This is the second video in a series of three about plantar fasciitis. The first one covered its symptoms, causes, and how it’s diagnosed. In this video, we’ll cover how it’s treated. First, I want to tell you that 95% of the time I’m able to reduce and eliminate the pain and inflammation of plantar fasciitis using conservative treatment. Many different modalities are used to treat this condition for several reasons. 

First, many different factors influence the development of this condition. We need to treat each of these factors otherwise you won’t get successful results. Every person who comes in has different treatment goals. Some people simply want to be able to walk a few blocks again, while athletes want to return to their sport. 
Finally, we’re all different. Some people will heal quickly with one modality, whereas someone else will need a different modality to heal.

5 Essential Areas That Must Be Treated in Plantar Fasciitis To Heal

While we're all different, any plan for treatment must focus on five essential areas.
•    Reducing or stopping your activities
•    Treating your inflammation
•    Improving your foot biomechanics
•    Reducing your calf tightness
•    Ensuring you understand how to shop for supportive shoes.

If any of these areas aren’t sufficiently addressed, it will be hard to totally eliminate your plantar fasciitis.

Stop Your Activities Causing the Pain

One of the first things you’ll need to do is stop any activity you normally engage in like extensive walking, running, or other active sports. Continuing to play with plantar fasciitis will just add insult to injury. Your feet can’t heal if the plantar fascia continues to get injured. 

Treat Your Inflammation

I’ve found that if I don’t get a patient’s inflammation down, whatever else I do to heal their plantar fasciitis won’t work. Inflammation is what drives the pain so that’s always the first step I take with a new patient. Some of the things I’ll recommend you can do at home, but I’ll start with what happens in the office.
After evaluating your condition, I’ll better understand the extent of your inflammation. If you’ve been suffering for a long time and I see a lot of inflammation on ultrasound, I may first suggest a shot of cortisone to get your inflammation down. We also have non-invasive MLS laser therapy, which can work well for people who’ve had their condition for some time or have had resistant or recurrent heel pain. 

For many of my patients, I’ll start by supporting the foot with taping and an Airheel. Both of these modalities are very effective at taking the pressure off the plantar fascia so you can start to heal. Occasionally I’ll recommend walking boots if your pain is intense, and you don’t get relief with either of the other medical devices. I’ll likely also recommend you start on an anti-inflammatory medication if you aren’t already on one as long as your doctor approves their use.

Some things you can do at home to help relieve your inflammation and pain are:

  • Icing
  • Massage
  • Use of a topical creamelf
  • Self-taping.

Icing is one of the most important things you can do to reduce inflammation and pain. You can even begin doing this before you come in to see me.
There are two methods you can use to ice your heel. 

•    You can fill a Dixie cup ¾ full of water and freeze. Peel the top down so that about 1 inch is showing. You can easily massage the affected area while holding onto the cup. Ice for about 7-10 minutes three times a day.
•    Use can also use frozen peas as a cold pack- Frozen peas are inexpensive and conform to your foot. 

Massage can soothe swollen tissue and help release your tight fascia. A good way to do this is by filling up a water bottle, putting it in the freezer, and rolling your foot on top of it. Finally, you can use a topical to temporarily reduce pain. I recommend either Biofreeze.or K2 cold therapy.

Improve the Biomechanics of Your Feet

If you have flat feet, high arches, or a tendency to overpronate you’ll put more stress on your plantar fascia. That’s why it’s critical that we correct your foot alignment. And the best way to do that is with custom orthotics. Some patients ask if over-the-counter inserts will solve their heel pain. If you have a mild case of plantar fasciitis, these could work but most people who come to see me have already tried this solution, and it’s failed. That’s because over-the-counter orthotics aren’t designed specifically for your feet. And often the level of support isn’t enough to get your feet back in alignment. Also, orthotics you buy at the store are only good for about 6 months. Custom orthotics can provide you with effective support for 3 years or longer, depending on your situation.

At our office, we offer two different types of orthotics. One type I call traditional offers us more flexibility in altering your orthotics should you have specific needs. 
In addition, I offer our patients 3D printed orthotics. These orthotics offer a higher level of precision because of the way they are made. We use an HP laser scanner to get a 3D photo of the bottom of your foot while standing and while walking. The gait analysis allows me to see the pressure points you place on your feet when you walk or run so I can ensure that your orthotics are made correctly. Because these orthotics are 3D printed it allows us to use different densities of materials from front to back if needed. 

Reducing Your Calf Tightness

One of the most overlooked issues that keep many of my patients from getting better is tight calf muscles. That’s why it’s crucial to treat this condition. When I assess my patients for plantar fasciitis, I always check to determine how tight their calf muscles are. When calf muscles are tight your feet can’t move in line with your motion when you walk or run. Instead, your feet are forced to pronate or roll inwards. That puts a lot of stress on your plantar fascia. If we don’t resolve your tight calf muscles you won’t heal from plantar fasciitis.

The key to overcoming calf tightness is stretching. When many people think of stretching their calves they primarily think of the runner’s stretch. While this is an important stretch many people don’t do it correctly or don’t do it long enough to make a difference. See below for the correct way to do stretches for plantar fasciitis.

In addition to these stretches I recommend using an Achilles splint to all my patients with tight calf muscles. But instead of using this at night, I ask my patients to use it for 20-30 minutes a day for each calf. See below for the right way to use this splint.

Another good first step if you’re suffering from plantar fasciitis and you have tight calf muscles is to use a heel lift. This slight increase in the height of your heel helps to relax the pull on the Achilles tendon and calf muscle which reduces the tendon on the plantar fascia. I’ll put a link to a heel lift in the description below.

How to Shop for Supportive Shoes

Because faulty foot biomechanics play such a big role in developing plantar fasciitis, shoes can make a critical difference in helping to correct it. Along with orthotics, it’s important to purchase shoes that are stable and supportive. You might be surprised to know that many patients walk through the door wearing old, worn-out shoes or shoes that are so soft and flexible they don’t provide any support at all. Wearing stable, supportive shoes is an important consideration for closed-toed shoes, boots, and sandals. Check out this video to learn how to shop for supportive shoes.

I’ve written a book called “How to Buy Shows to Prevent Plantar Fasciitis”. It contains many recommendations for the best shoes to buy and which shoes to avoid.

Because many of my patients are very active in sports, I’ve also written two books to help them prevent plantar fasciitis as well. 
One is focused on runners and the other on hikers

In conclusion, I hope this has given you the tools you need to help you manage your plantar fasciitis pain at home and a better understanding of how podiatrists treat your condition in the office. If you’ve tried everything to calm down your heel pain and it hasn’t worked, please give our office a call so we can get you back to doing what you love. 

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.