What does posture mean? To many people it indicates the difference between someone who’s having a good day versus someone who’s down on their luck. Slumped shoulders and a hunched stance might indicate boredom or a lack of confidence, while an upright back and squared shoulders can convey confidence and interest.
Posture communicates plenty–but what posture communicates about your health is one of the most important things you should be aware of. Because it turns out that when your mom told you to sit up straight, she was on the right track. However, science tell us that when it comes to posture, she should have been just as worried about your feet!
Why? Keep reading!
Posture Basics, Head to Toe
Poor posture–hunching, sunken shoulders, and a slumped back–can have a dramatic effect on your muscles and ligaments. It can lead to injuries of the knees, heels, feet, back, and even difficulty with breathing and digestion. Bad posture is typically caused by–and exacerbated by–an imbalance in your muscles in strength and tension, and the muscles in your feet play a critical role. For example, tight calf muscles paired with weak plantar fascia can wreak havoc on your gait and foot posture (the alignment of the foot itself). This poor posture is a vicious cycle, causing the body (which naturally leans slightly forward) to tilt further forward or backward, adding additional strain to your feet and heels, and making plantar fasciitis–and posture–worse.
Postural Benefits of Wearing Orthotics
Wearing orthotics can have a tremendous positive impact on good posture, since the way the feet absorb and distribute impact has a big effect on the rest of the body. While orthotics are often seen as just a solution for heel pain, they can also be used as simple at-home solution to improve posture in the following ways:
Correct Gait Abnormalities
Your feet are your foundation every time you run, walk, jump, or stand. The impact from these simple daily activities, combined with the weight of the human body can place a great deal of strain on the heel and arch of the foot. Over time, as the body tries to compensate for this strain and pain, gait abnormalities can develop that result in poor posture.
Since orthotics help lift the arch to an optimal height and cushion the heel, the feet (and therefore the ankles, legs, hips, etc.) are more balanced, helping you avoid stumbles and falls that can injure or throw any number of the body’s muscle groups, bones, or tissues out of alignment and creating poor posture.
Pronation is where your foot turns too far inward as you step forward, causing the arch to flatten excessively. Pronation is associated with increased incidences of plantar fasciitis, heel pain, gait abnormalities–and poor posture. Orthotics can help correct overpronation while you walk.
Distribute Weight and Impact More Effectively
Because orthotics cushion and support the arch, you’re able to more effectively distribute and bear the weight of walking, running, and jumping. And when your arch is able to do its job in absorbing impact effectively, you’ll feel less aches and strain to your hips, back, and legs.
What to Look for in Orthotics to Improve Posture
There are a lot of different orthotics to choose from on the market. If you’re looking to improve your posture, you’ll want to keep an eye out for the following qualities:
Lightweight: Heavy orthotic shoes can negate some of the positive postural effects of using orthotics in the first place, and don’t allow for much flexibility in rotating between different pairs of shoes. Look for lightweight orthotic inserts that can be added to any pair of shoes.
Cost effective: There’s not much evidence that expensive prescription orthotics are any more effective than inexpensive orthotic inserts (some of which are more than 90% effectivein treating heel pain and plantar fasciitis!) Balance quality with cost!
Cushioning and Supportive: The perfect blend of support and cushioning can be surprisingly hard to find. If you can crush your orthotic insert in your hand, it’s not likely to stand up very well to the rigors of walking, running, or jumping. Make sure your chosen orthotic is sturdy enough to stand up to some pressure while still providing cushioning for your heel and arch.
Fascia Bar Technology: This patented technology brings the arch to the optimal height for support and comfort during physical activity. This innovative technology helps the arch tremendously with weight distribution and impact absorption.
Other Ways to Improve Posture
Another great way to improve your posture from the feet up is by using simple stretches to make sure that your muscles and tendons are limber and not too tight. Taking a few minutes every day to stretch your calves, fascia, and other muscles and tendons in the feet and legs can make a world of difference. When your muscles are limber and stretched, you’ll avoid a situation where one group of muscles is pulling another forward or backward subtly, throwing off your stride–literally.
