12: Plantar Fasciitis Explained: How to Get Back on Your Feet

Step into our latest episode of "Your Checkup", where we tackle the pain of plantar fasciitis, a condition our host, Nicole,  knows all too well. Join us as we delve into the symptoms, from that sharp heel pain to those dreaded first steps in the morning. We'll walk you through the most effective treatments and preventative measures, sharing personal experiences and expert insights to help you get back on your feet. Whether you're a fellow sufferer or just curious, this episode will provide the support and knowledge you need to take the next step toward relief. 

Takeaways

• Plantar fasciitis is a common cause of heel pain in adults.
• Symptoms often include sharp pain in the heel, especially in the morning.
• Diagnosis is primarily based on patient history and physical examination.
• Treatment options include rest, proper footwear, and stretching exercises.
• Home remedies like rolling the foot on a ball can provide relief.
• Most people with plantar fasciitis improve within a year.
• Consulting a doctor is essential for personalized treatment.
• Self-care strategies can be effective in managing symptoms.
• Massage can help alleviate foot pain.
• This podcast is not a substitute for professional medical advice.

Keywords

platar fasciitis, foot pain, heel pain, treatment options, home remedies, self-care, medical podcast, health tips, plantar fascia, injury prevention

Transcript

Ed Delesky, MD (00:00)
Hi, welcome to your checkup. We're the patient facing medical podcast where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky a family medicine resident in the Philadelphia area. And we are so excited you can be here with us again today. All right. So we were cooking. got off the night shift and here we go. I was making, I was making a salad and

Nicole Aruffo, RN (00:12)
I'm Nicole Aruffo I'm a nurse

Ed Delesky, MD (00:26)
If you didn't think that spring mix, feta cheese and avocado were a good mix, they certainly are. But you know, was trying to get the pit out and I took a serrated knife and I was holding it in my hand. was cupping this avocado and I put the serrated knife in the pit and I'm cut, cut, cut. And then it slips and it jumps and cuts my hand.

Nicole Aruffo, RN (00:47)
He acts like he's never cut his finger with a knife before. Eddie also has just realized that he can cook. So he's using more kitchen tools. So stay tuned for more injuries.

Ed Delesky, MD (00:51)
Well, for me, this was novel.

Yeah, well that hurt, but, and I'm gonna try to get the most genuine answers out of you here. Yeah, what else hurts? When you first wake up in the morning, what do your feet feel like?

Nicole Aruffo, RN (01:11)
Out of

well, depending on the day, it feels like I get out of bed and I'm standing on knives.

Ed Delesky, MD (01:26)
So, you know, we, I asked you this when we first like, you know, I don't know, we were just thinking about feet and getting up in the morning. Cause when I would get up, I'd be a little stiff and then I'd look over at you and you'd be wincing in pain, which seemed not normal. And then, I don't know, do you feel that where, where in your foot does it hurt when you first get out of bed?

Nicole Aruffo, RN (01:46)
It's like up by my heel.

Ed Delesky, MD (01:48)
Like on the bottom part? okay. How long did you think that was normal for?

Nicole Aruffo, RN (01:54)
Well, it's been a couple years.

Ed Delesky, MD (01:58)
And it

Nicole Aruffo, RN (01:59)
This is actually the exact conversation that we had.

Ed Delesky, MD (02:02)
And

does it stay painful or does it get better throughout the day? now if you're sitting for a while and you start moving again, does it affect your ability to run at all?

Nicole Aruffo, RN (02:07)
pens.

Yeah, it does because a couple weeks ago you and I went for a run at the beach and I made it like a half mile and then I had to stop because it felt like I was running on knives.

Ed Delesky, MD (02:26)
Yeah. So you have plantar fasciitis. Yeah. And that's exactly

Nicole Aruffo, RN (02:31)
the exact conversation that we had. Yeah. Well, I think it was like after we a little after we moved in together and you like saw me every morning and you're like, well, you're in pain every morning.

Ed Delesky, MD (02:33)
and

Why are you

in pain every morning? my God. Yeah. So that was, I mean, you probably figured that out a long time ago.

