Plantar Fasciitis Support Groups

There are many Facebook support groups, often more than one for a given problem or diagnosis. One of my clients being treated from Plantar Fasciitis recently encouraged me to join a group called Plantar Fasciitis Help and Support. It's based out of the UK but has members from all over the world.

Support groups are beneficial on the whole. It's always nice to know there are people with shared experience walking the path with you. It's good to hear stories of the people who struggled and overcame their problem. It's usually helpful to learn specifically what products and treatments did and did not work for others.

But from my little neck of the woods (orthopedic rehabilitation), support groups are not completely good. There is definitely confusion. There are over-confident laypeople who make sweeping conclusions from their own personal study of N=1. There is plain bad advice.

Just because Crocs are the only thing that give you relief does not mean that this is good advice for all. Just because foot exercises (likely done incorrectly) made your pain worse does not mean that exercise is always bad. Just because your specialist pointed out a heel spur does not mean you will or will not respond well to omega-3 supplements. Cortisone injections simply cannot be miraculous AND of the devil.

And on and on.

Here are a few key points that those dealing with Plantar Fascitis should consider:

1.  Plantar fasciitis is a common problem with a myriad of different causes.

There is no one cause of all cases. There is no one solution that will help all cases. No one exercise. No one medicine, shoe, or orthotic. Other foot problems are often misdiagnosed as plantar fascitis. Lastly, plantar fascitis often occurs in conjunction with other foot conditions like diabetic neuropathy, posterior tibialis tendinopathy, and entrapment of the medial plantar nerve.

So when the Youtube guy in a white lab coat with a $110 haircut says that you should never stretch because it irritates plantar fasciitis...well, actually, he's partially correct. What he is describing is nerve entrapment with plantar fasciitis, not merely plantar fasciitis. In that case, some stretches should be avoided and others encouraged.

What I take issue with is the NEVER/ALWAYS presentation. It is RARELY so simple.

2. Mechanical problems demand (at least some) mechanical intervention.

Sure, I would advise taking an omega three supplement because all inflammatory and healing processes in the body are indeed electrochemical in nature. Anti-inflammatory drugs and injections are often merited, though it's unwise to rely on these for the long-term. In the end, plantar fascitis is primarily a mechanical (movement related) issue.

No matter the drug, supplement, soak, or cream, if you return to the same mechanical forces on the foot, the issue is highly likely to reoccur. Icing, massaging, foam rolling, and ultrasound can also be helpful. But yet again, when the foot hits the ground is when the crap hits the fan. You can quote me on that. 

3. Simple rest.

I understand that this may demand some time away from your normal work duties and exercise habit. But you must lay off your feet for a while. Rest is often not given an honest try, and there is absolutely no better way to control the pain and inflammation in a highly irritated foot. Gentle stretches are often helpful and aggressive stretching is often painful. But if you rest and return to the same mechanical forces on the foot, well, you know what's going to happen.

4. "Okay, okay already - so what should I do to address foot mechanics?"

You may get away with "fixing" the root of the problem by changing to a high quality shoe that is appropriate for your foot type. Or maybe you truly do need an off-the-shelf or custom orthotic. Just don't expect much from the typical Dr. Schols gel/foam ones. They are made so that the tolerance level is great. But the treatment effect is usually minimal. The closest thing you will get to a "natural cure" to plantar fascitis includes taking time to identify movement issues from the great toe and up the kinetic chain, which comes in three steps:
  1. Address weakness, tightness, and faulty movement patterns at the pelvis, lower back, knee, and ankle.
  2. Translate this into a new pattern of walking, running, jumping, etc. You really should see yourself walk, run, etc under video. 
  3. If you are very active on your feet or if your foot is a "structural outlier" -very low, high, wide, etc, - you will likely need a custom orthotic device.
5. Conservative treatment has limits.

Be wary of individuals and products who speak always/never and promise you the world. Chronic plantar fascitis just may not respond to any intervention outside of surgery.  Though surgery should be saved as a last resort, it's sometimes necessary. The scar tissue, arthritic spurring, or thickening of the plantar fascia just may be too far along.

When this is the case, do not consider your more conservative efforts in vain. Go ahead and ask any surgeon about this. It's still wise to attend to appropriate footwear, foot exercises, general exercise habits, running/walking form, and possibly an orthotic. You want to get every mechanical factor in your favor to the greatest extent possible in order to experience a good surgical outcome.


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