Ashlee Williams, MD (Host): Foot pain can be the absolute worst. And if you're suffering from heel pain, you could have plantar fasciitis, and this may cause you to struggle with walking, exercising, and even standing. So, what are the best options to heal your heel pain?

Welcome to the Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm talking with Dr. Kristy Golden, a board-certified podiatrist at Kaiser Permanente about how to prevent and treat plantar fasciitis and get you back on your feet. Thank you so much for joining me today, Dr. Golden.

Kristy Golden, DPM: Thank you for having me. I'm excited to be here.

Host: Such an exciting topic. So, let's just start with what is plantar fasciitis?

Kristy Golden, DPM: Sure. So, plantar fasciitis is the most common cause of heel pain on the bottom of the heel. So, the surface of the heel that strikes the ground. And it's very sharp. It can feel like a knife kind of stabbing in the bottom of the heel. Most people who have plantar fasciitis always complain about pain after a rest. So when they first get up in the morning, or they drive for a long period of time, or they're sitting down at their office, and then they go and stand, intense heel pain, sort of out of nowhere, causing a limp, and they come to us for this. So, we see people all day everyday with plantar fasciitis here in Kaiser, and about one in 10 people will develop plantar fasciitis at some point in their life. So, it's a very common condition to see and to have.

Host: Yeah. I see it a lot in my clinic. People come in and they're like, "Doctor, I'm having such severe pain in my feet." And it's so classic. They'll say, "It's the first step when I get out of the bed in the morning. I'm having such severe pain. What do you think it could be?" Is that what you're seeing a lot of in your clinics?

Kristy Golden, DPM: Absolutely. Very common. The causes of plantar fasciitis, you know, I always say you could come up with a reason why anybody would have plantar fasciitis, but what it really is is the ligament on the bottom of your foot called plantar fascia, which is attached to the heel bone, and then runs the span of the bottom of the foot and attaches to the bottom of the bulk of the toe. It's a very tight structure, like a tight rope. It does not stretch. So, when you're resting and your toes are pointed, especially if you're sleeping for long periods of time, the bottom of the foot tends to contract, get very tight. And then, when you first stand up, then your arch comes down and the arch lowers considerably, puts a lot of tension in that ligament. And instead of the ligament just stretching, it pulls away from the heel bone, creating pain and inflammation at the attachment site of the plantar fascia at the heel bone. So, that is the cause of plantar fasciitis, and it can be brought on by all sorts of reasons. Like I said, there's a reason you could come up with for anyone to have plantar fasciitis.

Host: So, how do you treat it?

Kristy Golden, DPM: A couple of things. In fact, I always say you got to throw the kitchen sink at this, you know. First, I would look at why it started. So, things that lower the arch are body weight changes, increasing body weight, increasing activity levels very abruptly, standing and walking for prolonged periods of time, carrying heavy things, like if you have to do that for work, if you have to carry equipment for your job, or if you're a mom and you're always carrying children around, these are the things that lower your arches. And then, if there's a lack of support from the bottom of the arch in your shoe, that combination, that equation being off is what lowers the arch quickly and causes tension in the bottom of the foot, and for plantar fasciitis to have a flare up.

I'd like to kind of identify with each patient what the causative factor is for them and then go from there. But, no matter what the cause is, the treatment will be, usually, the bulk of the treatment is the same. I always say time is not the tincture for this. You can't wait it out. You know, some people will come in and say, "This has been eight months. I was hoping this would go away or get better, but it isn't." And that's very common.

So, the first thing to talk about is your shoes. You know, the shoes matter so much when it comes to plantar fasciitis and a lot of patients through just trial and error kind of figure that out and they'll say, "I feel better when I'm in sneakers than when I'm barefooted or in flip-flops and that makes perfect sense. We can talk a little bit later about shoes if you'd like, but you know, shoes are something I'm very passionate about talking to patients about. And it's just sort of a big factor in our foot health and prevention of foot pain and also treatment of things like plantar fasciitis. So, wearing the proper shoe, that's number one.

Number two is stretching. The bottom of your foot being too tight, that's why plantar fasciitis comes. And so, you have to take some time every day to stretch out the bottom of the foot. And that can be done with any stretch that also works on the hamstrings and the back of the calf, because the posterior chain in our body is connecting from the bottom of our spine, really all the way down to the back of the heel then through the bottom of the foot to the toes. All of that is really connected in one big posterior chain. And when one part of it is tight, like the plantar fascia, usually the whole back of the leg is tight. So, stretches that accommodate elongating the back of the leg, that really helps with plantar fasciitis.

