Plantar Fasciitis – Prevention, Treatment and Healing Techniques

How does that saying go? “If I only knew then what I know now. “

The Author Enjoying the Wasatch Backcountery in 1976, Reynolds Peak UT. Note the Wooden 3-Pin Touring Skis & Wool Army Pants, Cutting Edge Technology for that Era.

The Author Enjoying the Wasatch Backcountry in 1976. Note the Wooden 3-Pin Touring Skis & Wool Army Pants, Cutting Edge Technology for that Era.

If I knew back then what I know now, I could have avoided a lot of injuries and most of my plantar fasciitis (PF) troubles. But I probably would not have had that sense of immortality and invincibility that comes with the innocence of youth. It is youthful fearlessness that inspires grand adventures of life. Sure, I made some big mistakes in my youth, but I would not trade youthful exuberance for the cautiousness that comes with age. Recently, more than a few friends and acquaintances have asked for advice on how to heal their PF. With their needs in mind, I have compiled a smorgasbord of techniques that can help prevent and treat PF. Perhaps penning these words and posting them here will save someone from going through what I have. These are my opinions regarding what helps and what doesn’t. Everyone is different. Techniques that work for me may not work for you. Embrace experimentation to find what works for you. This is firsthand knowledge and experience. Some of it totally contradicts the typical regurgitated drivel you get from the “experts”. Some techniques help prevent PF. Others techniques will help treat it once you have it. And obviously some work both as prevention and treatment. A table summarizes techniques that I have tried or am familiar. After the table, I’ll elaborate on each technique and it’s usefulness. Before the table, let’s first define PF.

What is Plantar Fasciitis?

Plantar Fascia

Plantar Fascia

The connective tissue that runs from the heel along the bottom of the foot up to the toes is the Plantar Fascia. Plantar Fasciitis is a catch all term for injuries to the plantar fascia. It is characterized by pain typically on the bottom of the foot in front of the heel where the fascia attaches to the heel bone (calcaneus). It is not limited to this but can also cause pain and sensitivity along the bottom of the foot towards the toes and commonly on the sides and back of the heel. It is common to have Achilles tendon pain in conjunction with PF. I’m going to address what is chronic PF.

Please be aware that treatment for acute injuries experienced for the first time can be very different from what I am going to cover. There is varying professional opinions on exactly what is going on in PF. The prevailing medical opinion is that chronic PF is a condition of inflammation. In reality, there is little evidence of inflammation with chronic PF. The latest theory is that with PF the fascia has been subject to repeat tearing and scaring. The fascia has stiffened and lost its elasticity and strength over time. Biopsy studies do not find inflammation, but typically find necrosis (dead tissue) and collagen degeneration. Personally this makes sense to me, as I have never experienced any inflammation or swelling with my PF. Inflammation can be an important part of the bodies healing response. Some of the techniques listed here actually wake up or inflame the tissue to stimulate healing. When you factor in the aging effect of collagen degeneration and the slow healing that comes with age, this also explains the increased incidence of PF with age. PF becomes more common with age and the incidents really jump after age 50. That age coincides with the drop of hormones with the onset of menopause and andropause.

Can it Be Healed?

There is always the possibility of total healing. But with some injuries like PF, the probabilities of complete recovery are slim. I heard the well know running coach and exercise physiologist, Jack Daniels, say that in his experience once an elite runner gets Plantar Fasciitis that they never compete at the same level again. As a recreational runner, this is something to note but it does not mean one has to stop participating in the sport. It just means that they will not be as competitive as they once were and expectations need to be adjusted.

A Table Listing Techniques to Prevent or Treat PF

The following table lists techniques that I have used or am familiar with. The items with a * (such as Acupuncture) are techniques I personally have not used but I am familiar with or know people who have utilized. 

Technique Prevents PF or Treats PF Positive and Negative Side Effects
Heat Treats Increases circulation
Ice   Numbs pain, decreases circulation, shortens and stiffens fascia leading to potential tearing
Alternate Heat Cold Treats Increases circulation, stimulates healing
Massage (A-Stim, Gua Sha, Graston) Treats Increases circulation, stimulates healing, can cause tearing.
DMSO Treats Increases circulation, relieves pain, smells very bad, irritates skin
Cortisone Steroids*   Relieves pain, weakens tissue leading to further damage in future, requires a doctor’s prescription
Bio-Identical Androgens Treats Bio-Identical Testosterone applied topically with DMSO stimulates tissue regeneration healing, expensive and requires a doctor’s prescription also violates anti-doping rules for athletes
Anti-Inflammatory Drugs   Masks pain, can lead to further overuse and damage
Ultra Sound*   Increases circulation, causes tissue damage
Infra Sound Treats Maybe Increases circulation, stimulates healing response
Acupuncture* Treats Maybe Stimulates healing response
Electrical Stimulation Prevents and Treats Strengthens, increases circulation, stimulates healing
Orthotics Prevents Prevents stretching and tearing, can weaken
Strengthening Exercises Prevents Strengthens, toughens tissue preventing tearing
Stretching Prevents Maybe Lengthens, if overdone can tear
Night Splint Prevents Prevents shortening at night preventing tearing in morning
Compression Socks Prevents Maybe Adds support when running preventing tearing, can irritate Achilles tendon causing pain
Taping Prevents Maybe Adds support when running preventing tearing
Barefoot Prevents and Treats Strengthens, toughens tissue preventing tearing, stimulates healing, if overdone causes injury
Minimal Shoes Prevents Maybe Strengthens, toughens tissue preventing tearing, if overdone causes injury
Supplements Prevents and Treats Maybe Nourishes and promote healthy tissue preventing injuries and gives resources needed for tissue repair

Heat

Heating up the Heels with a Heating Pad

Heating up the Heels with a Heating Pad

I love my heating pad for soothing aches and stiffness. I’ve even used it right before a workout or race to heat up my Achilles tendon and plantar fasciitis. It really helps avoid those first few miles of tightness and pain. It probably helps prevent further micro tearing. Experiencing pain probably translates to – you guessed it – micro tearing your connective tissue!

Ice

Rolling your Foot on a Frozen Water Bottle - Don't Do It!

Rolling your Foot on a Frozen Water Bottle – Don’t Do It!

