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Saturday, November 6, 2010

Heel Pain and Podiatrist Recommended Shoes.

Plantar Fasciitis.

What can I say? In podiatry school, our professors told us that most of our future practices would be dedicated to helping patients who suffer with plantar fasciitis and that we would be treating heel pain every day of our careers. If I didn't believe it then, after ten years in private practice (and a wicked case of heel pain for yours truly ten years ago) I certainly believe it now!

People like to say that they have a "heel spur" but in my experience it is usually not the actually heel spur that is causing pain. It is the inflammation and swelling of the soft tissue called plantar fascia as it inserts into the heel bone (the calcaneus) that causes the pain. 

On a patient's first visit, I always get an x-ray to rule out any possibility of a stress fracture or another underlying problem (bone tumor, ect). Many times, a patient will have a stress fracture and plantar fasciitis and, strangely enough, in my experience it is usually the stress fracture that heals first. I will also sometimes get an ultrasound to make sure there is no bursa which is a small fluid filled sack under the heel bone that can cause pain. Patients often have the sensation of "walking on a hard pebble" when there is a bursa present. More often than not, there is no bursa present and the pain typically is plantar fasciitis or an undiagnosed stress fracture. 

Plantar Fasciitis typically presents with patients who complain of waking up in the morning and having severe pain when they first get out of bed but the pain gets better with more walking and this process repeats itself every time they get up after sitting down for any length of time. A Stress Fracture is usually a dull, constant ache that gets worse with more walking and hurts most at the end of the day. Patients often think that because the pain is not excruciating that it can't be a fracture. In reality, fractures are usually more like a dull ache that just won't go away -a toothache type of pain - it's moderate but not terrible. One example, I had a patient who had chronic pain in her right foot for twenty years. We took an x-ray and it turned out that she had a chronic stress fracture of her second metarsal bone that she had been walking around on for years! After eight weeks of immobilization and rest, she was pain free. I always tell patients that if your foot hurts for more than three days - see a Podiatrist! You'd be surprised at the relatively simple non-surgical things we can do to ease your pain and get you on the path to healing.

I find that I can successfully treat heel pain ninety-nine percent of the time without surgery, using pain-free conservative modalities, proper shoegear and inserts. 

I always advise my patients that the treatment of plantar fasciitis is a two-step process:
First, we must get them through the healing process. 
Second, after they heal, we must get them into proper shoes and inserts so the problem does not return (and it will try to return!).

My Recommendations for Patients Suffering with Heel Pain: 
*Go to a Podiatrist and get x-rays to confirm that you are not walking around on a stress fracture!
*Stop walking barefoot. The only time you should be barefoot and standing is in the shower. And yes, that is long-term!
*Stop wearing flip-flops.
*Do wear Croc Clogs (with the strap to the back) as your house shoe. As soon as you get out of bed in the morning, you should be stepping directly into your Croc Clogs.   

Let me stop here for those of you who are horrified at the possibility of giving up your flip-flops - if you stop walking barefoot, stop wearing flip-flops and do wear Croc-Clog's (with the strap to the back of the heel) around the house - you will have prettier feet, save money in medical bills, and have less pain in your feet, knees, hips and lower back and probably get a significant improvement in your heel pain over the next several weeks. 

More Recommendations:
*Once again - go to a Podiatrist to get you through the healing phase. I won't go into all the therapies/modalities at this time but will skip forward to that happy day when you are on the road to recovery and we shall concentrate on proper shoe gear and inserts...

Shoe Recommendations:
*Croc Clogs around the house (with the strap to the back)
*For a good Walking shoe:
     *MBT's (with arch support - either a custom-molded orthotic or a good over-the-counter insert). 
     *Sketcher Shape-ups (with arch support) 
     *Spira Walking Shoe (with arch support)
     *New Balance 927 (with arch support)

 **Please see my reviews on all of these shoes on previous blogs that I have done. These shoes are not for everyone and can often be pathology specific. For instance, if you have Achilles Tendonitis, balance problems or certain neurological disorders, you do not want to get into the MBT or the Sketcher Shape-up.
**You can also refer to the "Podiatrist Recommended Shoe Store" at the top of this page for photos of these shoes and other recommended shoes. 

For more information, please refer to my article on "Chronic Pain and Your Feet" which goes into more detail about the importance of shoes. 

I hope this was helpful!!

Have a Wonderful Day...
Dr. Cathleen A. McCarthy


mathewsn said...

