Plantar Fasciitis

Plantar Fasciitis is the inflammation of a thick band of tissue that runs from the bottom of your foot and connects your heel bone to your toes, called plantar fascia. We recently spoke to an orthopedic foot and ankle surgeon with HOI, to get answers to commonly asked questions regarding treatment options to help with inflammation and pain caused by plantar fasciitis.

What are the best sneakers for those with plantar fasciitis?

I advise my patients that there isn’t a single best shoe for plantar fasciitis as each person has their own unique alignment and will tolerate each shoe differently. However, in general I recommend a sneaker that has a support insole and a soft heel with appropriate depth. With any new shoe or sneaker, I recommend patients slowly incorporate them into their day-to-day life by starting off wearing them for 30 minutes to 1 hour and slowly building up each day. Any new shoe that causes worsening discomfort, particularly as patients progress in duration, should be discontinued.

Should flip flops be avoided?

In most situations, I do not recommend patients wear flip flops as they do not have enough support or cushioning. However, there are some sandals that have a heel with extra cushion, and an arch support built in which may feel comfortable for patients with plantar fasciitis.

What are your thoughts on ice packs made for those with plantar fasciitis?

Most ice packs have trouble fitting around the heel at the location of the pain, however the plantar fasciitis ice packs that strap around the middle of the foot may fit better and provide some relief for inflammation along the plantar fascia.

What are the benefits of using rollers or balls for your feet?

I often recommend patients incorporate rollers or balls into their plantar fascia-stretching program because they are a great way to help break up scar tissue and alleviate tension within the plantar fascia. When looking for a roller or ball, I recommend patients find one that has enough firmness and structural support to provide continuous compression to the area. If the roller or ball is too soft, it will likely fail to provide enough structural support to maintain the pressure needed to alleviate tension. An additional option would be a cryoball type device in which a patient can manually roll their arch while providing cooling to the area simultaneously, however I usually recommend these in addition to rollers/balls as opposed to in replacement of them.

Is wearing compression socks a good idea?

The key to compression socks is finding one that is comfortable. Often times patients will buy a compression sock with a significant amount of compression only to find that they can only tolerate wearing it for a short period of time. A compression sock with a moderate amount of compression that fits uniformly around the foot, ankle, and leg is more likely to be tolerated and therefore more likely to be worn longer and work more effectively.

Which orthotic should we be wearing?

There is no single orthotic that is best for each patient; however, in general I usually recommend an over the counter orthotic that has a heel cup, a cushioned heel, as well as a mild to moderate arch support. The orthotic should mold comfortably to the foot without any pressure areas along the heel or instep.

How about night braces?

Night splints can be tricky for patients because the ones that are more structural and supportive are often not tolerated as well, while the softer braces or socks often do not have enough strength to maintain the foot in the desired position. In general, I recommend patients try the night splint that is a bit stronger and more structural first, as this will hold the ankle and foot in a stretched out position to alleviate tension within the plantar fascia. If a patient is unable to get used to sleeping in this type of night splint, I will then have them try the plantar fascia sock that may be more tolerable. I emphasize to patients that the night splint should not cause additional pain or discomfort. Additionally, patients should slowly break in the night splint and if they are unable to tolerate it resulting in loss of sleep they should discontinue it.

Is there a medicated cream you recommend?

I often support the use of medicated creams in addition to the other modalities as they may provide local relief of inflammation. There is variation in types of creams, but in general I recommend one that has either holistic anti-inflammatory properties such as Arnica, or medical anti-inflammatories such as Voltaren gel. With any cream, I advise patients to first place a small amount locally during the day and observe for any adverse or allergic reactions. Assuming there are no reactions, patients can then slowly taper up on the creams. Also, while the systemic absorption is very low with these creams it is important for patients with medical problems to check with their primary care doctor first regarding safety in usage.

What are the benefits of using resistance bands?

Resistance bands can be beneficial in aiding in stretching the calf muscle, as well as the plantar fascia. Patients using resistance bands should first start with bands that have low resistance and slowly taper up to medium and high resistance based on how their symptoms respond. In general, patients want to ensure that the band is long enough that they can comfortably hold it and maintain a steady stretch without straining their lower back or hip musculature.

Thoughts on using slant boards for our calves?

Stretch/slant boards can be very helpful in aiding patients’ plantar fasciitis symptoms as they focus on stretching the calf musculature which is integral in treatment of plantar fasciitis. I generally recommend a slant board that is adjustable so as to increase stretch as patients master the technique and tolerate the stretching. Boards that start around 10 degrees, but increase to 30 or even 40 degrees allow for a gradual, controlled, and tapered stretch as patients improve. While they may cost more money, they are worth it in my opinion, as they provide multiple benefits including safety, adaptability, and a gradual controlled progression. Wood stretch boards with a padded cover often hold up better than plastic boards. Another product I’ll recommend is a calf/Achilles rocker which easily fits under a desk so patients can stretch their calf while multi-tasking on other projects.