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Suggest Treatment For Plantar Fasciitis
Question: Is plantar fasciitis treatable and curable? How?
Usually after a good night sleep I wake up with no pain on my right foot heel, however after walking for a while on hard surfaces pain develops, it gets more acute with more walking and then diminshes gradually after getting home and resting my foot. Please recommend treatment for healing . Thank you
Usually after a good night sleep I wake up with no pain on my right foot heel, however after walking for a while on hard surfaces pain develops, it gets more acute with more walking and then diminshes gradually after getting home and resting my foot. Please recommend treatment for healing . Thank you
Brief Answer:
use soft footwear
Detailed Answer:
Hi,
Thank you for posting the question.
I have gone through your medical history in detail.
These are symptoms of plantar fascitis (inflammation of plantar fascia of heel) for sure but the main reason for it should be diagnosed.Calcium deposits in plantar fascia or a calcaneal spur can be a triggering factor for plantar fascitis.
If you have been using hard footwear with firm insoles,then this can lead to a bony projection called a calcaneal spur.
I would suggest you to get a Xray of the heel region done to rule out calcaneal spur or calcium deposits.
If a spur is diagnosed,then the spur can be removed only by surgical means.No medicines can dissolve the spur once formed.
But,if you use soft footwears with a silicon heel pad cushion,then you may not need a surgery ever.It is always better to avoid surgery for plantar fascitis as chances of recurrence are very high.
If even using soft footwears is not helping,then a local steroid injection shot at the inflammed area can help immensely to reduce the inflammation.You may need 2 or 3 such injections at 3 weeks interval each,for best results.
If you are obese,weight reduction can help.
Application of local analgesic gel with hot fomentation will help reduce the inflammation.
I hope the answer was useful.
Feel free to ask me any follow up queries that you may have.
Thank you.
Kind regards.
use soft footwear
Detailed Answer:
Hi,
Thank you for posting the question.
I have gone through your medical history in detail.
These are symptoms of plantar fascitis (inflammation of plantar fascia of heel) for sure but the main reason for it should be diagnosed.Calcium deposits in plantar fascia or a calcaneal spur can be a triggering factor for plantar fascitis.
If you have been using hard footwear with firm insoles,then this can lead to a bony projection called a calcaneal spur.
I would suggest you to get a Xray of the heel region done to rule out calcaneal spur or calcium deposits.
If a spur is diagnosed,then the spur can be removed only by surgical means.No medicines can dissolve the spur once formed.
But,if you use soft footwears with a silicon heel pad cushion,then you may not need a surgery ever.It is always better to avoid surgery for plantar fascitis as chances of recurrence are very high.
If even using soft footwears is not helping,then a local steroid injection shot at the inflammed area can help immensely to reduce the inflammation.You may need 2 or 3 such injections at 3 weeks interval each,for best results.
If you are obese,weight reduction can help.
Application of local analgesic gel with hot fomentation will help reduce the inflammation.
I hope the answer was useful.
Feel free to ask me any follow up queries that you may have.
Thank you.
Kind regards.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Dear Dr. XXXXXXX
Thank you very much for your answers and advise.
For a little more of history, this is the 3rd or 4th time that I experience the heel pain in the last 1-2 years. Before, it happened immediately after playing tennis on hard surface but the pain only lasted a few days and then went away. I have not played tennis in the last 9 months but I did a lot of walking on my trips, mostly on hard surfaces (I tend to walk 8-10 hours a day when going out of town and visiting other places).
A few more questions please:
-I will have an X-ray done in the next 1-2 days to look for spurs or deposits.
If a spur is found, will surgery be able to remove it without permanently damaging the plantar fasciitis? What is the success % of such procedures? and why are you concerned about recurrence?
- I will start using soft shoes and gel inserts. Is it your opinion that this will help mitigate the pain and allow walks without pain even if a spur exists?
- If there is no spur, how long does it take for this condition to heal?
- What over the counter medication is more effective for pain management:
Advil or Aleve? and what is the difference between the two?
- I have 2 vacations coming up over the next 30 days, both will require walking a lot and also hiking in National Parks. How to manage my condition to be able to enjoy these trips ?
