Help Plantar faciitis!!!

and it sucks

what changed in your life over last 6 months?

good website ref: http://heelspurs.com/index.html

At one time I played a ton of racquetball and was afflicted with it.
Heel cups help for just general walking and a sports podiatrist can show you ways of taping your foot.
My non-medical feeling is do everything you can before you resort to a cortisone shot.
My memory was it hurt like heck when you first bear weight and start to move but gets a little better as you go along

Had it once years ago – initially quite severe and painful. Very easy to reaggravate. Never sought treatment for it. Just rested it. 18mos before it was resolved. Would have been more like 9-12mos had I not tried to become active too soon. Didn’t realize how long it could take to fully resolve. It’s been 20yrs now with no reoccurence. Also, young fella’ at work developed it two years ago. Avid hoopster. Hasn’t played since. He is resting it on his Dr’s advice. He reinjured/re-aggravated it a couple of times in the first year, trying to get back too soon. Not sure what else he and his Dr. have tried. Have you seen a doctor about it? That’s the place to start.

as long as it’s getting worse, rest only, no stretching

maybe a heel lift or shoes with more heel support

look into a night splint – there is a soft splint that I found easier to sleep with – strassburgh sock:
http://www.drnelsonclinic.com/strassburg_sock_night_splint.htm

you will probably want anti-inflammatory, see what you can get from your doc. cox-2’s supposedly work better, my coverage wouldn’t provide them so I went with massive dosage ibuprofen or other cox-1’s until my stomach would start to scream

I’ve seen good results with acupuncture treatment. The results can often be dramatic.

Of course changes in exercise habits, stretching and footwear are very important.

Also lower extremity/hip injuries can play a role in creating excess and imbalanced wear and tear on the feet.

Find a qualified healthcare provider to assist you.

Good Luck!

A couple of years ago I was faced with the same condition. It struck suddenly on a BP trip in the West Virginia Highlands and I was barely able to hobble out of the wilderness. After a lot of research, I’d offer a few thoughts:

1. PF is by far the most common foot injury, so not surprisingly, there is a ton of info available on the internet. A lot of it is bogus, however, and is intended only to sell “magical cures” (so beware).

2. The actual cause of any particular case of PF can be difficult to diagnose, but statistically, it appears that most PF injuries are, in fact, induced by over-pronation when walking or running. Over-pronation often worsens with age and the effects tend to be aggravated with weight gain (either from fat or by strapping on a loaded backpack). If you’re not familiar with over-pronation, the internet offers an abundance of data. As far as I can tell, over-pronation was the primary cause of my PF.

3. PF usually heals on its own, as long as the primary cause of stress is reduced or eliminated. It took a few weeks in my case during which time I found that gentle calf-stretching before and/or after walking seemed to help prevent re-injury.

4. If over-pronation is the cause of your PF, you’ll probably need to re-evaluate your footwear setup in order to resume hiking without pain. In my case, I still wear lightweight running shoes on the trail, but I now use New Balance 766’s, which offer better medial support than my previous trail shoes. In addition, I also use black (low profile) SuperFeet insoles with the 766’s. I tried both custom and standard (green) trim-to-fit SuperFeet which offered slightly better support, but both types were ultimately too harsh for my relatively flat feet.

The good news is that after 18 months of footwear trial-and-error, I am now able to again walk 20-25 miles a day over rough terrain carrying a full pack with no problems.

Jim Wood.

Check out “Fixing Your Feet, Prevention and Treatments for Athletes” by John Vonhoff. Lots of great advice in here on Plantar fascitis and a number of other foot problems. Highly recommended.

Throw away any shoes that aggravate it so you
won’t be tempted to wear them.

Wear only new supportive running shoes that fit your arch. All the time.

Get an expensive orthotic.

Skip the cortizone.

Rest

Don’t stretch till it hurts.

Accupressure and massage for the back of your
calf.