Ice numbs the pain which lead to temporary relief. But ice impedes circulation and healing. It also tends to tighten and contract the fascia. These are all negative effects. The worst thing you can do is stretch a cold tight contracted circulation impaired foot. And this is exactly what happens when you roll a frozen water bottle under your foot. At best, you are slowing the healing process; at worst you are causing more trauma and damage. It is a shame (or sham!) that the roll a frozen water bottle technique is so commonly recommended.

Alternate Heat and Cold

Alternating Hot and Cold

Alternating Hot and Cold

Alternating soaking your foot in a cold then a hot bath stimulates circulation and wakes up the feet. This triggers healing and tissue repair. The cold causes the tissue to contract pushing out blood and fluid. The warmth causes blood vessel dilation flooding the tissue with blood. An evening foot soak is very relaxing. Alternate between the cold and hot every couple minutes and do this a half dozen cycles. End with the warm soak. Add some Epson salts for an additional soothing and nurishing treatment. Epson salts contain magnesium and sulfur – important nutrients for connective tissue repair.

Massage

Gua Sha Massage on Foot

Gua Sha Massage on Foot

There are a myriad of massage techniques. The most effective I have found is the Chinese technique of Gua Sha. The westernized version is called A-Stim or A-Stym or Graston Technique. It is simple and only takes a couple minutes. It involves using a dull blade like tool held at 45 degrees and scraping along the area to be treated. If you can reach the area, like your feet, you can do it yourself. The traditional Chinese tools are made of either Jade or Water Buffalo horn. In the Picture, the jade tool is on the floor and the horn tool is in my hand. The A-Stim tools are typically plastic. The Graston tools are metal. I like to use Coconut oil for massage as it is a totally saturated oil that does not go rancid. Check these links out for more information on Gua Sha and A-Stim and Graston Technique.

DMSO

Over the counter DMSO

Over the counter DMSO

Locally you can buy DMSO at Big-R (Now Murdocs). It is sold for treating connective tissue injuries in animals. DMSO sold at a compounding pharmacy is probably of purer quality but may cost a bit more. DMSO is a transdermal migrator. That means it gets absorbed immediately when you apply it your skin. As soon as you put it on your skin, you can taste it – amazing. Be careful to use only pure quality DMSO and make sure your feet are clean to prevent impurities from getting absorbed into your body. Pure DMSO causes skin irritation, so dilute it with pure water and use sparingly. Immediately, DMSO has a warming effect and relieves the pain and stiffness of PF. Long term it many help nurish and heal the damaged tissue.

Cortisone

Corinsone is a steroid that your physician can inject into or near the injury site. I’ve never used Cortisone, but from what I hear it miraculously helps relieve pain. Unfortunately, it tends to weaken collagen leading to further damage down the road.

Bio-Identical Testosterone

Applying Bio-Identical Testosterone topically on your foot in conjunction with DMSO will deliver a very effective steroid directly to the tissue that needs regeneration. By itself, this technique does not offer a quick miracle cure or much pain relief. When carried out over time, it can help the healing process. Unfortunately this is expensive and most insurance such as Medicare does not cover Bio-Identical Testosterone. Ironically most insurance does cover injectable synthetic versions of Testosterone. Synthetic Testosterone and other androgenic steroids have dangerous side effects. If athletes like Lance Armstrong, Steve Scott, and Scotty Hamilton had used Bio-Identical steroids instead of synthetic they probably could of avoided testicular cancer. Although, they may not have gotten the performance boosts though that made them the best Americans in their respective sports. You use to be able to buy inexpensive Bio-Identical Testosterone as a topical cream from foreign pharmacies without a prescription. Unfortunately just this year, 2011, our nanny state regulatory oligarchical government began confiscating it at customs. I wonder how it is that our federal agencies can block a safe drug at the border, but alow in the unsafe ones. So to get Bio-Identical Testosterone, you will have to get a prescription from a doctor and pay top dollar. Good luck finding a doctor who is educated to this or at least open minded to it. If you are over 50, also consider bio-identical thyroid hormone replacement – orally. The condition of low thyroid (common after 50) is associated with stiffening of the connective tissue and a slowing of the healing process. Precurser conditions to PF.

It needs to be pointed out, that using Exogenous Testosterone is a violation of anti-doping rules  for competitive athletes.

Anti-Inflammatory Drugs

Drugs may help mask the pain and make things feel better, but they do nothing to heal PF. By masking the pain, they may allow you to do things that pain would normally prevent. This action has the downside of potentially leading to more overuse and further injury.

Ultra Sound

Ultra sound is high frequency or high pitch sound beyond the human ability to hear. Sound is a mechanical vibration and ultra sound is a deep penetrating high frequency vibration. It can bring penetrating heat into an injury sight. It has the downside of causing localized tissue damage by overheating (burning) and dehydrating. Other than cleaning jewelry, I have no personal experience with ultra sound. I know numerous people that have had ultra sound therapy. In my observation, it did little to correct their problems.

Infra Sound

Infra Sound Machine

Infra Sound Machine

Infra sound is very low frequency sound almost like a tremble or rumble. When cats purr they are emitting infra sound. Cats purr when they need to heal. And cats heal very quickly compared to other mammals.

Besides cats, humans doing Hands-On energy healing emit infra sound.

Kow Kat the Bodhisattva Kitty Doing Her Healing Thing

Kow Kat the Bodhisattva Kitty Doing Her Healing Thing

I have an Infra Sound massager that I use. Our house is also the home to four cats. So I have a lot of experience with Infra Sound for healing. Having a purring cat snuggle up to you is a relaxing and effective treatment for what ails you.

Acupuncture

I’ve personally never used acupuncture, but I know some people that have had some amazing success with it. Perhaps getting poked with a needle triggers some healing response. Traditional Chinese Medicine (TCM) explains pain as a blockage of the flow of Chi (internal energy). Acupuncture or even acupressure helps unblock the flow. If all else fails, give it a try. I just can’t bring myself to allow someone to stick needles in my feet. And this is from someone who went to China to get trained in Traditional Chinese Medicine!

