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[amlithist]

I feel like a total hypochondriac, starting two threads here and all, but it's late in the semester, I'm tired and cranky, and my foot hurts, so here goes:

Anybody ever deal with plantar fasciitis?  I think mine was brought on by a bout of extra walking on city sidewalks back in October, followed a week later by standing in one spot for about 3 hours (an Obama rally!).  I went to walk off at the end of the rally, and I felt like someone was drilling through the bottom of my heel--OW! 

Since then, I've been trying to stay off it as much as possible (which isn't much, since I generally walk a lot while I teach, and you've gotta get from one place to another, after all), taking ibuporfen/Tylenol/Aleve/aspirin (trying to see which works best on any given day), and wearing my New Balances with heel cusions to work (yes, I truly am a fashion plate these days!)  But I can't help it, and I don't care what it looks like--it hurts like crazy, or alternatively, when the left heel isn't hurting quite so much, my right knee is throbbing because I'm sure I've changed my gait to favor the left foot.  So "looks" are the least of my problems.

My doctor looked at it and seems to think it will resolve itself with time and rest (hopefully lots of "feet up on the sofa" time over the holidays); from what I've read, this sounds about right.  Today it's sore but not bad, but who knows--tomorrow I may barely be able to stand on it, or it may be OK.  When it's really flared up, though, it hurts to even touch that foot to the ground or lay it on the bed.  Any experiences, suggestions, advice, anyone?

I swear, I hit 45, and everything started falling apart.  This is not nearly as funny as it was when I was 15, and it was Mom who had all the aches and pains.  (And for the record, I'd like to once again point out:  it's hell gettin' old.  Thank you.)

[ratiosrule]

I just heard about this on Dr. Zorba Paster on Your Health (NPR) a week or two ago. As I recall, he basically told a caller to NEVER go barefoot and to NEVER wear heels again. You can't even go barefoot in the shower. Poor thing! This link may help:

http://www.wpr.org/zorba/resources.htm

[voxprincipalis]

Yes, I have been having a particularly bad flare-up for a few months, since I hurt my toe over the summer and changed my gait for a few weeks to accommodate.

Wearing different heel heights helps. On days when it is particularly painful, a higher heel is better for me than a lower heel.

Of course you know about the stretching multiple times a day, and especially before getting out of bed in the morning. In addition to the time-tested rolling the sole of one's foot over a frozen can of juice concentrate (or whatever), there are some good stretches here:

http://medgadget.com/archives/2006/11/new_stretch_rel.html

... plus the standard stretches that you can do on a stair or against a wall. (These are easily Google-able if you don't already know them.)

Taping is also supposed to work -- I haven't tried it yet but my last painful day was so painful that I intend to next time. One of my classes is a movement class and I could hardly teach that day.

Good luck -- I am suffering along with you...

VP

[dept_geek]

Stretch. Often. Do exercises to strength your lower legs and ankles. One thing that worked pretty well was to get a pair of inexpensive heel cups (those squishy things that fit in your shoes). Cut a hole in the heel cup around the intersection of the inner & lower 1/3 lines.. about dime sized. That seems silly but does seem to take some of the pressure off where the tendon hits your heel.

[doppelganger]

Oh yeah, been there, suffered that.  After years of on-again off-again PF, caused in part by working on a concrete floor and my refusal to stop doing stupid things like walking around barefoot and wearing shoes with no support, I had to go full barrels blazing to get it under control:

1. custom orthotics
2. expensive shoes that will accommodate the orthotics, with a slight but chunky heel only (1" or less)
3. a steady diet of anti-inflammatories for a while
4. physical therapy (ask for the Graston technique)
5. twice-daily exercise sessions with a theraband
6. tons of ice
7. those awful night splints
8. and a cortisone shot in each heel

After nearly a decade of regular flares, I haven't had pain in four or five years now.  But, it took a few months of dedicated multi-pronged attacks. 

Don't be me.  Rest.  Ice.  Ibuprofen.  Massage that sucker.  Stretch.  Buy good shoes. 

Talk to a physical therapist, get a piece of theraband, and get a list of the heel, ankle, and calf strengthening exercises, and do them on both feet. 

[dellaroux]

I've had heel spurs flare up twice and associated plantar fascitis the second time as well.

Both times the instigating issue was shoes. The first, I just had to stop wearing any high heels, ever again. Did that and after a few months it stopped. (I also made my MD show me the x-rays so I'd be able to visualize what the calcifications looked like, since I dance and give walking tours weekly).

The second time it started because of walking shoes (Reeboks) that had gotten too worn down to support my feet properly, and because I'd gained weight. This was at the end of a very stressful combination of school, housing, and work-related situations as well, so I had to wait a bit before I could fix everything.