Something I haven’t tried but my step mom had
success with laser from a chiropracter?

Plantar fasciitis is a very aggravating injury. I had it two years ago and here are some of my insights:

1. It will take a long time to heal.

2. Get new shoes, of good quality.

3. Don’t bother taking anti-inflammatory drugs because they don’t help very much and you’ll be taking them for months straight.

4. Get your omega-3s (fish oil) to promote your endogenous anti-inflammatory machinery. Fresh ginger is also a good anti-inflammatory.

5. Go on gentle barefoot walks. This may be challenging at first but it will begin to strengthen and heal your feet. I think shoes and lack of proper foot strength contribute tremendously to PF.

6. Stretch your calves gently.

7. PF can be caused by overpronation. The cause of this is often in the hips. A pyriformis stretch I borrowed from yoga helped me tremendously. You can probably find it online. It will feel awkward at first because you’re probably very tight in those muscles.

I second Stephen’s recommendation of barefoot walking. Start with soft surfaces like grass, then work up to pebbles and finally railroad gravel. Flat surfaces like carpeted floors won’t do much good, however.

You’ve probably heard of foot massages and reflexology. There are a tremendous number of nerves in the bottom of the foot (similar in number to the hands) and these nerves are not properly stimulated when we wear shoes and walk on flat surfaces, which sets up a change reaction throughout the entire body, eventually causing all sorts of problems. Walking barefoot on a textured and uneven surface is like getting a foot massage with every step.

Also, ignorant people, including many doctors, for some reason think the human foot was designed for walking on our heels. In fact, the human foot is an adaptation of the generic mammalian foot, which is designed for weight to be placed on the front of the foot (not the ball alone, but the entire front of the foot). Humans, as the only upright mammal, have adapted to use the heel for balancing, but the heel should not normally be used for walking.

When you walk on your heels, as most boots and shoes force you to walk, you remove the plantar fascii and achilles tendons from the system of joints supporting the bodies weight. These connective tissues then tend to become weak. Later, when you go hiking, these weakened connective tissues are put under stress and they get torn. The solution is not to encase your foot in even heavier boots, but rather to slowly strengthen the tendons and muscles of the foot so they can do what they were originally intended to do.

For someone currently suffering from plantar fasciitis, the first step is to repair what was damanged, which will take months, then strengthen the connective tissues so they won’t be damaged again. The way to do this is to walk properly.

Another thing. When a person disables their plantar fascii (the arch of the foot) and the achilles tendon, by walking on their heels instead of the front of their foot, all the stress of walking is transferred to the knees and higher joints. If the person then disables their lumbar curve and hip joints by using a sturdy hip belt, that leaves only one joint to take all the stress of walking–the knee. Guess which joint hikers, especially those who use heavy boots and hipbelts, have the most problems with?

Another nice way to get some massage/relief is to roll your foot on something round. A tennis ball, can of something, a free weight, the legs on your office chair… Combined with regular, gentle stretching of calves and ankles, it will hopefully reduce the tension and strain on the foot.

-Mark

Okay, not to get into a flame war, but you have two different treatment modalities being offered here, some of them in the same post.

I don’t profess to be an expert on PF, ,but I have been working as an orthotist for 14 years, and treated a number of patients with PF. I also have flat feet and have had a number of occurrences of plantar fasciitis, including one in the right foot at the moment.

PF is an inflammation of the broad band of fascia under the sole of the foot, usually under the heel. It does NOT NORMALLY include a heel spur.

It is commonly most painful ON GETTING OUT OF BED (morning or thru the night) and on standing after prolonged (more than 20min) of sitting

Common causes include overpronation, increasing age, increasing weight. Decreasing flexibility will also contribute, especially flexibility of the calf muscles.

Acute treatment means trying to prevent the plantar fascia pulling on the insertion under the heel, especially ON GETTING OUT OF BED OR AFTER SITTING. Every time you feel that shooting pain, you’re essentially going back to square one.

