By Dr. Steven Gershman, DPM
My blog "Can plantar fasciitis cause leg pain" describes plantar fasciitis pain and its causes. In this blog I will discuss what most of you are probably looking for and that is plantar fasciitis relief or treatment.
As I have written in many of my blogs, treatment of most foot afflictions begins with looking at shoes. I ALWAYS have my patients bring in a bag of their shoes on the first visit and again if new issues arise later. I find many of the problems patients present with often start with poorly fitting or old worn out or just inappropriate shoes.
Treatment with Plantar Fasciitis Shoes
What is a plantar fasciitis shoe? First the shoe MUST fit well. It needs to be long enough that there is a thumbs width from the big toe to the end of the shoe when standing. It also needs to be wide enough that there are no areas bulging out at the ball-of-the-foot or squeezing the foot. The outsole should be stiff at the middle of the foot, so it doesn't bend easily while it does bend near the toes. Heel height should be close to or the same as the front of the shoe so the heel sits at or near the same height as the forefoot. Heel elevation is a problem for fasciitis many times as it jams the big toe joint which is one cause of plantar fasciitis. In addition, extra depth is helpful as it allows inserts or orthotic devices to be added. Orthofeet manufactures many shoes that are appropriate plantar fasciitis shoes. They are designed with a wide shape, extra depth, and generous toe box. The built-in orthotic insole is removable to accommodate custom orthotics. Their unique construction includes an ergonomic sole that is made with a mild rocker bottom to propel the foot forward and facilitate foot motion. Also, shoes should be replaced every year, at the very least, as when shoes age they lose support and stability.
Treatment with Plantar Fasciitis Orthotics
Generally, the next step in treatment after shoes is a proper insert to go in the shoes. If the person over pronates then a non-custom orthotic is the choice to start. Orthotics for plantar fasciitis need to support the arch/fascia so it doesn’t over pull on the heel bone insertion. Also, the orthotic should reduce the arch drop that lengthens the foot which stretches the fascia. Orthotics should unlock a dysfunctional big toe joint by reducing the pronation that can cause it. I usually start with the Orthofeet Biosole Gel Sport Orthotic for my patients with plantar fasciitis. It is supportive and rigid enough to reduce pronation and is very comfortable from day one. The gel pad under the heel makes it effective for heel pain.
If the shoe/non-custom orthotic combination fails to improve the symptoms in a few weeks, or if the pain is severe, I will either inject the fascia with a steroid/"cortisone" or go to oral prednisone/steroid or both. I don't inject initially until the shoes and inserts are in place as the injection can fail if the underlying cause isn't dealt with first. Injecting steroids can lead to plantar fascia tear or rupture, which is more likely without insert support first. In some cases, NSAIDs like Ibuprofen can be helpful.
If the non-custom orthotics fail to improve the symptoms, then a rigid custom orthotic with a soft cover is the next step. The orthotic needs to contour the arch but NOT try to elevate it beyond its natural shape as this can jam and irritate the fascia more. Proper orthotics reduce pronation, support the arch and fascia and unlock a dysfunctional big toe joint.
Other Plantar Fasciitis Treatment
If all else fails, the next step is immobilization in a walker which is worn with the insert in it and worn all day and night. One theory is that night splints alone can help by keeping the fascia in a constant mild stretch at 90 degrees to the leg. I haven't found night splints are very effective, but the walker boot worn 24 hours a day is quite effective, especially when worn with the Biosole Gel Orthotic. In fact, there is often immediate pain relief in the walker boot or air cast walker.
Physical therapy hasn't proven to be that helpful in most cases I have seen over 31 years. Some stretching done first in the morning can be useful if it doesn't cause pain. Ultrasound or cold laser therapy may help also but are time consuming for patients.
Some cases of plantar fascia pain can be from a plantar fascia tear. Usually this is a partial tear as a complete rupture usually stops hurting after a while on its own as the fascia has in effect been disconnected as in a fascia surgery. However, it does end to destabilize the foot in time. A partial tear can be treated the same as plantar fasciitis as true fasciitis is actually caused by micro tears in the fascia.
Other cases of fascial pain can be caused by plantar fascial fibromas which are benign tumors on the fascia. The fibromas are made of connective tissue and bulge out of the bottom of the foot on the fascia. The lumps or fibromas can be painful although many are not. They can be treated with "cortisone" injections to shrink them. Surgery is a last resort and not always successful on fibromas as they can return. Injections are often repeated over time as the fibromas can come and go.
Plantar fasciitis pain can last for weeks or months but with proper treatment can improve sooner. Podiatrists see plantar fasciitis every day in practice and can help you back to health. Orthofeet shoes and inserts are a cornerstone in this podiatrist’s treatment plan. To view Orthofeet Plantar Fasciitis shoes click here.