Scott Webb (Host): Plantar fasciitis is a common foot ailment that is often brought on by excessive walking and exercise. But the good thing is that there are many treatment options, and patients often get relief simply by investing in some new shoes. Joining me today to tell us more about plantars is Dr. Frederick Diel. He's a podiatrist with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks for joining me today. We're going to talk about something, and that something, of course, is plantar fasciitis. And I think it's one of those things that people maybe know about, maybe they've experienced it, maybe we had it and we didn't know it. It's really going to be great to have your expertise today and talk through some of this stuff. But before we get there, tell us about your specialty of Podiatry and the various conditions you treat.

Dr. Frederick Diel: Podiatry in general deals with any issue of the foot and ankle, from ankle sprains, any sport injuries, bunions, ingrown toenails, all the way up to heel pain.

Host: Yeah. So, you cover the gamut, as they say. And I've done a bunions podcast recently for Franciscan Health. So, I know a little bit more about bunions than I used to know. As I said, I'm going to really pick your brain here today about plantars. So, look, I know that taking diligent care of our feet is important, right? And often we don't think of our feet as maybe as much as we should. You do, but the rest of us maybe don't in this sort of healthcare journey. And we hear a lot about plantar fasciitis, especially with sports, but it's not necessarily just a sports injury. So, let's talk through some of the misconceptions. What do we need to know?

Dr. Frederick Diel: In general, plantar fasciitis is one of the most common causes of heel pain. It basically involves inflammation of the thick banded tissue that runs from the heel to the ball of the foot, connects the whole bone to the toes, and it's known as the plantar fascia.

Host: Yeah. And what are the causes? Like, I know that I've heard it associated with sports, as I mentioned. Is it the result generally of trauma, you know, sort of like an acute injury? Is it a gradual thing?

Dr. Frederick Diel: It can actually be both. Usually, my best example is I say people did something more than what they usually would do, like they went on vacation, did a lot more walking than they used to, or was helping somebody move. Also, it can be from high-impact activity, like you start training for a 5K or running or anything that causes impact or strain on the heel.

Host: Yeah. And are the symptoms just pain, like, "Aw, my heel hurts," or is it something that sort of happens gradually and then it becomes intolerable for people?

Dr. Frederick Diel: It can usually be both. Like I said, if someone did a lot more walking or they went on vacation, it can come through as like a sharp intense pain that radiates along the arch, or it can be something that comes on gradually where you'll feel it first thing in the morning, will be worse, and then it kind of loosens up through the day. But usually, a little bit of tightness you'll feel in the back of the heel.

Host: Yeah. And I'm wondering, and maybe it should be obvious, but when we think about sort of home remedies before we seek medical attention, right? Is it just, okay, well, if your heel hurts, maybe don't walk as much, maybe try some different shoes? What can we do at home to help ourselves?

Dr. Frederick Diel: Actually, both of those. Definitely try to avoid going barefoot. Try to wear comfortable gym shoes, something with a good arch support in it. One of the biggest things you can do at home to avoid this is stretching. This comes from when that band of tissue gets very tight and the tighter it is, the more pain you have. So if you can do calf stretches, any stretching before exercising and just avoid impact or going barefoot.

Host: All right. So then, when do we seek medical support? I mean, I'm guessing you're going to say, "Well, when it becomes completely intolerable and you can't walk anymore, that's a great time to come see me." But maybe, do you recommend coming in a little bit sooner at sort of the onset of the symptoms?

Dr. Frederick Diel: Yeah, definitely. If you've tried the stretching at home, icing is another one that you can try, freezing a water bottle and rolling that in your arch. If you've tried the stretching, the icing, a lot of people will have already tried different gym shoes. Anything that's starting to affect your daily life or causing you to walk differently, come on in. You don't have to wait until it's excruciating.

Host: Right. Until we're hopping to get in the front door. All right. So, are there some folks that are just more prone and susceptible to plantar fasciitis? Is there something about their anatomy or the types of workouts they do or shoes that they wear? You know, you see what I'm getting at? Like, are there just some people that are going to get this more than others?

Dr. Frederick Diel: Some people can, some people will be a little bit more flat-footed than others. But definitely, all of us are carrying a few extra pounds today, so that weight definitely contributes to it. High-impact exercises as far as like running, jogging, any impact aerobics, that can add to it. People that just work on their feet an awful lot and are on their feet all day, that'll also contribute to it. But a lot of people have like a flatter foot, and that'll contribute to it.

Host: It's something that folks don't usually think about, right? That we don't think about our shoes probably enough and we don't treat our feet as nicely as we should. And I guess along the lines of when we think about avoiding fasciitis, maybe we should think about our feet more, maybe we should maybe invest in shoes more often. What do you recommend?

Dr. Frederick Diel: Definitely, check your shoes. We usually recommend about every three to six months. The more you're on your feet during the day, the more the shoes will start to wear down. You definitely want to check to make sure that they're not wearing uneven, that the sole is still in good shape. If you're doing running or jogging, you definitely want to switch your shoes out a lot more frequently.

