Bob Underwood, MD (Host): Plantar fasciitis is a common and sometimes frustrating medical condition that affects millions of people each year. Characterized by persistent foot pain, it occurs when the band of tissue connecting the heel to the toes becomes inflamed. The pain is often most severe with the first steps of the morning and can be exacerbated by prolonged standing or walking.

Despite its widespread occurrence, many individuals suffer in silence, struggling to find the right treatment. This is Expert Insights with the Carle Foundation Hospital. I'm your host, Dr. Bob Underwood, and today we are joined by Dr. Sarah Anderson, Doctor of Podiatry with Carle Health, a foot and ankle specialist who will guide us through the latest understanding of plantar fasciitis and some of its challenges and ways to manage and treat it. Thanks for listening as we explore this condition and how it affects the lives of so many people. Dr. Anderson, it's good to have you on to join us today to talk about plantar fasciitis.

Sarah Anderson, DPM: Thank you.

Host: What is plantar fasciitis? How do you define it? How do you explain how it differs from other types of heel and foot pain; things like Achilles tendonitis or heel spurs, how is it different from that?

Sarah Anderson, DPM: I think you hit the nail on the head mentioning how it's painful first thing in the morning, first steps in the morning. That's kind of one of the hallmarks. It's like you had mentioned, it's inflammation of that band of tissue, which is basically the, the main arch support to the foot. And it can happen for any number of reasons, but it's characterized by pain on the bottom of the foot, on the bottom of the heel.

And again, those first steps in the morning, or four steps after you've been seated for a while are when you feel it. It's different than Achilles tendonitis in the sense that it's on the bottom of the heel. Achilles tendonitis is really in the back of the heel; what we call the posterior aspect, and it's something that can kind of travel up the leg and behind the calf. So it's, it's very different as far as the location, although it can have similar symptoms. The first steps can be painful as well. Heel spurs are something kind of all together. That's just kind of a calcification of the plantar fascia.

It's not something that is different than plantar fasciitis. It's really more of an x-ray finding of just a calcified plantar fascial ligament. So, really it's the bottom of the heel. That's pretty much the hallmark for plantar fasciitis, but it really only hurts when you're walking too. That's, I guess, a different thing is when you're weight bearing.

Host: So the plantar fascia actually extends from the heel out to the base of the toes. Is it across the whole bottom of the foot or is it more localized to the heel?

Sarah Anderson, DPM: It's across the whole bottom of the foot. There's three bands. There's the medial band, the central band and the lateral band, and it fans out across the entire foot. The band that gets the most irritated is the medial band or the band on the big toe side. And that originates there at the inside part of the heel. And that's the attachment that we 90 percent of the time see causing the problem.

Host: Are there risk factors for developing plantar or is it just kind of random or idiopathic? And if there are risk factors, what are they?

Sarah Anderson, DPM: We see this most commonly, as far as age goes between 40 and 60, although I definitely see it in late 20s, early 30s, for sure. I've been seeing that more and more in the past 10 years. Weight is certainly a risk factor, being overweight, wearing poor shoes is a risk factor as well. Wearing poor shoes while trying to increase activity also puts you at risk as well.

Host: So what are some non-surgical treatment options for plantar fasciitis and how effective are they?

Sarah Anderson, DPM: Non-surgical, 90 percent of the time is going tocure this. The hardest part is waiting it out. It can take up to a year for your symptoms to resolve. I've also had it, I had it after I had my son, when I was walking barefoot a lot at home because I was on maternity leave and of course I had gained some weight, and those are known risk factors and it definitely, was my introduction to plantar fasciitis.

So I had to take a dose of my own medicine on that. Really the non-surgical treatments are wearing good shoes at home, supportive shoes. Walking barefoot really can cause issues, with this and weight fluctuations again, will kind of initiate that irritation. But the non- surgical options are orthotics or arch supports.

Again, not walking barefoot. Physical therapy is also a mainstay and is really one of the most important treatments. Non steroidal anti inflammatories for people that can take them are also critical. And then there's some other kind of newer therapies, things like cold lasering or extracorporeal shockwave therapy, which aren't covered by insurance, but in some patients have shown to be effective.

So, 90 percent of the time within a year, it will be cured with those types of non-surgical treatment options. It's just the waiting that's really tough.

Host: When should someone start to consider surgery for plantar fasciitis and what does that surgical procedure actually involve?

Sarah Anderson, DPM: Twenty five or thirty years ago, if you went into a podiatrist or even an orthopedic surgeon specializing in foot and ankle, it was not uncommon to discuss surgery within a few months, relatively quickly. And that's for patients that again, failed the supportive shoes and therapy and orthotics and stretching and that kind of stuff.