Electrical Stimulation

Compex Device - Electro Stimulation

Compex Device – Electro Stimulation

Electrical stimulation of the local nervous system can cause muscles to contract and relax. This technique exercises muscles directly; bypassing the brain. I have a Compex device that Hammer Nutrition up in Whitefish sells. I mainly use the active recovery program. I’ve had good success with muscle recovery. If it wasn’t for my Compex device’s active recovery program I would of never held up for a week of skiing where we were skiing 20,000 to 40,000 vertical feet every day. My quads would have been blown out after a couple days. As it was, I hung in there for 6 days straight keeping up with the youngsters. Every evening after skiing I would do my active recovery on my quads and it made a huge difference. I have used the Compex on my feet with good success. If I am consistent, it helps manage my PF – preventing my PF from getting out of control. A benefit of Compex is that you can treat your feet while relaxing in bed or watching TV or typing on the computer. It is a non-weight bearing method of exercising.

Update 2015 – Alternative Placement of Electrodes

Electrodes on Calf and Arch

Electrodes on Calf and Arch

I noticed a professional runner using an alternative placement of electrodes on the Calf and the Arch of the foot. I’ve tried this placement and it contracts and exercises the bottom of the foot. Similar to the towel crunches.

The device is the Marc Pro which I have not used, but is probably comparable to the Compex.

Orthotics

If properly fit, Orthotics, will help prevent you from tearing your fascia during weight bearing exercises. They keep the plantar from over stretching and tearing. I wish I knew this way back 30 – 40 years ago when I was indulging in some edge of the envelope skiing.

Pounding my Feet upon Landing in the North Cascades, 1979. At least my Skis had Edges by 1979

A Foot Pounding Landing in the North Cascades, 1979. Still 3-Pins and Floppy Leather Boots, But at least my Skis had Edges by 1979

Going back to the 1970’s when my life revolved around skiing, I can remember after more than one hard landing feeling like I bruised my heel. More likely, I partially tore my Plantar Fascia. I was lucky, more than one skiing partner ended up with shattered ankles or worse.

If I had orthotics, this probably would not have happened. I started using rigid Orthotics in my ski boots and it makes a huge difference. Especially considering you tend to spend nearly all day on your feet when skiing or coaching skiing. Alpine ski boots also crush your foot flat when buckling them tight putting the fascia under constant tension.

Lightweight Semi Flexible Shapeable Orthotic

Lightweight Semi Flexible Shapeable Orthotic

I’ve had less success with running with orthotics as they tend to get in the way. They are also heavy and stiff preventing natural running. There are some semi stiff and fairly light footbeds (insoles) that are sand-able allowing customization. They seem to offer just enough support to be helpful.

I got these at Zombro physical therapy. They are inexpensive. This particular brand is only sold through health professionals like physical therapists.

Rigid 3/4 Length Orthotic

Rigid 3/4 Length Orthotic

The downside of orthotics is that they interfere with your foot’s movement. This may prevent it from getting exercised and stronger. Chronic use of orthotics lead to weaker feet. In the long run, weak feet leads to PF. Poor fitting orthotics can feel like you are standing on a golf ball. This can be painful experience. It probably causes a bit of tearing and stretching to the fascia. So take the time to get your orthotics to fit right. They should feel good, not like your foot is being tortured. Don’t let your physical thearapist or doctor bully you.

Strengthening Exercises

Calf Raises

Calf Raises

There are a couple good exercises that help strengthen your foot and lower leg – helping prevent further problems with PF. The two simplest are calf raises and towel crunches. Doing calf raises on a stairway works well. I like to alternate with my feet straight ahead, pigeon toed and also duck footed.

Towel Crunch

Towel Crunch

Doing calf raises one leg at a time adds a greater challenge if your feet are strong enough. Towel crunches work the toes and bottom of the foot. I prefer the Compex electro stimulation for working the bottom of my foot. .

Stretching

Calf Stetch

Calf Stetch

I must confess I lack the patience to do much stretching. What stretching I do partake in is usually in an activity such as Yoga – especially the hot Yoga (Bikrams). Stretching is most beneficial when the body is already warm. So stretch after workouts instead of before. Or do it while taking a warm bath.

Stretching your Foot, Achilles tendon and calf prevents their shortening with age and the resulting risk of PF.

Night Splint

Night Splint

Night Splint

These really help prevent the morning heel pain of those first few steps. Remember pain usually means you are straining or tearing – not a good thing. The splint keeps the plantar fascia from shortening and tightening up during sleep. Night splints are cheap. I bought the one pictured on eBay for $20.00. They are much more when purchased through your physical therapist, or at the hospital through an orthopedist. But maybe you have health insurance and it is covered by those paying premiums into your insurance company.

Alpine Ski Boot Liner for a Night Splint

Alpine Ski Boot Liner for a Night Splint

An even cheaper (free) option is an old alpine ski boot liner. The downside is your foot tends to sweat and they will get pretty smelly and gamey after a while. Cutting the toes out allows them to breath a little and fit looser.

 

Compression Socks

Compression Socks - My Fav. Zoot Recovery

Compression Socks – My Fav. Zoot Recovery

You can think of compression socks as easy to take on and off tape. They can help support the foot preventing tearing of the fascia. In my experience, they put pressure on the back of the heel and tend to irritate the Achilles tendon. So you have to monitor that situation and not wear them all the time. There is a lot of variation between brands and models of compression socks. Look for a future post on the blog doing a comparison and review of compression socks.

Taping

There are countless taping techniques for supporting the plantar fascia and arch. Some suggest running tape on the bottom of the heel up to the base of the toes. Others suggest a X pattern to support the arch. Regardless, the idea is for the tape to support the fascia and prevent the fascia from stretching. There are videos on the Internet that demonstrate various taping scenarios. I’m too lazy to spend time every day taping my feet, so I rarely do it.

Barefoot

Walking on Gravel with Socks

Walking on Gravel with Socks

A technique that I have had success with is barefoot walking or light running. I think this tends to stimulate the feet and trigger some healing to take place. Especially if the surface you are walking on is rough. Walking on a gravel surface really stimulates the feet. Think of it as a generalized acupressure treatment. If your feet are tender, wear some socks to protect them. The prickly surface of the MSU track also has enough roughness to do the trick. Just a couple minutes of this a few times a week can really make a difference. Remember to not overdue it as you can cause more problems than you are correcting.

Minimal Shoes

Minimal shoes force your foot to work harder causing it to grow stronger. This applies if you do not overdo it and injure your foot in the process. If you already have PF, start very slowly with just a few minutes at a time.