Nicole Aruffo, RN (02:53)
I mean,

simple Google search will not to be a Google doctor, but you know, it's one of those like benign things that the Internet will tell you.

Ed Delesky, MD (03:03)
Yeah. And this ends up being the most common cause of foot pain and heel pain in adults. And I mean, if you're listening, you might, this has been happening a lot. Like, I don't know. People have been messaging me and saying like, my God, that was a soleus strain that I had. Or, wow, I got sunburned this week. This is really topical with all of the heat that's been going on, know, the summer, summer safety thing, the heat wave. So it ends up being the most common.

Like I said, the most common cause of foot pain and heel pain. And I mean, literally like a million people probably go to see their doctor about this. No, you, you didn't. I mean, we talk about it a lot, but it's incredibly common. so when, when we think about the foot and we think about what the plantar fascia is at first, so it's this white tissue that is on the bottom of your foot.

Nicole Aruffo, RN (03:40)
I didn't.

Ed Delesky, MD (03:59)
And if you're imagining from your heel to your toes, it attaches to the skin that overlies it. And it's, it offers support to the bones and the structures in the foot that go from the heel to the toes. And the pain when plantar fasciitis occurs and you know, anytime in something in medicine, something that has an itis after it, that there's inflammation. So that's the leading understanding right now. The itis. The itis. But there's pain.

back on the inside, usually, towards the heel. And so, you know, here we have about, like, who this can affect most often. Is there a certain group of people that are affected by this more than others?

Nicole Aruffo, RN (04:43)
The peak ages are about 40 to 60 years old, then even earlier if, specifically if that person is a runner.

Ed Delesky, MD (04:50)
Yeah, and there are some risk factors that are discussed in the literature, but these are a little wishy washy. What are some of those that may predispose people to having plantar fasciitis?

Nicole Aruffo, RN (05:06)
So some risk factors of plantar fasciitis that were suggested are weight, heel spurs, and diabetes.

Ed Delesky, MD (05:14)
And there's also some conversation around if this is caused by micro trauma and overuse injury, which when you kind of look at it, gets at excessive training, especially an increased in distance running, or maybe you're wearing someone, not you, someone's wearing inappropriate shoes in terms of arch support and running on hard surfaces. Or if they don't have as much flexibility in their ankle, like they can't dorsiflex or get their toes to the sky as much. And.

You know, this actually is pretty common in dancers as well, ballet dancers.

Nicole Aruffo, RN (05:51)
Yeah, they have a lot of feet problems. Do you ever watch those TikToks or reels of, they probably don't ever come across your desk, but they do mind of ballet dancers who do point and what they have to do to their feet when they dance and stuff. It's kind of crazy.

Ed Delesky, MD (06:10)
That is crazy. Do the shoes offer support to support them going like that?

Nicole Aruffo, RN (06:16)
And like the top of it like they're different shoes Wow But they do all kinds of crazy things to like their feet and their toes to like prep their foot

Ed Delesky, MD (06:25)
to like withstand that. Interesting. So I know we talked about it when we first got things started here, but as our resident content expert and a survivor, much like I was with the calf strains, what does this feel like in your own words?

Nicole Aruffo, RN (06:36)
I'm a survivor.

Well, I'll give like the textbook kind of description of what they say it feels like and maybe if you're doing some of your own research. So it says pain at the bottom of your foot closer to your heel, which I would agree with, like knives on your heel. Worse in the morning and then better with activity, worse with inactivity and then gets better kind of as the day goes on, which I also agree with. And then pain worse.

when you're walking either like in bare feet or just, you know, like flip-flops on supportive shoes on a hard surface. And I agree with all of that. Definitely worse in the morning. And then kind of as the day goes on, it feels better until I like start running again and then it's a cycle.

Ed Delesky, MD (07:31)
Yeah.

I know it's really, it's really frustrating diagnosis from everything that I was reading. And when you talk to these people who come in the office for diagnosis labs, aren't that helpful? And honestly, imaging isn't terribly helpful either. The diagnosis is basically made by this history of heel pain. That sounds exactly like what you're describing and actually being able to have tenderness where the, where the plantar fascia goes into the heel. And that can actually be used in treatment as well.