They found that the outcomes on that, five years down the road were really pretty bad. It was about 40 percent of patients had complications with only about 70 percent of patients actually feeling at least a little bit better. So surgery is really a last ditch effort. It's something that we don't even consider doing if a patient has gone less than a year.

When someone's operated on now, there's a school of thought where we just go in and release the calf muscle. We don't even deal with the plantar fascia itself because that fascia gets tight when your calf muscle is tight. So there's a lot of patients nowadays, that just undergo a calf muscle release instead of undergoing a true fasciotomy, which is where we cut the ligaments.

And again, it's really swung the other way as far as that surgical pendulum goes. We just don't really operate unless it's absolutely necessary. I tell any patient that I see or anyone struggling with this, definitely get a second opinion before having surgery because we just know the outcomes are so poor.

Host: Thank you for letting me know that because when I went through my training, of course, fasciotomy was it. And so it's changed and it's good to know that that's different from when I went through my training.

Sarah Anderson, DPM: When I was coming out of school, you were seeing some of those early papers, again, smaller study sizes back then, coming out saying, hey, not a great idea to cut that main arch support of the foot, wait it out, do activity modification, rest and therapy, it will get better, it's just again the waiting that's the main problem.

Host: What about some lifestyle changes? You mentioned weight before, activity. How about diet? Are any of those things important for the development, treatment, healing of plantar fasciitis?

Sarah Anderson, DPM: Yeah, like I used my own example, gaining weight and then being barefoot, definitely, that alone was the instigating factor. And that being said, I do see plenty of patients that have very normal weight, but are just very active. And again, maybe their running shoes are a little too old.

We tell people to replace running shoes every 500 miles or six months, whatever comes first. So I've certainly seen very active, very fit runners develop it again, from poor shoe gear. That's the most critical piece of the puzzle. I always tell patients is wearing poor shoes, even for someone that's normal weight, that has no other medical issues, that alone can cause the fascia itself to flare up.

Host: So are there practical daily habits or stretches or anything like that, that people can incorporate into their routine that will either prevent or maybe alleviate foot pain from plantar fasciitis.

Sarah Anderson, DPM: The best prevention is wearing good shoes. And I am a stickler for that. Doesn't have to be an expensive shoe. It has to be a supportive shoe. Unfortunately, we've seen things like, Crocs and, Hey Dude shoes, which are these really soft, flexible shoes come in; avoiding those and only using those for specific situations is critical.

That's the best way to prevent it. I tell people, if you pick a shoe up. And you try to fold it in half and it can fold in half easily, it's no good. You want something with a rigid, thick sole to use on a daily basis; even, at home first thing in the morning, I've got some fuzzy Birkenstocks with a nice fat sole that I wear and that's kind of helped me keep it healed since I had it several years ago. Stretches can also be very helpful. My favorite calf stretch is the one where you kind of hang your heel off the stair or keep your forefoot on there and stretch that heel out. Any yoga enthusiasts who are big into downward dog, that's another great stretch where you have those heels off the floor and you can really feel that stretch in the back of your legs. Any type of calf stretch is going to be what's best for kind of preventing this. But number one most important, are those shoes and having supportive shoes, even more so than stretching.

Host: So, what should our listeners know about seeking care for plantar fasciitis at Carle Foundation Hospital?

Sarah Anderson, DPM: So we have a great foot and ankle department. We have an absolutely outstanding physical therapy department with multiple locations as well. I always encourage people to try the shoe changes at home first, again, doesn't have to be expensive, just a rigid shoe.

 Wear it first thing in the morning, and have a dedicated indoor pair. And then also, wear something supportive outside of that, doing those things and stretching. And again, some patients that can take non steroidal anti inflammatories. Trying that stuff first for a good six to eight weeks. If that's not helping, we certainly have our department, which is available to examine, work anyone up, and then get patients in with therapy, which again, is one of the most effective treatments, more than steroid injections even.

For some patients too, getting up to where we're at in Champaign is not always a possibility. So even having their primary care provider prescribe them therapy close to where they are and trying that first, knowing that they're always welcome to come up and see us, too. We have a very big service area that we service and routinely see patients that live a couple hours away.

So sometimes coming to us directly, it's not always an option, but we do offer Telehealth visits and we have locations in Champaign and Danville and also down south, Richland Memorial and, McLean County Orthopedics as well. Multiple providers. Happy to see anyone.

Host: Thank you for helping us all learn something today that's new about plantar fasciitis. Thanks for being on.

Sarah Anderson, DPM: You are very welcome. Thanks for having me.

Host: And for our listeners, if you'd like more information or to connect with one of our providers, please visit carle.org. That's C-A-R-L-E dot O-R-G. Additionally, for a list of Carle providers and to explore Carle sponsored educational activities, be sure to check out carleconnect.com.

 And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm your host, Dr. Bob Underwood.