Good shoes to prevent "heal pain", plantar fascitis?

[doclm]

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Hello,

Two weeks ago I had heel pain from walking on my feet for around 16 hours each day at work. What are some good shoes to prevent such a pain? Since then I purchased and returned over 5 pairs of shoes however I cannot find the right pair to help with this pain.

Thanks for your advice.

 

[JohnfootDr]

Ice, Stretch (good stretches for your Gastroc will also stretch your Plantar Fascia), NSAIDS.

I'd actually recommend taking the insoles out of your shoes and putting a pair of something like Spenco Orthotics or SOF Sole orthotics in their place.

Otherwise something like Danskos will work great.

That is, naturally, assuming you have Plantar Fascitiis rather than a stress fx, or other pathology.

John

 

[Dr_Feelgood]

I'm doing some research on this topic. Unfortunately, it takes awhile to go away but the most effective treatments are stretching and orthotics. Some people use a can from the pantry to stretch their fascia out. I do not recommend NSAIDs for the simple fact that fasciitis is not really an -itis, it is not an inflammatory process. So if there is no inflammation then why take an anti-inflammatory. Ice is the same thing, but at least w/ ice you get some numbing of the nerves in the area.

My thoughts stretch and get some good OTC insoles, Spenco and SOF are great.

 

[doclm]

Ice, Stretch (good stretches for your Gastroc will also stretch your Plantar Fascia), NSAIDS.

I'd actually recommend taking the insoles out of your shoes and putting a pair of something like Spenco Orthotics or SOF Sole orthotics in their place.

Otherwise something like Danskos will work great.

That is, naturally, assuming you have Plantar Fascitiis rather than a stress fx, or other pathology.

John

Thanks for your advice. I'll try some stretches and orthotics.

Does an increased arch support help?

Thanks. 👍

 

[doclm]

I'm doing some research on this topic. Unfortunately, it takes awhile to go away but the most effective treatments are stretching and orthotics. Some people use a can from the pantry to stretch their fascia out. I do not recommend NSAIDs for the simple fact that fasciitis is not really an -itis, it is not an inflammatory process. So if there is no inflammation then why take an anti-inflammatory. Ice is the same thing, but at least w/ ice you get some numbing of the nerves in the area.

My thoughts stretch and get some good OTC insoles, Spenco and SOF are great.

Yeah, I developed this problem a few weeks ago from putting in some serious OT at work. However, since I wore some flat shoes that should of been replaced last year, I developed this problem. 😳 Although it seems to get a little better now, it does seem like its taking a LONG time to go away.

Thanks for your advice, I will probably resort to stretches and insoles.

Having this come up and trying to find the right shoes has really made me realize that there are some crappy shoes on the market. The worst ones that I came across were some $29.00 cheapo Target shoes. After wearing these for 5 min. I had to stop for a break, before I could finish walking to work. Although, I have some unusaully wide feet, these shoes really sucked. Not to mention that Target has the worst return shoe policy. The others that I tryed that didn't work were a Nike cross-trainer, Dr. Scholls , Addidas, and my old pair of DMX's. Just yesterday, I got a pair of Wide Saucony's that seem to be better. Although they are considered a running shoe, the mesh helps with allowing the flexability, and the soles have adequate cushioning.

I would of got some New Balances right away if they had some good styles that were in a whiter color, for work. Also, I found that Etonic made a new shoe that had some awesome cushioning, however they ran about $100.

 

[Dr_Feelgood]

Yeah, I developed this problem a few weeks ago from putting in some serious OT at work. However, since I wore some flat shoes that should of been replaced last year, I developed this problem. 😳 Although it seems to get a little better now, it does seem like its taking a LONG time to go away.

Thanks for your advice, I will probably resort to stretches and insoles.

Having this come up and trying to find the right shoes has really made me realize that there are some crappy shoes on the market. The worst ones that I came across were some $29.00 cheapo Target shoes. After wearing these for 5 min. I had to stop for a break, before I could finish walking to work. Although, I have some unusaully wide feet, these shoes really sucked. Not to mention that Target has the worst return shoe policy. The others that I tryed that didn't work were a Nike cross-trainer, Dr. Scholls , Addidas, and my old pair of DMX's. Just yesterday, I got a pair of Wide Saucony's that seem to be better. Although they are considered a running shoe, the mesh helps with allowing the flexability, and the soles have adequate cushioning.