Proper stretching and properly supporting the feet and heels help ensure that your weight falls on the balls of your feet first as you walk–instead of your heel. With a heel-first gait (caused and exacerbated by bad posture), your feet absorb greater impact and aren’t able to propel the body forward as effectively–meaning you’re having to work extra hard to walk the same distance and putting additional strain on your fascia and heels.
Improving Foot Posture
As you work to improve your overall posture, make sure you don’t neglect the posture of your feet themselves. Improving overall posture is hard to do when your feet–which support the weight of your entire body–aren’t in the correct position!
Properly aligned feet should face forward, rather than one or both feet turning inward or outward. As you properly support your feet and stretch your calves, heels, and fascia, you should find that your feet align more properly and that physical activity becomes more comfortable as well. An additional method that can be taken to improve foot alignment if you’d like to see faster results is wearing a night splint that supports your feet and heels, and keeps the fascia limber even while you’re sleeping.
By correcting your posture from the feet up, not only will you look better–and communicate more confidence to the people around you–but you’ll feel better and avoid future injuries with a body in balance.
There’s plenty of anecdotal evidence for most Plantar Fasciitis treatments. Everyone has a cousin or friend of a friend who swears by a particular way of banishing heel pain.
But what does the evidence say?
While anecdotes and recommendations from friends and family shouldn’t be discounted–especially if the treatment is affordable and low risk–it’s also important to know how different treatments stack up in clinical studies and peer-reviewed journals. Looking at this evidence, alongside recommendations from people you know and love, can help you make the best decision for your foot health and healing.
Evidence-Based Plantar Fasciitis Treatments
In this article, we’ll review some of the treatments for Plantar Fasciitis and heel pain that are backed by the most high-quality evidence. Each of these treatments has been legitimized by rigorous double-blind, peer reviewed studies and documented by scientists, doctors, and podiatrists in journal articles and highly regarded publications.
Since expense and invasiveness are usually the biggest deciding factors in treatment options, we’ve divided these evidence-based treatments into inexpensive and noninvasive, moderately expensive and minimally invasive, and expensive and invasive categories.
Inexpensive, Non-Invasive Treatments Backed by Evidence
Surprisingly, some of the simplest, least expensive treatments for plantar fasciitis are also backed by the most evidence.
That’s why the overwhelming majority of podiatrists and doctors recommend trying these proven, effective treatments for heel pain before moving onto more expensive options. Numerous studies, including research published in American Family Physician, show than 90 percent of patients can resolve their Plantar Fasciitis using only noninvasive and conservative methods.
The effectiveness of orthotic inserts is heavily debated. But evidence like Blake and Denton’s review of orthotics’ effectiveness published in the Journal of the American Podiatric Medical Association show that orthotics generally have 70%-90% effectiveness. And this study published in the Journal of Foot and Ankle Research shows that even non-custom orthotics can reduce the load on a damaged arch by 34%.
It’s important to keep in mind that not all orthotics are created equal. A double-blind study conducted by the University of Iowa found that Heel Seats, with patented Fascia-Bar Technology, are twice as effective as a leading orthotic insert. Heel Seats lift and realign the plantar fascia, target pain with acupressure, and cushion the heel for pain relief.
Stretching and Massage
Dr. Emily N. Schwartz’s review of different plantar fasciitis treatments confirmed that stretching and massage are two of the most effective at-home treatments for plantar fasciitis.
Stretches that improve flexibility and strength in the arch, Achilles tendon, ankle, calf, and legs can help the arch and supporting systems bear weight properly, and distribute impact. Massage can help improve blood flow to the injured area as well as break up scar tissue and adhesions.
Taping and Splinting
Dr. Podolsky and Dr. Kalichman’s review of several clinical trials and studies showed that taping is an effective short-term treatment method plantar fasciitis. Taping helps relief pain, apply soothing pressure with a gentle stretch, and stabilize the arch.
Splinting, similar to taping, helps keep the foot flexed in a mild stretch to reduce the morning pain and stiffness that is common with plantar fasciitis. In one study published by Clinical Orthopaedics and Related Research, 68% of participants improved their plantar fasciitis pain by using a night splint. In other studies, participants have reported struggling to use night splints consistently because of the hard brace. In these situations, Sock Night Splints can be a softer, but still effective solution.