Dr. McCarthy, I came across your blog today and wondered if you would be interested in reviewing a pair shoes by Kuru Footwear (www.kurufootwear.com), we have been told by our customers that our shoes are very helpful in the recovery from Plantar Fasciitis.



zthinker said...

i have read some of your blogs. here is what i've learned:

1.feet are designed to only function properly with shoes.

2.the arches of your feet are not designed to hold weight, that's what arch supports are for.

3.feet are suppose to be stiff and inflexible, especially as we age, that's just part of life.

4.once a foot muscle, tendon or ligament is tight or weak, there is nothing that can be done, except to support that position.

5.the higher we're away from the ground(thick soles), the better protected we are and there is less chance of falling.

6.cavemen didn't have to run on man-made surfaces, shoes come from nature, especially the modern one's.

7.feet are suppose to be shaped like our shoes, especially later in life.

and yet you quote daVinci on your website ...
"the human foot is a masterpiece of engineering and a work of art"...as long as you were shoes.

why do we exercise the body through it's full function and range of motion, yet the feet we simply support it- weak or tight?

shoes, including orthodics, are a tool and have a place. but neither should be used all the time. we wouldn't put the body in a full, padded, limited range of motion suit. think of the smell, think of all the muscle- misdeveloped from short ROM, weak stiff. temporarily we do and some people- the minority, have to wear a brace all the time. they are the exception, not the standard. Please consider you position to others when you downplay the feet. it's not really accurate.
i agree with daVinci.

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Zthinker,

Thank you so much for your comments - they are very interesting and I don't disagree with what your saying.

What I would like to reiterate is that when I give my opinion on these issues, that I am coming from the very specific point of view of a Doctor of Podiatric Medicine. No one makes an appointment and comes in and says, "Hey, my feet feel great, I am having no problems and, oh, by the way, let me give you a co-pay!" I see patients who have injured themselves and are in pain and are asking for my help.

You can say what you want about my methods but I have been doing this eight hours a day, five days a week for the last ten years and - it works! I specialize in conservative, non-surgical treatment of foot and ankle injuries and I have a amazingly high success rate. You can argue with me about a lot of things and I might be wrong (god knows I am not perfect!) but, on this one issue, I know from experience that it works. Believe me, after all the years of surgical training that I went through, I was pretty shocked when I came to the realization that I can get most people better without surgery by 1) Healing them and 2) Get them into proper shoes and inserts so that the problem does not return.

I know there are a lot of people out there who walk barefoot and do barefoot running and, if they are lucky enough to have fabulous biomechanics and no problems or pain then - more power to them!

In the meantime, there are a lot of people out there with "biomechanically challenged" feet who need some extra help and support from shoes and inserts - that's who these blogs are for.

Once again, thank you so much for your input and I really appreciate you taking time to read my blog!

Hope all is well,
Dr Cathleen A McCarthy

Anonymous said...

Dr. McCarthy,

I was wondering if you have heard of heel injections of fillers and/or body fat to alleviate heel pain due to the loss of fat pad in one's feet?

I have had chronic plantar fasciitis for years (plus surgery), which is much better when walking, but as soon as I am static standing on my feet I have instant pain in my heels. My physio thinks it is due to loss of fat pad from wearing foam orthodics for so long.

Thank you for your response in advance.


Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Julie!
Thanks for reading the blog!

Yes, fillers are a appropriate treatment for fat pad atrophy. The problems with the fillers are: they only last six months on average, there are no guarentees, there are risks associated with getting this done and it is not covered by insurance and it is expensive.

Overall, I do not recommend it. I would encourage you to get very hard-core compliant with: no barefoot (ever!), no flip-flops, no walking around the house in socks, no flimsy bedroom slippers. Wear Crocs Rx (with the strap to the back) in the house and invest in excellent shoes. For a sandal, have you tried the Wolky "Jewel", "Tulip" or "Cloggy"? For your walking shoe - try a New Balance like 928. I assume you are in arch support? Whether it's a custom molded orthotic, a OTC insert from you Pod or a Tully's heel cup - in the right shoe any of these will help.

Please keep in mind, I've never seen you as a patient so I recommend you follow up with your Podiatrist as needed. You may want to try wearing a Tri-lock brace (which you can probably get from your Pod), which will help with the pain when you are standing still. Also, have you tried compression hose? When I was in my residency and had to stand in one place for a long time with surgeries - I wore my Dansko clogs and compression hose. The compression hose (up to the waist) were fabulous! It's inconvenient, I know, but in my opinion - pain is more inconvenient!
Let me know how it goes...
Cathy McCarthy

Anonymous said...

