Wednesday, April 29, 2009

Treat Your Own Plantar Fasciitis

plantar fasciitis diagram
Understanding the Cause Suggests the Cure for Plantar Fasciitis
Plantar Fasciitis defined is simply an inflammatory condition caused by strain and over stretching of the ligament that spans the bottom of the foot. This plantar ligament functions to provide spring in your step as well as support the longitudinal arch. Inflammation of such can cause severe pain, particularly when barefoot, when first standing, upon awakening, or standing after prolonged sitting. Plantar fasciitis often precedes and plays a major factor in heel spur formation. As a side note, Plantar Fasciitis has a funny sort of spelling and is often mis-spelled as plantar facitis or plantar fascitis.
The use of gel or cushion under your foot can temporarily relieve or soothe plantar fasciitis. However, this offers temporary relief at best and should not be considered a long term solution. It is a common misconception by both sufferers and physicians alike that a soft cushion under the foot resolves a bevy of foot problems. In reality this measure compromises foot support in the long run, similar to the lack of support for the spine when sleeping on a soft mattress. I prefer to recommend proper support of the arch of the foot, thus relieving strain on the plantar fascia. This functions to actually reduce pressure on the attachment point where the plantar ligament (fascia) attaches to the heel. Excessive tensile forces at this point of insertion over time are the etiological factors that form heel spurs. In essence, a heel spur is your body's response to the ligament pulling on the bone, forming what doctors call a traction spur.
  1. The first step is to break the cycle of inflammation (swelling) and pain with ice and cold therapy.
  2. You must wear an orthotic that both supports the arches of the foot and offers a heel cup. The heel cup serves to elicit side pressure, thus squeezing and fluffing up your own natural fat pad. Your fat pad is nature's way of providing good shock absorption and comfort under the heel. It is not uncommon for those presenting with plantar fasciitis to have signs of a compressed, flattened out fat pad, subjecting the heel to undue stress and increased inflammation. Custom orthotics are great, but there are some over the counter orthotics like Superfeet Orthotic Comfort Insoles that do a great job as well.
  3. Wear only rubber soled shoes with good heel counters, good pronation control and good lateral stability.
  4. Other important factors to consider:
  • Going barefoot is a no no, even in the shower. It is important to wear massage or acu-pressure sandals with arch support. Make sure they are rubber so you can wear in the shower. Keep them by your bed and slip your feet in to them first thing, so your heels never have to touch the floor.
  • Never allow swelling to build up in the plantar fascia. Pain is a good indicator of swelling. Thus, if your arches and/or heels get sore during the day, make sure to soak your feet in ice water at night for 10-15 minutes. This is every bit as effective as shots of cortisone.
  • Maintain flexibility in your achilles tendon and calves. Tension in these soft tissues is transmitted to the plantar fascia as you walk or run. The best method is to first warm-up your calves somehow as they will stretch more easily without straining them. It is best to stretch them while wearing shoes that includes the orthotics we have already discussed (never barefoot and never with cold muscles).
  • It will also greatly benefit you to utilize deep tissue massage manipulate and to loosen the plantar fascia and muscles of the calf. There is a specific muscle called the "posterior tibialis" which almost always involved in the formation of plantar fasciitis. You can use your own home massage devices or try something like a Footsie Massage Roller. If you cannot implement your own massage at home a competent deep tissue massage therapist would be advisable.


  1. I have suffered with this condition for years although I have thought that it was caused by my achilles tendons being too short. I have had surgery on both legs to lengthen the achilles tendon, but have not had relief.

    As the awareness of Essential Oils are coming more and more of an alternative to different health conditions, I would like to let you know that I have had some success with using them for this condition. At there are two Essential oil blends that I use regularly. Muscle Rub is formulated to help muscle and bone pain and Pain-Go helps nerve regeneration and is wonderful for acute pain. I have really enjoyed using these two blends.
    I'm grateful to have found your blog to help me understand more about this condition.

  2. backdoc - Responding to Milly,
    Certainly, your doctor's recommendation to treat Plantar Fasciitis with surgical lengthening of the Achilles tendons is not unreasonable. This is because tightness in the Achilles tendon and/or calf muscles causes undue strain and tensile forces on the plantar fascia during the walking gait cycle as the lower leg moves forward and over the foot. However, if your condition has become chronic, the lengthening of the Achilles will only be a first step in the treatment. Once the plantar fascia has been repetitively irritated and inflammed, it may require some direct attention in the form of
    deep, trans-friction massage and ice water therapy. Most definitely, all Plantar Fasciitis conditions require orthotic support and good shoes for proper long term treatment and the least chance of a future flare up.