Icing is a tried-and-true technique for many different types of pain relief–not just plantar fasciitis! Researchers from the Department of Physical Therapy at Loma Linda University showed that cold therapy (icing) was very effective in relieving pain and even reducing the thickness of the plantar fascia (one of the telltale signs of plantar fasciitis!).
Moderately Expensive, Minimally Invasive Treatments Backed by Evidence
For about 10% of people, at-home treatments for Plantar Fasciitis are not effective. If conservative treatments aren’t working after 9 months to a year, it may be time to consider moderately expensive and minimally invasive treatments backed by evidence.
These treatments are generally less than $200 per treatment, depending on your insurance coverage, show a great deal of promise in studies and clinical trials, and require minimal downtime.
Radiation therapy uses a very low dose of radiation (similar to an X-ray) to This therapy is also on the lower end of cost, has minimal side effects and risks, is simple and non-invasive, and is not painful.
A key study by Dr. Robert Michael Hermann, MD, showed that radiation therapy can be a very effective non-invasive treatment method for plantar fasciitis patients. A 2012 study by the American Society for Radiation Oncology confirmed that 80 percent of study participants reported complete pain relief after radiation therapy, and 64 percent were still pain free after 48 weeks.
Ultrasound therapy uses sound waves to break up tissue, improve blood flow, and reduce inflammation in painful feet and heels. The procedure is easy, quick, and relatively painful.
Evidence from several studies shows that ultrasound therapy can improve heel pain by up to 90%, including a 2013-2014 study conducted by Advanced Medical Imaging that followed 65 patients with chronic plantar fasciitis who used ultrasound therapy.
Intracorporeal pneumatic shock therapy (IPST):
This newer therapy is inexpensive, minimally invasive, and shows a great deal of promise in treating Plantar Fasciitis. IPST uses a small probe that emits shock waves to break up heel spurs. It requires local anesthesia, but minimal downtime. One double-blind clinical study conducted by the medical faculty at Mustafa Kemal University showed a 92% success rate in pain reduction with IPST.
More Expensive Medical Interventions Backed by Evidence
These evidenced-based methods for treating plantar fasciitis can be very effective, but are usually only recommended after more conservative or less expensive methods have been exhausted, because of the recovery time and expense involved:
Topaz Surgery, or Topaz Coblation therapy, uses a tiny wand to make a few dozen holes in a grid pattern over the plantar fascia. As these holes are made, the wand releases small amounts of radio wave energy to destroy and remove bits of tissue to break up scarring and encourage a healing response.
Either local anesthesia or sedation may be used. And while recovery time is much easier than surgery, a walking boot and orthotics should be used, and total recovery time takes 4-6 weeks.
Topaz surgery has been approved by the FDA since 2002, and a study by Department of Orthopaedic Surgery at Singapore General Hospital showed that Topaz is a very effective medical intervention for plantar fasciitis. A study published in Foot and Ankle Surgery in 2016 showed that Topaz has an 80% success rate (similar to traditional surgery).
Plantar Fasciitis Surgery
While surgery is a big decision, it can be a good choice for individuals whose heel pain is chronic or does not respond to conservative treatments. Studies conducted by doctors and researchers at the New Britain General Hospital and the Center for Orthopaedic Care, among many others show success rates of 80% to as high as 96%, with few complications.
While surgery does require more downtime and recovery time, the evidence is clear that this last-resort is generally extremely effective.
You have plenty of choices when it comes to how you will treat your heel pain. But the most important deciding factors in getting you back on your feet should be evidence of effectiveness combined with your own unique health needs!
Whether you’re able to resolve plantar fasciitis using conservative treatments like orthotics and stretching, or need to have plantar fasciitis surgery, the goal is the same: helping you walk, move, and enjoy life without pain.
You may have heard that the thickness of your plantar fascia ligament is related to whether or not you have a condition called Plantar Fasciitis.
But what exactly does that mean? How thick is the average plantar fascia ligament? Why does the ligament get thicker in response to Plantar Fasciitis? How will you know if your plantar fascia is thicker than normal? And what can you do about all of it?
This blog post will cover everything you need to know about plantar fascial thickening.
Normal Plantar Fascia Vs. Thick Plantar Fascia
Just how thick is too thick? Several studies have shown that a healthy plantar fascia ligament runs between 2-4 mm thick in about 90% of people. Women usually have a thinner plantar fascia ligament than men (which may be another reason that women are more likely than men to get plantar fasciitis in the first place!)
