Heel pain can interfere with multiple aspects of your life and can be a source of aggravation or even depression when doing everyday activities. To do almost anything you have to use your feet and when they hurt, you hurt all over! It is no wonder that you are exploring alternatives for pain relief for this debilitating condition. To put this in perspective, it makes sense to start with plantar fasciitis remedies and treatments that are currently used, initially with the onset of foot pain. Then we will progress to treatments that are available when the problem has been there for a few months or even years.
More than 90% of heel pain is caused by a condition called plantar fasciitis. Typically, but not always, this condition is more painful when getting up in the morning out of bed, or after sitting and then getting up. The pain can be intense and radiate to the arch, ankle, or even up the leg. Pain can be very severe, not allowing you to put weight on the heel. There is usually no injury that brings this on. The foot usually appears normal from the outside, with no bruising, swelling or deformity noted. While these findings are typical, your pain could be from another cause and a diagnosis may be helpful for you.
Use this blog as a guideline, but a qualified healthcare provider may be needed to help you make a diagnosis. This information is not intended to provide you with a diagnosis. It is intended to make you more informed, and knowledgeable so that you can seek resolution of your condition from the right approach.
Plantar Fasciitis Remedies #1: Correct the cause of the problem
The plantar fascia is a ligament on the bottom of the foot that provides stability of the foot. When you take a step, your foot acts as a shock absorber and adapts to the terrain. As you move forward the foot needs to become stable to efficiently move the body forward. For this to occur the plantar fascia ligament must become tight, through the movement of the toes upward.
Many people have insufficient movement in the big toes when they step forward. This lack of movement can occur for a variety of reasons.
- The most common reason for this is the way you walk. If you stand throughout the day in one place or if you walk in a small space, it is likely that you are not rolling through the foot properly. Walking like this for several hours daily can result in significant fatigue of the foot, including abnormal strain on the plantar fascia. The plantar fascia now has the job of stabilizing a very unstable structure, which is something it is not designed to do.
- Another reason is wearing shoes that are too stiff. These types of shoes do not allow the toes to bend properly as they restrict movement. Many shoes on the market today are very stiff. So stiff, in fact, that the foot just cannot bend through these shoes at all. Examples of these would be various work, hunting or outdoor boots, rocker-designed walking shoes and, clogs with stiff soles (see image below). While this footwear will rest the plantar fascia, they will also limit the normal function of this ligament and cause problems with the normal movement of the foot and plantar fascia. They are not a good long-term solution for you.
- Also, Arthritis in the big toe will restrict movement of the toe. When this is present, there is no way for movement of the big toe to occur, and this makes it impossible to restore normal foot function at this point. It is best if problems can be identified earlier, so that arthritis can be prevented, if possible.
- Finally, your foot is meant to bend behind the toes and restricting this normal motion is bad for postural movements of the foot and the joints above the foot. (Ankle, knee, hip, and low back). The lack of movement of the big toe, is secondary to a postural problem of the foot that limits toe mobility.
When the foot posture is not right, the big toe will become restricted to the point where it simply will not bend normally anymore. In fact, over 95% of people with heel pain will have this problem. This can be resolved with the Lux Step insole. The unique and patented features of this insole will re-align the soft tissues, which are causing the restricted motion and allow normal movement of the big toe joints to occur once again.
Plantar Fasciitis Remedies #2: Stretch the heel cord
The heel cord is often tight with plantar fasciitis. When the ankle does not move correctly, the foot is functioning abnormally, and this can lead to plantar fasciitis. When the foot posture is incorrect, the arch is where most of the motion comes from, not the ankle. This results in a tightness of the Achilles tendon in the back of the leg. When the Achilles tendon is tight, it causes tightness of the plantar fascia and then you have plantar fasciitis. Once the foot posture is improved and motion of the foot is restored, the ankle will start to move, and the Achilles tendon will eventually stretch out. Depending on how flexible your tendon tissues are, this could take a few days, weeks, months, or even years. Doing exercises to improve flexibility of the heel cord can be helpful.
- Do wall push up exercises to stretch the Achilles tendon. These are simple to do and should be done 2-3 times a day with your shoes and insoles on your feet.
- Wear a night splint to hold your foot up while sleeping. These can be helpful but are not always comfortable to wear, while sleeping. They are worth a try if you are not getting better quickly.
After trying the above two remedies if you are still experiencing pain the remedies listed below are the next remedies you should try in the following order.
Plantar Fasciitis Remedies #3: Reduce the pain
Controlling the cause of heel pain is the primary objective otherwise the pain is likely to re- occur. If pain persists, there are multiple ways to reduce the pain in the heel.
- Cold therapy. Ice is a wonderful way to reduce local inflammation. A cold pack wrapped in a towel, can be applied to the heel 2-3 times a day after physical activity. This can reduce the swelling and pain in the tissues of the heel. Be careful with this if you do not have good circulation in the foot.
- Topical analgesics can be of some benefit. There are several over-the-counter brands on the market. Also, those containing CBD oil can also be helpful.
- Oral anti-inflammatories, such as Advil, Nuprin, Ibuprofen. These can cause side effects and it is best to check with your doctor if you have medical problems before taking these. Turmeric (Curcumin) is a natural anti-inflammatory, and it does not have any side effects.
