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Plantar Fasciitis
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Plantar Fasciitis - September 1, 2005 10:11:00 PM
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goodlooks58
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From: CA
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A question to the group: I have had plantar fasciitis since last 3 weeks. I am very close to going to the podiatrist and getting a cortisone shot to kill the pain. If surgery is suggested what are my options. What is out there without the need for surgery to help fix this problem.
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Re: Plantar Fasciitis - September 2, 2005 8:07:00 AM
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jma
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I would recommend that you don't get the cortisone shot. Do foot inserts that support the arch help? Try rolling your foot in a frozen water bottle. Maybe some taping of the foot can help. If so, orthotics may help if their are biomechanical issues. Its a start.
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Re: Plantar Fasciitis - September 2, 2005 8:12:00 AM
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jma
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Have x-rays been taken? Where does it hurt?In the middle of the foot or more by edge of the heel? Does it first hurt in the AM, when you take a few steps?
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Re: Plantar Fasciitis - September 2, 2005 8:27:00 AM
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PTupdate.com
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Before getting the shot, try:
1. Make sure you have a decent amount of true subtalar dorsiflexion, if not, stretch
2. Make sure you are not dealing with a neural issue, via slumping/DF and eversion
3. Strengthen intrinsics and extrinsics, even if you think they are strong
4. Wear a shoe with good mechanical control, and put in an arch support if necessary. NewBalance 608/609 are inexpensive, still available, and work so very well
5. Use the frozen water bottle as noted above
6. Try pulsed US right at the insertion into the calcaneus (works for me every time mine flares up) and also iontophoresis
7. Soft tissue mobilization to plantar fascia
8. Make sure you have good first ray mobility and first toe extension, but not too much mobility of first ray
9. Stick your heel in a bag of ice every chance you get....being only 3 weeks old, probably still true inflammation occurring.
Odds are, with all listed above and no other issues (weighing 300lbs and/or being diabetic, having equinus, fusion, etc) you should be able to get rid of symptoms very very quickly
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Plantar Fasciitis - September 2, 2005 10:12:00 AM
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ehanso
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From: Minnesota
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You may have already done this but.... Check your shoes (both work and leisure), make sure you have good support, heel counter and heel cushion. Check with a good orthotist and have him/her evaluate your gait and foot mechanics. A quality pair of orthotics may help. Also pay attention to how you position your feet when sitting, driving etc. I had this problem for months and one day realized that I had my foot slightly twisted when I was driving and sitting. After correcting this, it amazingly helped. Good luck
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Re: Plantar Fasciitis - September 3, 2005 3:43:00 PM
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goodlooks58
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From: CA
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Thanks for all your help and suggestions. I have been wearing orthotics since last 10 years due do severe pronation/flat feet. Every 6 months I get my feet re-evaluated and my DPM tweaks my othotics and I usuallly get a new pair as I flatten them. My DPM changed her office and in this she was late 1 month in getting my new orthotics. I think this messed me up. My pain is more in the heel/calcaneus region and not that much in the arch. Mornings and late evenings are painful and stiff.Stretching and self-subtalar mobilization with mild masage in the plantar fascia region has helped significantly. Today I finally am able to do 30 min of treadmill walking. What are your comments on the new high-tech foot orthotics whereby the computer makes the impression after you take 3 steps versus the tradittional cast impression done by my DPM. My brother swears by the high tech orthotics as flat feet runs in my family. I am buying new New Balance running shoes as all the literature suggests New Balance to be the better brand when it comes to pronation support. Any suggestions on the shoe brand?
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Re: Plantar Fasciitis - September 3, 2005 4:12:00 PM
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FLAOrthoPT
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Falls, what about checking with a good PT for this. I think orthotists are fine, much better than DPM, but I think the PT is the only one who is going to take hip knee and pelvis motions in considerations as well.
I still think the gold standard of orthotics is taking measurements of what the foot is doing in non weight bearing, it;s available range, and static weight bearing, and comparative dynamic gait and then cast in non weightbearing taking in account everything you;ve learned about how the foot is and where it's neutral is. Then correct the orthotic to control the heel primarily and control the forefoot if needed as well. rule of thumb that heel should be about half of the forefoot in posting, and you should not correct all the way, it'll be uncomfortable and may not fit in shoe, I usually correct about 50-70% on average. Other than that there are lots of opinions regarding orthotics, but impressions during weight bearing can only creat an accommodative orthotic not a precriptive corrected orthotic IMO.