I would of got some New Balances right away if they had some good styles that were in a whiter color, for work. Also, I found that Etonic made a new shoe that had some awesome cushioning, however they ran about $100.

Asics are good also. If you get a good pair of over the counter orthotics they can help make an okay shoe into a great shoe.

One thing to remember is that your orthotic should be supportive but not rigid. Only in certain situation to you want a rigid orthotic. This is a mistake people make and then they hate their orthotics.

 

[dpmrunner]

Ok, so I'm not a pod yet but I can offer some good shoe knowledge. I've worked at a running and walking shoe store for over three years now, one that all the local podiatrists send their patients to.

Your best bet for comfort would be a shoe classified as a running shoe although if there are restrictions with mesh or color where you work I would recommend a walking shoe.

If you're not familiar with different shoes then the best bet would be to go to a running specialty store in your area even though you don't run. All shoe brands have slightly different cuts so usually one can find a brand that works for them and stick with it. Unfortunately, a good shoe that will last will start at about 90 dollars and up, but you can find some old colors etc that are discounted to 60ish or 70 dollars. For example, mizuno typically runs wider throughout the shoe and has a higher arch but the creation model has the highest arch where the alchemy is lower. Asics are pretty standard, middle of the road shoes, new balance have two lasts to their shoes and so on. Hope this helps some.

 

[JohnfootDr]

Dr. Feelgood,

When my current attendings treat Plantar Fascitiis and do an injection, it gets charted as Plantar Fascitiis with Pain and Infracalcaneal Bursitis (some insurance companies don't pay for injections to the plantar fascia, but will pay for injection into an inflammed bursa.

I do not recommend NSAIDs for the simple fact that fasciitis is not really an -itis, it is not an inflammatory process.

If it is not an inflammation, then how would you define it? I personally call it something closer to an enthesiopathy (strain of the plantar fascia at it's insertion/attachment to the calcaneous and periosteum). This causes a localized inflammatory response (swelling, pain). There is still an element of inflammation.

Additionally, you mention above that ice numbs the nerve. This is a short term effect. NSAIDS are almost universally Analgesics first and anti-inflammatories second.

Upon injection of local anesthetic and corticosteroid into the area, the patients normally get up to 1 week of relief (even if no other measures are taken). The local wears off after 6 hours (depending on the mix and type of locals uses). The corticosteroid reduces the inflammatory response in the area for the remaining period.

John

 

[jonwill]

Dr. Feelgood,

When my current attendings treat Plantar Fascitiis and do an injection, it gets charted as Plantar Fascitiis with Pain and Infracalcaneal Bursitis (some insurance companies don't pay for injections to the plantar fascia, but will pay for injection into an inflammed bursa.



If it is not an inflammation, then how would you define it? I personally call it something closer to an enthesiopathy (strain of the plantar fascia at it's insertion/attachment to the calcaneous and periosteum). This causes a localized inflammatory response (swelling, pain). There is still an element of inflammation.

Additionally, you mention above that ice numbs the nerve. This is a short term effect. NSAIDS are almost universally Analgesics first and anti-inflammatories second.

Upon injection of local anesthetic and corticosteroid into the area, the patients normally get up to 1 week of relief (even if no other measures are taken). The local wears off after 6 hours (depending on the mix and type of locals uses). The corticosteroid reduces the inflammatory response in the area for the remaining period.

John

I believe Feelgood is referring to the article written by Yu that suggested calling it plantar fasciosis because in a study he did, histologically, there were no signs if inflammation. However, I had some issues with the paper. I agree with you John. And since I've seen NSAID's and corticosteroid injections work so well, I'd have a hard time not calling it fascitis.

 

[dpmgrad]

I believe Feelgood is referring to the article written by Yu that suggested calling it plantar fasciosis because in a study he did, histologically, there were no signs if inflammation. However, I had some issues with the paper. I agree with you John. And since I've seen NSAID's and corticosteroid injections work so well, I'd have a hard time not calling it fascitis.

Actually, the article that described the histological findings of chronic plantar fasciitis as plantar fasciosis is written by Dr. Harvey Lemont and 2 other TUSPM students in the May-June 2003 issue of JAPMA.

 

[Dr_Feelgood]

Actually, the article that described the histological findings of chronic plantar fasciitis as plantar fasciosis is written by Dr. Harvey Lemont and 2 other TUSPM students in the May-June 2003 issue of JAPMA.

