up with anymore, but they have a bunch of options.

The Dansko clogs were the only shoes I could wear for about a year and a half. Which was not great because I have crappy wobbly ankles and tend to fall over spontaneously in Dansko clogs because of something weird about the soles. But they really were fantastic for arch support in the most painful phase of PF.

More recent flare-ups have been entirely manageable with stretches and golf ball rolling, but I've heard great things about trigger point massage and myofascial release. If I have a serious flare-up again I think I'd try to find a really good massage therapist dealing in one or both of those modalities.
posted by Stacey at 7:47 AM on August 30, 2013 [1 favorite]

Walk-in clinics tend to go for the fastest diagnosis; from experience, a rushing doctor diagnoses all foot pain as plantar fasciitis. That's what mine was diagnosed as, but after my own research and symptoms presented as completely atypical, I went to a podiatrist and got a real diagnosis of morton's neuroma and a treatment plan.

imo, IANAD, but your presentation sounds like something is damaged.

So... try to get a recommendation for a podiatrist, a) to ensure that the diagnosis is correct and b) to get a useful treatment plan.
I got a recommendation from a shoe store that makes orthotics (rather than waiting around in a clinic for hours), and my podiatrist is AWESOME.
posted by L'Estrange Fruit at 8:49 AM on August 30, 2013

I had terrible foot pain that was misdiagnosed for months. It turned out to be a dislocated cuboid bone.
posted by futz at 9:07 AM on August 30, 2013

After bad plantar fasciitis in both feet, two things that have made it so I don't need to wear crazy supportive insoles in all of my shoes is as much as possible are wearing birkenstock insoles in all my pairs of shoes and in the house wearing felted slippers that have adapted to my arch shape. I used to not be able to walk without supportive shoes and now I can have bare feet for semi-extended periods of time or wear high heels all day at work without arch pain.

I also wore one of those arch support sleeves for some of the worst pain early on and it helped to bring the pain down to a mangable level.
posted by urbanlenny at 9:08 AM on August 30, 2013

You're going to hear a ton of occasionally conflicting advice, but I think we at least all agree on the fact that your pain level is fairly normal, and stretching is good.

I had chronic PF for years, and various treatments (shoes with better support, therapeutic doses of ibuprofen*, stretches) helped some, but it never really went away. And taping my feet actually caused me some achilles tendon issues, though I was doing it myself from instructions on the Internet, so I may have been doing it incorrectly. The best thing that happened to me was getting referred to a physical therapist for a different leg injury--he thought treating my PF should be a priority, too, since being in pain made me walk differently, which likely contributed to the other injury.

I did 2 months of physical therapy, which included weekly office visits and following instructions for stretches and ice massages (these are painful at first, but really worth it) at home, and wearing a night splint (the ones that look like this work better than the ones that are just socks or fabric bands, and are more comfortable to wear than the ones that look like huge walking casts). I continued the stretching and ice massage after the office visits stopped. A month or so later, the pain went away. Now I keep up about half the stretching routine, and use ice after I've done lots of walking, and I cannot believe I used to think being in so much pain all the time was normal. It only comes back when I've been especially rough on my feet or I've gone too long without stretching.

So to answer your follow-up question, stretching, evening ice massages and sleeping in a night splint should help with managing the end-of-the-day, keeps-you-up-at-night pain as well as help mitigate those excruciating first steps in the morning. Going to a foot doctor and possibly getting physical therapy, to get treated by a physical therapist and learn proper stretches, is a very good idea, too.

*I am not a doctor and cannot give you medical advice, but regarding the ibuprofen, it's as much for relieving inflammation as it is for relieving pain. And in order to relieve inflammation, you have to take it regularly, not randomly or just when you hurt, and usually at a higher dose. According to my doctor this dose is 600 mg every 4-6 hours. You should, of course, check with yours.
posted by rhiannonstone at 9:46 AM on August 30, 2013 [2 favorites]

Definitely see a PT. A lot of advice that I got from my doctor and trainer and the internet and other well-meaning folks was just wrong, specifically around stretches. Any stretch that puts the bend in the foot rather than up through the calf (ie using a towel around your toes) is likely to exacerbate the problem. The PT can also look at your specific gait and recommend shoes that will help you specifically - what works for one person with PF might be completely different than another person.
posted by judith at 10:11 AM on August 30, 2013

I had a little bout of PF lately (that I'm hoping has cleared up) and icing my arch helped a lot with pain. Also, Ibuprofen does absolutely nothing for me in doses of less than 800mg, and I'm a normal sized adult (actually probably signficantly below average weight for an American).
posted by cnc at 10:26 AM on August 30, 2013

Are you confident in the diagnosis? I've bruised my foot and once I sprained it and the pain was amazing but slowly and consistently got better which sounds like what you're describing more than PF.

When I had a bone bruise on the bottom of my foot (stood on a pointy rock juuust right) I couldn't wear shoes unless they were slippers and was more comfortable barefoot. Arch support dug into the bruise and killed. My doc xrayed it to make sure it wasn't broken too, stress fracture was the first thing she suggested given how quick it came on.
posted by fshgrl at 10:59 AM on August 30, 2013

It took me six weeks before I could walk without feeling like I was being stabbed in the foot. Now I try to wear good shoes and make sure I stretch my foot after exercise.
posted by betweenthebars at 11:44 AM on August 30, 2013

Response by poster: As an update, the plantar fasciitis is much improved, but the calf pain turned out to be DVT. I've been put on warfarin and am not likely to have any serious complications now treatment has started.
posted by plonkee at 12:33 AM on September 11, 2013

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