I am looking forward to your reply
Thank you again
xxxxx
I will work to loose weight (I am 5'10" and 192lbs, about 25 lbs over normal weight)
Thank you very much for your answers and advise.
For a little more of history, this is the 3rd or 4th time that I experience the heel pain in the last 1-2 years. Before, it happened immediately after playing tennis on hard surface but the pain only lasted a few days and then went away. I have not played tennis in the last 9 months but I did a lot of walking on my trips, mostly on hard surfaces (I tend to walk 8-10 hours a day when going out of town and visiting other places).
A few more questions please:
-I will have an X-ray done in the next 1-2 days to look for spurs or deposits.
If a spur is found, will surgery be able to remove it without permanently damaging the plantar fasciitis? What is the success % of such procedures? and why are you concerned about recurrence?
- I will start using soft shoes and gel inserts. Is it your opinion that this will help mitigate the pain and allow walks without pain even if a spur exists?
- If there is no spur, how long does it take for this condition to heal?
- What over the counter medication is more effective for pain management:
Advil or Aleve? and what is the difference between the two?
- I have 2 vacations coming up over the next 30 days, both will require walking a lot and also hiking in National Parks. How to manage my condition to be able to enjoy these trips ?
I am looking forward to your reply
Thank you again
xxxxx
I will work to loose weight (I am 5'10" and 192lbs, about 25 lbs over normal weight)
Brief Answer:
Queries answered
Detailed Answer:
Hello XXXXXXX
Here are the answers to your questions. Hope these answers help you.
1.Surgery will remove the spur,but in doing so,the normal plantar fascia will be damaged as the spur lies deep within the substance of the fascia.
Long term success rate is less than 10 %. Because it is a weight bearing part of our body,such spurs almost always tend to recur after a few days.
2.Yes,if you wear soft shoes and gel inserts you will have almost negligible pain even if the spur exists,provided you lose those extra pounds of body weight .
3.If there is no spur,then the condition should heal within 3-4 weeks once you start using soft shoes and sole inserts.Taking a local steroid injection shot will accelerate the healing process.
4.As far as effectiveness is concerned,advil is more potent and will provide better and faster pain relief as compared to aleve.
But the safety profile of aleve is much better and compared to advil,it can be used safely without any side effects for longer periods of time.
In your case I would recommend Advil for initial 5-7 days,followed by aleve for 1-2 weeks (depending upon the severity of pain.)
5.You can always enjoy your vacations by wearing soft cushion heel footwears,applying local analgesic gels/sprays followed by hot fomentation and taking the medicines as i have mentioned earlier.Avoid walking long distances at a stretch.
Thank you.
Queries answered
Detailed Answer:
Hello XXXXXXX
Here are the answers to your questions. Hope these answers help you.
1.Surgery will remove the spur,but in doing so,the normal plantar fascia will be damaged as the spur lies deep within the substance of the fascia.
Long term success rate is less than 10 %. Because it is a weight bearing part of our body,such spurs almost always tend to recur after a few days.
2.Yes,if you wear soft shoes and gel inserts you will have almost negligible pain even if the spur exists,provided you lose those extra pounds of body weight .
3.If there is no spur,then the condition should heal within 3-4 weeks once you start using soft shoes and sole inserts.Taking a local steroid injection shot will accelerate the healing process.
4.As far as effectiveness is concerned,advil is more potent and will provide better and faster pain relief as compared to aleve.
But the safety profile of aleve is much better and compared to advil,it can be used safely without any side effects for longer periods of time.
In your case I would recommend Advil for initial 5-7 days,followed by aleve for 1-2 weeks (depending upon the severity of pain.)
5.You can always enjoy your vacations by wearing soft cushion heel footwears,applying local analgesic gels/sprays followed by hot fomentation and taking the medicines as i have mentioned earlier.Avoid walking long distances at a stretch.
Thank you.
Above answer was peer-reviewed by :
Dr. Kampana
Dear Dr. XXXXXXX
Thank you so much for your thoughtfull answers and patience with my questions.