That is the one. Also the only study that has any EBM that has been done on plantar fasciitis was done in 1956 and the results were shaky. Dr. Blockey did the study and saline was as effective as steroids. Since then no one has compared a simple saline injection to steroids.

NSAIDs have been studied the average effectiveness was not proven either. The most effective results were night splints, orthotics and stretching according Dr. Cook's study compared various conservative treatments.

Lamont's theory is based on the same findings in tendonitis. I do realize that both of these ideas are highly debated but as I said there is no EBM that says the NSAIDs or steroids do anything. That is why we are doing the double blind study on the use of steroids versus saline.

 

[krabmas]

That is the one. Also the only study that has any EBM that has been done on plantar fasciitis was done in 1956 and the results were shaky. Dr. Blockey did the study and saline was as effective as steroids. Since then no one has compared a simple saline injection to steroids.

NSAIDs have been studied the average effectiveness was not proven either. The most effective results were night splints, orthotics and stretching according Dr. Cook's study compared various conservative treatments.

Lamont's theory is based on the same findings in tendonitis. I do realize that both of these ideas are highly debated but as I said there is no EBM that says the NSAIDs or steroids do anything. That is why we are doing the double blind study on the use of steroids versus saline.

I've heard that injections only work well in acute flares of faciitis. if the patient comes in because they'e had this pain for 3 years the injection probably will not work.

so I think there may be components of inflammation and some cases with out inflammation.

We also learn at NYCPM that there are many causes of plantar faciitis
1) compression of baxter's nerve - so no inflammation there
2) wolf's law for the growing spur - the facia pulls to hard on the medial calcaneal tubercle and bone starts to grow - an inflammatory process so I hear.
3) I'm sure there are more since we learned about 4 but ....blah.

so it would make sense that the injections work for some people and not others, and that histologically unless the acute flare was caught it would not show on microscope.

 

[jonwill]

I've heard that injections only work well in acute flares of faciitis. if the patient comes in because they'e had this pain for 3 years the injection probably will not work.

so I think there may be components of inflammation and some cases with out inflammation.

We also learn at NYCPM that there are many causes of plantar faciitis
1) compression of baxter's nerve - so no inflammation there
2) wolf's law for the growing spur - the facia pulls to hard on the medial calcaneal tubercle and bone starts to grow - an inflammatory process so I hear.
3) I'm sure there are more since we learned about 4 but ....blah.

so it would make sense that the injections work for some people and not others, and that histologically unless the acute flare was caught it would not show on microscope.

That is exactly my beef with Lemont's study. His histologic specimens came from REMOVED spurs and fascia from surgical cases. In other words, these were ALL chronic cases of plantar fascitis in which conservative treatment had failed and most likely had progressed to "fasciosis". I thought it was a bit premature to state that fascitis was not at some point inflammatory (ie acute phase).

 

[Dr_Feelgood]

That is exactly my beef with Lemont's study. His histologic specimens came from REMOVED spurs and fascia from surgical cases. In other words, these were ALL chronic cases of plantar fascitis in which conservative treatment had failed and most likely had progressed to "fasciosis". I thought it was a bit premature to state that fascitis was not at some point inflammatory (ie acute phase).

I would just like a little literature to proof that it is an inflammatory disease.

 

[krabmas]

I would just like a little literature to proof that it is an inflammatory disease.

do some research and then you'll have the literature!

 

[Dr_Feelgood]

do some research and then you'll have the literature!

I'm doing research on plantar fasciitis, so I have done literature reviews. I'd be happy to share what I've read w/ anyone interested. If you have a definitive article on the subject that has a high level of EMB, I'd be happy to read it. That is the problem on this topic; most of the articles are weak in the area of EBM. I think that this is true b/c there are no good animal models. It is tough to get progressive histological slides from humans, and I can't think of many bipedal animals maybe kangaroos. Maybe our Australian friend can tell us if kangaroos have plantar aponeurosis and if they can do research on them down under.

Again, I'm not assuming that I know anything or everything on the subject, but I'd like a little proof. Call me a Doubting-Feelgood.

 

[krabmas]

I'm doing research on plantar fasciitis, so I have done literature reviews. I'd be happy to share what I've read w/ anyone interested. If you have a definitive article on the subject that has a high level of EMB, I'd be happy to read it. That is the problem on this topic; most of the articles are weak in the area of EBM. I think that this is true b/c there are no good animal models. It is tough to get progressive histological slides from humans, and I can't think of many bipedal animals maybe kangaroos. Maybe our Australian friend can tell us if kangaroos have plantar aponeurosis and if they can do research on them down under.