Some outliers who don’t suffer from plantar fasciitis may have a plantar fascia ligament as thick as 5 mm. However, numerous studies have shown that for the most part, when the arch of the foot is thicker than 4 mm, there’s a very strong correlation with Plantar Fasciitis.
A study by Dr. Karabay MD, Dr. Toros MD, and Dr. Hurel MD, showed that individuals with heel pain had a plantar fascia thickness measuring an average of 4.79 mm.
Don’t worry: A thick arch doesn’t cause Plantar Fasciitis. It’s just a strong indicator that Plantar Fasciitis is present!
What Is Plantar Fascial Thickening, and Why Does It Happen?
A thicker plantar fascia ligament often goes hand in hand (well, foot in foot) with a diagnosis of Plantar Fasciitis for a couple of reasons:
- Wear and Tear: Plantar fasciitis is caused by wear and tear, trauma, tiny injuries, or overuse of the plantar fascia ligament. A healthy arch distributes weight and absorbs impact sort of like a spring. But with enough trauma, overuse, and injury that spring will collapse–and the feet will flatten. Research from Chang Gung Memorial Hospital has shown that flat feet are related to plantar fascial thickening. Some experts speculate that this tissue thickening happens for the same reason a callus or bunion develops–too much use, pressure, or damage.
- Scar Tissue: Scar tissue can be another reason why the plantar fascia ligament might be thicker than usual. Over time, as the body attempts to support and heal the damaged fascia, tiny lesions and scar tissue can build up, adding extra bulk.
- Swelling: Inflammation and swelling in the area may lead to a thicker plantar fascia ligament.
Identifying a Thickened Plantar Fascia
MRI or ultrasound imaging are two of the most common tools doctors will use to see if the plantar fascia is thickening. These tools show a clear picture of soft tissues in the foot including muscles, ligaments, and tendons.
MRI and ultrasound can also help rule out stress fractures, as well as pinpoint erosion of the fatty heel pad (another telltale sign of Plantar Fasciitis) and heel spurs. Identifying a thickened plantar fascia can help your doctor confirm a diagnosis of plantar fasciitis, since this is one of the most reliable indicators of the condition.
How Can You Prevent Plantar Fascial Thickening?
The best way to prevent plantar fascial thickening is to keep the arch of your foot healthy, supported, and rested.
- Try to avoid long periods of standing when possible
- If your feet or heels hurt or look red and swollen, ice them to bring down the pain and inflammation
- Maintain a healthy body weight when possible, to avoid putting excess strain on your arch
- Wear high-quality orthotic insoles to cushion and support your arches when standing or walking
- Stretch your feet, ankles, and legs to improve strength and flexibility in your arch and supporting muscles and ligaments
Most people don’t have any idea they have a thickened plantar fascia ligament–until heel pain strikes. Thankfully, with easy at-home preventative treatments like these, you can maintain your arch health–and avoid plantar fascial thickening!
Radiation therapy, also known as radiotherapy, is a medical treatment that uses a targeted dose of radiation (a type of energy) to break down certain types of tissue in the human body.
Higher doses of radiation are commonly used to shrink cancerous tumors. Lower doses of radiation, on the other hand, can be used to break up scarring and damaged tissue in the ligaments of the heel and arch.
An important study by Dr. Robert Michael Hermann, MD, found that radiation therapy is an effective non-invasive treatment method for a high percentage of plantar fasciitis patients. Here’s what you need to know before you decide to give radiotherapy a try!
What Is Radiation Therapy (Radiotherapy)?
Radiation therapy uses the same kind of energy that’s used in X-rays to damage or destroy certain kinds of tissue.
While radiation therapy might sound a little intimidating–since it’s the same type of therapy used to treat breast and prostate cancer patients–you should know that the radiation therapy for Plantar Fasciitis is delivered in a much lower dose.
Radiation is measured in units of (Gy). Cancerous tumors are usually targeted with a dose of approximately 60 or 70 Gy per treatment (high enough to break down the DNA and molecules of a cancerous tumor). Plantar Fasciitis, on the other hand, is usually targeted with a dose of only 3 Gy–about 20 times less.