But there are also other causes.

Nicole Aruffo, RN (08:07)
I your thumb in my heel and I...

Ed Delesky, MD (08:10)
I totally did that. Whoa, whoa, geez. And all this to say in the nature of this podcast that this isn't medical advice. There are a bunch of other things that can cause heel pain, which is why you specifically need to go to your doctor to have them take a look because there are several other things. This just happens to be the most common.

Nicole Aruffo, RN (08:28)
Okay, so what's kind of what are like the general universal treatment things that someone could be able to do? Maybe just like do at home.

Ed Delesky, MD (08:37)
Mm-hmm.

The, this is the key piece, I'm sure everyone who has plantar fasciitis is like interested in how can I get this to go away? And when we were reviewing for this show and reviewing different articles, it comes to pass that it's a really frustrating diagnosis. There isn't a lot of great evidence to support one over the other in terms of things to do, but there are several and they may or may not work, but let's go through them because

Each of them is important. And the biggest thing to take away is that about 80 % of people who have plantar fasciitis will get better after one year. So that's an encouraging thing that four out of five people will get better. Right. Do you feel better about that now?

Nicole Aruffo, RN (09:27)
no, it's been like probably three years, so.

Ed Delesky, MD (09:31)
So you fall in that small,

Nicole Aruffo, RN (09:33)
Well,

I also haven't like really done anything to make it better consistently. So.

Ed Delesky, MD (09:38)
let's talk about what we could do.

Nicole Aruffo, RN (09:41)
Because honestly, I don't know, it's like annoying and painful and inconvenient, but like there are worse things, you know?

Ed Delesky, MD (09:49)
Yeah, I guess there are worse things. I mean, but you tell me this all the time, right? Like we can't compare to worse things. Rest and avoiding exacerbating activities is the first thing and maybe seems most obvious, but there's some evidence here that in studies where they looked at runners and they saw that their distance load and if they know there's a study about general lower extremity body soft tissue injuries and as people reduced their

straight as people reduced the distance that they were running, they had fewer incidences. Yeah. So rest and avoidance is something that's important. Cushioned footwear is actually a really high point that this is similar to the calf strain one. This is like a tangible takeaway that someone can go do and grab. If a heel cup, like a prefabricated silicone heel insert,

Nicole Aruffo, RN (10:27)
That makes sense.

Ed Delesky, MD (10:49)
actually may do wonders. There are certain studies where they took people with heel cups and stretches and just people with stretches and the people with the heel cup and stretches did better overall.

Nicole Aruffo, RN (11:03)
Yeah, this did really help when you put them in my shoes. Especially if they're shoes like that you are wearing like all day. You know, every day, all day supporting your heel all day. Like if they're like what you were to work or whatever, like in my sneakers that I wear to work and like I walk to work and I think that helped.

Ed Delesky, MD (11:08)
Yeah.

Right.

And there's probably more to be said about the anatomy of someone's foot. Like if you have flat feet, that may put you more at risk. high arch that may put you more at risk. Or if your shoes, like I wear shoes into the ground until they're falling apart. I bet a lot of people probably come forward. That's my own personal problem. Is that what they say? Yeah. Yeah. We're already up on that. And I feel like I just got these.

Nicole Aruffo, RN (11:35)
We're really high.

zero problem. You're supposed to change your shoes every six months.

We got those sneakers six months ago.

Ed Delesky, MD (11:57)
Well, I don't know. It was feels like a long time ago. anyway, so those are those are two. And then for more significant pain, you'll obviously have to go see your doctor for this one. They do glucocorticoid injections for severe pain or otherwise steroid injections right at the site where people are tender. And sometimes you may need a sports medicine doctor or orthopedist or podiatrist to do this.

But I mean, if you have a bold, savvy primary care, they may do it as well. And there's some evidence that you can get some benefit with one or two, but how long, how many you need, they're generally safe, but that's a conversation to have with your own doctor. But if things really aren't going away, you're in a lot of pain, you can get a steroid injection as well. And lastly, I would say in the nature of things that are totally within the realm of you being able to do at home,

are stretching exercises to help with your plantar fasciitis. And we've talked about this. I mean, they're subtle and you can do them all the time. I guess the best way to think about incorporating these would be to pick one and do three sets of 10 and just pick a certain time during the day that you're going to do them.

