My brother still plays basketball with his high school buddies, and over the decades they’ve collected their fair share of injuries along with their trophies — including plantar fasciitis, which is an inflammation of the plantar fascia (a thick band of tissue that extends from the heel to the toe) that causes stabbing heel pain. This problem is not unique to aging athletes, however — it’s the most common reason people visit podiatrists and affects one in 10 people at some point in their lives, usually in middle age or later. If you are overweight, a runner, have arches that are too high or too low or just spend a lot of time on your feet (especially on hard surfaces), you are at higher risk for this very painful condition.
Researchers recently evaluated various treatments for plantar fasciitis and got a bit of a surprise when they learned what works best — it’s simple, easy to use and can be bought for just $10 or so at your local drugstore. I turned to James J. Irrgang, PT, PhD, president of the orthopedic section of the American Physical Therapy Association and coauthor of the APTA’s recently issued clinical guidelines for treating plantar fasciitis, to learn how his team graded the various treatment options. But first Dr. Irrgang emphasized that if you’re dealing with your first bout of plantar fasciitis, it’s wise to see your doctor to make sure that this is, in fact, the right diagnosis. He/she will also be able to provide advice about the various options for treating your condition.
To identify the best treatments, Dr. Irrgang and his colleagues examined more than 50 published studies of plantar fasciitis and came to some unexpected conclusions about what does and doesn’t work. Grading the results, they found that…
Orthotics = Grade A.Orthotics were the surprise winner, with the most consistent evidence supporting their efficacy for plantar fasciitis patients. Orthotic shoe inserts support the arch, distribute pressure more evenly and act as a shock absorber to lessen the impact of walking on the soles of your feet. It’s not all that clear why orthotics work, but they do — the researchers are sure about that part. In fact, the research indicates that many people get the same result from off-the-rack orthotic inserts that cost $10 as from custom-made ones that start at about 30 times that price. It doesn’t seem to matter whether you choose insoles made of foam or plastic (which have varying degrees of rigidity) or opt for a felt arch insert, a rubber heel cup or a gel heel pad — studies consistently demonstrate that orthotics relieve pain and improve function.
To buy:Off-the-shelf orthotic inserts range in price from $10 to $95. There are different types for different problems — including those designed to help support arches or correct overpronation, supination, etc. — so if you have one of those issues it might affect your choice. Custom orthotics, fabricated to fit your foot exactly, might be necessary if you also have bunions, hammertoes or various ankle problems, but these are expensive, ranging from $300 to $500 or so from a doctor, and health insurance may cover only part of the cost (or sometimes none of it).
Whatever type you choose, count on using orthotics for at least three months, Dr. Irrgang said — longer if you find them more comfortable. Don’t wear them just for walking or running — he says you’ll get the best results with continuous wear… by wearing them in both shoes even if you experience symptoms just on one side… and by getting new ones when you see signs of wear. If you’ve tried the drugstore variety and they’re not helpful, Dr. Irrgang suggests asking your physical therapist or doctor if another type might be better for you or if you should try a different form of treatment.
Night splints = Grade B.For those who suffer from plantar fasciitis for longer than six months, Dr. Irrgang told me that there’s “moderate evidence” suggesting that wearing a night splint will help. This device prevents arch and calf muscles from tightening up at night, which is what causes the debilitating heel pain that most plantar fasciitis sufferers experience first thing every morning. Expect to wear the splint nightly for one to three months, longer if necessary.
Buying information: While older, rigid night splints were uncomfortable, now there’s a softer, sock-type splint that has mostly solved that problem and seems equally effective. You need only one unless you have symptoms on both sides — they’re available online from the Hammacher Schlemmer catalogue (www.Hammacher.com), Footsmart (www.FootSmart.com) or Amazon (www.Amazon.com) for $30 to $70.
Stretching = Grade B. According to Dr. Irrgang, stretching your plantar fascia and calf muscles can bring short-term pain relief and greater flexibility. Here’s how to do it: Sit on the floor with one leg extended and the other bent, with that knee in the air. Grasp the toes of the bent leg and gently pull up and toward you, straightening your leg slowly. You’ll feel resistance that gradually increases — go as far as (but not beyond) where it begins to hurt. Hold for 20 seconds for five repetitions or for three minutes continuously, whichever you prefer. Repeat three times a day. Note:Use stretching in addition to orthotics, not instead of them. In a comparison study, patients achieved better results with stretching combined with orthotics than with stretching alone.
Other Treatments = Grade C.Though massage, taping and/or ultrasound treatments help some people, there’s little research supporting the use of any of these approaches, Dr. Irrgang said. That’s why researchers gave these therapies a grade of “C” — they might work… they might not. I asked Dr. Irrgang whether there’s any reason not to try them and he said go ahead — if it works for you, it passes the true test.