Supplements

Proper nutrition is important for tissue regenerating and healing. Nutrition that especially helps maintain connective tissue and collagen is important. Minerals such as magnesium and sulfur are important for connective tissue healing. Remember, topical DMSO is a source of sulfur. Nutrition and supplements is a vast topic and I’m just not going to get into here.

Closing Thoughts

The techniques this blog lists should give you an arsenal of tools to treat your PF or prevent the scourge of PF in your future. Experiment and see what works for you. The big three that have had the most success for me are:

  • Night splint
  • Stimulating massage like Gua Sha
  • Electrical Stimulation using Compex

Honorable mention goes to:

  • Barefoot Walking on Gravel
  • Alternate Heat Cold
  • Strengthening Exercises

I’ve experimented with other techniques. One that comes to mind is The Bowen Technique. For me, Bowen treatments resulted in some mixed and rather bizarre reactions. The treatment was explained as kind of like pressing the reset button. Despite the Bowen method being gentle and subtle, it can really rearrange things in your body. After treatments, my knee and ankle joints feel so different that I have been injury prone. My joints loosen up and take a while to find a groove to move through. During this period, I have experienced painful cartilage catching and my joints just giving out. I expect these reactions are partly due to the damaged condition of my cartilage. My joints have taken a beating from a lifetime of extreme activities. Nevertheless, I’m still exploring this method and am not sure I can recommend it at this point. There are other new techniques that I have heard about, but do not know enough to comment on. One is injecting your own adult stem cells harvested from your own tissue. You may have to go to Europe to get this treatment. Reinjection of your own collagen (Autologen) is a treatment available in the U.S. You are on your own researching these techniques. Please comment if you have any experience, good or bad, with any of these techniques or know of any other methods that desirve mention.

Lotions and Potions – Update 2-24-2012

Lotions and Potions most do not work for PF, but SyCircue helps

Lotions and Potions most do not work for PF, but SyCircue helps

When I first wrote this blog, I did not mention topical creams or lotions. Most are homeopathic that have been recommended by others. I’ve tried many, but other than the benefit of the massage of rubbing them in, I’ve noticed very little benefit. I’ve tried Emu oil, Traumeel, Inflamyar and some I just do not remember. They are probably good quality oils and creams, but for the money they just have not offered much benefit. Most are designed to treat inflammation; a condition not associated with your typical case of PF. I’m now adding this update regarding lotions because recently I tried another remedy that is worth mentioning. It is German homeopathic topical lotion called SyCircue by Syntrion. If I apply it frequently such as 3 or 4 times a day, I have gotten noticeable benefit from it. It is not a miracle cure, but it is the only lotion potion that has offered any real improvement to my Plantar Fasciitis. SyCircue claims to enhance circulation and that seems to be the bottom line with treating and healing PF.

Prolotherapy

Although I have no firsthand experience with proliferate type therapy, I have heard lots of antidotal success stories of healing of connective tissue injuries such as PF. Prolo therapy involves stimulating or turning on the healing process by injecting substances (dextrose, ozone, …) directly into the injured connective tissue. This results in inflammation and turns on the body’s inflammation response and the resulting tissue regeneration. For more information see: http://www.prolonews.com/prolozone.htm . Also check out Dr Minkoff for an example of a doctor that uses Prolotherapy in his practice. Dr Minkoff is an experienced athlete and well versed in treating sports injuries.

Update 2014

With consistent exercise and various foot treatments, I have been fortunately free of PF pain for the last couple years. Disappointingly, I still get bit of Achilles pain on the back of my heels. This problem seems to be very shoe specific. Shoes that are stiff and put pressure on the back of my heel when trying to flex the shoe sole cause the most problems. I have had the best success with easy flexing shoes such as the Skechers GOrun that do NOT aggravate my heels. I have tried the recommended reverse or eccentric calf raises as a way to treat Achilles problems, but have not had any breakthroughs as of yet.

Other Tips:

Yoga Toes At least a couple times a week, I wear some toe spreaders while I am walking barefoot or sitting around indoors. Wearing these devices have strengthened and widened my feet over time. There are various brands, but they all do about the same thing. I got some really cheap pairs on eBay. Being Barefoot Whenever indoors, if possible, I try to give my feet a break from shoes and go barefoot. Walking or standing barefoot, exercises the feet. This practice has helped strengthen my feet, making me less prone to injury and PF problems. Skechers GOrun A very flexible shoe like the Skechers GOrun allows the foot to move naturally through its range of motion and helps strengthen the feet. The unique property of the Skechers GOrun’s hump in the middle seems to have the added benefit of spreading out the foot and giving the foot something to grip. It is kind of like standing across a curved surface such as log. The Skecher’s GOrun is or was known for the odd feeling of the hump in the middle – especially when standing or walking in them. When actually running in the Skechers GOrun, the hump was not as noticeable. Many people complained about the feeling of the hump and Skechers responded by unfortunately removing the feeling of the hump in later versions of the shoe. For me, the original Skechers GOrun with the noticeable hump in the middle is a miraculous shoe and helped my foot health immensely. The later versions are more conventional and do not have the revolutionary therapeutic characteristics.

More Updates and Ideas Spring 2014:

Scenar

Recently, I became aware of these devices and bought one online from the Ukraine for a few hundred dollars instead of the US price of few thousand. I don’t have PF anymore, but I still have tenderness at the back of my heels – more like Achilles tendinitis. Treating the sides and back of my heel with the Scenar has really helped alleviate my heel pain. It is not feet related, but here is another personal anecdotal story regarding the Scenar. This winter, I developed chronic lower back pain and sciatica. Prolonged cold and record snow required more snow shoveling than my aging body could handle. Warm baths, massage, and the heating pad gave me some temporary relief. But what seemed to finally give me lasting relief was using the Scenar device on my lower back and hips. It could be just coincidental, but it sure seems like the Scenar device really helps with muscle/skeletal/joint and connective tissue problems. A simple explanation is that the Scenar is a TENS (Trans-cutaneous Electro Neural Stimulation) device with biofeedback. It adapts its response to the impedance (electrical resistance) of your body. Do some research on it and give it a try.

Pulsed Magnetic Field

Another electronic healing device I have tried on and off over the last couple years is a pulsed magnetic field emitter. It is an electromagnet (coil of wire) that is energized at a particular frequency. The frequency is 8 Hertz (8 pulses per second). It supposedly helps jump start the healing process by increasing circulation and accelerating local cellular metabolism. Unfortunately, the effects are either very subtle or this type of treatment just did not work for me as I did not notice any health benefits from being exposed to pulsed magnetic fields. It may or may not work for you.