Things that will help acutely;

Don’t get out of bed. A good option if your servants are happy to bring you all your meals. Even better is to get them to carry you, perhaps along the length of the AT, in a litter. Otherwise not very practical.

DON’T GET OUT OF BED WITHOUT DOING 3 MIN OF GENTLE STRETCHING. This is quite doable. You need to stretch the back of the calf and the sole of the foot. I do this lying on my back. Keep the sore foot/leg on the bed, foot pointing up. Put the other heel on the toes, and use the heel to pull back GENTLY. You should feel a stretch, possibly focused at the sore spot, but not pain. Hold for fifteen seconds. You should feel things loosen up after about 10 sec. Release and repeat 4 times.

Do NOT step out of bed onto the floor. This requires preplanning the night before. DO NOT put your feet on the floor. Put them into your shoes with insoles, or similar. I use a pair of Birkenstocks, and find they’re fine. After you’ve been walking for about ten minutes, and everything has stretched a little, feel free to take them off to have a shower etc, but you’ll probably find you’re most comfortable to put them on again straight after.

If you forgot to put your shoes/sandals out the night before, there is another option. Step out of bed, and walk on the outside border of your foot, with the ball of the big toe off the floor. This will minimise pressure on the plantar fascia, until you put your shoe on.

Custom insoles. This may NOT be necessary, altho they should provide a better fit than off the shelf(OTS) ones. If your feet are essentially normal, OTS will provide enough support to reduce the strain on the plantar fascia. (Remember I make the custom ones, and don’t sell OTS). If your feet are flat, go for a custom pair. You may find that an orthotist provides more comfortable and affordable arch supports than a podiatrist, but you would have to check this out for your self.

Taping. This can be a fantastic option acutely. You should get a physio to do this the first time and show you how to do it properly. You should get some instant relief as the tape does the job of the plantar fascia. The tape will need to be replaced or added to fairly frequently as it stretches.

Once the pain settles down you will need to look at what caused the PF in the first place. Now I’m talking from personal, not professional experience, since this outside my sphere of practice. However like every other PF sufferer, I have strong opinions on how to prevent it recurring.

I can’t see anything in any other post that I fundamentally disagree with, but I think the big thing missing is flexibility.

The plantar fascia is being torn away from the heel bone (calcaneous). Why? True, we’re carrying a heavier weight. But with good orthotics and shoes this should be well supported.

My theory is that on day 3 or 4, when our weight should be less, we’ve done a lot more excercise than we’re used to. The calf muscles are tight, they pull the calcaneous backwards, pivoting on the talus, and the plantar fascia tears.

There are two parts to this solution. Stretch and stretch.

Stretch for two weeks before the trip. This is the classic calf stretch, but with the back foot slightly rotated toward the opposite side. ie, right foot pointed slightly left. This corrects the calcaneous position.

Then, out on the trip, stretch when you get into camp. Stretch again before you go to bed. Stretch before you get out of bed (see above). Before you start walking, go for a 5min stroll around camp. warm up the calf muscles. Have a last look at the view, then just before you put on your pack, do a calf stretch. These should all be held for 15sec (No bouncing) and repeated at least twice.

Hopefully this will help you avoid that twinge we all dread, when we know it’s time to put the shoes beside the bed every night for the next 6-12 weeks

Cheers, Rod

Rod Lawlor
Senior Prosthetist / Orthotist
Royal Children’s Hospital
Melbourne, Australia

Rod, What’s your opinion of PNF stretching when not in the acute phase of the injury? Any benefit for this condition?

Well, I can agree with Rod’s emphasis on flexibility, but I take strong objection to certain other statements.

First, the amount of weight carried by the average lightweight backpacker should not cause damage any part of the body. 20 lbs on a man who weighs 160 lb is not a footbreaking load. If the plantar fascia gets torn, it is not because the human body is poorly designed, nor because 20 lbs is a footbreaking load, but rather because the plantar fascia had been allowed to become weak, or because the person misused the body somehow.

