Plantar Fasciitis – Frequently Asked Questions answered by former foot surgeon, David J. Sables, D.P.M. Dr. Sables now practices exclusively in biomechanics.
Should I buy a compression sleeve for my foot?
The compression sleeves that came out a few years ago have lost their hype. Some patients that simply need compression for swelling relate it is helpful. Others, especially if it is not fit appropriately, relate it only squeezes their foot and does not help. I have tried multiple types, they do vary. Some seemed to squeeze the foot but the better ones seemed to assist the normal foot movement. I would suggest looking for one that has slight compression but is reinforced about the normal tendon pull on your foot. (For example it is reinforced along the posterior tibial tendon as it runs into your foot).
Should I use a tennis ball, golf ball or coke bottle to roll on my foot?
All will give a massaging action that stimulates increased blood flow for healing, muscle relaxation and reduction of inflammation (the part that really hurts). However, the inflammation is usually deep in the heel and about the curved part of the heel bone. Therefore, I recommend the footrubz; it is a golf ball size that can get into the “crevices’ of the foot (to the deeper tissues). It also has nubs on it that act like a tapotement massage as you roll it. You can also control the compression while rolling. That is, you can apply as much force as you desire.
Note: Some studies relate in order for a massage to work on the muscles, you have to massage for at least 90 seconds on the same area. I would concentrate the roll at the area of pain for at least this amount of time daily.
Do I need to wear my orthotics all the time?
If you are suffering with pain, then yes. The more you wear the orthotics, the better it should feel. Orthotics should be reducing the tension on the fascia, so without them, you may be increasing the tension or pull. I recommend looking at the shoe and orthotic as you would if you were wearing a cast. The shoes and orthotics are protecting from abnormal tension of the fascia and are much more comfortable and convenient than a walking boot. I typically recommend shoe and orthotic use as much as possible for the first 3 months of wearing. Afterwards, you can go without the orthotic for a short period. Your body will let you know how long and when to put the orthotics back on.
When my plantar fasciitis is gone, can I stop using orthotics?
I recommend continued orthotic use as in most cases, the cause was biomechanically induced. Most of us walk on a flat (unnatural) floor the majority of time so keeping your foot supported is usually helpful. Also, I have seen many patients who relate they stopped wearing orthotics because they did not have any more pain, but come to find out another biomechanically induced problem like tendonitis or joint pain recurs.
Should I have surgery to get it over with?
Surgery is not a guarantee. It should be reserved for cases that have failed multiple non-surgical approaches. I’ve even seen patients that relate their problem is worse now after surgery. However, it was usually that they did not undergo multiple nonsurgical treatments, including not trying orthotics first.
I had surgery. Do I need orthotics now that it is not hurting?
Yes! If the fascia was released, then it is not functioning in re-positioning the foot in gait as it should. An orthotic will help realign the foot, providing support where the fascia was supporting.
Will plantar fasciitis ever go away?
In many cases, yes. Some will only need standard home treatment while others need more. Some literature relates it will resolve in about 10 months! A long wait? I think so. I strongly feel that in most cases it is biomechanically induced. Therefore, addressing the biomechanics seems to be rather successful in my practice for over 30 years now. It may take multiple disciplines to relieve it such as addressing the biomechanics, the inflammation, any tendon tightness, diet/nutrition and any systemic issues that can be inhibiting healing.
I bought expensive shoes that they said were for plantar fasciitis but my foot still hurts!
Buying a shoe that they claim is for plantar fasciitis is like playing roulette. Feet have different shapes so the shoe will have to have specific features built in according to your foot type needs. There is not one shoe that will fix plantar fasciitis for all.
I iced it for an hour! It is not helping!
Unless it is an acute injury, I feel over icing has a negative effect. It is like playing outside in the winter where your hands freeze. You then come inside to warm up and you can feel the tissues swelling thick. Once the blood vessels sense you can now get blood to the site, it overflows with blood to make up for the lost circulation from the cold. For over 20 years, I recommend a contrast soaking. That is, soak in hot then cold then hot and then back to cold. Total time not to exceed 15-20 minutes. This allows constriction to squeeze out inflammation and vasodilation to bring in new blood for healing. Most patients relate doing such the night before will “save” them in the morning.
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