Red Laser

Red laser pointers are so cheap (a few dollars) that you might as well buy one and try one. Red light does penetrate into the body beyond the skin layer. There are lots of claims associated with light therapy in general and red light therapy in particular. Give it a try. Besides illuminating your feet in red light, you can always use it as a cat toy.

Concentrating and Injecting Your Own Stem Cells a Tissue Regenerative Treatment

Recently (2015), I attended a health conference and heard Harry Adelson talk about Adult Stem Cell Therapy. This therapy is becoming the new face lift treatment of choice by the rich and famous. But it is useful for treating other problems that that would benefit from tissue regeneration, such as Plantar Fasciitis.

For eliminating wrinkles, Stem Cell Therapy is more expensive but yields more natural and longer lasting results than Botox. Concentrating and injecting your own stem cells triggers tissue regeneration. Botox just paralyzes the facial muscles and leave a person with a face that looks plastic and frozen. Remember Joe Biden, Hillary Clinton and John Kerry’s stretched grinning or frown faces from pervious election cycles? You probably will not see that in future election cycles as older candidates will opt for the more natural looking results from Stem Cell Therapy.

In simple terms, Stem Cell Therapy involves harvesting your own stem cells from your fat and bone marrow. The stem cells are then concentrated and injected in the tissue that needs regeneration (healing and regrowth).

Whenever you get a trauma to your tissue that causes damage to small blood vessels (capillaries), stem cells are liberated and trigger the repair process. This is part of the mechanism in how a cut or abrasion heals. This is why therapies that induce a certain amount of trauma and tissue damage help to initiate a healing response. This explains one of the reasons why therapies such as Prolo, A-Stim, Graston and Massage work. They induce some trauma that liberates stem cells initiating a healing response.

Check out Harry Adelson’s clinic for more information about Adult Stem Cell therapy.

More Thoughts Regarding Plantar Fasciitis – Updated 2015

After keeping my PF in check and well managed for a few years, some long hikes and backpacking adventures caused a major flare up this past summer.

Plantar Fasciitis is an Impact Injury

One contributing cause of Plantar Fasciitis is impact loading on your feet. The impact can be acute high force such as a single jumping down onto a hard surface or even a single sprint workout session. Or the impact can be chronic low force and accumulative from spending a long time on your feet walking or hiking or just standing. Obviously, it is hard to actively participate in life without spending time on your feet. But you can make some wise choices like avoiding long hikes on back to back days – especially carrying the extra weight of a Backpack! That is what did me in most recently.

Shoe Choices to Avoid Impact Loading on Feet

There are some shoe brands that claim they help minimize foot pain such as that from Plantar Fasciitis. It is worth mentioning a few brands. At least some shoe manufactures are thinking in the right direction. Learning about their technology will give you some ideas how to minimize impact loading on your feet by proper shoe choice.

Kuru

These shoes make significant claims that their shoes help relieve foot pain. There are lots of reviews and anecdotal testimonies that these shoes are great for people with PF. In my experience, they are better than most shoes for relieving PF pain. But for me, they are not miraculous. In my opinion, they are suitable casual wear or light duty work shoes or walking shoes. They are expensive, a bit clunky and heavy. They may or may not work for you. Fortunately, Kuru does have an accommodating return policy that encourages people to try them.

The theory of how Kuru eliminates heel or PF pain is that the shoe cradles/cups and supports the heel preventing impact pressure on the bottom of the heel distributing evenly to the whole heel and sides. Think of how your foot sinks into soft earth or sand.

Kuru Shoes Technology

Kuru Shoes Technology

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Oesh

Four years ago, I did a review of the original Oesh shoe. The theory behind this shoe is that is a pro-pronation shoe allowing your foot to naturally roll inward as you walk. Ironically, for me, this shoe works best for situations where I have to stand for a long period of time in one place like attending a concert, sports game or church. The dynamic rolling inward action of the sole feels good when standing, but is less noticeable when actually walking.

Although the theory remains the same, the newer models as compared to the original employ a different technology to accommodate the rolling or compressing of the medial side of the shoe. The original shoe had a cantilevered and hollow sole that hinged on the lateral side of the foot. The new models accomplish this with varying soft midsole material from lateral (outside) to medial (inside). I have not tried the newer models so I can’t comment if they are different from the original.

Oesh Shoe Technology

Oesh Shoe Technology

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Skechers

Thanks to the original Skechers GoRun and its mid foot strike technology, I was actually able to start running again a few years back. The original GoRun had a pronounced hump in the middle of the shoe that forced a mid-foot strike when running. The hump was a byproduct of the fact that the shoe did not have a traditional raised heel. Its sole was thickest in the middle instead of the heel which is more typical. This prevented a runner from loading or impacting the heel of the foot when running. This helped relieve the pain of existing Plantar Fasciitis or the heel impact that can lead to the development of PF. These shoes were great for running, but not so great for walking or standing.

Skechers Original GOrun Midfoot Strike Sole Profile

Skechers Original GOrun Midfoot Strike Sole Profile

With subsequent models, Skechers toned down the pronounced hump in the shoe making them more traditional and causing more heel impact when running in the newer models. You could take a pair of the new models to a grinder or belt sander and grind down the heel to try and duplicate the radical mid foot profile of the original. Give it a try.

Plantar Fasciitis Caused by Incorrect Running Walking Movement (Update 3-2017)

Here are some great ideas on how running or walking with your weight to far back puts undue stress on the Plantar Fascia and Achilles Tendon. The fix is to learn correct movements using the Feldenkrais Method. I really enjoyed reading this information. It makes sense.

 

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About Bridger Ridge Run

The Bridger Ridge Run blog is an information portal for all those seeking to learn more about the Bridger Ridge Run event held every second Saturday of August in Bozeman Montana. This blog contains notifications about important registration dates and deadlines, history of the event, training advice and other stories and entertaining tidbits of information about the Bridger Ridge Run.
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50 Responses to Plantar Fasciitis – Prevention, Treatment and Healing Techniques

  1. LTilley says:

    I have actually done acupuncture on my PF. It was the first pain relief I had in months. The needles are so thin you don’t feel them. The problem is the pain relief lasted a couple of days – it’s not a one time fix. It takes several sessions. I have to pay 65.00 a session and insurance won’t pay.