Second, the flexibility we need is general flexibility. Every step we take involves shocks to the body. The connective tissues, including plantar fascia and the achilles and other tendons, plus the ligaments to a much lesser extent, are specifically designed to absorb those shocks. They are like rubber bands, which absorb energy when stretched, then release energy when unstretched. So the flexibility we need is to allow our body to move along gracefully, as if on springs, with shock energy absorbed into all the various tendons (but especially the plantar fascia and achilles tendons, which are among the biggest and most powerful tendons in the body), and then released as we take the next step forward. Not only is such flexibility healthy, it makes walking much easier, so we don’t need to burn so much energy.

As I noted above, wearing boots and hipbelts interferes with such flexibility. I might also add that orthotics and arch support and other contraptions also interfere with true flexibility. Arch supports are fine during rehabilitation, but they are not a substitute for using the body properly. The human body is not poorly designed. The only proper use for arch supports and other orthotics, after an injury has healed, is to retrain the body to walk properly. Once this is accomplished, the orthotic should be removed.

If you don’t use your tendons to absorb and release shock energy, then you must use either muscles or bones or skin or joint capsules to convert the shock energy (actually, kinetic energy) into heat energy. In the case of muscles, the heat energy results from use of the muscles, which is okay as long as you don’t tear the muscles. In the other cases (or when the muscles are torn), the transformation of kinetic energy into heat energy can only result from tissue deformation and destruction.

The problem with using muscles is that it isn’t sufficient. The muscles simply lack the power to absorb all possible shocks, and this is especially true when they get tired.

Using skin to absorb shocks will result in things like heel splits (from banging the heels), which then opens the way to infections.

Using bones to absorb shocks will cause stress fractures. There is decent amount of blood supply to the bones, so stress fractures will eventually heal, but this is not something you want.

Using joint capsules, or whatever the doctors call things like the meniscus of the knees, to absorb shocks will eventually destroy the joint. There is no blood supply to the meniscus or hip joint capsule. Once you’ve ruined them, you have to get a replacement knee or hip.

Paul,

I think that stretching in the non-acute phase is a good thing, to prevent a recurrence of an acute episode.

As Frank notes I think this is best accomplished with whole body stretching. For ME this is probably best acheived with some yoga stretches. The advantage of this whole body stretching is that having long calf muscles won’t help much if your hamstrings, quads and gluts are tight.

Long gastrocs and soleus will help prevent reinjury in day to day life, but increased load may overide this, leading to a flare up.

(Note that the definition of load here is work done by the body, not load carried in the pack)

Frank,

Sorry I probably could have phrased that more simply. I agree that a 20lb increase in weight should NOT be enough to cause a flare up of PF. I think that it is more likely to be related to the acute lack of flexibility as muscles tighten up a few days into a trip. Otherwise most PF injuries would occur on Day 1, not Day 4.

I have a little difficult with your theory on tendon elasticity however.

My understanding of biomechanics is that most impact shock is absorbed by eccentric contraction of the antagonistic muscle group. Therefore when the foot lands at heel strike, most of the shock absorption SHOULD be taken by the knee being bent, and the quadriceps muscle group extending in a controlled manner. Some is taken by the Triceps Surae (Gastrocs and Soleus) extending to provide controlled plantar flexion of the foot to foot flat.

However landing with the knee straight will transfer shock through the bones and connective tissue as you note.

The elastic energy that you mention is provided by the muscles, as I understand it. Tendons (which are attatched between muscles and bones) such as the achilles have limited elasticity, certainly not enough to provide the range of motion that normal walking requires. Ligaments (which join bones to bones without a muscle in between) such as the plantar fascia also have limited elasticity. They can stretch a little, but once beyond that stretch point they tend to completely rupture, as opposed to a partial tear. Since they have less blood supply than muscles they are also slower to repair, and are more likely to have inelastic scar tissue in the healed structure. Unfortunately for Todd, and quite a few of us here, that means that the biggest risk factor for PF is to have had a previous episode of PF.