One example I always tell people to do is to stand on a stair. So, let's say this is a stair, okay, and you're facing up the stairs. You want to put your toes on the stair and let your heel hang down below the level of the stair, really drawing your body weight down through the heel. That's a really quick, easy, accessible way to stretch out the back of the leg and reduce the pain. And that can be done preventatively and also in the moment. when you have heel pain. So, I am often telling patients, if you're feeling like your heel hurts, you should next thing think, "I need to find a stair and just take a minute and stretch," and hopefully that will relieve some of the tension.

Host: And those are usually a lot easier to find, because I know a lot of times I'll recommend like a frozen water bottle or a tennis ball. But usually, people can easily find a step just to stretch that.

Kristy Golden, DPM: Yeah, totally, or a curb, you know, if you're outside. If you're a runner, you can use a curb before you start to run, that's a big one. Anything that you can let your heel hang lower. What you don't want to do is calf rises. You don't want to tighten the calf muscle. When the calf muscle is tighter, then it's, you know, pulling harder on the heel bone, creating more tension there. It can actually make plantar fasciitis worse.

Host: Interesting. So, you did mention shoes. So, what type of shoes should people look for for more support?

Kristy Golden, DPM: That's a great question. So everybody needs four pairs of shoes, really, right? They need a house shoe that gives them enough support, often overlooked by especially moms who are carrying all the things in the home and tend to be barefooted when they're doing it. So, you need a house shoe. One that's a slide is really great. You know, a very good athletic slide that the arch rises in the arch and the heel sits down in a padded cup. And ideally, you want to look for the sole of the shoe to be a bit of a rocker. So, in other words, when you put the shoe on a flat surface, the front underneath the toe doesn't touch the ground and the back underneath the heel also doesn't touch the ground. That really helps decrease the bottom of the foot strain when you're walking. So, you need a house shoe. You need a work shoe and that varies, of course, depending on your job. If you're lucky enough to be able to wear sneakers to work, then you should pick a sneaker with those same characteristics. You know, that really thick supportive sole, a slight rocker on the bottom of the shoe, and a padded heel. And then, you need a sneaker. You need a sneaker for exercise, you know, the right sneaker. Nothing flat, nothing flexible. You should not be able to bend your shoes and twist and turn them. And then, finally, you need what I call an errand shoe. So, like you're running to the doctor, you're running to the grocery store, you know, places where you don't think you're going to walk that much, but you end up putting thousands of steps in. And if you're just sliding on the wrong pair of shoes to go on your errands, that could really cause a flareup of fasciitis to come, or even make it impossible to go away.

Host: Interesting. So, you mentioned a flareup. So, what are the best ways to prevent plantar fasciitis from developing or flaring?

Kristy Golden, DPM: So, prevention of fasciitis is really about always being conscious of your shoes and that's something that people don't tend to be conscious of until they have foot pain and then see a podiatrist and start to think about shoes in that way. But shoes can really be the treatment for so many foot conditions. So, checking with your shoes, you know, making sure they're not flat, flexible, that they give you that proper support in the arch and the heel. That goes a long way in prevention of flareups.

Number two is I love to recommend yoga for patients. You know, incorporating stretching into our daily lives. And I know you know this, it's so important, you know, in prevention of so many musculoskeletal problems. We tend to emphasize exercise to patients, which is of course so important. But you have to balance that with stretching. You don't want to be all strong and too tight, you know, because that leads to just, you know, pain. So, incorporating some yoga, some daily stretches to prevent the back of the leg and the bottom of the foot from getting too tight, that's big.

And then, finally, weight, you know, body weight plays such a big role In foot pain of all kinds, especially rapidly increasing body weight, so pregnancy, that's a big one. Or you know, you've just become more sedentary because of the time of year or the holidays or what have you, that's when we see a lot of foot pain coming in from no injury, just regular daily stuff. Now, all of a sudden, feet are really painful and, you know, many times, there's been a little bit of a weight gain. Even as much as five pounds can cause a flareup.

Host: Right. Well, thank you so much, Dr. Golden, for this great information. There's so much to learn about heel pain and how to treat it. To recap, plantar fasciitis is common. It's a foot injury that occurs when the plantar fascia is strained and damaged faster than it can heal. There are lots of treatment options available for plantar fasciitis, most of which you can do from home. Examples include rest, stretching, and strengthening the foot. Ice and wearing supportive shoes can also be extremely helpful. When choosing a supportive shoe, look for shoes with ample cushioning, good heel and arch support, and shoes with shock absorption. And four, the best ways to prevent plantar fasciitis from developing or flaring are doing regular stretching and strengthening exercises for your feet and legs, and wearing supportive shoes and easing into exercise, especially if you're trying a new routine.

For more information about foot health from our experts and other health advice, visit kp.org/doctor. And listen to more episodes of healthier You wherever you get your podcasts. If you enjoyed this episode, be sure to share it with others who may find it helpful. Thank you. And from all of us at Kaiser Permanente, be well.