Nicole Aruffo, RN (13:13)
And they're like all over the internet too. This is not like secret information that only doctors know. It's kind of, I feel like those stretches are like pretty universal and easily accessible, right?

Ed Delesky, MD (13:26)
Yeah,

I'm just looking at pictures right now. Like one of them is literally massaging the area. The next yeah, when I've been

Nicole Aruffo, RN (13:32)
That's the best.

Yeah, I'm actually faking it so you rub my feet every night.

Ed Delesky, MD (13:40)
I'm seeing a calf stretch exercise here with a towel, where it's a longer towel, you're sitting down kind of perpendicular to the ground and you put a towel down and pull your calf because it's all connected. I'm seeing foot ankle circles where your foot's pointing out straight and you go counterclockwise and clockwise to rotate your ankle while it's straight.

Nicole Aruffo, RN (14:03)
And we can put some visuals on our Instagram too. That's a good one. No, I think that's like the biggest one, the most helpful one.

Ed Delesky, MD (14:07)
I'm seeing toe curls, is perhaps the most subtle one.

And I think the actual nature of that works is that you are crinkling your toes. So it's kind of activating the fascia a little bit because that sudden feeling in the morning is because you're stretching the fascia by the nature of how your foot's going down to the ground. Because when you've been sleeping, your foot sleeping plantar flex. So your foot's down a little bit, like your toes pointed down.

that'll get to the nature of one of the other contraptions that is advertised, but who knows if it actually works. Yeah. Right.

Nicole Aruffo, RN (14:45)
I think it does work.

I've been wearing it to bed when you're on night shift. It's not a cute accessory with my cute pajama sets.

Ed Delesky, MD (14:54)
And that we can talk about like reading studies and stuff because that's important too. But the toe curls are huge. And let's see what else we got here. you could just do it with a towel as well if you need to motivate yourself. And then unilateral, okay, one side. So I use some jargon there. One sided heel raises, almost like you're doing with your calf raise exercises that we've talked about in the other episodes. And like I said, doing those stretches or exercises for three sets for 10 repetitions will

probably give you something to work towards and help out. And also they looked at studies, sorry to the physical therapists out there for this one, that doing it with the physical therapist versus doing it at home didn't quite make a difference. So that's super convenient because you don't have to lug it all the way to physical therapy in a busy life.

Nicole Aruffo, RN (15:44)
And also for other like home remedy type things. I feel like I can say, cause this isn't like.

Ed Delesky, MD (15:50)
Yeah, but this is like right up there.

Nicole Aruffo, RN (15:53)
I really like, well, if you don't have someone to like actually rub your feet like Eddie so patiently does anytime I ask him pretty much on demand, you can roll your foot on like a tennis ball or a lacrosse ball is nice because it's like really hard and you can like, um, like lean onto the one side or I have, I got on Amazon, it's like a double lacrosse ball and it gets like both side of your feet and then you can put it vertical and just like stand on it. Oh, I feel so good.

or people like the frozen water bottle and then rolling, which also that's like, duh, like if something's inflamed, put ice on it. That's not rocket science. Yeah, and then roll your foot on it.

Ed Delesky, MD (16:33)
That's like the good way.

That's awesome. There's actually some evidence here talking about non-steroidal anti-inflammatory agents. It's short for NSAID, which I'm sure a lot of people have seen, also in terms of, like ibuprofen is another medicine, or naproxen, which brand names are Aleve or Advil.

short courses discussed with your doctor and look, I'm not going to pretend like people are all healthy out there. Some people have conditions that actually they can't take these medicines. So you got to talk to them. But I'm saying I'm seeing two to three week courses, which I haven't prescribed myself, but it seems like something that could be reasonable to ask about. There's a long list of other options and procedures that have kind of little benefit. The one I want to talk about because

it gets into like something that you can do at home. Maybe if you're really motivated, you can do it. It's the night sock. And if you're going to look at or a night splint, I don't know if this is a specific brand, but when I learned it from sports medicine, they called it the Strasburg sock. What does that look like?