The advantage of using muscles to absorb energy is that they adapt to stress quite quickly. They do this by growing more muscle fibres which is the difference you can see in muscle size 4-6 weeks after starting a training program.

This is different to the increase in thigh size that you see at the end of a days hiking, which is caused by inflammation as the body removes all those dead muscle cells which couldn’t hack it. Don’t worry, this how it’s suppossed to happen, and if you did a day a week of hiking, only the strong ones would be left, along with a heap of new strong ones.

I agree with your comment about the need for orthotic support. If you have normal feet you shouldn’t need them. One of the best ways to help feet is to spend as much time as possible walking around in the woods in bare feet.

However if you have crappy feet orthotics may give you some necessary support and readjust your gait, WHILE YOU ARE WEARING THEM. They will not correct abnormal feet, nor will excercise, physio or chiropractic.

More than for any other animal species, humans are born with deformities. Why? Because we fail to breed them out by natural selection, and we fail to weed them out through survival of the fittest.

If you have flat feet you will run slower. You will be less likely to run down a rabbit for dinner. But a burger tends to move pretty slow, so you might get lucky and catch one of them. So not only do you not starve to death, you find someone to breed with, who also knows that you won’t starve to death, and have children, almost ensuring that they will be too slow to catch the rabbit.

Please don’t think I think this is a bad thing. It’s why I’m here, and my kids are here. However I think that to suppose that all humans are born perfect or even the same is probably unrealistic.

Rod

Rod, we are in complete agreement that shock energy that must be dissipated should be dissipated via muscles, rather than elsewhere in the body (skin, bones, joints).

My argument is that a non-insigificant fraction can be absorbed and released by tendons and ligaments, especially the plantar fascia and achilles tendon. True, tendons and ligaments are not very elastic, but that is not a problem. The steel springs on the bottom of a truck, which closely ressemble the plantar fascia, are also only slightly elastic, but that slight elasticity is all that is needed to keep the truck from being vibrated to pieces.

In any case, there is no easy way for muscles to relieve the strain on tendons for the simple reason that whatever a muscle does is ultimately passed through a tendon somewhere.

Finally, I completely agree that it is easy to make muscles stronger than tendons or ligaments, due to greater blood supply. Nevertheless, it is POSSIBLE to make certain tendons and ligaments stronger. In particular, the critical plantar fascia and achilles tendon. The blood supply is very limited, so the strengthening will be very slow, but it will happen, eventually. The key is to use these tendons and ligaments on a daily basis, which is done by walking properly on the front of the foot, rather than on the heels.

There is really no substitute for strengthing the plantar fascia and achilles tendons for hikers, because even with heavy boots, they will get a tremendous work out walking uphill. I suggest people should walk on the front of their feet even on flat surfaces (walk gracefully like a cat, in other words), but almost everyone uses the front of the foot for going uphill. If the plantar fascia is weak, because we’ve been walking on our heels for years, then extended amounts of uphill walking will likely cause a tear.

Peter, Let me try to be a little clearer, when I said PNF stretching during the non-acute phase, I did not mistype “PF” as “PNF”. What I meant was “PNF” (proprioceptive neuromuscular facilitation) which is a stretching technique to train the proprioceptors in the muscles not to overreact to a sudden stretch. I didn’t want to spell it out for appearance’s sake. I can see how you would have understood it to be that I misspelled PF as PNF; I was hoping that by appending “stretching” to it I would not be misunderstood. Sorry I wasn’t clearer.

PNF is a technique often utilized by PT’s (physical therapists), atheletes (knowledgeable martial artists for instance) and others to train the proprioceptors to not “fire” a reflexive nervous impulse quite as readily, therefore the muscles learn to “relax” just a tad more, under stretch. This results in less stress on both the muscles and connective tissue.