Happy to let you know that I had the X-ray done yesterday and there are no injuries, spurs or calcifications present in my foot.
I would like to ask a few more questions regarding my condition:
1. Could you explain a little more about the application of local analgesic gels/spray followed by hot fomentation. What is hot fomentation? Are these local analgesic gels/sprays available over the counter? How often should I apply?
2. Regarding Advil vs Aleve ...I am used with Tylenol , is Tylenol as effective for my condition and does it have a better safety profile than Advil or Aleve?
3. Is the pain medication usefull only for relief of the pain or helps in the healing process by reducing inflamation?
4. I noticed that recently after walking my right foot plantar fascia gets hot, more hot than the left foot where the plantar fascitis condition does not exist. I don't have an issue with my foot getting hot when I don't wear shoes or socks, at home or any other time. Is this because of the material of the shoes and socks or is a direct result of the inflamation due to the plantar fascia condition? or is something else?
5. Will you agree that one of the most important long term solution for my problem is to loose the extra weight?
6. I like biking and when biking the heel is not involved...would you say is safe for me to bike right now or wait until healing? What about swimming?
7. I used to play tennis and over the last 1-2 years from time to time I developed pain on my right foot plantar but usually pain dissapears in about 1-2 days. I have not played tennis in about 6 months but I may have injured my plantar by walking 10 hours a day on hard surfaces when in a recent vacation...I noticed that now the pain is more severe and healing process is much longer...what is it happening at the fascia microscopic level? Is it getting weaker and the healing process more difficult? Once injured, are you always more prone to injuries?
Does the fascia has "memory" of previous injuries?
Will I always need to wear soft shoes and insert even after healing?
Sorry to take so much of your time with so many questions.
Thank you,
xxxxx
Thank you so much for your thoughtfull answers and patience with my questions.
Happy to let you know that I had the X-ray done yesterday and there are no injuries, spurs or calcifications present in my foot.
I would like to ask a few more questions regarding my condition:
1. Could you explain a little more about the application of local analgesic gels/spray followed by hot fomentation. What is hot fomentation? Are these local analgesic gels/sprays available over the counter? How often should I apply?
2. Regarding Advil vs Aleve ...I am used with Tylenol , is Tylenol as effective for my condition and does it have a better safety profile than Advil or Aleve?
3. Is the pain medication usefull only for relief of the pain or helps in the healing process by reducing inflamation?
4. I noticed that recently after walking my right foot plantar fascia gets hot, more hot than the left foot where the plantar fascitis condition does not exist. I don't have an issue with my foot getting hot when I don't wear shoes or socks, at home or any other time. Is this because of the material of the shoes and socks or is a direct result of the inflamation due to the plantar fascia condition? or is something else?
5. Will you agree that one of the most important long term solution for my problem is to loose the extra weight?
6. I like biking and when biking the heel is not involved...would you say is safe for me to bike right now or wait until healing? What about swimming?
7. I used to play tennis and over the last 1-2 years from time to time I developed pain on my right foot plantar but usually pain dissapears in about 1-2 days. I have not played tennis in about 6 months but I may have injured my plantar by walking 10 hours a day on hard surfaces when in a recent vacation...I noticed that now the pain is more severe and healing process is much longer...what is it happening at the fascia microscopic level? Is it getting weaker and the healing process more difficult? Once injured, are you always more prone to injuries?
Does the fascia has "memory" of previous injuries?
Will I always need to wear soft shoes and insert even after healing?
Sorry to take so much of your time with so many questions.
Thank you,
xxxxx
Brief Answer:
Queries answered
Detailed Answer:
Hello XXXXXXX
Its my pleasure to answer all your questions and clear all your doubts until you are thoroughly satisfied.Please do not hesitate to ask any doubts that you may have.
Here are the answers to your new questions.
1. Local analgesic sprays/gels usually contain diclofenac,linseed oil,menthol,capsacin ets as active ingredients.You should apply this ateast twice a day.Rub the gel gently over the painful part for approximately 10 minutes and keep the heel dipped in lukewarm water for 15 minutes.This is called hot fomentation.
