There are nearly 2 million cases of plantar fasciitis in the United States every year. As an orthopaedic surgeon, I’m quite familiar with this issue since nearly 20 percent of my patients come to me about plantar fasciitis. Although there is a surefire way to fix the problem, (the treatment I recommend is coming in following entries) the current treatments aren’t really addressing the issue, and they are costing millions for those who suffer from the heel pain. Many are quick to blame the chosen treatments on profit, but I’m here to set the record straight.
There are two main factors that are contributors to mistreatment, neither of which is profit. Many doctors dealing with plantar fasciitis think their treatment plans are the right course of action. That is, expensive surgeries, useless orthotics, and temporary relief through medicine. The other factor leading to the mistreatment is that patients are demanding these treatments; despite how medical studies have shown they are ineffective. Many believe that a surgery will fix their plantar fasciitis problems; it’s a misconception that surgery is what they need.
Honestly, I don’t think the patients or the doctors know how expensive these treatments end up. In 2007 alone, there was an estimated $376 million in expenses for third parties. But what about the patient costs? (Kuo Bianchini Tong, MD, John Furia, MD) The authors of this study revealed that this estimate is low, and I have to agree; it’s definitely a conservative number since the patient’s expenses aren’t part of the study… The study doesn’t take into account lost time from work, OTC items, chiropractic visits, acupuncture, night splints, diagnostic studies, among other costs.
So what should we learn from this? An exorbitant amount of money is spent on these treatments every year, but the real issue isn’t just the expense, it’s that most treatments are unnecessary and ineffective.
How much have you paid to relieve your plantar fasciitis problems? Were the treatments effective?
I used to work for Aircast in R&D although I did not design the Aircast Airheel, I did (very briefly) work on it.
Do you think that an inexpensive brace like this works better than surgery (which generally doesn’t work for plantar fasciitis)?
To be honest, surgery and some braces can help. But neither of them address the underlying issues of plantar fasciitis. They provide temporary relief, at best.
Thanks for the information. Are you going to put up more posts on this soon? I’d be interested in your ideas on what to do about this; orthotics don’t make much difference, I’ve had steroid shots in my heel, which provide temporary relief, and I’m doing exercises recommended by my Md and chiropodist. I can feel it starting to come back again, not happy that I’ll be going through it again. Thanks.
Thanks for the kind words. We appreciate it. It seems there is a need for more plantar fasciitis truth, so we will be sure to post about it again. I can’t technically advise anyone about any situation regarding the medical field, but I can tell you that stretching the calf is effective.
Stay tuned, we will hopefully have a post about calf stretching.
Thanks. I have been advised to do the calf stretches, but have not done them as consistently as I should. I will definitely be doing them regularly from now on.
Please keep us posted on your success with regular calf stretching. And as always, thanks for reading.
Would you please explain the “useless orthotics” statement? I’m a terrible pronator and have been told that if I don’t wear them I’ll end up walking on the sides of my feet. New York Times seems to think there is no logic to how they’re made. I’d have to agree with that statement. Is there any science to orthotics? Are there guidelines on how to cast a foot properly? Is this information available to the public?
My left foot plantar fasciitis came about through using crutches after Morton’s Neuroma surgery on the right foot. My physical therapist showed me how to tape the foot, told me to freeze water in a bottle and roll it on the arch of my foot, and to do contrast bathing. Eventually it went away. After the second surgery on my right foot I used a knee cart and a wheel chair and stayed off my left foot. It was much happier.
I can not render individual medical care in this venue, but I can comment on orthotics…
Orthotics are very often prescribed with reckless abandon, especially “custom” orthotics, while over the counter orthotics usually get the job done at 10% of the cost! There is no doubt they can be beneficial, but they must be prescribed appropriately.
Your story sounds like a typical tale of coercion used way to often. To put it very simply, I view orthotics kind of like shoes, “if the shoe fits, wear it.”
At the end of the day, whether you already have orthotics or you are considering their use, you are the final judge as to whether they are helpful or not.
What kind of treatment or therapy regimen do you suggest for plantar fasciiatis, Doctor?
I can’t technically give any medical advice, but I can tell you that consistent calf stretching is the only method that works. Thanks for reading. Stay tuned for some future entries on plantar fasciitis.
Very interesting info! I have suffered from severe foot pain for years, and I’d say most treatments I’ve had were ineffective. No one ever suggested stretching! The last podiatrist I went to tried to get me to agree to (another) set of expensive orthotics, and said that my problems, including the plantar fascitis, are due to a “biomechanical defect”. Does that mean no hope of relief?! In the meantime, I’ll start stretching..Thanks!
It really makes me angry that podiatrists recommend these useless treatments. I’m sorry that this hasn’t been made available to you until now. Stretching calves on a consistent basis is an excellent solution for dealing with plantar fasciitis. Thanks for reading, please let me know how stretching is going for you.
Over the course of a year, I probably dropped about $2500 to deal with my foot pain that had developed around August 2010. This includes doctors visits (primary care, and two podiatrists), OTC orthotics, injections, custom orthotics, physical therapy, dixie cups for making ice, hot/cold pads, athletic tape, having a yoga instructor write up a custom plan, sports massage, and all kinds of trial-and-error footwear.
Just two months ago, I was to the point where I was spending over an hour a day on my stretching routine. 30 minutes alone, just before getting out of bed, for fear of re-injuring a torn plantar fascia.