I’ve used this technique for many, many years when stretching (viz. “relaxing”) nearly all muscles, but didn’t know if there was any hard research on its applicability in rehabilitating a PF injury. Just thought you might know since you were in the field, that’s all.

Rod, BTW, excellent explanation in your last post on muscles and connective tissue, etc. Totally right on the money with all I’ve learned regarding Muscle and Excercise Physiology, and Kinesiology.

[Note: for any unaware, muscular contractions actually can have two components: concentric and eccentric. The eccentric portion of a muscle’s contraction which Rod mentions is when the muscle lengthens under load; the concentric portion is when the muscle shortens under load, e.g. the famous bicep curl exercise: concentric = when curling/raising the weight up from it’s starting position; eccentric = when resisting the return of the weight to its starting position of the repetition; BTW, it’s the eccentric portion of the contraction that does “damage” to the muscle and is responsible for much of of a muscle’s damage related soreness/discomfort/pain after unaccomstomed exercise (note “damage related” = this does not discount/ignore physiological byproducts which can cause soreness); that’s also why most PT rehab exercises for severe injuries begin with just “one-way” Isokinetic exercises (resistance only when moving which generally also, based upon the design of the exercise machines, do not have any eccentric loading of the muscles) versus Isotonic execercises (e.g. free weights and machines – even if your muscles aren’t moving they experience stress just holding (isometrically) a fixed position. Also, most of the strength gains made via resistance training are acheived during the eccentric portion of a muscle’s contraction.]

[Note to those interested in stretching: It’s actually quite amazing how much further, with less stress one can stretch (and hold it) w/o any damage. When I’ve helped people, even those who have never stretched (i.e. “stretched” as in performing formal stretching exercises) perform a PNF stretch, they were amazed that within 60 seconds they were stretching further than they ever have done before with no discomfort. If interested, do a web search on PNF, proprioceptive neuromuscular facilitation, or on the book “The Science of Stretching”.)

Try MSM ( methylsulfonylmethane)
It is relatively cheap and I have not heard of any side effects. Best if pure (not with vitamin c added). Start with 1/4 of a teaspoon and increase over 2 weeks to 1 full teaspoon per day just in water or juice if you like ( I have it with beer sometimes)For the first few weeks you will smell a bit of garlic ( basically it is a similar sulfur compound to allicin the active ingredient and pungent smell of garlic) I do not know if others can smell it, but you will. After that the smell will disappear ( I have no idea why) I started taking it because I had a “cold” for a long time and could not get rid of it ( I have not seen a doctor for over 30 years, so no antibiotics or drugs for me) but have noticed that certain pains in my knees and feet have disappeared, however they do come back if I don’t take it for more than a few days ( so it is not a cure).
Do not take it at night because it will keep you awake.
Please understand that I do not sell or profit in any way from this and usually refrain from telling others. ( because it sounds too simple).
Franco

Franco, I’ve heard amazing stories about MSM and even know a couple of people who have had great success taking it. I knew them both before and after its use.

It did nothing for me, however for ruptured muscles – two different injuries.

It’s certainly worth a try for others though.

superfeet insoles

I developed bad heel pain about 6 yrs ago on a trip after foolishly hiking (closer to running) fast and hard up & downhill on a bedrock trail. Didn’t help that I carried a 40lb pack pack then.

I now wear foam inserts everyday in all my shoes or boots. I superglue them into my hiking boots. This has provided relief for me. I don’t like the stiff gel type inserts. I also limit walking barefoot on hard floors to protect my heels.

BTW thanks 4 that informative heelspurs.com link.

I had fasciitis problems with one of my feet that worsened after I took up karate. I think it was mostly due to tightening of my calves, but stretching didn’t help all that much. I tried several things–night splints, orthotics, exercises–none of which was terribly helpful.