Usually,these gels/sprays are available over the counters but in some countries you may need a doctor's prescription.Please check this out in local pharamcy stores.
2. Yes.Tynelol is equally effective in treating this condition and has a better safety profile compared to advil and aleve.
3. These medicines help in both,pain relief and healing process.Fibrinolytic enzymes like trypsin,chymotrypsin and serratiopeptidase along with collagen peptide tablets act as adjunctive therapy and can be used along with tynelol to facilitate the healing process.
4. This does not seem to be related to the material of the socks or shoes and is due to inflammation underneath the soft tissues.
Nylon/plastic socks and footwear may temporarily give a feeling of warmth if worn for longer periods of time.
5. Yes,long term permanent relief is directly related to the amount of body weight you lose .
6. You can continue biking and swimming even now quite safely.
7.At microscopic level,pain substance is accumulating in the plantar fascia with some amount of dead cells and debris.This needs to be washed out to get relief from pain.A local steroid injection acts exactly here and removes the debris and pain substance for the site of inflammation.
Healing process will become more and more slower if you do not lose weight early or if you continue using hard footwear or walk on hard surfaces.
In long term,yes,the fascia becomes more prone to future injuries but if you use soft footwears ,you will never have heel pain and you should continue using it even after the healing is complete.
Thank you.
Queries answered
Detailed Answer:
Hello XXXXXXX
Its my pleasure to answer all your questions and clear all your doubts until you are thoroughly satisfied.Please do not hesitate to ask any doubts that you may have.
Here are the answers to your new questions.
1. Local analgesic sprays/gels usually contain diclofenac,linseed oil,menthol,capsacin ets as active ingredients.You should apply this ateast twice a day.Rub the gel gently over the painful part for approximately 10 minutes and keep the heel dipped in lukewarm water for 15 minutes.This is called hot fomentation.
Usually,these gels/sprays are available over the counters but in some countries you may need a doctor's prescription.Please check this out in local pharamcy stores.
2. Yes.Tynelol is equally effective in treating this condition and has a better safety profile compared to advil and aleve.
3. These medicines help in both,pain relief and healing process.Fibrinolytic enzymes like trypsin,chymotrypsin and serratiopeptidase along with collagen peptide tablets act as adjunctive therapy and can be used along with tynelol to facilitate the healing process.
4. This does not seem to be related to the material of the socks or shoes and is due to inflammation underneath the soft tissues.
Nylon/plastic socks and footwear may temporarily give a feeling of warmth if worn for longer periods of time.
5. Yes,long term permanent relief is directly related to the amount of body weight you lose .
6. You can continue biking and swimming even now quite safely.
7.At microscopic level,pain substance is accumulating in the plantar fascia with some amount of dead cells and debris.This needs to be washed out to get relief from pain.A local steroid injection acts exactly here and removes the debris and pain substance for the site of inflammation.
Healing process will become more and more slower if you do not lose weight early or if you continue using hard footwear or walk on hard surfaces.
In long term,yes,the fascia becomes more prone to future injuries but if you use soft footwears ,you will never have heel pain and you should continue using it even after the healing is complete.
Thank you.
Above answer was peer-reviewed by :
Dr. Remy Koshy
Dear Dr. XXXXXXX
Very greatfull for the answers and guidance with my condition.
I live in Long Beach, CA so it should not be an issue getting the over the counter medication you recommended.
As you can see from my questions I am worry perhaps more than I should...it is a combination of my engineer mind, curiosity and detail orientated, and the good fortune that I am about to reach 64 years of age without once in my life going to a hospital or having any operations or any other condition except minor colds from time to time, and not having to take taking any medications . Having this good fortune which I appreciate more and more as years go by, when plantar fascitis condition occured, which impeded my daily walks routine, I tend to amplify things in my mind and worry.
Your patience with my questions already have put my mind to ease and all I have to do now is to follow your advise and wait for healing.
I will stay in touch as the condition improves
Respectfully yours,
xxxxxxxxxx
Very greatfull for the answers and guidance with my condition.
