Treating chronic plantar fasciits: My answer to someone who has battled plantar fasciits for years.
Below is a real response I gave to a recent runner who reached out to me with a case of chronic plantar fasciits.
As always, Dr. Campitelli recommends consulting a physician prior to starting any exercise program and the information provided here is not recommended to be advice in place of seeing your doctor for a medical problem.
Thank you so much for reaching out and I will try to do my best to answer this. Dealing with chronic planner fasciitis is a tough situation. It is not uncommon for patients who come to see me with chronic plantar fasciitis to have already been told to not go barefoot, wear orthotics, and wear stability motion control running shoes. I make a point that it’s pretty simple, if they have been doing this for 6 months to a year and now they’re here seeing me, then it’s probably not working so its time to try something else. I see this scenario over and over again. I’m not saying the orthotics are bad or that the motion control shoes are bad, the problem is they should only be temporary. I do not treat chronic player fasciitis with orthotics or shoes. I will use them in acute situations where the patient needs to be off their foot but when the condition is chronic the foot needs to be strengthened. In this situation my advice to you would be that you need to learn how to function and walk and run again while dealing with this pain or inflammation. I’m assuming that you don’t have a fracture or acute situation occurring. What I tell my patients is to begin barefoot activities a half hour each day. I also want them doing calf raises, towel curls with their toes, and any strengthening exercises for the foot arch and lower extremity. I stress that these need to be performed barefoot. When you perform these in a shoe you will cheat and not isolate the muscles to your lesser digits and arch. Many times when performing calf raises with shoes on you will perform this on the ball of your foot meaning the great toe joint and eliminate using all the other muscles that control your toes. The idea is that you want to strengthen the musculature in your calf which supplies tendons to your foot and toes creating a more stable base for your foot. Even though these muscles are in your calves, they supply the tendons to the arch of the foot and toes which are very crucial in maintaining a stable base of support. Here is a link to a video I recently posted on YouTube demonstrating strengthening exercises for runners. When you begin feeling stronger and have less pain I would advise doing these three or four days a week.
The other point that I mentioned is learning how to walk again. Our society has been tainted with shoe gear in that it allows and creates a different gait of ambulation for us. Our bodies were designed to walk and run however not with shoes on that have high heels and arch supports. When we walk in shoes with higher heels we tend to have a different gait and stride in that we swing our foot to get the heel to clear the ground and land on our heal. This translates into taking longer strides which increases the impact force on our foot and more importantly to the heel with each step. When I’m describing this two patients in my office, I make the analogy that it’s almost as if you’re walking on ice. You want to take short steps and try not to accentuate your stride length. This will decrease the impact forced to your foot.
Another scenario that you want to try to do is when standing do not lean on one foot and then the other foot in attempt to give the opposite foot a rest. You want to stand with your feet approximately shoulder width apart and with a gradual forward lean to your midfoot and forefoot. We were in shoes that have a slight angle or increased heel height, we tend to lean backwards to accommodate for this and put more force and pressure on her heels eliminating the muscular contractions of our foot and lower extremity.
In summary, you need to learn how to walk again, run again, and function in a manner that will strengthen your foot. It’s going to take time for this change to occur and for you to see a reduction in pain. It may they take 4 to 6 weeks before you start to see a difference however you should begin noticing changes in your symptoms. Keep in mind that while performing these activities and lifestyle changes you will still need to wear shoes. In other words if you’re going barefoot and functioning when doing these exercises you may want to complete the rest of your day and a pair of cushioned shoes to give your foot rest. Remember when you hear the statement that going barefoot strengthens your foot, it also works your foot harder. So it does help to rest the foot the remaining portion of the day with a shoe. Eventually you will become stronger and not need to rely on a shoe as much.
Well said doc!
I’m a Norwegian two-time Olympic runner (13.06 5k back in ’04) as well as an MD like you. I have been following your blog for a while and want you to know that I’ve added you to a list of the Top 100 Running Blogs for 2014 on my small personal marathon blog.
You are there, and deservedly so, in spot # 16 :
My blog is quite new and certainly not as established/medical oriented as your site, but I try to share quality, inspirational posts with my readers.
Keep up the wonderful work. If you ever want to get in touch to discuss running, do not hesitate to do so.
Marius Bakken, MD