Nicole Aruffo, RN (17:48)
Um, so cute. It's basically a, um, like long sock and you, well, you told me the sports guy you were with told you it has to be the one that goes up to like your knee. Cause they'll have shorter ones. So has to go up to your knee and then it has a strap on it from your toe that then pulls up and then you like wrap it around your calf and it kind of just keeps your foot flexed all night. And so then you're

So you're not like when you're sleeping just regularly without anything, like toes are pointed. So when you're sleeping at night without anything, whether you think about it or not, like your toes are more, more pointed and they're not in that flex position. And so when it's pointed that plantar fascia is like stretched out. And then if you sleep with it flex, it's like shortened kind of for like lack of a better description. I think so then when you wake up,

Ed Delesky, MD (18:47)
Mm.

Nicole Aruffo, RN (18:47)
This like thing that's causing you pain wasn't stretched out all night. Exactly. It kind of in the spot where it's supposed to be.

Ed Delesky, MD (18:53)
And that first step in the morning isn't the first time in seven to eight hours that it's been stretched. Yeah. Which causes the pain inherently. So that's the logic behind it. Now, if you were to go dive deep into these libraries of medical literature, they would give wishy washy answers about whether these work or not. But here we are. We have you saying that they help. Right. I mean, and this is the nature of some medical research where

a study is done to evaluate an intervention, but it doesn't necessarily speak on to how it would have individual benefit for a person. And so it's worth a try, right? Like what do you have to lose because we're not recommending surgery. People don't usually get surgery for plantar fasciitis. And because most of the time it gets better after a year. So you've got a long laundry list of things to do and try.

before you even get to anything before steroids. You gotta try all these things at home first, right?

Nicole Aruffo, RN (19:58)
Yeah. And they're easy.

Ed Delesky, MD (20:00)
They're easy.

Nicole Aruffo, RN (20:01)
Like you can do like a lot of the stretches when you're just in your everyday life. You can roll your feet. Like a lot of times I'll do it. Actually our ball thing's in the kitchen. I'll do it if I'm like standing in the kitchen. Oh my god, that what that is? Yeah. Green thing? Uh huh. Or I'll do like when I'm getting ready or like doing my hair, I'll just like roll my feet. Yeah, that's what that is. Yeah.

Ed Delesky, MD (20:29)
So all in all, plantar fasciitis is a really common, annoying, painful condition, but there's a lot to do. And I mean, you may be listening to this and you may think like, wow, I have this heel pain. I'm not saying you have plantar fasciitis. I'm saying you should go see your doctor and think about it because maybe you do, but you also may have several other things. And that's something we didn't talk about because the list is long and complicated. And that's not the point of this.

Nicole Aruffo, RN (20:56)
You can also use it as an excuse to get your significant other to rub your feet and be like, my God, I heard this on a podcast. They said it would make me feel so much better.

Ed Delesky, MD (21:04)
Included

that massage actually helps. I massage. Well, what doesn't it help? Awesome. So pretty soon, keep an eye out because we're going to have a functionality where you'll be able to send us a text message through our show notes. And I mean, we're all ears. We're open to feedback. We're open to ideas because this is a long effort. And, you know, we do this weekly and we'll see what other what other abilities we might have with our upgraded

podcast host, but that's going to be one of the features we'll have access to so we can better connect with you all. And we were so excited that you were able to come back with us today and we hope that you learned something for yourself, a loved one or.

Nicole Aruffo, RN (21:48)
neighbor.

Ed Delesky, MD (21:50)
And make sure you subscribe, rate and review wherever you listen to your podcasts. Follow our Instagram, your checkup podcast. And soon enough, we'll have a website. And so I'm really glad you came back and please, most importantly, stay healthy, my friends. Until next time, I'm Ed Delesky Thank you and goodbye. Bye. This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health.

Nicole Aruffo, RN (22:07)
Nicole Aruffo out.

Ed Delesky, MD (22:20)
It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor.

Nicole Aruffo, RN (22:48)
I

am not your nurse.

Ed Delesky, MD (22:49)
and make sure you go get your own checkup with your own personal doctor.