As far as footwear...and NB...actually this used to be true, but if you look at most newer nb shoes they have a built up lateral forefoot which suggests it is prime for supinators. I'd stick with asics, avia, and most A brands. But the things I have heard and always look for is if you have a floppy pronator instability foot get all the necessary corrections in the shoe. SO:
1)Make sure the shoe inside is a board design not 2 pieces hammocked together (this can be seen by taking out the liner and looking for any obvious or not so obvious stitching down the middle
2)Make sure the overall shoe is not designed in a C curbe pattern. Grab the front of the shoe with the sole facing you, and put a finger right dab in the middle of the front and right dab middle of the back, this should create a line with equal parts shoes both sides if it is fairly straight
3)Make sure the heel cup cannot be pinched together easily to provide good heal support
4)Make sure you cannot twist the shoeany more than about 90 degrees too easily, that is you do not want poor torsional support of the shoe
Everything else is just flash...the tread or aggressiveness of the tread really is what dtermines cross training from aerobic from running etc, good cushioning never hurts
In my experience nikes are typically terrible for pronators, as are most NB these days. Avia, Asics and Brooks seem to be more suited, but check each shoe...
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Re: Plantar Fasciitis - September 4, 2005 12:21:00 AM
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Randy Dixon
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I have a problem with orthotics in the treatment of PF. Almost every chronic PF patient has orthotics but it never resolves the issue. Yes, it sometimes controls the issue but then you have to wonder where all that misplaced motion is going if it's not being absorbed by the plantar fascia.
I'm generally against motion control shoes and cushioned shoes for the same reason. If there is a biomechanical fault and you are fixing it at the level of the foot, you haven't corrected the fault, only transferred it somewhere else.
The human foot was pretty well designed to absorb and distribute shock, and you have to think that evolutionary forces worked pretty hard on this particular piece of anatomy. People who went lame, died. We didn't have fancy shoes or orthotics until very recently. So I don't think you have a pre determined genetic destiny to have flat feet and/or PF, assuming that is a causative factor. It seems to me much more likely that something went wrong biomechanically, and I am much more likely to suspect that it is too much interference at the foot level rather than too little.
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Re: Plantar Fasciitis - September 4, 2005 3:32:00 AM
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jma
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If the biomechanical fault "is" at the level of the foot, then I would assume orthotics is the best way to go.
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Re: Plantar Fasciitis - September 4, 2005 4:44:00 AM
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FLAOrthoPT
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I agree that PF is not treated well with orthotics, I was just responding to the above post. However, I disagree that orthotics are not useful. When you have a patient with totally abnormal pronation that also has abnormal amounts of motion at the sub talar joint and excessive foot motion, etc, etc...or someone so limited that they have 2 degrees of eversion and their subtalar neutral is at 2 degrees eversion then the only way to correct this if it is causing meniscal problems or hip and pelvis problems is start out by correcting the ground reaction forces and then move up the chain appropriately.
I agree that some peoples foot abmormalities are caused by the lower chain,but more proximal in nature. A curve of the spine even can cause one foot to pronate more to try to change the length of the leg, and correcting that may effect the back etc. That is why it is imperative to try to catch these things as early as possible. You saw one of my last posts calling BOSTON PTs. That kid was 8. He does not have ehlor danlos, but he has so much motion in his feet he is actually walking on th einside of his feet, valgus at the knees, increased Q angle, cannot play sports because running is too difficult...why NOT correct the feet?
I think you are saying, hey lookout, the foot may not always be the problem, or that we may be opening up a whole new can of worms by treating the forces at the feet, but I think most of us take all these things into consideration before making orthotics...sometimes the good does not outway the bad we may cause, but to say the human foot was pretty well designed....sure in a "normal" biomechanical situation. But when the foot is hypomobile beyond treatment techniques, or hypermobile,, etc ,etc then why not start by treating the ground reaction forces and normalizing them at the foot and then work up from there?
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Re: Plantar Fasciitis - September 4, 2005 2:04:00 PM
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Randy Dixon
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Actually FLA, I didn't doubt that you were considering these factors and certainly orthotics have their place, not everyone is "normal'. But I have seen orthotics offered as a solution in the vast majority of these cases, including in running magazines and books on injury prevention, where I don't think they are appropriate or at least not stand alone treatments.