Host: Now, I've never had a plantar fasciitis as far as I know, but I have known some folks who have, and also heard of professional athletes, especially basketball players maybe more than others. I've heard that it can be a really long and intense healing process. Why is that?

Dr. Frederick Diel: Main reason is because there's no real way to stay off of our feet. So once that plantar fascia gets irritated and inflamed, you have to walk on it. So, you constantly are repetitively irritating it just by walking and just by day-to-day activity. So, that's why the stretching is important, and any chance you can to take any sort of pressure off of that fascia is recommended.

Host: I see what you mean. So, it's not necessarily unique to plantar fasciitis, that it's a long and intense healing process. It's just more of the fact that we're always on our feet. We have to use our feet to do things, to walk, to run, to whatever. So, the nature of our bodies and living our lives just makes this one of the probably many sort of foot-related things that are slow to heal, right?

Dr. Frederick Diel: Absolutely.

Host: Wondering when we think about the pain and how it can sometimes be just intolerable, what else can we do to manage pain? You said the ice and don't go barefoot and the stretching. Is there any over-the-counter things that we can try?

Dr. Frederick Diel: Definitely. Any type of anti-inflammatory as long as you can tolerate it like Advil, Aleve. Icing, like we mentioned, it's a very good technique. Freezing a water bottle and rolling it back and forth in your arch, like two to three times a day for probably, you know, five to ten minutes will definitely help because ice is a natural anti-inflammatory. Avoiding going barefoot is a big one. Anything that you can get into a gym shoe with an arch support will help take a lot of pressure off of that. But usually, Advil and Aleve are the two go-tos for anti-inflammatories.

Host: Sure. In terms of OTCs. Wondering then about staying active. I was joking earlier about people hopping into the office. But absent of, you know, not hopping or using crutches or something like that, how can we stay active and mobile while trying to help our plantars heal? Pun intended, I guess.

Dr. Frederick Diel: Biggest thing there is stretching. You can continue to do activities. Avoid any impact activities. So, hold off on any running or jogging or jumping in the meantime. You can do anything water-based, swimming, water aerobics, anything bike, elliptical, where you're not going to have impact on the heel. Also stretching, stretch before you work out and stretch after you work out so you can really keep that loose and that'll help reduce the pain.

Host: So if we've been diagnosed and we've come in and we've seen you and you say, "Yes, this is what you have," you've talked about the things that we can do for ourselves, is there anything in particular that you do? Like I'm assuming that this is all sort of conservative type treatment, that there's no surgery per se. But from your perspective, when we see you and we're in the office with you, what do you do to help folks?

Dr. Frederick Diel: Well, like I said, rarely do we have to do surgery on this. A lot of what we start with is we'll instruct people on the proper stretching, we'll go over arch supports. Sometimes depending on the foot type, we do more of a custom arch support. We also do anti-inflammatories. If those don't work, physical therapy. Physical therapy has different techniques that they can do, and they're not just stretching. They can help the fat. And we go all the way up to where we have the cortisone shots, similar to what you would get in the knee. We can do that in the heel as well. We also do taping, immobilization for like really bad flare-ups.

Host: Yeah. So generally pretty conservative, but a lot more that you guys can do, you know, to help us than we can probably do for ourselves at home. Just wondering, if someone is the type of person who's more prone to getting plantar fasciitis, is it likely to return? You know, once you've had it once in one foot, is it going to be a recurring thing? Or do folks generally, they sort of learn what brought it on the first time and are able to manage it better?

Dr. Frederick Diel: Short answer, it can return. Usually, like you said, most people will develop routines where they'll stretch. Ultimately, what it comes down to is the more stretched you can keep this ligament, the less it will flare up and the less pain you'll have. A lot of people will change the type of shoes they're wearing. They'll switch their shoes out more often. They'll wear better arch supports and what basically caused their pain in the beginning, they'll stop doing that. It's a lifestyle change.

Host: Yeah, right. That's always good advice. Like that thing that you're doing that's causing the pain, stop doing that, right? Just don't do that. This has been educational today. As I said, when we got rolling here, one of those topics that we think we know about, but we probably don't, but you do. And that's why it's great to have your expertise. I'd just give you a chance here at the end, final thoughts, takeaways, or maybe just generally speaking, when it comes to proper foot care, what do you recommend?

Dr. Frederick Diel: Basically, it comes down to wear shoes that are supportive for you, whatever feels comfortable. With exercise, all of us want to be healthier, but you also have to stretch before you do the exercise. Because the more you exercise, the tighter that will get. And just listen to your body. A lot of people, like I said, training for 5Ks, they'll do a little bit too much too soon, so just listen to your body and back off if you have to, but definitely want to keep people up and moving. So, stretching is the key.

Host: Stretching is key. Perfect. We're going to underline that and bold that. Doctor, thanks so much for your time today. I really appreciate it.

Dr. Frederick Diel: Thank you very much.

Host: And for more information, visit franciscanhealth.org and search plantar fasciitis. That's F-A-S-C-I-I-T-I-S. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.