Dear Dictor, i'm Mardiana from Malaysia...i'm working as a staf nurse at ICU University Malaya Medical Centre for 12 years, and now i'am suffering of heel spur...would you mind to give me the best example of running shoes that i can wear during my duty...thank you doctor...

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Mardiana,
Thank you so much for reading the blog!

I would recommend trying the New Balance 928 or a rocker bottom shoe such as the MBT of the Sketcher Shape-Up walking shoe. I would also highly recommend some arch supports - try PowerStep, which you can purchase over-the-counter or a Tully's heel cup.

You can also try wearing a Croc RX clog (with the strap to the back), which offers excellent shock absorption for the heel.

For more in depth information, please search within my blog for these 2 articles:

'My Feet Hurt'


'Shoe Recommendations for patients recovering from Lisfranc's fractures.'

They are both quick and easy reads and very comprehensive!

I wish you the best,
Cathy McCarthy

Shoes For Foot Pain said...

I like your second process as this problem might return if the patient don't use proper shoes or sandals..

Doctor of Podiatry Discusses and Recommends Shoes. said...

Thank You and Happy Thanksgiving!

hallux valgus surgery los angeles said...

Good blog! I have found here much useful information for yourself and would like to thank you for done by work.

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hello LA,
Thank for reading and thank you for the kind words!

What's N a name? said...

This is the best site I have read on feet and shoes. I have been wearing Birkenstocks as my slippers at home. My massage therapist just recommended croc-rx as you do on your site. I would like to heard your thoughts about birkenstocks. I don't see them in your list of recommended footwear.

Jason shwartz said...

My dad has a friend who has really bad foot pain because of some swelling. We all have told him that he needs to just go to a podiatrist to determine what the problem is though. He just doesn't want to believe that something is wrong unfortunately. http://www.advancedfootclinic.org/portland-areas/tigard-podiatrist/

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Jason,
Sorry for the delayed response! I highly recommend that your dad's friend follow up with a podiatrist for x-rays and evaluation. Chronic swelling can mean a number of things might be going on including a fracture or stress fracture. Also, tell your dad's friend that pain is his bodys way of telling him that something is wrong and that he needs to deal with it, which means going to a doctor.
Thank you so much for reading!

R Reed said...

Hello! Just saw a podiatrist about the severe pain in my heels and feet after working 12 hours on concrete. He recommends wearing a boot with a heel like a cowboy boot. While I respect his input, I am afraid this would make my feet hurt more! I'm 55,6'1 and weigh 190.

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi R. Reed,
Sorry to hear that you are having heel pain. I don't know if that would work for you because I don't know your foot type. RX Crocs around the house, New Balance 928, custom-molded inserts or an OTC arch support like Powersteps should all help. If the heel pain is not resolving, make sure you get x-rays to make sure there is not a more serious problem like a stress fracture.
Good luck!

Pain doctor Phoenix said...

Wow is just the simple word that may explain that how much I liked it. It is a very helpful information. I was looking for. It’s great to be here though by chance.

Doctor of Podiatry Discusses and Recommends Shoes. said...

Glad I could help!
Thank you for reading the blog!!

Anonymous said...

Do crocs RX have enough support for Achilles Tendinosis ? I have plantars fascillitis in both heels and the AT in one ankle

Doctor of Podiatry Discusses and Recommends Shoes. said...

Hi Anonymous,
Assuming that you are just using the Rx Crocs Ultimate Cloud or Relief as a bedroom slipper and also depending on the severity of your Achilles tendonitis, the Rx Crocs are fine. They are not for all day activities and wear. As soon as you are ready for your day, you should switch up to something more supportive like a New Balance 928. Avoid rocker-bottom shoes as these are a disaster for anyone with Achilles issues. Please check with your podiatrist to make sure that this is the appropriate plan for your specific injury.
Thanks for reading!

kimberly said...

I have had Plantar fasciitis for three years, and over those years i have had steroid injections three times. i've been doing the stretches but i still wake up in pain. This article is great for anyone who as plantar fasciitis, this is site will greatly help anyone suffering from it. once i cured mine i created a blog to prevent people from spending a ton of money as i did. i beleive the readers here will greatly benefit from it. http://www.howtocureplantarfasciitis.org/blog/plantar-fasciitis-treatment/

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