Plantar Fasciitis 102: Do's and Don'ts Needed

[vladimir]

Never had flip flops, never will

Glenn O'Brien, GQ's Style Guy, thinks "they are the last sad thing on the road to stylistic surrender." I try to live by his diktats as much as possible , but here in Asia we don't wear shoes indoors. So, if the choice is bare feet or flip-flops, they are the better alternative. But I agree with the others that they're not very good for your condition.

 

[farsidefan1]

I have had FAR too much experience with it. I found the absolute cure and it worked in almost exactly a month. Go to a podiatrist and get hard shoe insert molds. He instructed me to remove the shoe lining, put in the insert then put the lining back in. Wear them every minute for the first week or 2. If I got up in the night I had slippers with the inserts by the bed. after a month I was cured but anytime I go for more than a week on a livaboard without using the inserts I start feelling the symptomes again. With the hard inserts I don't bother with any of the other torture, er, exercises. I've been fighting PF for 10 years. I recently spent 2 weeks in Palau, one week on the Aggressor with barefeet, and one week on shore with Sam's. I wore the shoes with inserts for my shore time (not on the boats) and had no issues. Maybe I am cured permanently but I still make sure whatever shoes I'm wearing have the inserts in 3-7 days a week. After the first month I was able to dispense with the bother with the slippers. Pay the bucks and get hard molded inserts. The softer ones you can get at costco are nice now and then but I don't think they are hard enough to provide the pressure you need when fighting a full on attack. Best wishes, you should be fine in a month.

 

[DrKevbo]

Hi ya,

I have had PF myself. I also am a Podiatrist and have treated literally 100's if not thousands of cases. Also happen to be an avid diver.

First... whats causing the pain. The plantar facia is a large stong tendon that supports the bottom of the arch. It has a wide attachment under the ball of the foot and is very stable and strong . Its other attachment is at the bottom of the heel and is the "weak link in the chain". The plantar facia or PF acts as a shock absorber and a spring. you can think of the bony arch as a bow and the plantar facia as a bow sting. when you are off you foot the arch is high and the PF is short. when you step down the arch partially collapses steetching and lengthening the PF. Thats normal function. Whats happening to you is that you step down, the arch collapses, the plantar facia stretches, but then your acrch wants to collapse more... the PF cannot stretch anyfurther...the body pushes down...the hard sufaces pushes up and so you get small tears in the PF where it attaches on the heel. Then you get off your feet, sit or go to bed. Because of the micro tears, it causes swelling, stiffness and shortening of the PF. So, when you get up that first step puts strain on a cold, tight, swollen PF and BANG you re-injure it. So, you are trapped in an inflamation cycle. You say you have had this in the past and it went into remission. Thats good, but there is some scarring from when you had it last time, makeing each flare up worse and harder to knock into remission. Also, when you tear the pf at the heel, it can stimulate calcification of the insertion and this is how a spur grows.

Now what to do about it. There are 2 goals. 1) controll the collapse of the arch and 2) break the inflamation cycle.

1) Controlling the arch is done by strapping taping and orthotics. I also put night splints in this catagory. a night splint will stop the shortening of the PF when you are off it, and can be effective in some people.

2) Breaking the inflamation cycle can be with:
* Nsaid Non Steroidal Anti-inflamatory Drugs or aspirin like drugs. I do no favor them, because it flat out doesnt do a good job and can have side effects
* Steroids- 1 to three cortical steroid injections is the gold standard for breaking the inflamation cycle. in my experience nothing works as well. there are oral steroids, but not near as effective.

If you have done all this and still have the pain, you need to consider having it "fixed". There is an outpatient procedure called a Plantar Facial release. It is minimal excision- I do this with a 1 inch incision and 2 stitches. Quick-it takes me about 10 minutes. fast to heal- I have you wear a boot for 10 to 14 days then back in your normal shoes. high success rate and low complications. all in all a great little procedure.

As far as all this relates to diving. Finning is not a problem at all. its the walking around without support that can flare things up. the best defense is a heavier stiff bottomed booty with a good molded aarch support.

I may not know a lot, but I know a lot about planat faciitis, so If you have any ? Id be more than happy to answer them.

 

[Phoenix1]

Everybody: As the original poser, I'd like to thank everyone for their help. I've been doing a little bit of what everyone has suggested, with excellent results:

--Ice as needed
--Twice daily Aleve
--Stretching my calf before getting up in the morning
--Wearing orthopedically good shoes (chef's clogs, steel arch dress shoes)
--No strenuous activity
--Daily periodic calf stretching, standing with toes on a book, etc.

The key, as DrKevbo put it, was to break the inflammation cycle. It seems as though I may have broken that cycle by the end of last weekend. Total time to do so: about a week.