Again, I'm not assuming that I know anything or everything on the subject, but I'd like a little proof. Call me a Doubting-Feelgood.

Maybe you can do an actual study. short of collecting tissue from humans there is a fairly new theory and devices that measure temperature. I know the point of inflamation (if any) of PF would be pretty deep to the skin but it may still work.

The devices measure skin temperature - some are used for diabetics to measure their skin temperature to tell if they are about to ulcerate.

You could measure the temperature of each patient's skin over the medial calcaneal tubercle that comes in for plantar faciitis pain.

There is another theory that all pain has a temperature increase whether inflamatory or not so you'd have to see if there was a higher temp for the acute stages of PF depending on the duration of pain or something like that.

what do you think?

 

[jonwill]

I'm doing research on plantar fasciitis, so I have done literature reviews. I'd be happy to share what I've read w/ anyone interested. If you have a definitive article on the subject that has a high level of EMB, I'd be happy to read it. That is the problem on this topic; most of the articles are weak in the area of EBM. I think that this is true b/c there are no good animal models. It is tough to get progressive histological slides from humans, and I can't think of many bipedal animals maybe kangaroos. Maybe our Australian friend can tell us if kangaroos have plantar aponeurosis and if they can do research on them down under.

Again, I'm not assuming that I know anything or everything on the subject, but I'd like a little proof. Call me a Doubting-Feelgood.

NONSENSE! Just give IlizaRob an ankle block, open him up, and take a look. He's a tough guy. I've seen him play ball in the mornings!

 

[Dr_Feelgood]

Maybe you can do an actual study. short of collecting tissue from humans there is a fairly new theory and devices that measure temperature. I know the point of inflamation (if any) of PF would be pretty deep to the skin but it may still work.

The devices measure skin temperature - some are used for diabetics to measure their skin temperature to tell if they are about to ulcerate.

You could measure the temperature of each patient's skin over the medial calcaneal tubercle that comes in for plantar faciitis pain.

There is another theory that all pain has a temperature increase whether inflamatory or not so you'd have to see if there was a higher temp for the acute stages of PF depending on the duration of pain or something like that.

what do you think?

I'll look into it. That is the one thing that we have been addressing, we want to make the study as strong as possible, BUT we have to rely on quantitaive analysis like patient pain assessments. I'll bring it to the crew. Of course, by the time most patients come in to get help w/ PF it is already a chronic condition and that has been proven to be non-inflammatory (Lamont's study and the multiple tendinosis studies).

Maybe big bad Ilizarob will let us induce PF in him and track his progression.

 

[IlizaRob]

NONSENSE! Just give IlizaRob an ankle block, open him up, and take a look. He's a tough guy. I've seen him play ball in the mornings!

Just cut the thing off. Im sick of biological structures and the pain and problems they cause. Just give me a prosthetic and I will be on my way. I will never get PF with that!

 

[IlizaRob]

I'll look into it. That is the one thing that we have been addressing, we want to make the study as strong as possible, BUT we have to rely on quantitaive analysis like patient pain assessments. I'll bring it to the crew. Of course, by the time most patients come in to get help w/ PF it is already a chronic condition and that has been proven to be non-inflammatory (Lamont's study and the multiple tendinosis studies).

Maybe big bad Ilizarob will let us induce PF in him and track his progression.

You can induce PF on the foot JonWill cuts off. I will no longer be needing it.

 

[JohnfootDr]

WBC labeled scan....

Would take some funding money, but get the acute phase PF patients, and run a WBC labeled scan...no WBC accumulation in the area, no inflammation.

John

 

[Dr_Feelgood]

WBC labeled scan....

Would take some funding money, but get the acute phase PF patients, and run a WBC labeled scan...no WBC accumulation in the area, no inflammation.

John

That would be a great idea and very accurate. But do you think that the patients would come in early enough to catch the disease it is acute stage or are they probably in a chronic condition? My basic thoughts on the subject are that PF undergoes the same stages as tendonitis, where the chronic stages are not inflammatory. That was the basis for Lamont's article, and our research. I would be interested in the WBC labeling but man-alive talk about a serious amount of money.