  2. Brian says:

    Have you had any experience with correct toes? Specially longer term. Of course they are selling and a very overpriced toe separator that can be worn within a sizeable toe box shoe. Which is what makes it more unique, as most cannot be worn inside a shoe. It goes on the principle that you stated which is that past a certain point of the initial injury inflammation isn’t the problem fasciosis (dead tissue)is the problem. Brought about by not enough blood circulation. This video explains it better than I can. Reviews on Amazon are meh but a lot of people admit to not following the correct procedure longer term. https://www.youtube.com/watch?v=tNPfbB2sX5Q

    • Yes, I have tried Correct Toes. I found them hard, uncomfortable and difficult to get a good fit. For me, wearing them in shoes did not work – especially walking or running any distance. They are very expensive compared to others.

      My favorites are just ultra cheap soft bulky ones. You can customize trim them with scissors to remove some of the bulk. They are generally too bulky to fit in shoes, but great for wearing and walking around in the house. I also like to wear them when I do callisthenic type of exercises.

  3. Ashley says:

    Very in depth article. For Cold, Blood flow stimulation and taping, check out this web site – http://kingbrand.com/Plantar_Fasciitis_Treatment.php?REF=34PV1 – Has the best at home treatment. Very convenient and you get the best results. High quality and great customer service support.

  4. Ironmangermany says:

    Hi
    I am a German 52y male Ironman triathlete (9x finisher, 1 big race per year plus (half)marathon races). I am a decent runner (2014: 3:34h marathon in Ironman, 2016: 1:32h half marathon in Ironman 70.3). Some years ago I suffered from achilles tendinitis and cured it by switching from heel strike to front/midfoot strike. Since then I ran even faster than before. Since some years I also suffer from osteoarthritis (hallux rigidus) in my right big toe joint. During training 2015 I gradually developed PF on left foot. Last Ironman in autumn, after 1 month pause suddenly massive pain.

    Tried the following, always just with short relief:

    – cortison injection 2x
    – total stop of running up to 7 weeks 2x
    – shock wave therapy
    – osteopathy (foot arch reconstructed)
    – icing
    – NSAID Etoricoxib (Arcoxia)
    – MBT shoes (just for walking); running only with Different ‘normal’ running shoes

    Inbetween always running training (speed intervals with 3:45min/km pain free, total distance up to 20km/90min) with good results (2016 half ironman see above). Autumn 2016 things became worse. A rehab trainer noticed that my left foot turned some degrees too far clockwise while touching the ground. I can correct this actively but the improvement didn’t last long.

    Running is more or less pain free (different shoes with orthotics) but increasing pain afterwards….

    Actually I try a new therapy:

    Fascia Distortion Model (after S. Typaldos).
    See: https://www.fascialdistortion.com

    I had 3 treatments yet (to be continued). First results are promising and hopefully this will cure PF!

    The therapist does a kind of accupressure with a lot of force on the most hurting points plus a deep friction massage. This shall re-align the distorted fascia into the normal structure. This causes an increase of the local inflammation and gives signals to the body for self-healing.

    I will let everybody know if this works!
    Any ideas/suggestions/questions welcome.

    Ironmangermany

  5. shaynahanson says:

    What if you have micro tears? I am worried about doing massage and excercise that will exacerbate these tears…
    Any thoughts on this?

  6. Roller paper says:

    It’s difficult to find knowledgeable people in this particular subject, however,
    you sound like you know what you’re talking about! Thanks

  7. Susan Dotson says:

    What do you know about EPAT or Therapeutic Laser Therapy for PF? I’m desperate!

  8. Mel says:

    OMG thank you so much for your insights I have been ice-ing like mad for two weeks for a really bad (recurring) PF flareup and now understand I have probably made it worse! Will try the alternate heat/cold and night splints and report back. Thanks

  9. i am suffering of PF for about 1 year. went to doctors tried insoles night splint pt cortizone etc. I find your blog special b/c you clearly differentiate btw PREVENTION and CHRONIC. once you are chronic [i.e. you kept on “pushing off” and saying to yourself “it will get better”…] then you are dealing with a totatally different ball game. Now, i am still not clear wether the “gravel treatment” is even for “chronic” [like myself] more important, can it make it WORSE. this is the great confusion: that almost everey treatment can make it better OR worse!!! so we are left totally baffled, i pray to Go-d to send me the right ideas and find the right thing. Please Mr. Bridger Ridge Run give me some solid HONEST>>> personal, advice and may G-d bless you.

    with honor Judah from Brooklyn

    • Consider trying Adult Stem Cell Therapy. If you do, report back. I have no first hand knowledge, but from what I hear the results are significant. See the new short write up at the very end of this blog post. Or try Prolo therapy, as it is described at the poor man’s Stem Cell Therapy!

      • thanks for your advice! i have been walking on gravel everyday for the past month. You say that gravel is the best treatment. have you had FIRST HAND EX with this? I see mixed results i.e. my hell fells a little better [far from healed] but my knee starting hurting. can you give any explanations or suggestions as of how to do the “gravel walking” [should you try to step intentionally on the point that hurts— how long per day— should you ice it etc,, plz be so kind and answer with as much detail as possible

        thanks again

        Judah from Brooklyn

  10. bonnie jean richardson says:

    I have recently started using ‘food grade diatamaceous earth’ as the corner stone for absorbing hydrolyzed collagen, msm and glucosamine. I also like a quality magnesium oil trans dermal absorption. I have found these two additions in my vast pantry of herbs, vitamins, supplements – I also take 1 tablespoon of cod liver oil w/warm milk and 3 1200 mg fish oil capsules on an empty stomach – all of these are taken on an empty stomach spaced apart at least 20 minutes, taking warm fluids moves through the stomach faster.

  11. Elle says:

    Excellent info. On my own I decided that ice rolling only dulled the pain, but did not help in repair. I am going mad from pain, which is helped for two hours by Vicodin, but even with this I can barely walk. I desperately need a remedy. I would like to add something that I read on an Australian website. It states that folks who have low arches should avoid using a night splint, because according to a study it compromises the arch and lowers it even more.

  12. Terry Rood says:

    Where did you buy your scenar device? I am confused by the options.

