In the last 2 posts, I have talked about how plantar fasciitis presents and does not present. This understanding can help us develop the best working diagnosis that we can begin treatment. One important aspect of that treatment will be orthotic devices, both OTC and custom made. Let us first talk about the variety of mechanics that you may need to consider regarding your plantar fasciitis treatment. Some of these mechanical changes revolve around:
- Taping
- Shoe selection
- OTC arch supports
- Custom made arch supports
- Miscellaneous such as heel lifts and heel pads
- Stretching tight structures
Taping has been one of the major treatments for plantar fasciitis for years. Where the Low Dye, and all its versions, have dominated this arena, I personally switched to Quick Tape with great results 11 years ago. Quick Tape is sold by Pedifix.
How to Tape your Arch with Support the Foot Tape The old name of Quick tape.
I love to teach my patients how to use Quick tape and will tape them during the first visit treating plantar fasciitis. Although I am sure there may be exceptions, nearly 100% of my plantar fasciitis patients feel much better with this tape that they can maintain 3-7 days before changing.
Shoe selection can be somewhat tricky as there are 4 components that I seek:
- Deep heel counter for future use of inserts
- Heel not too hard in its attempt to control (like New Balance 1540 or Brooks Beast)
- Zero Drop shoes when the activity is primarily standing
- 10-12 mm heel drop when the activity is primarily moving
- Great flexibility across the MPJs for our Windlass
- Ability to Power Lace (non-velcro) / Runner's Knot >>
OTC arch supports can help you get the ball moving mechanically right from the first visit. The goal is some form of mechanical transfer of body weight from the painful heel into the arch (as long as it is comfortable). If their pronation can be helped, you can also get good improvement in the Windlass mechanism. My go-to devices are Sole™, PowerStep™ and PureStride™. You have to be organized to have enough sizes stocked in your office to dispense. I want the devices to be adjustable in my hands. Your suffering patient can leave with their inserts and foot taped and feeling you are the best doctor ever.
Custom arch supports are sometimes made for plantar fasciitis and KevinRoot Medical has a version P-13 for plantar fasciitis. I say sometimes since the typical 3-4 week problem that comes into your office typically only needs some tape, ice, stretching, and good shoes. Plantar fasciitis is overuse, and training modulation tips can be the best treatment of all. However, even when your treatment will be successful in the short term, many feet need “the talk” about long term prevention. You get good in practice picking out the feet that biomechanically are susceptible to recurrent pronatory problems. And, you must tell them, custom orthotic devices are not a hall pass to abuse their foot as much as possible while they train. They can still get plantar fasciitis, shin splints, and the rest of overuse injuries, but we assume it takes more abuse to break down. Having worked with Iron Man Triathletes for years, they are always balancing abusive workouts with all that the medical field can supply. And, one of these are great running custom made functional foot orthtoses.
Heel lifts do have a role in plantar fasciitis. And, even if the plantar fasciitis is on the right only, unless you are treating a limb length issue, the heel lifts or heel pads should be on both sides for balance. Heel lifts can transfer weight from the painful heel forward into the arch making the patient feel better. However, if the weight transfer is not significant, the heel lift can just hold even more weight on the heel area causing increased pain. So, it is trial and error. Heel lifts are used under orthotic devices and typically not alone. The reason for this is a heel lift increases stress just past its distal edge and that can be right on the place that is injured. Therefore, I prefer heel lifts to be used with arch supports and not alone.
Heel pads typically really have no place in straight plantar fasciitis. The “itis” is not related to weight bearing. Yet, some of my plantar fasciitis sufferers love some form of heel padding. Anytime I place a heel pad, I want it on top of an orthotic device, as being under can produce some instability. I love the orthotic device to be on the most stable surface possible.
Stretching should be part of Occam’s Law for plantar fasciitis. When I talk about stretching for PF, I am talking about stretching the PF, gastrocnemius and soleus separately, and lower hamstrings. Typically you start with the achilles and plantar fascia (called 3 positional achilles stretching), and add in the hamstrings when/if you have time to measure them for tightness.
How To Stretch for Plantar Fasciitis and Achilles Tendinitis
The plantar fascia is not known to be an easy tissue to stretch, but doing the above in the video, along with rolling your foot over an ice bottle seems to work just fine for most.
Stretching in general is better after you have warmed up, say one hour after you wake up each morning, and then after workouts and before bed. 2 sets of a 20 count for each stretch is preferred.