    Your comment about the benefits of a brand of therapeutic oil known as Pain-Go is interesting because it apparently contains the essential oil
    known as "Helichrysum" that has some anecdotal evidence of having anti-inflammatory qualities. Perhaps that is substituting for ice water treatments in your case.

  3. Interesting stuff - I an having trouble with my right ankle (I think), at least that is where it seems to hurt. The pain seems centered around either the lower achilles tendon (behind, not above my heel) - and on the top/front outside of my ankle (almost but not quite over the arch).

    The pain seems to come and go. At times it's like my ankle will simply give-way. Walking on the balls of my foot avoids the pain - usually hurts like HECK first thing in the morning etc. Slipper of barefoot can hurt and I can avoid it (somewhat) by wearing shoes with heels (like normal loafers). Cold packs at the point of pain seem to help. Four Advil helps.

    I play a fair amount of tennis and workout regularly. My calves are in shape and flexible. My tennis shoes keep me on the balls of my feet so the only pain I feel while playing seems to occur in the end of a serve as I land or if I happen to stomp into a stop.

    The pain is not a stabbing sort of pain - more like a strain thing.

    Does this sound like Plantar Fasciitis??

    Any thoughts appreciated -

  4. backdoc - responding to Kicker
    Thanks so much for the compliment and we appreciate your post. To begin with, what you describe is NOT Plantar Fasciitis. It is more likely a condition known as "Achilles Tendonitis," which is basically inflammation of such tendon, particularly troublesome at the insertion of the achilles tendon into the calcaneous (heel bone). The Calcaneous acts as a fulcrum to leverage great power in propulsion of the foot. It is thus a point that takes the brunt of extreme tensile forces and is susceptible to overuse syndromes. As a common example, if you were to work into your tennis game too fast after years of inactivity on the tennis court you could be susceptible to developing an Achilles Tendonitis. The quick start and stopping motion that is natural to tennis exerts an unbelievable degree of force on the foot and ankle and often elicits micro-tears where the achilles tendon inserts into the bone. Inflammation ensues and often can be initially expressed in tenderness throughout the calf muscle and achilles tendon. It also often leads to an inflammed tendon sheath (a guide-path that the tendon runs through). Eventual adhesions can set in causing the tendon to stick to the sheath. In more chronic phases, the tenderness will usually focus more at the point of insertion into the heel bone. This could certainly be quite painful in the morning as you indeed describe. This makes sense because you mention playing tennis with a shoe that has a raised heel. This decreases tension on the achilles tendon. When you wake up in the morning, the calf muscle has shortened some during the night. As you stand, the tightness exerts undue force upon the achilles tendon insertion because the heel is flat on the ground.

    Kicker, the pain you are experiencing on the top/front/outside of the ankle may or may not be related. It could be suggestive of a lateral instability of the foot/ankle and the need for orthotic support.

    It is certainly advisable to have a physician rule out other possible sources of pain like a calcaneal stress fracture or other problems.

    However, if you already knew it was Achilles Tendonitis, you could try the following:

    (1) minimum 10 day lay off from the tennis court while following the instructions in this list. During this layoff, you should employ walking, good calf stretching and antagonist muscle stretching. Then return to the court very slowly and continue to follow the rest of this routine.
    (2) stretching of the dorsi-flexing muscles of the foot and ankle (those along the shin, opposite the calf)
    (3) good foot orthotic insoles like Superfeet
    (4) ice water therapy 15 minutes per day
    (5) please note that NO STRETCHING should ever be done prior to warming your muscles with gentle exercise and after just beginning to perspire. Light stretching is then to be done, with your more intense stretching to ALWAYS follow you main exercise session.
    (6) good Cyriax or cross-friction trans-fiber massage of the calves and achilles tendons may be useful
    (7) a trial of ultrasound therapy from a physical therapist or self-massage with sonic massage therapy may be employed.

  5. Plantar Fasciitis Treatment
    Looks amazing!!!! /I look forward to your feedback /thanks for this man it was very helpful.

  6. i am suffering pains similar to the descriptions above but it will best to be sure...i have been to two different doctors (4times) already and i did blood test and no indication of inflammation... severe pains i suffer whenever i wake up every morning made me cry...both soles and my two toes in my left foot...other than that, i suffer also with back pain just right below my nape and goes through my shoulder...and every joint feels "light" pain...

    thank you for your gift!