I had heard of MBT shoes before, and I knew a store near me carried them (Eneslow), but they are pretty goofy looking and I didn’t give them much thought. The shoe store focuses on people with problem feet, and MBT’s literature says the shoes simulate walking on uneven ground and strengthen your feet, which I thought would be helpful. I was looking for some new shoes at that store and couldn’t find anything that I liked, so I tried them on, they fit OK, and I decided to take a chance on them. I was actually thinking of getting the shoes before I went but I just couldn’t bear to get them if I could find something else.

I bought the shoes and went to the free class they offer here in New York. The class was helpful just for the information if nothing else. The shoes have definitely strengthened my feet, and also helped with proprioception when walking. The shoes have also changed how I walk. I now land closer to the mid-foot instead of heel-striking in all shoes. I also lead more with my mid-section instead of with my legs and feet–though that probably doesn’t make much sense until you wear them.

The two big downsides to the shoes are the price ($235 or so) and they look pretty goofy. But they’ve helped me tremendously, and I actually consider them the most comfortable shoes I own.

The US site: http://www.swissmasaius.com/

The UK site looks like it might have more useful information:
http://www.mbt-uk.com/

If you live somewhere you can walk barefoot a lot, I say do that, but here in New York, there’s not much chance of that. And too much walking on flat surfaces makes your feet weaker.

I had plantar facitis once. I didnt get it from backpacking but from too much speedwork in high school track, wearing worn out running shoes.

Here is my advice:

1) Seek out a good orthopedic surgeon or Primary Care Medical Doctor who has completed a “Fellowship in Sports medicine.” The Sports Medicine Fellowship trained MDs are the ONLY doctors I will use anymore for injuries like plantar fascitis.

2) Dont go to a podiatrist! Podiatrists are not Medical Doctors and oftentimes they just like to put you in expensive orthotics…thats how they make their money. Again, go to a Sports Medicine Fellowship trained MD rather than a podiatrist.

3) Do not believe the usual claims and hype about needing orthotics. All orthotics do is take the stress off one area of your body (foot) and put it somewhere else…your knees, your shins, your lower back, etc. Orthotics are mostly a big $$$$$ making scam pushed by podiatrists and obsessed runners who cannot and will not give into the simple fact that they must rest for a while to get over an injury.

I used to believe all the hype about prescription orthotics, cause I read “Runners world” magazine and a lot of runners are basically obsessed with training. A lot of them abuse their bodies and treat their body like its a machine or something. I got some orthotics and they took the stress off my foot pain, but put it somewhere else…my kneecap area and I developed patellar tendonitis as a result of orthotics.

Several years later when I consulted a REAL Sports Medicine doctor, I was amazed to discover that most Sports Medicine docs look askance at prescription orthotics. I was told, “all orthotics do is take the stress and put it someplace else.”

OTC shock absorbing insoles on the other hand, are fine. Choose your shoe properly first though.

4) Ice ice ice your heel! Ice treatment is the best thing for plantar fascitis, besides resting it. With regular ice treatment, you can oftentimes “shock” the worst plantar fascitis case down in a short time. As long as you rest at the same time.

Can you say ICE?!? Its good stuff…

5) You have to rest your injury. There is simply no way around the fact you must rest and let the injured area heal up.

6) Do not backpack in shoes with no support, such as running shoes or trail shoes. On the other hand, avoid extremely stiff backpacking boots which have no flex in the ball area of the boot. Boots which are extremely stiff put stress on this area of your foot, as well as the achilles tendon.

7) Replace your shoes regularly, dont train (backpacking or running) in worn out shoes of any type.

8) If you are a backpacker who is also a runner, avoid speedwork completely. It just tears your feet up.

9) There are no shortcuts to recovery. You have to bite the bullet and rest, ice the area and change your training mentality if necessar if you wish to avoid reinjury.

Been There, Done That