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Re: Plantar Fasciitis - September 4, 2005 7:15:00 PM
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goodlooks58
Posts: 425
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From: CA
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Antoher addition to pronation treatment: I feel that my othrotics somehow work better for me when I strengthen my Gluteus medius and stretch the Achilles/Soleus. In fact I have to do these exercises almost everyday inorder to function as a PT standing the whole day. Leg press exercises works even better. I have educated many of my patients who have severe pronation and who also wear orthotics..just my experience.
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Re: Plantar Fasciitis - September 5, 2005 5:48:00 AM
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ehanso
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From: Minnesota
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FLA, I agree that a PT should be the first line of defense. I assumed (we all know what that spells) that this was already part of the plan. We have seen fair results with computer generated orthotics. The technique is intriguing but i am not sure of the fit and mechanics. Sometimes the bells and whistles can overwhelm the reality. In the end, the basics always seem to be to win the day.
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Re: Plantar Fasciitis - September 6, 2005 5:06:00 PM
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bonmar
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From: Boston, MA
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Randy,
You stated in the above post that "the human foot was pretty well designed to absorb and distribute shock, and you have to think that evolutionary forces worked pretty hard on this particular piece of anatomy.....We didn't have fancy shoes or orthotics until very recently"....
I had this type of conversation not too long ago with a DPM. Since so many people get orthotics to assist in foot mechanical correction, I was questioning what people did prior to the "invention" of orthotics in the early 1980's.
The DPM told me that our ancestors did not have as many problems with their foot mechanics since there was no concrete. With the invention of concrete, ground reaction forces increased and has contributed widely to the foot problems we see so many times today.
Food for thought......
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Re: Plantar Fasciitis - September 7, 2005 8:26:00 AM
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Yogi
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From: San Antonio, Tx., USA
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As I recall, the rationale for the "Earth" shoe (remember, backward wedge sole) was that when folks walked in the sand, the impression in the sand had the heel deeper. I never figured out how that meant we should walk uphill in our shoes, but oh well. I haven't figured out the "toe bouncers" either. Young males actively plantarflexing prior to toe off. Anyone with any theories why on either?
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Re: Plantar Fasciitis - September 7, 2005 1:40:00 PM
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Randy Dixon
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Yogi,
I think the Earth shoe idea was actually that it would help posture by affecting the tilt of the pelvis.
Bonmar,
Yes, it is an idea that should be considered. I can think of about half a dozen considerations off the top of my head, the fact that footing is usually smooth and level today, that we tend to stand more than walk, that we wear shoes that prevent or inhibit the natural movement of the foot, that we sit a large part of the time and probably change the biomechanics of the LE, that we are heavier and less fit, etc. But of all those, including the fact that concrete is hard, I don't see orthotics as being a good solution. Not that there isn't every any good use for them, just that I believe they are overused by a factor of 10.
For example, I doubt, but don't know for a fact, that goodlooks has a pathological reason for needing orthotics. My guess is there is a biomechanical reason that if addressed would have fixed, the problem, (or could have years ago).
So goodlooks, what do you think? Do you have things that are noticeable, everted feet when standing, tibial torsion, apparent leg length differences, gait differences, anything?
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Re: Plantar Fasciitis - September 7, 2005 4:41:00 PM
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PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Yogi,
The "toe bouncers" may have not fully integrated their plantarflexion reflex from birth. Similar to "toe walkers", they retain a fair amount of this behavior, and in females, results in some of the best calf development I ever laid my eyes on!
With regards to orthotics: I personally do not jump right into the idea, unless it is reallllly obvious. So often, this patinet is the female wearing Keds/Easy Spirits/flats and other shoes that are "soft and comfie" with no mechanical control. Just getting them into something more stable is often enough. When not, I use the inexpensive AliMed pre-fabs, as they can be sold for less than 20 bucks.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Plantar Fasciitis - September 8, 2005 4:06:00 AM
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JLS_PT_OCS
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Is anyone aware of convincing evidence demonstrating the efficacy of custom vs off the shelf orthotics?
Or is this yet another one of our interventions we primarily do because we can charge for it?
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Plantar Fasciitis - September 8, 2005 3:57:00 PM
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jma
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Joined: August 24, 2000
From: NY
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I think there was something to that effect a while back but I can't remember where I read it from. We'll see if I can find it or not.
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Re: Plantar Fasciitis - September 9, 2005 4:08:00 AM
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PTupdate.com
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Jason...which orthotics are you indicating people prescribe "because we can charge for it"....pre-fabs, custom, or both?
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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