  7. Hi Anonymous from Aug 16th. I'm so sorry, for some reason your comment ended up in the Google Spam file and I didn't see it until today. You could have a combination of plantar fasciitis, but the pain in the toes is confusing. Perhaps that is another issue or maybe you don't actually have fasciitis. You could be having signs of diabetes so should be evaluated for such. It is also possible that your back condition is the exclusive cause of the pain. I know that you seem to have been to various docs for such without any apparent help, but I think it is important that you continue to get evaluated until the problem can be definitively diagnosed. Perhaps an orthopedic specialist that works with both spinal and foot conditions would be best. He or your primary should also do the testing for blood sugar issues.

  8. Hi My doctor said I have achilles tendonitis, but I have serious pain under my right heel and to the inside of the heel. This is now causing me pain in my lower back on the same side and pains in my leg. It is all the same side. It hurts if my foot presses on anything underneath. Ive had this years, but seems to be worsening, as Im not sure how to treat it? I also have the problem, of after sitting for a while or in the morning I can hardly walk. Is this achilles or plantar fascia.. Could bad posture at a computer all the time and weight cause this problem. Thanks for any advice

  9. If you have either one of the Achilles Tendonitis or Plantar Fasciitis issues long enough, you will eventually have both problems. One leads to the other. If you are overweight, that is a real problem. It will be real hard to rid yourself of the problem if you carry the strain that extra weight will place on the plantar fascia. The nice thing is that you can usually solve either one of these problems with the same treatment. Follow my recommendations in the article above and start a program to change your lifestyle that will lead to a permanent healthy weight.

  10. Your article was immensely helpful. I was wondering, though, can plantar fasciitis be caused by a lower back issue and if so, would the treatment be any different? I just had an MRI and was diagnosed with levoscoliosis and a bulging disc at L5-S1. I would like to try some of the treatments outlined in this article, but didn't want to do anything that might be contraindicated for my lower back problems.


    1. Hi Michelle, so glad you were helped by the article.

      Regarding your question about the likelihood of a lower back issue being the primary cause of plantar fasciitis I will say, it is not likely. However, an imbalance in the lower back may indirectly contribute to the development of such. In other words, if there is a pelvic misalignment of one hip lower than the other (and perhaps a scoliosis as you describe), it can certainly add stress to the plantar fascia on the low hip side. If that is found to be a contributing factor, one should address that is part of the treatment plan. Sometimes this would require either a heel lift or foot orthotic to correct such an imbalance. That being said, the inflammation of the plantar fascia is intrinsic to the foot and the foot has to receive the comprehensive treatments I have outlined in this article if one is to have the best overall outcome. The treatment plan I suggest is generally always a well-received approach. I hope you feel well soon!

  11. I say positively diagnosed, because not all heel pain is the same and your sore heel maybe the result of, for example, calcaneal bursitis or some other injury. However, generally one of the best symptoms for diagnosing plantar fasciitis is that you will have excruciating pain first thing in the morning when trying to take your first steps out of bed.

    This is because overnight your muscles and ligaments relax and the plantar fascia ligaments that form the main arch of your foot (the instep) tightened while you sleep.

  12. While that I have to agree that not all heel pain is the same, it is certainly very clear in how to distinguish between plantar fasciitis and calcaneal bursitis. The pain is in a completely different locale. Plantar fasciitis is located on the bottom of the foot from the heel forward into the arch area. Calcaneal bursitis present with pain in and around the Achille's Tendon where the calcaneal bursa are located. Another way to describe the location of pain associated with calcaneal bursitis would be behind the ankle.

  13. Thanks for the great post on your blog, it really gives me an insight on this topic.

  14. Thanks for the post. I had been looking for something related and found your web site in the process.. I will definitely be back for more.

  15. I'm agree with your all treatments because these are very helpful to remove heel pain and and Heel Spur permanently. I'm also suffering heel pain from last two month and I think these treatments are good for me. I will try these.

  16. Dear Doc
    I am suffering from plantar fasciitis for about a year. It started spontaneously in both feet and has changed my life significantly since last year. I have tried every method possible but ut has not disappeared completely but has followed a waxing waning support. Pain is maximal in the mornings or prolonged standing. I just want to know how long it lasts. Can it become life long?

    1. Hi Rajiv, certainly plantar fasciitis can be a frustrating, painful and long term chronic condition. Many people suffer on and off for years. The trick to resolution is making sure you are not carrying extra weight and that you follow each and every one of my recommendations in my "plantar fasciitis solution" dictated in my above article. The Superfeet Green Insoles you see here:
      are far better than most custom orthotics in my experience. An exception and best custom orthotics for plantar fasciitis are called "Sole Supports" but must be casted at a physician's office.

  17. Great post. I’ve never had PF, thankfully, but a friend has and it seems to be an ongoing problem for her.


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