Despite all of this, there was no improvement. Then, about a month or so ago, I found something about trigger points on Google. I was able to locate, and massage a few knots in my shins and calves, and noted marked improvement within a day.
More Google searches, now for ‘trigger points’ rather than ‘plantar fasciitis’, led me to “The Trigger Point Therapy Workbook.” It cost me $13.00 on Amazon. A month after it arrived, I not having any noticeable foot pain and I’ve resumed my normal activities.
And I’ve ditched my orthotics.
It required massaging these knots a few times a day, for a few weeks to “release” them. There is some pain involved, because the lactic acid release will make your calves burn for a couple weeks. But drink plenty of water, and it will pass. It’s nothing as bad as the heel pain, or one of those damned cortisone injections.
I’m not trying to sell anything, and I have no relation to the authors of that book. I know all cases are different, but I thought I’d share what helped me.
Is there any possible link between -itises and childhood rheumatic fever? I’m thinking there is, because the group-A strep responsible for rheumatic attacks connective tissue, including the heart. What other explanation could there be for one person having many hypermobility/connective tissue issues, including: piriformis syndrome, iliotibial band syndrome, Achilles tendinitis, Haglund’s deformity, plantar fasciitis, hypermobile SI joints/pelvis, most of which were concurrent? This happened in my early 40s.
Anyways, active release was very helpful for the Achilles tendinitis and plantar fasciitis. Keep up the good work in discouraging surgery for plantar fasciitis.
Hi minus 56,
Very good stuff. Maybe I need to learn from you. I have seen this litany of issues in one person many times. This is my one comment I do not think it is inflammatory first, unless we are looking at something like rheumatoid arthritis. In my medical life dealing with foot and ankle problems it has served me and my patients very well thinking of these things like you mention as mechanical which leads to chronic inflammation.
Now don’t be so smart or you will make me angry. AO
I am wondering if you have any thoughts on the fibromylagia-plantar-osteopenia patient. I am super healthy, not overweight, except for these conditions above and my feet have worsened as I approach 47. This time my plantar on my right foot is where I cannot walk at all now. I just left another podiatrist. Steriods, pain pill, orthotics ( not custom) and told me to grab me some Brooks sneakers. Gave my stretches too along with ice, etc. The condition can go away when all this is applied but it comes back. My ankles feel bruised and almost like the weight of my body is too heavy for my feet to hold me. I am on the petite side and tiny feet, size 6. I have spent lots of money through the years. I do not wear anything but sneakers and Steve Madden sandals when I cannot wear my sneakers. Have not worn high heels in years. But I must say my wardrobe is lacking now. 🙁
First, I assume when you say “plantar” you mean plantar fasciitis. Absolutely no criticism intended, but you sound much like the 56 year old, you are just ahead of your time. The 56 year old syndrome set of issues resulting from equinus has a wide age range with the average age of 56. While I can’t and shouldn’t accurately diagnose your problems, why don’t you just start calf stretching and see what it gets you. I think you will be amazed, but be patient. One suggestion, make sure the contact area of your foot is in the middle as depicted and not out towards our toes. That contact int gives and inferior stretch and produces a lot of force thru your osteopenic metatarsals.
Stay healthy my friends,
I have been suffering with PF for 4 months .Ive tried everything and even resorted to physical therapist for shock wave trt out of desperation as nothing else is working.Im a big believer of stretching and have been doing it daily but more so with the foot then the calf,yet each time I got off my slant board after a minute or so I felt instant relief walking.I came across your site and it’s like OMG !!!!!! Now FINALLY someone who may know what he’s talking about.
I will start your 3×3 daily stretch and am very optimistic.
I have a slant board which gives you a option of 3 different degrees of slant to really stretch your gastrocnemius and soleus.
Are you firm on the step or will the slant board be just as good?
Also, would massaging ,trigger point massage Be beneficial for the lower leg?
What do you recommend that can be helpful when it comes to the actual plantar fascia where it is so tender and usually inflamed ?
massaging, ice, heat, or do you believe in just leaving it alone?
THANK YOU FOR ALL YOUR KNOWLEDGE AND SHARING WITH US .
Hi there Jan,
You bring up some very good points here, but it still makes me angry. Feel proud.
Simple, stupid stretching works! I think the slant board is fine, but it will not isolate the gastrocnemius like the stair step will. As long as you are stretching on something, you will be making progress. You want to feel it in the top of your calf or the gastrocnemius, just below your knee. Forget the soleus, really. If the slant board gets to the gastro then you are good.
Here is a critical and basic philosophical point. Sometimes I know I sound like stretching is all that is needed and forget about everything else, i.e., don’t even treat the foot, or the plantar fascia, right? Human nature will always take us back to the obvious (foot or ankle pain) and away from the obscure (equinus, calf too tight). So, if I was to go easy on the calf stretching and mix it with other foot directed treatments no one would ever stretch. 30 years delivering this message has honed this skill.
So, to carry this to closure, of course, you can do anything you want to palliate or treat the symptoms (the obvious). As such you suggest you could try trigger point massage, plantar fascial stretching, ice, heat, NSAIDS, and the list goes on, but DO NOT FORGET THE OBSCURE, your gastrocnemius. This is why so many fail even with the best of intentions.
Jan, I have two missions. Second, is to be disruptive to Western medicine, but my primary mission is to save the human foot and ankle with one thing- calf stretching. In case it is not obvious my primary mission requires the secondary mission.
Stay healthy my friends,