However, as soon as I could, I got new shoes and I started feeling a bit better. I also started giving myself a ballet barre in the AMs and a couple months later got myself back into class--first one and now two times a week.

I continued to walk (painfully, at first) a couple miles a day--I don't own a car and use public transportation--and to attend swing dances and the occasional Renaissance dance once or twice a week. Starting each class would give me a twinge, but strengthening my feet has worked.

I still need to lose some more weight, but I was just thinking yesterday how my feet don't hurt at all now, and I can remember just about a year ago when they were really sore a lot of the time. Two ballet classes and 1-2 swing dances a week are not a problem, nor is the walking.

I've kept eating what I was eating and I did try some orthotics but they just unbalanced my feet in other ways (and I know my feet pretty well, so I wasn't going to make them unhappy over a theory.)

I tried those thing-ys with the little cutouts for a brief while during the first episode, which must have been 15 or more years ago, now. They were semi-OK but I think I didn't need them long; within a few months the pain had stopped and the spurs were accommodated.

I HOPE this doesn't happen again; I think the main thing is to keep up with classes, keep strengthening all walking apparatus, and keep my shoes from getting worn down unevenly (or,more realistically, get new ones ASAP once I notice any sense of unevenness in knees, ankles, etc.)

But it does seem to flare up and then subside, which is what one doctor, anyway, told me it would do.

[expatinuk]

Had it... it does take about 18 months to go away. Only wear shoes such as supportive athletic shoes. I found that the heel cups etc were a total waste of money for me. I also found that a lot of the stretching exercises just made it worse while it was flaring up. They are great when the inflammation subsides to prevent another flare up, but for me they just made it hurt more.

I ended up on anti inflammatory drugs for a while.  But the main thing was to make sure that I was wearing shoes that gave a good arch support.

Oh.. the exercises that the physical therapist told me to do were funny... you try lifting the arch of your foot  off the floor WITHOUT using your toes... it's not that easy!

[sikora]

I've had it, and it's painful and can be intractible.  I was cured by orthotics.  In September, I was fitted with new orthotics, but a few weeks ago I started having heal pain again (Somedays I walk three hours).  I had the orthotics readjusted, and I feel a lot better.

I've started a retail job last night, and it requires me to stand for my whole shift at a cash register.  Heel pain is coming back, and the cure for that would be not standing so much. Impossible at that job.  Fortunately, I will be there only six weeks. 

[amlithist]

Thanks, everybody, for the input, though the "18 months" that seems to be customary doesn't thrill me!  :(  Oh, well, like Mom used to say, once you hit 40, everything starts to go to hell (and I'm well past 40)!

Not to sound snarky or cheap or whatever, but does insurance pay for shoes/orthotics as a matter of course, or do I have to go to a podiatrist and have a prescription?  There are a couple of stores locally that carry Redwings, other work shoes, and "comfort shoes" for those who work on their feet; I think I'll check one of them out this weekend.  Wearing heels hasn't been an issue for years, though I wore all sorts of crazy stuff in high school (late '70s, 4" platforms, spikes, etc.).  After my first baby, it seemed like my balance got thrown off or something--I nearly kill myself now if I try to wear even a medium heel, so I live in more-or-less flats, and my New Balances. 

I know I don't do myself any favors either with my work habits--I feel like I spend my whole day with my butt in a chair, but I actually teach three classes back to back, and I tend to pace/wander the room while I teach, so I easily walk a mile and a half every morning.  I used to walk a few miles every morning, but after my bout with cellulitis this summer, I switched to a recumbent stationary bike for 7 or 8 miles a day.  Between the walking on concrete, then sitting for long periods, and the abuse on my knees with the heels all those years (not to mention playing baseball with the boys in HS and being a shortstop, plus a knee injury), I guess I'm probably lucky I'm just starting to have these problems now.

[sikora]

When I had good insurance, it covered orthotics. When I had lousy insurance, it didn't.  But that insurance was "headless" and "footless":  it covered nothing about the clavical and nothing below the ankle. :)

 I suggest you see a podiatrist.  It's a very common problem, and a podiatrist will have had lots of experience. 

[dellaroux]

The type of exercise seems to be the issue, not the amount.

As noted above, I walk several miles a day since I haven't owned a car in almost 20 years, use public transportation and usually have two or three places to go in any one day. And in the summers I'm out for 6 hours each Saturday in July and August giving tours.

But I'd gotten away from regular ballet/modern, which stretches and strengthens the plantar surface overall, in the past few years, and that was what (with the sagging support in my shoes) seemed to trigger it for me.

It was going back to that--carefully, at first, in giving myself a brief class for several weeks before going back to a fully taught one--that made the difference; I was walking through both onsets all the time, but not dancing.

And I know that isolation exercise someone mentioned; another is to plant your feet flat on the floor and scrunch and stretch your toes to lift and flatten the arch. I'm more in favor of isotonic/isometric work, not weights, which can stress muscles and tear them, in my opinion.