I live in Long Beach, CA so it should not be an issue getting the over the counter medication you recommended.
As you can see from my questions I am worry perhaps more than I should...it is a combination of my engineer mind, curiosity and detail orientated, and the good fortune that I am about to reach 64 years of age without once in my life going to a hospital or having any operations or any other condition except minor colds from time to time, and not having to take taking any medications . Having this good fortune which I appreciate more and more as years go by, when plantar fascitis condition occured, which impeded my daily walks routine, I tend to amplify things in my mind and worry.
Your patience with my questions already have put my mind to ease and all I have to do now is to follow your advise and wait for healing.
I will stay in touch as the condition improves
Respectfully yours,
xxxxxxxxxx
Brief Answer:
YOU ARE ALWAYS WELCOME
Detailed Answer:
Hello Mr XXXXXXX
It is good to hear that you have maintained such a good health even at this age.
Plantar fascitis is a very minor issue and you should not worry much about it.Be assured that it will eventually heal and you will soon return back to your normal healthy living.
I would also like to mention here that a raised uric acid level in blood may rarely cause these symptoms.If the symptoms do not improve as expected in a week or so,then you can get your serum uric acid levels checked in blood.
Do let me know the progress of the symptoms.
Thank you.
Take care.
YOU ARE ALWAYS WELCOME
Detailed Answer:
Hello Mr XXXXXXX
It is good to hear that you have maintained such a good health even at this age.
Plantar fascitis is a very minor issue and you should not worry much about it.Be assured that it will eventually heal and you will soon return back to your normal healthy living.
I would also like to mention here that a raised uric acid level in blood may rarely cause these symptoms.If the symptoms do not improve as expected in a week or so,then you can get your serum uric acid levels checked in blood.
Do let me know the progress of the symptoms.
Thank you.
Take care.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Dear Dr. XXXXXXX
I should have added to my note regarding good health and good fortune, good genes. I already feel better with my foot, I am wearing soft tennis shoes, the pain is now very mild.
Thank you for your advise and the added note about the uric acid level. When I return from my vacation I will have all the blood tests done including uric acid level.
One thing I know for sure is that my Doctor will ask again, like he does every year during my physical exam, "Have you done the colonoscopy?" and I always say "I am thinking about" and then another year passes by.
This an issue that I have been struggling for many years and as you very kindly are willing to listen to my worries I perhaps could share with you my concerns and ask for your advise.
I do not have any history in my family of colon cancer. However I understand that this is an important screening to do. I am worry about the following:
1. During the colonoscopy procedure I heard that there is the possibility of puncture and internal bleeding. How is is this addressed and are any complications in the event that this occurs? Will this situation lead to a surgical procedure?
2. I heard that sometimes the procedure may miss polyps which are small or flat, what is happening in that case? Did the colonoscopy procedure failed? Can small or flat polyps, hard to detect, be cancerous or they have to grow to a certain size before becoming cancerous?
3. By removing the polyps (if any are present) will this lead to a more vigurous growth at the same location, that can become cancerous?
4. Is biopsy done on the removed polyps and what happens if any are cancerous?
Surgery and removal of part of the colon?
5. Is the stool test kit for blood as effective as colonoscopy?
6. What is the rate of growth of these polyps, why do the form and why some could be cancerous and others not?
7. Can any polyp growth become cancerous?
8. Once you start on the path of colonoscopy, is this a procedure that you have to do again and again, until what age?
9. What is your recommendation regarding colonoscopy?
10. What are the triggers of colon cancer and what are the inhibitors (life style, food...or others) for prevention?
Many thanks again for your guidance
xxxxxxxxxxx
I should have added to my note regarding good health and good fortune, good genes. I already feel better with my foot, I am wearing soft tennis shoes, the pain is now very mild.
Thank you for your advise and the added note about the uric acid level. When I return from my vacation I will have all the blood tests done including uric acid level.
One thing I know for sure is that my Doctor will ask again, like he does every year during my physical exam, "Have you done the colonoscopy?" and I always say "I am thinking about" and then another year passes by.