Plantar Fasciitis Remedies #4: Get an injection
Injections can be helpful particularly if the pain is severe, and you simply cannot function well. Keep in mind that controlling the source of the pain is important so these injections will just provide a temporary resolution of the pain.
- Cortisone injection. When heel pain is present for a longer time period, the ligament will thicken and become quite diseased. Cortisone will help reduce the swelling of the plantar fascia. (However, it will also weaken the plantar fascia). When the fascia is tight, this can provide a lengthening of the plantar fascia for you. It can also, in rare cases, cause a rupture of the plantar fascia. This risk is increased if multiple injections are given over several weeks or months. The injection needs to be given right in the plantar fascia itself, preferably by a doctor skilled in this technique. Please also note- If it is given too deep it can irritate a nerve just under the fascia called Baxter’s’ nerve and this can increase your pain. If it is given too shallow, it can cause a loss of the protective fat pad on the heel and this problem is difficult to fix. It is because of these potential complications, that I recommend cortisone injections on a selective basis after the primary reason for the pain has been identified and addressed.
- Platelet Rich Plasma (PRP) injections and stem cell injections have a lower risk profile than cortisone. These are expensive and insurance coverage is usually not available as these are considered “experimental”. They are worth some consideration for stubborn heel pain when other options have been exhausted. I have had success with these injections in my practice.
- Botox injections. These have been reported in the literature to be effective for this condition, although I have had no experience with them.
Plantar Fasciitis Remedies #5: Rest the foot
Sometimes a little rest is helpful. Getting off your foot for one week and on crutches can be challenging but helpful, for those with long-term problems. After the pain is gone, I would gradually return to more weight-bearing and activities over more time. This regimen is extremely helpful, particularly for athletes such as runners. This program can take several weeks but well worth it, when needed.
Plantar Fasciitis Remedies #6: Look for other foot problems
Sometimes the heel pain is secondary to a more severe foot problem, such as a bad flatfoot. When this is the case, the heel pain is secondary to the other problem and needs to be addressed before the heel pain will go away. This one issue is the reason why some treatments do not work out well, over the long term or fail to resolve the pain at all. If you are looking only at the heel and nowhere else, and the heel does not get better, you are missing the problem.
Some things I see commonly that cause this problem are a tight Achilles tendon, a very unstable flat foot, a remarkably high arched rigid foot, or an uncorrected club foot. It could also be from a recent knee or hip replacement, and you are still having difficulty walking. Other areas to consider are a back injury or back pain, or overall recent trauma, such as an automobile accident, prolonged illness and difficulty with strength and mobility. These are all things to consider. You won’t get better unless you have identified the right cause of your pain.
Plantar Fasciitis Remedies #7: Consider Physical Therapy (or other non-surgical measures)
- Physical Therapists and Chiropractors can evaluate and improve flexibility, work on strength deficits, and do things such as work on your walking style, which can make a significant difference. Dry needling can help but does require patience and multiple treatments. Some of their modalities (E stim, ultrasound) may have an effect on the inflammation of the ligament and surrounding soft tissues as well. Certain manipulations can have a beneficial effect on ankle joint mobility as well. If physical therapy is going to help you, you should see results within a few weeks. If you are not seeing results, it is time to evaluate whether this is worth the time and expense to continue. This is a discussion you should have with your Physical Therapist or Chiropractor.
- Shockwave therapy can be considered a therapeutic modality but does require a doctor to do this. I view this as a treatment of last resort before going to surgery. The availability of these machines is limited, so this may not be an option for you depending on where you live.
Plantar Fasciitis Remedies #8: As a last option, consider surgery
Occasionally I do need to correct a flatfoot to improve the motion of the big toe joint in people with heel pain. Tight Achilles tendons are also another problem that will commonly cause heel pain. When these problems exist, surgery makes total sense and sometimes needs to be considered sooner rather than later.
When the problem is in the heel only, I rarely have had to do an isolated procedure to the heel. The only exception to this is a nerve entrapment of a nerve, on the inside of the ankle that needs to be released. If the problem is plantar fasciitis, surgery on the plantar fascia should not have to be done. We do not have good long-term studies looking at the effects of cutting and lengthening the plantar fascia and its possible side effects.
Endoscopic debridement of the inflammatory tissue under the plantar fascia is showing excellent success, even though the studies to date are small, this approach makes sense intuitively. Finding the right doctor to do this is key to its success.
These are some good options for you to consider. There is help for you. What would your life look like without heel pain? We understand foot pain and how to provide plantar fasciitis pain relief.
Our solution, The Lux Step insole has successfully eliminated foot pain in many of our customers and it can work for you too!
About the Author
James Clough, DPM, is a podiatric surgeon and has been in practice for over 35 years. Dr. Clough’s philosophy of practice is to employ the best technology and the latest procedures to achieve optimal outcomes for his patients. He prefers a conservative approach to most foot problems initially, is able to treat complex foot deformities surgically, and has a special interest in foot biomechanics and sports injuries.
Dr. Clough received his medical degree in podiatry from the California College of Podiatric Medicine in San Francisco, followed by a surgical residency at Metropolitan Hospital – Parkview Division in Philadelphia, Pennsylvania. Dr. Clough is a Board-Certified diplomate with the American Board of Foot & Ankle Surgery and a Board-Certified fellow with the American College of Foot & Ankle Surgeons.