  13. Menopausal Woman says:

    Hi,

    Have been suffering with PF past 3 years. After a few months, my feet seem to heal up enough so that I think I’m okay, and then I’ll push my activity just a little, only to find my feet flared up again. Such a bummer!
    Been trying various treatments with some (short-lived) success, but not totally cured yet. It’s not a severe case of PF, but just enough to inhibit/prevent me from enjoying my physical activities, and wonder whether or not I’ll ever get back to doing the things I used to be able to do with pain-free feet.
    Although my AM pain isn’t terrible (majority of pain comes on later in the day after being on my feet all day) I’ve committed to wearing the boot nightly. Years ago, my husband said the night splint was the only thing that helped his PF. Also have been experimenting with gua sha — but not sure how much pressure to use. Should you scrape deep enough on your foot so that it turns pink and hurts, or just use enough pressure with the buffalo horn to simulate a massage? And how often would you “stimulate” your feet without risk of hurting them?
    Also, I’ve noticed that walking on a sandy beach seems to help. Unfortunately, I don’t live near the ocean, so walking on the grass will have to do.
    Has anyone tried the herb Cissus for PF? I’ve read that it’s great for connective tissue, tendon and ligament repair, and increased collagen production.
    Thanks,
    Menopausal Woman

  14. Carolina says:

    Hello to all my PF colleagues. I’ve found this blog today I’ve been reading a lot about PF for about the last 6 months. I used to be an active person, I did yoga also Bikram yoga, recreational outdoor runs, dance and so on, now I’m confined because my left foot. I had an ankle surgery on my left ankle, it was dislocated and the deltoid was repaired and after wearing plaster and then a fiberglass cast for 9 weeks, I wore a walking boot for 6 weeks which made me limp during the recovery process. Due to this I ended having a tear on right hip. 11 months after my ankle surgery I also had a arthroscopy on my right hip. While I was recovering from this last surgery the PF made an entrance in my life, just when I was starting to walk without my hip brace and crutches. They did an MRI to confirm my distal PF and stress reaction of the tibial sesamoid. That was 6 months ago, so of course I’ve been doing PT to recover from these surgeries, I’ve tried a lot of the resources out there to get better or to be back to normal or better said to walk normally, at this point easier said than done. Well my question is, have some of you have try EPAT (Extracorporeal Pulse Activation Therapy) with success? The last doctor I’ve been going for my PF reasons, has that treatment available. One thing is that EPAT is not covered by the insurances since it’s an experimental treatment, but after my surgeries and dealing with PF for so long I would like to give it a try. I didn’t want the surgery to release the fascia that my ankle surgeon would like it to do it, then I looked for a second opinion from a different doctor (the want who has the EPAT available). I’ve been reading and it’s supposed to have around 80% of success???
    Honestly after reading your blog, which btw has an amazing approach and give us a lot of options and information about how to deal with the PF. I also have something similar to the complex therapy (electric stimulator) that you mentioned, I would like to add a picture of mine to see if I could use it like your complex since those were given to me after my two surgeries so I don’t have to buy it. Any comments will be more than welcome, and to be honest I’m getting pretty desperate. I wish I could have found this blog before…. #sigh….

    I have tried: cortisone shot at the beginning of my PF, PT, taping, the iced bottle massage, the Epsom salt, I’ve been using every night my night splint for the last 5 months, I do the stretching exercises, I did try some ultrasound treatment in my PT, I have wore my painful orthotics for the last 5 weeks, I alternate the orthotics with the walking boot, I also have a special compound cream that my last doctor prescribed me (Ketoprofen 10%, indomethacin 5%, triamcinolone 0.2%, lidocaine 5%). I’m taking gelatin pill, osteo bi flex and I just start liquid collagen to see if I get some benefits.

    I’m going to try: electric stimulation, heating pad, EPAT. I really appreciate if you could tell me where should I put the pads on my foot to apply the electric stimulation ? And many MANY MANY thanks for all your recommendations and help.

    • frank says:

      I was in PT at Excel PT for a blown hamstring last spring and mentioned my PF and that i was considering surgery as i had tried everything else you mention above including cortisone shots two different years leading up to the ridge. Jason at Excel suggested dry needling. 5 treatments – which went about a month i would guess – and the PF pain was gone. I’ve run pain free for 10 months now and am symptom free. I still wear orthodics and stretch when i remember but pretty much give all the credit to the dry needle. Hurts, but far less than cortisone shots.

      • Thanks for the tip on dry needling, Frank.

        Sometimes the body needs a trigger or irritant, like being poked with a needle, to turn on the healing response. I do not know much about dry needling and have never tried it, but it sounds like another treatment modality that may help people.

    • Melanie says:

      Did you end up doing EPAT? I’m terribly frustrated because only one treatment of EPAT made my pain way worse, and constant. It’s been 2 weeks and the doctor has no idea why and it’s not going away.

  15. This was cool topic. I was looking for something like this. Thanks for making my day

    • roxanne says:

      I am also a “victim” of P.F. I found a physical therapist certified in A.R.T. and the result has been amazing. Google it. (Active Release Therapy)

  16. Kel says:

    FEETURES compression socks are working wonders for me! I have PF and am doing all the above plus the open toe socks.

  17. I partially tore my Plantar Fascial ligament 3 weeks ago. (MRI confirmed) the foot & ankle specialist said surgery would not be needed. I have been in a air cast for the 3 weeks. I do regular treatments to my foot (e-stim, hot/cold packs, steroid crème from a friends acl surgery) Is there anything I could do to get me back out on the Rugby field faster?

    • Try topical DMSO. Topical homeopathic healing creams (SyCircue, Trameel) may help. Make sure you are getting the nutritional building block needed for tissue repair. Bone broth, gelatin, essential amino acids, minerals, food that builds connective tissue.

      Focus on keeping your range of motion in your foot. Make sure as it heals and scar tissue forms, that your connective tissue does not shorten.

  18. Warren Moore says:

    Are you familiar with Neil Smiths work at the Foot Alignment Clinic and the VFAS. Any thoughts on the process?

