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Good Article - Plantar fasciitis is painful. Some people are treating it the wrong way.

Pig Vomit

Pig Vomit

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Nov 12, 2022
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I've seen a lot of posts about plantar fasciitis over the years. I speak from experience....it's painful and it sucks.

Came across this great article in the Washington Post, thought I would share. Not sure if the paywall will block folks, so I've copied and pasted for everyone.


Plantar fasciitis is painful. Some people are treating it the wrong way.

Flip-flop season is here, and so is your risk for plantar fasciitis. Here’s what causes it, how to prevent it, and how to treat the foot pain.

Plantar fasciitis, a common reason for heel pain, can lame anyone, from marathon runners to Tiger Woods.

It’s one of the most common of all soft tissue injuries, but the condition isn’t just inflammation (as the “-itis” in the name suggests) of the plantar fascia, a ligament that lies under the skin at the bottom of each foot, experts say. It also is a mechanical failure that requires a physical intervention — stretching and strengthening the foot’s ligaments and muscles.

If you have plantar fasciitis, don’t just rest your foot. Stretch it, apply tension to the arch of your foot, and gradually return to walking while wearing a supportive pair of shoes, researchers say.

Common treatments for plantar fasciitis address the inflammation, often by icing or even immobilizing the foot. Prolonged rest — the first step in the “R.I.C.E.” treatment plan of rest, ice, compression and elevation — can lead to a longer recovery time for the plantar fascia, says Keith Baar, a professor of molecular exercise physiology at the University of California at Davis.

“The inactivity and the immobilization actually exacerbates the injury,” Baar said.

To speed up recovery, Baar and other experts say, you should stretch the foot and apply tension to the plantar fascia to physically lengthen the ligament and encourage healing.

What causes plantar fasciitis?

It’s all about the forces pushing and straining the bottom of your foot.

Imagine the arch of your foot is the arch of a wooden bow. The plantar fascia is this taut string between the two ends of the bow — the ball of the foot and the heel. Every step a person takes, the arch of the foot collapses under their weight, and the plantar fascia stretches, says Bryan Markinson, a podiatrist at Mount Sinai in New York City.

After thousands of daily steps over decades, the plantar fascia can sometimes say, “I’ve had enough,” Markinson said.

A sudden increase in use or a greater force on your feet, through excess weight or slamming your foot in an accident, can cause microscopic tears at the weakest point of the plantar fascia, where the tissue connects to the heel. This leads to sharp pain and swelling — the dreaded specters of plantar fasciitis.

The plantar fascia also is affected by what’s around it. A tight calf muscle or Achilles’ tendon can pull the plantar fascia taut at the heel, making the tissue more susceptible to an injury.

The injury is followed by inflammation intended to repair the tissue, Baar said. That inflammation around the tissue, though, can “make the material weaker.” That’s why experts such as Baar are recommending patients with plantar fasciitis keep using their feet as much as possible with a decreased load on the plantar fascia — by wearing supportive shoes or initially cutting back on intensive workouts such as running long distances.

“That inflammation is going to be necessary but if we get too much of it and it goes on for too long, it’s really bad for the tissue,” Baar said. “We actually say if you’ve got a soft-tissue injury, you should never immobilize it.”

Some people are predisposed to developing plantar fasciitis because they have flat feet or high arches, experts say. People who work in certain occupations that require them to stand on their feet also are at a higher risk of getting injured.

But, “you can get plantar fasciitis from running off a bus,” Markinson said. “When you land on the front part of your foot, your heel is in the air and you’re asking the plantar fascia, for a split second, to bear the whole brunt of your body’s weight.”

In rare cases, the pain in your heel might be caused by systemic inflammatory arthritis such as rheumatoid arthritis — not plantar fasciitis, Markinson said. Physicians can order a blood test to rule that out.

How can I prevent plantar fasciitis?

Stretch at the start of the day, or before and after working out, experts say.

“Every time you take a step, you’re putting a tremendous amount of stress and strain through that area,” said Lorraine A.T. Boakye, the director of clinical research for Penn Medicine’s Foot & Ankle Division in Philadelphia. “The goal is to get it prematurely stretched so that each step is not an aggressive ripping or stretching.”

To stretch the plantar fascia, place your foot flat on the ground and then raise your toes and the arch of your foot to pull on the plantar fascia.

By stretching and holding, you’re physically lengthening the plantar fascia and putting tension on the tissue. You should stretch other parts of the foot and lower leg, too, which will ensure those muscles and tendons aren’t pulling on the heel or toes, where the plantar fascia is connected. You can also strengthen the muscles in the foot to support the plantar fascia more, said Stuart Warden, a professor of physical therapy at Indiana University.

If you’re preparing to work out more, gradually increase the amount of time and effort you exert while exercising. Our connective tissues are naturally stiffer when moving at higher speeds, making it more likely the plantar fascia could become damaged, Barr said.

Late summer and early fall are also “plantar fasciitis season” for podiatrists because patients come in complaining of foot pain after walking in flip flops and flats for months, said Priya Parthasarathy, a podiatrist in Silver Spring, Md., and a spokesperson for the American Podiatric Medical Association.

Think about what you’re wearing on your feet. You’ll want to wear shoes and soles that hug the arch of your feet, experts say.

Why does my foot hurt the most in the morning?

We often point our toes down when we’re asleep, squeezing the plantar fascia. The moment we step out of bed is then the first time the band of tissue has been forced to stretch in hours. If you’re already injured, that step will cause some pain.

To mitigate this, you can wear a splint around your foot to hold your toes up at night, stretching the plantar fascia as you sleep, Boakye said.

“Some people have to wrap their head around sleeping with a bulky contraption,” she said. “But, if they’re able to do it, results can be pretty good.”

For mild cases of plantar fasciitis, walking will stretch the plantar fascia, and the pain will start to dissipate.

How can I treat plantar fasciitis?

Daily stretching will apply a load on the plantar fascia, encouraging the tissue to heal, said Karim Khan, a professor at the University of British Columbia at Vancouver, and the co-author of a textbook on sports medicine.

“When you load a tissue, it sends a signal to the nucleus of the cell,” Khan said. “The cell makes new collagen and repairs the tissue.”

There are insoles, ice balls, spike balls and socks to help treat plantar fasciitis. Baar said the same basic premise remains true for the products that work: Each one puts tension on the plantar fascia.

Surgery is an option for serious cases, but the majority of patients don’t end up needing surgery, Boakye said.

How long does recovery from plantar fasciitis take?

There’s no one timeline for recovery from plantar fasciitis, experts say. Recovery from plantar fasciitis depends on the person and the type of activities they want to return to. If a patient has already been dealing with the foot pain for months, it could take a longer time to recover.

Boakye said she tells patients it’ll take “six months to a year” for the plantar fascia to heal.

“Most people are kind of shocked that it could potentially last that long,” Boakye said. “But, ultimately, I’ve heard, chatting with patients that are on the other side of things, that it was helpful to know that it’d be so long.”
 
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