That's not to say I'm 100%. It feels like 90-95%, but my instincts tell me that rushing back to normal activity risks backsliding.

I did go to a running store yesterday and got a decent pair of sport shoes to replace the old cheap sneakers I usually knock around in. I also had stiffer arch supports put in for good measure. I don't think I have ever had footwear feel so good. After about 10 minutes in them, the sales person and my wife noticed a remarkable improvement in my gait; "back to normal" as my wife put it.

I will say that this recovery occurred faster than in the past. There are probably big tears and little tears, and this one may have been little. Add the determined steps above, and initial recovery was much faster than in the past.

Still, for the next month or so before the dive, I plan to gradually ease back into my routine.

And no boat shoes without inserts.

Thanks again everyone for your help.

 

[spectrum]

A good orthopedic doctor will have specific brand/models of shoes they endorse. My GP said to replace shoes every 6 months, the orthopedist every 3! Even good shoes structuraly breakdown long before they fall apart or become unattractive.

3 pairs a year and a set of orthotics have made a world of difference to me.

I think ortotics are like nitrox. If you have used them the benefits are obvious eeven if not sientificaly quantified.

Pete

 

[DrKevbo]

The type of shoe that you are looking for is a "antipronating" shoe. Pronation is the term for the foot motion that causes the plantar faciitis in the first place. Antipronators have become a very popular running shoe type. specific antipronating shoe selection is a personal choice. However, I am a big fan of the ASICS Gel-KAYANO. Just remeber " cheap shoes are no bargain"

 

[Phoenix1]

After about 2 hours at the running store to choose the right pair, I got Asics Gel 2160s with green Superfeet inserts. My wife got the Kayanos. We both really like our choices. I'm gradually increasing wear time, and slllllooooowwwwly working back into a normal routine. My biggest enemy will be the cavalier notion that after a week or two, all's better.

Replacing shoes every 3-6 months may be ideal but not very practical. I have 6 pairs of dress shoes, each $200-300 a pair. Sorry, my bank account can't handle that. On average, I wear these shoes once or twice a week for a few hours when I go to meetings. 50 dollar athletic shoes may be another matter, but I'm more likely to swap out inserts than toss them. Compared to barefoot (tempting, because I work at home) or deck shoes (close to barefoot), better shoe wearing practices will likely go a long way.

 

[DandyDon]

After about 2 hours at the running store to choose the right pair, I got Asics Gel 2160s with green Superfeet inserts. My wife got the Kayanos. We both really like our choices. I'm gradually increasing wear time, and slllllooooowwwwly working back into a normal routine. My biggest enemy will be the cavalier notion that after a week or two, all's better.

Replacing shoes every 3-6 months may be ideal but not very practical. I have 6 pairs of dress shoes, each $200-300 a pair. Sorry, my bank account can't handle that. On average, I wear these shoes once or twice a week for a few hours when I go to meetings. 50 dollar athletic shoes may be another matter, but I'm more likely to swap out inserts than toss them. Compared to barefoot (tempting, because I work at home) or deck shoes (close to barefoot), better shoe wearing practices will likely go a long way.

I think the 3-6 month suggestion referenced shoes of every day use, while rotating 6 pair would extend that proportionally. I suspect that shoes with laces are good longer than loafers too, and the initial quality would vary as well. Replacing heel taps and half soles promptly should help.

Have you looked into hard shoe insert molds...?

 

[Eric Sedletzky]

I had it really bad for about six months before finally going to the doctor.
It was classic overuse syndrome PF.
Here's what the doctor had me do. He told me to put a water bottle into the freezer until it was rock solid then while I'm sitting watching tv or whatever I was to roll my foot on it hard, he expressly told me to make it hurt. He also had me rub it hard with Aspercreme again to really make it hurt up to the point where it almost bring tears (for both proceedures). I was to do this a couple times a day.
The idea being that I actually reinjured it in a controlled fashion which would spark an expidited healing reaction, which it did. Otherwise what happens is your body just reaches a truce with the original injury and never fully heals if it's not worked and manipulated.

My experience with shoes was different from other peoples'. High arch support is actually what caused mine. I had a pair of boots and also shoes that had an annoying high arch that would put a lot of pressure in that area and that's what actually injured it. I was better off with totally flat shoes like Converse Chuck Taylors or Vans and even flip flops. As long as there was no pressure on the arch pushing up I was fine. Even bare foot.

But before employing any advice from anyone on the board I would go to your qualified physician and get a proffesional opinion and path to recovery.

 

[Cruisin Home]

FWIW my wife suffered with this, tried many of the treatments suggested, and eventually found almost total relief from certain models of "Crocs". not a bad boat shoe either.