What to Expect From Radiotherapy for Plantar Fasciitis
One of the most common concerns about radiotherapy for Plantar Fasciitis is the potential side effects. Many people are aware of the unpleasant side effects that sometimes happen from higher-dose, tumor-targeting radiation, which can include hair loss, fatigue, and skin irritation.
However, it’s important to understand that the tiny dose of radiation delivered during radiotherapy for Plantar Fasciitis won’t cause these side effects. Radiotherapy itself is very quick and completely painless, and may take as little as five minutes.
In the days following radiotherapy for Plantar Fasciitis, you may notice a small amount of swelling or redness, which will pass quickly. However, you will be able to walk as you normally do. (Remember to wear orthotics to support your healing arch and avoid reinjury!)
In general, radiotherapy treatments for Plantar Fasciitis are administered once or twice a week, for a course of six to eight weeks. The cost of radiation therapy will vary depending on your insurance coverage, but many insurance companies cover the procedure, and you may only be responsible for a copay.
Is Radiation Therapy Effective for Plantar Fasciitis?
The reason radiotherapy is effective at destroying cancerous tumors is that the targeted radiation completely completely destroys cancer cells. This high dose of radiation will, of course, also damage normal cells. However, these normal cells have the ability to repair themselves–while the cancer cells do not.
When it comes to Plantar Fasciitis, low doses of radiation break down painful scar tissue in the heel and arch. The small dose of radiation can also trigger a healing response, as the cells that have just sustained some damage repair themselves.
In a recent study by Dr. Hermann MD, 200 patients were treated with radiation therapy for Plantar Fasciitis. Three months after the course of radiation therapy, almost 70% were pain free or had very little pain. At 54 months, a little over 60% were still pain-free or almost pain free.
Are You a Good Candidate for Radiation Therapy?
While most cases (over 90%) of Plantar Fasciitis respond well to conservative treatments such as orthotics, physical therapy, icing, and stretching, other cases are more stubborn.
For chronic, complex, or debilitating cases of Plantar Fasciitis, surgery may seem like the only option left. But if you’ve tried conservative options without success, noninvasive radiation therapy can be a great option before you undergo the expense, pain, and recovery of Plantar Fasciitis surgery.
If you’re considering radiation therapy for Plantar Fasciitis, talk to your doctor about your questions and concerns–especially if you’re looking at having surgery. While everyone’s health and circumstances are different, radiation therapy shows a great deal of promise as a less expensive, less invasive alternative to surgery.
Diagnostic imaging can be an invaluable tool for treating and diagnosing heel pain, allowing doctors and healthcare providers a literal look beneath the surface.
What are the different types of imaging commonly used for Plantar Fasciitis and heel pain? When is diagnostic imaging needed? And what can you expect from imaging in terms of cost and experience?
This blog post will answer common questions and help you make a more informed decision about diagnostic imaging with your healthcare provider.
When Is Diagnostic Imaging Needed?
If you’re dealing with Plantar Fasciitis or heel pain for the first time, your doctor isn’t likely to recommend an X-ray or MRI. A review of your health history, lifestyle, and a physical exam can usually provide your doctor with everything he or she needs to know for a diagnosis.
In general, diagnostic imaging is used for Plantar Fasciitis and heel pain in two common situations:
Stubborn or Chronic Plantar Fasciitis
While an amazing 90% of Plantar Fasciitis cases respond well to conservative treatment methods, the remaining 10% can be very stubborn or chronic. In this case, your doctor may use diagnostic imaging to take a closer look at the mechanics of your foot, to determine why your heel pain is resistant to treatment, and how to move forward.
Ruling Out Other Conditions
Several foot conditions can masquerade as Plantar Fasciitis. Depending on your symptoms and medical exam, your doctor may decide that diagnostic imaging is needed to rule out tendonitis, bursitis, a stress fracture, a plantar fascia tear or rupture, nerve entrapment, tarsal tunnel syndrome, and so forth.
Plantar Fasciitis that has a very sudden or dramatic onset, is accompanied by pain that doesn’t respond to conservative treatments, or gets worse with conservative treatments is likely to result in diagnostic imaging.