 

[Zummy]

Can anyone tell me what is usually in the shot given for plantar fasciitis? I know there are variable mixtures.

I had my first visit to a DPM yesterday for my heel/arch pain. We decided to go ahead with the heel injection since I've been having it for about 7 mo now.

I know it had celestone, marcaine, and lidocaine, but there was at least one more med (maybe two) that I can't remember now. Anyway, the heel pain is gone but my foot feels "achy" today. Is that common after these shots? Is it normal to feel sharp, but deep, visceral and electric-like sensations during the shot?

And why did it feel like there was glass in my foot when he pushed on my heel shortly after the injection? Yuck. That sensation did resolve but my foot felt achy with strange cutaneous (not totally numb, but not totally normal) sensation last night.

Any info would be appreciated! Thanks!

 

[Dr_Feelgood]

Can anyone tell me what is usually in the shot given for plantar fasciitis? I know there are variable mixtures.

I had my first visit to a DPM yesterday for my heel/arch pain. We decided to go ahead with the heel injection since I've been having it for about 7 mo now.

I know it had celestone, marcaine, and lidocaine, but there was at least one more med (maybe two) that I can't remember now. Anyway, the heel pain is gone but my foot feels "achy" today. Is that common after these shots? Is it normal to feel sharp, but deep, visceral and electric-like sensations during the shot?

And why did it feel like there was glass in my foot when he pushed on my heel shortly after the injection? Yuck. That sensation did resolve but my foot felt achy with strange cutaneous (not totally numb, but not totally normal) sensation last night.

Any info would be appreciated! Thanks!

The only other thing that I would guess might have been in it is a short acting steroid such as hydrocortisone. I am kind of surprised he/she used marcaine and lidocaine, seems like over kill to me but what the heck do I know. As for the achy, one the local anesthetic has worn off. Two, I'm not saying that you are having this but steroid injections can have a "flare-up" phenomenon.

As for the glass, that was probably the local as has the "weird half alive half dead feeling. Think about when you get a local during a dental procedure. Because your sensations (pain, temp, position sense) are block at different levels of anesthesia, your body has some signals but not all. So your mind is a little confused as to what the heck is going on.

Again at 7 months, I’m with holding my judgement on the validity for injections. Since it is no longer in an acute stage, it is less likely to be an inflammatory condition. If it was an acute condition sure b/c the insult to the periosteum. That is this guy’s opinion. I’d suggest stretching at least 3 times a day and getting a good pair of OTC insoles. Try soaking your foot in warm water before you stretch, or stretching during the shower, from most of my reading that seems to be the most effective treatment. Again this is my opinion and I don't have 20 years of clinical experience to back it up. I have read a lot of research in this area and that is what I am basing my comments on.

 

[jonwill]

Can anyone tell me what is usually in the shot given for plantar fasciitis? I know there are variable mixtures.

I had my first visit to a DPM yesterday for my heel/arch pain. We decided to go ahead with the heel injection since I've been having it for about 7 mo now.

I know it had celestone, marcaine, and lidocaine, but there was at least one more med (maybe two) that I can't remember now. Anyway, the heel pain is gone but my foot feels "achy" today. Is that common after these shots? Is it normal to feel sharp, but deep, visceral and electric-like sensations during the shot?

And why did it feel like there was glass in my foot when he pushed on my heel shortly after the injection? Yuck. That sensation did resolve but my foot felt achy with strange cutaneous (not totally numb, but not totally normal) sensation last night.

Any info would be appreciated! Thanks!

Could have also been sodium bicarbonate (shot hurts less). Celestone contains both short and long acting corticosteroids.

 

[Trauma Mama]

Before you buy several pairs of shoes that may/may not work (I have tried Danskos, Birkenstocks, etc.), try taping your foot with 2" athletic tape while you're at work. It works like a charm for me, and supports the plantar fascia during activity. You do want to remove it while at rest. I buy mine from heelspurs.com for a couple bucks a role, and they have a diagram that shows you how to place it on your foot. I also use a soft arch support (high arches), but the biggest relief has come from taping, stretching, and ice. I freeze a water bottle and roll it with the arch of my affected foot after work/exercise. Stretch tid, especially right before you get out of bed, and when you tape your foot. A tension band works really well for this. I snagged one from a physical therapist.

Good luck- hopefully something noninvasive will work for you, too.

 

[jonwill]

Good post. These are all conservative treatments that work on the majority of our patients.