And replacing the shoes, of course, although it took a few months for the damage that had been done to reverse itself...(with one set-back following a hard landing after nearly tripping on a broken edge of sidewalk...grrr).

I still want to work on the weight, anyway; I suspect it hasn't helped. Although it's held steady or decreased slightly, I'm not losing, but I think it probably had something to do with the second onset in addition to the shoes.

I believe there has been work done to show a relationship between heel spurs and fascitis, and one study seemed to recommend that the usually assumed "the spurs cause the fascitis" causality was in fact backwards. (Can't cite it now, don't recall the source, sorry.)

I've always assumed it was piezo-electric stress from stretched muscle insertions inducing calcium deposits on the lower heel surface, but whatever the relationship, there does seem to be one.

And the spurs do seem to get accommodated after a while....I don't think mine have taken as long as 18 months both times, so maybe there is hope there, too.

[bread_pirate_naan]

Do you wear the soles of your shoes on the inside seam(pronate) or the outside(supinate)?

[amlithist]

Do you wear the soles of your shoes on the inside seam(pronate) or the outside(supinate)?

Hmm...I had to stop and think, since I've been pretty careful in recent months to keep several pairs of good walkers and switch off among them every couple of days, so none are really worn at this point.  But normally, in the past, it'd be supinate--the outsides wear more quickly, but generally only in the heel area.

Does this make a difference? 

[bread_pirate_naan]

Do you wear the soles of your shoes on the inside seam(pronate) or the outside(supinate)?

Hmm...I had to stop and think, since I've been pretty careful in recent months to keep several pairs of good walkers and switch off among them every couple of days, so none are really worn at this point.  But normally, in the past, it'd be supinate--the outsides wear more quickly, but generally only in the heel area.

Does this make a difference? 

Yes, it means your feet probably aren't flat, and you aren't knock kneed.  If you were my student and I could see your posture and gait there would be a number of issues to address to have you stand more evenly, but supination most often suggests weak adductors(generally the inner thighs) and tight hips (perhaps some low back pain due to compression).

Pronation corresponds to low or no arches, which can be developed in some cases -- weak abductors and generally poor muscle tone. 

Different exercises are needed to correct either, long term.  As the entire musculature and fascia of the body are actually connected head-to-toe, the most satisfactory stretching will include the thighs and hips at the bare minimum, not just feet and calves.

If you have a yoga mat, get it out at home and lie on your back with the center of each foot lined up with the outside edge. 

If you have no mat, recline on the floor with your feet wider than hip distance apart.  Simultaneously, with an exhalation, drop both knees to the left.  Your left leg will rotate out and your right will come towards the center of the mat. 

Inhale, bring your knees back to neutral with the soles of your fleet on the floor. 

Exhale, release your knees the other direction. 

Inhale bring them back to center.   Repeat this three times on each side an then with an exhalation allow yourself to stay in the stretch for three to 5 long eash breaths relax ing into the pose, returning to neutral on an inhalation.  Repeat the  rhythmic preparation and take a long stretch the other direction. 

To finish, come to neutral.  Exhale, draw both knees towards your chest and let your lower back lengthen. This is just one of several movements that would support you, but I cannot see you with my own eyes.  This is a stretch, not a strengthener. 

[infopri]

I'm sorry you're going through this amlithist.  I've been in your shoes--and soon you will be in mine.

Mine started the same way yours did: I did a whole lot of walking (around NYC), and then I rested in the hotel room...and when I got up, I nearly fell over.  I was completely unable to put weight on the foot.  After struggling with it for a few months, I went for physical therapy, which helped a lot, but not enough.  I saw a podiatrist and got the expensive orthotics.  (Apparently, I have flat feet.)  I did more PT.  I taped it.  I did more PT.  There really was a lot of improvement, but eventually I opted for cortisone.  Two shots, a couple of weeks apart, and it hasn't bothered me in at least a year or two.

A few months ago, however, the other foot started.  I didn't bother with PT this time, instead just doing the exercises at home.  As someone upthread said, the most important time to do them is when you've been off the foot for a while: first thing in the morning before you get out of bed, when you've been sitting at your desk for a while, etc.  Stretching really does help.  If I don't stretch before getting out of bed, I can't walk.  If I stretch, it barely hurts.

I second the suggestion to see a podiatrist.  As someone else said, they have lots of experience with PF.  I also recommend some PT just so that you can learn the exercises that will be most helpful to you.  Then do them, and don't cheat.  If that doesn't work, go for the cortisone. 

P.S.  My sister also had PF and did none of these things.  She spends a lot of time on her feet (she works full-time in retail), and she just wore sneakers all the time for a year and a half--but she did get better.  So there's that approach, too.