  19. GARY HAVEN says:

    Great info on plantar fasciitis. I had stopped doing much running the past 3 years because of it. I tore the left fascia 2 years ago and previously had stress fractures in my right calcaneous and cuboid bones due to running awkwardly because of the pain. My feet hurt all day at work also. I spent thousands(some mine and much of insurance) on a-stym, orthotics, platelet injections, cortisone injections, lithotrypsy (the treatment used to break up kidney stones), multiple shoes, p.t, electrical stim, etc…. I found a web site in November called “Heel That Pain”(I have NO financial or other interest in the company, btw) with very good visuals. They sell a heel insert that sits on your insole and has a “fascia bar” across the area where the fascia attaches to the heel.It keeps the fascia from flattening down and tearing. It’s comfortable and inexpensive ($25/pr.)-subsequent pairs are cheaper. I have been using them since Nov. 2012 and have run/worked pain-free since the 1st or 2nd week. I set the age-group record in the Big Horns 30k trail race last week(>60 men) and would love to do the same at the Bridger Ridge Run. I have the “heel seats” in all my shoes. They may not work for you but, they have helped me and several friends so far. Another option for us who have suffered from this.

    • Gary,

      Thanks for your story and suggestions. You provided information that will be very helpful to those that stumble upon this website.

      Glad you found some success with the HeelThatPain products.

      And congrats on your new found running prowess!

  20. rod georgiu says:

    how do you use the compex for PF?

    • Use the active recovery program with negative electrodes under the heel and positive at the ball of the foot. Click on the picture in the blog to enlarge to see the electrode placement. Turn the level up to what you can tolerate. Try and get to 30 milliamps and watch your toes twitch.

  21. foot patch says:

    You really make it seem so easy together with your presentation but I find this topic to be actually something which I feel I might never understand. It seems too complex and very huge for me. I am taking a look ahead for your subsequent post, I’ll attempt to get the cling of it!

  22. What are you thoughts on using a walking boot with PF?

    • If the walking boot keeps your foot dorsiflexed (preventing the plantar fascia from shortening) it would probably work well as a night splint. It may also help wearing it during the day while engaging in mild waking activity, office work, sitting, walking around indoors etc.

      My night splint (pictured above) is the walking version. I used it indoors around the house when my PF was really bad. It is not suitable outdoors.

      If you are thinking about engaging in active outdoor activity, I’m not sure if a wearing a walking boot while doing so will help heal your PF or protect your foot from further damage. That is an approach I did not take in treating my PF.

      Sorry I cannot be of further help of that.

      Give it a try

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  25. Meg Mercer says:

    Your information is by far the best and most comprehensive if any that I’ve found online. I’ve had this problem for several years. I’ve gone through physical therapy (which has always helped on other issues) which included the A-Stem with absolutely no resolution. I did get relief from a cortisone injection, but after 6 months the pain is returning. I am now planning on trying the DMSO/SyCircue, warm water with Epson Salts, Thyroid therapy (I’m 55+), and a night splint.
    Also I got custom orthotics. They seem to help a bit but hurt somewhat especially if I stand for long periods. How do I find someone who can properly make and fit orthotics?
    Thanks so much for all of your great information in one place!

    • Thanks for the kind words and compliments.

      Best of success to you in getting your feet working again – I’ve been able to manage my PF fairly well over the last year and have avoided invasive injections or surgery.

      If you are mainly focused on getting pain relief and not as concerned with preserving function, there are techniques using radio waves to deaden a nerve in your foot or even surgery to cut some tissue and relieve pressure on a particular nerve. An experienced and conventional podiatrist will know about these techniques.

    • Sherri says:

      I have dealt with PF for 2 yrs now and just started using DMSO. It works!!!!!! I can’t say how excited I am about it. So if you haven’t tried it, i would do that first.

    • I wear orthotics, the softer kind. As the hard plastic kind were really rough on my feet. I urge you to go back to the place which made your orthotics and have them adjusted ASAP, they could be doing more harm than good if not fitting correctly. I have gone back several time to have mine adjusted.

  26. Sharon says:

    II found this helpful, especially since you were not selling anything. I’ve had chronic pf for years now. I’ve just started a graston program, using a splint and stretching. We’ll see. I tried cortisone and I wish I knew then what I know now. I now plan on getting out, my Epson salt, electric stimulator, heating pad, DMSO and had a thought that maybe a vibrator would help with circulation and regeneration. What do you think?

    • Sharon, in my experience, the things that heat up and wake up the foot seem to work the best. Warm soaks in an Epson salt bath are wonderful. A Heating pad… Just the rubbing and attention from a massage works wonders. Going barefoot when possible and if you can put up with sleeping with a night splint on a consistent basis, it really makes a difference. Also, a mixture of DMSO and SyCircue really helped me.

      You are on the right track. If your vibrator is in the ELF (extremely low frequency) under 20 Hertz (cycles or pulses per second), that could work well – especially if you can vary the frequency. Experiment and find what works best. Before stretching, make sure you heat the foot up really well and be careful not to overdo it and tear or damage tissue when stretching.

      I’m not sure how old you are so the following my not apply. With age, hormone levels drop and connective tissue (fascia) tends to get stiff and brittle. Women are very prone to PF with the approach and onset of menopause. Making sure your thyroid hormone is at a healthy level can really make a difference. Hormone replacement therapy (HRT) can also help with PF. But if you are older, raising your hormone levels back up to those of youth does increase the risk of cancer.

      Being consistent and regular with these treatments (it takes time and work) has nearly eliminated my PF. I have not had any PF troubles for over 9 months. Yippie!

      Unfortunately, last winter I experienced a traumatic ski injury that made my left ankle and knee a bit unstable and wobbly. So now when I run, the instability puts additional stress on my left Achilles as it tries to stabilize my foot. So of course after a summer of running, I now have left foot Achilles tendonitis and pain! And compensating for this pain and soreness has caused pain on my right iliac crest, the top of the IT band. I’ve been using heat, SyCircue, DMSO, etc along with trying to rebuild strength and stability. I’ve kept these new problems in check, but after every run I’m sore and limping around.

      Bummer, I finally get rid of one problem, PF, and now I’m saddled with a new problems.

      Best of success on your path toward mastering your body.

  27. Boz Van Houten says:

    Hey, you left-out taping as one of the prevention /treatment options. I have found taping the bottom of the aflicted foot to be an essential tool in recovering from (inevitable) injury.

    • I’m glad taping has brought you success in recovering from injury.

      Thanks for bringing it to attention.

      The post mentions taping, but there is no picture of taping as I’m not a practitioner of it – mainly out of laziness.

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