Types of Imaging Used for Heel Pain
If you have recalcitrant Plantar Fasciitis (heel pain that just won’t go away), or your doctor suspects that your heel pain may be something other than Plantar Fasciitis, he or she may recommend one or more of the following imaging options.
If your doctor recommends imaging that you feel is unnecessary, or prior to trying conservative treatment methods, don’t be afraid to get a second opinion or ask more questions! Knowing what types of imaging are available–and what each type of imaging can accomplish–will help you be an effective advocate for your health.
A diagnostic ultrasound, also called a sonogram, is a quick and easy imaging method used to take a look at soft tissues in the foot (not to be confused with Ultrasound Therapy for treating Plantar Fasciitis). This imaging tool can rule out soft-tissue conditions like tendonitis, tarsal tunnel, nerve compression, and plantar fibromatosis.
Ultrasound can also show whether or not the fatty heel pad looks normal, and whether the plantar fascia is thicker than normal (thicker than 4 mm), flattening, deteriorating, or compromised by micro-injuries and small tears.
X-rays aren’t typically used to diagnose Plantar Fasciitis, since they don’t offer a good look at soft tissues. They can, however, be very valuable in ruling out or confirming a stress fracture.
X-rays can also be used to look for heel spurs or bone spurs on the foot that are digging into the fatty pad of the heel and causing pain, evidence of arthritis, or problems with alignment in the foot.
MRI (Magnetic Resonance Imaging)
An MRI uses a magnetic field combined with radio waves to provide detailed cross-section images of bones, tendons, and soft tissues. Unlike an X-ray or ultrasound, MRIs can take up to an hour, and require the patient to remain very still.
MRIs can pinpoint plantar tears or ruptures, tendon injuries, lesions, cysts, and sometimes fractures or heel spurs, without the radiation and expense of a CT-scan. MRIs are also sometimes used to confirm Haglund’s Deformity and Achilles tendonitis.
CAT-Scan (CT Scan)
A CT scan or CAT scan is a special type of X-ray with the ability to capture a detailed cross-section of your foot, including soft tissue and bones. However, CT scans aren’t typically used to diagnose or treat Plantar Fasciitis unless your doctor is concerned about tumors on the heel or calcaneus.
CT scans are more expensive, expose patients to a small amount of radiation, and generally do not provide more information than an MRI or X-ray for Plantar Fasciitis or other conditions that cause heel pain.
What to Expect from Imaging for Heel Pain
Knowing what you can expect from imaging will help you feel prepared, and may also help you make a decision about whether a particular kind of imaging is right for you.
What Does Imaging Feel Like?
All of the types of imaging covered in this blog post are painless. However, it’s important to understand that some types of imaging may still cause stress or discomfort because of the equipment, positioning, and time required for successful images.
Ultrasound and X-ray are the quickest and easiest forms of imaging. Both of these tools take just a few minutes.
A CT-scan usually takes 5-20 minutes, and requires patients to place the foot and leg into a narrow tube. Since CT-scans emit a small dose of radiation, they usually aren’t recommended for children, or pregnant women.
MRI scans take the longest, which can sometimes cause discomfort from laying on the hard table. The process can take between 30-60 minutes, and it’s important to stay very still. The machine makes loud knocking sounds while it works, which can be unsettling for some patients, and it may not be recommended for patients with tattoos, pacemakers, or metal screws or plates in the foot and leg.
Cost of Imaging
The cost of imaging for Plantar Fasciitis can vary quite a bit, depending on your insurance coverage and whether you get the imaging done in a doctor’s office or a hospital. Don’t be afraid to call ahead and ask about costs and discounts for same-day payment. If you can, verify whether your provider and the procedure is covered by your insurance before you havre the imaging done.
In general, imaging done in a doctor’s office will be less expensive than imaging done at a hospital. Ultrasound and X-rays are usually the least expensive imaging options, followed by MRI and CT-scans.
Remember, if this is your first experience with heel pain or Plantar Fasciitis or heel pain, imaging usually won’t be needed.
Resting your feet, icing, stretching, and supporting your arch with orthotic insoles helps most people heal within a few weeks to a few months. However, if you or your doctor don’t see results with conservative treatment, or you suspect your heel pain may be something other than Plantar Fasciitis, imaging can be an invaluable tool in making a correct diagnosis.