This an issue that I have been struggling for many years and as you very kindly are willing to listen to my worries I perhaps could share with you my concerns and ask for your advise.
I do not have any history in my family of colon cancer. However I understand that this is an important screening to do. I am worry about the following:
1. During the colonoscopy procedure I heard that there is the possibility of puncture and internal bleeding. How is is this addressed and are any complications in the event that this occurs? Will this situation lead to a surgical procedure?
2. I heard that sometimes the procedure may miss polyps which are small or flat, what is happening in that case? Did the colonoscopy procedure failed? Can small or flat polyps, hard to detect, be cancerous or they have to grow to a certain size before becoming cancerous?
3. By removing the polyps (if any are present) will this lead to a more vigurous growth at the same location, that can become cancerous?
4. Is biopsy done on the removed polyps and what happens if any are cancerous?
Surgery and removal of part of the colon?
5. Is the stool test kit for blood as effective as colonoscopy?
6. What is the rate of growth of these polyps, why do the form and why some could be cancerous and others not?
7. Can any polyp growth become cancerous?
8. Once you start on the path of colonoscopy, is this a procedure that you have to do again and again, until what age?
9. What is your recommendation regarding colonoscopy?
10. What are the triggers of colon cancer and what are the inhibitors (life style, food...or others) for prevention?
Many thanks again for your guidance
xxxxxxxxxxx
Brief Answer:
Queries answered
Detailed Answer:
Hi,
1. Puncture and internal bleeds during colonoscopy are dealt with by immediate hemostasis and internal stitching to avoid complications like peritonitis.No further surgical procedure is required.
2. Smallest of polyps are usually very clearly seen on scopy. These need to get much bigger to become cancerous.
3. By removing the polyps, it will cure the condition and not aggravate the cancerous possibility.
4. Yes, the removed polyps are biopsied and depending upon the stage, partial or complete colectomy/colostomy is done.
5. Stool test kit is less effective as compared to colonoscopy.
6. The rate of growths depends on genetic predisposition and staging of cancer.
7. Yes, practically, any polyp can undergo cancerous transformation.
8. It's better to get the colonoscopy done regularly if you have a genetic predisposition and should be done at least once in a year, lifelong.
9. Colonoscopy is highly recommended in people aged 60 and above.
10. Genetic predisposition, junk food, lowered immunity are triggering factors.
Staying healthy and timely diagnosis is the best mode of prevention.
Thanks
Queries answered
Detailed Answer:
Hi,
1. Puncture and internal bleeds during colonoscopy are dealt with by immediate hemostasis and internal stitching to avoid complications like peritonitis.No further surgical procedure is required.
2. Smallest of polyps are usually very clearly seen on scopy. These need to get much bigger to become cancerous.
3. By removing the polyps, it will cure the condition and not aggravate the cancerous possibility.
4. Yes, the removed polyps are biopsied and depending upon the stage, partial or complete colectomy/colostomy is done.
5. Stool test kit is less effective as compared to colonoscopy.
6. The rate of growths depends on genetic predisposition and staging of cancer.
7. Yes, practically, any polyp can undergo cancerous transformation.
8. It's better to get the colonoscopy done regularly if you have a genetic predisposition and should be done at least once in a year, lifelong.
9. Colonoscopy is highly recommended in people aged 60 and above.
10. Genetic predisposition, junk food, lowered immunity are triggering factors.
Staying healthy and timely diagnosis is the best mode of prevention.
Thanks
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dear Dr. XXXXXXX
I can see from your answers that the benefit of doing the colonoscopy for cancer detection far outweighs my concerns.
Thank you for your guidance, advise and patience with my questions.
I hope I did not take too much of your valuable time.
Very respectfully,
xxxxxx
I can see from your answers that the benefit of doing the colonoscopy for cancer detection far outweighs my concerns.
Thank you for your guidance, advise and patience with my questions.
I hope I did not take too much of your valuable time.
Very respectfully,
xxxxxx
Brief Answer:
Thank you
Detailed Answer:
You are always welcome.
Thank you.
Take care.
Thank you
Detailed Answer:
You are always welcome.
Thank you.
Take care.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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