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Treating Plantar Fasciitis

Q. "I am a 3.5-4.0 player and hit about four times a week, playing matches every other weekend. I have been dealing with plantar fasciitis for the past 12 months. The pain comes and goes. I have tried physical therapy and cortisone shots, but they are only temporary solutions. Short of retiring for awhile and wearing a cast... Does anyone who has dealt with this condition have any magic treatment advice?"

From Cindi K.:

A few things to try:

Stretch by standing on the balls of your feet on a step and lower your heels. Then, fill a tennis ball can with water and freeze it. Then roll it under the injured foot.

The one that really helped me was sitting in a hot tub and letting the jets hit the heel. I don't know why it helped, but I haven't had it since.

From Doug S., San Antonio, TX:

You need to start wearing insoles in all of your shoes that elevate your heel and give your arch support. This cured mine, and I still wear insoles in my work shoes to this day. That was 10 years ago.

From Howie W.:

Tulis heal cups worked for me.

From Tony B.:

Welcome to my world. I have suffered with this problem for years. There are no magic bullets for this one. There are several things you can do to manage the problem. Here is what has worked for me:

1. Proper warm-up and stretch before and after a match/workout. The one you see every old guy do. Stand at the net and push against the net post and flex your lower calf and Achilles tendon. Also stretch you hammies and gluts (you will find that it’s all connected, like the song says).

2. Buy custom made insoles (about $200).

3. Ice after playing or running. I freeze small Dixie cups of H2O, peel the paper off and roll the frozen cube in the arch of my foot till melted.

4. After you get the problem under control, don't stop all of the above and use anti-inflammatory for short periods, but do use them when in pain.

I am no doctor, but I have been treated by some very expensive ones.

From Paul B., Shrewsbury, MA:

YES, I've had plantar fasciitis... it sucks!! However it does go away!! It is an 'overuse injury' and, as mentioned, you are a 4.0 player. Think of all the on-court time and practice/drills/tournaments you have played. A lot, right??

What happens is the muscles that run the length of the bottom of your feet and connect at the Achilles tendon just 'break down'!!! All the stops, turns, twists, short sprints, split steps, etc., are just too much for those muscles and tendons. So, what to do??

First, REST. You'll have to shut down the tennis completely. How long? This will vary with severity of the injury. For me, it was approximately eight weeks. Yours may be shorter, but do not rush back to the courts.

Ibuprofin will help, and a healthy diet is always important, and keep your feet elevated when possible. MOST IMPORTANT... learn to STRETCH and do them 'faithfully' standing up, place your right foot behind you, FLAT on the floor, toes pointing straight ahead, support yourself with hands on a wall or fence, move hips slowly forward so you’re STRETCHING SLOWLY your Achilles and calf muscles. Feel the stretch up the entire leg, keep your leg straight. Do the reverse position for left leg. Hold for a count of eight for each leg. Do two sets on each leg, three times a day, don’t miss!! Stretch slow!!

The idea is you'll be pushing blood to the injured area, even the bottom of your foot. This will assist your healing.

Also, when you return to the court, be sure you are in a good tennis shoe with proper support. Simple water therapy like soaking helps, too.

Be patient, it will heal... plus think of all the Tennis magazine's you'll catch up on!!

From Tassie R.:

Get orthotics! Has no one told you this yet? They solved my foot problems instantly! You can get them for sports shoes and dress shoes and never have your feet hurt again! Check with a sports clinic to get the name of a good foot doc and go get fitted!!

From Christina T., Melrose, MA:

I have had it on separate occasions in both feet, and I found that going to a physical therapist who knows exactly how to attack the problem works very quickly and effectively.

The first thing they will tell you is to buy new tennis sneakers, since that is part of the problem. You may also get gel inserts for your shoes to cushion your heel so as to protect it from the pain (the ones that compress the heel to give more cushioning).

Finally, the therapist will perform massage and heat therapy to the area and also give you special stretching exercises. The pain will be gone after about three weeks of therapy, twice a week – I promise!

From Tom L.:

I have tried the following exercise, which helped me recover from my plantar fasciitis after having it for about 10 months.

While stretching the Achilles and calf has long been recommended to help the condition, a recent study in the “Journal of Bone and Joint Surgery” found that actually stretching the plantar fascia itself proved effective at reducing healing time. The stretch, as reported in “Running and FitNews,” should be done as follows:

1. From a sitting position, cross the foot to be stretched over your other leg so that your foot rests on top of your knee.

2. Holding the base of the toes in your hand, pull the toes back toward the shin. (To clarify, this would mean pulling the toes up away from the ground if you were standing.)

3. As you feel a stretch in the bottom of your foot, touch it with your other hand to check that the plantar fascia is tense under the skin.

4. To perform this stretch as in the study, do it 10 times, three times daily.

If you suffer from the dreaded PF, this stretch could help you get back on your feet and out on the roads.

From Chris B., Columbia, SC:

I've had plantar fasciitis in both feet. Healing takes a long, long time.

What worked for me was to take a doctor-recommended dosage of an NSAID, start slow in the morning, warm up carefully, and stretch after you work out. At times, it can be too painful to permit you to play your best tennis. Two weeks off or more this winter would be a good thing. Continue strengthening exercises, stretches and icing once the inflammation permits. You can find specific exercises and good advice online--for example, click here.

For the long-term, invest in sports insoles for all your workout shoes. Heavy-duty arch support helps. X-rays show I have a bone spur on each heel, but I rarely feel any pain.

From Ed S.:

I wish I had the magic bullet, but there is none. Rest and orthotics have helped me, but it remains a chronic condition. I had to give up off-court running for conditioning and have switched to low-impact activities, like spinning and stair machines. Good luck.

From Maurice S., Novi, MI:

Have you tried massage therapy for your plantar fasciitis?

From Cathy M., Lake Lotawana, MO:

When I was playing that much tennis, I, too, dealt with plantar fasciitis as a recurring problem. You can do many things to help this problem from putting you off your game, but in the long run, you may decide that six months off is the best course of action.

1. Get custom made orthotics and wear them on and off the courts.

2. Replace worn-out tennis shoes about every three to six months.

3. Make ice in small Dixie cups and tear off the top rim of the cup in order to ice down your heal three or more times per day and definitely after every time you play tennis.

4. Stretch out your arches every morning and again before and after you play tennis.

5. Wear a foot brace at night.

6. Play on clay.

7. Re-think how much tennis you are playing. As our bodies get older, they do not seem to tolerate as much impact as they used to.

From John G., Midwest Region:

I have had plantar fasciitis. There is no quick way to get rid of it. Rest is the only thing that works, and the sooner you start, the sooner you can get back. Stop playing now. The longer you wait, the worse it will get.

From Lynn S., Cedar Grove, NJ:

You may want to try castor oil (rub it in before bed and put a sock on). It’s an old remedy that certainly helped me!

From Linda N., Little Rock, AR:

I had plantar fasciitis for 14 months, aggravated by working in the operating room on tile floors and playing tennis, also four or five times weekly. It reached the point where I could hardly walk, especially upon first getting out of bed in the morning or arising from a seated position. I finally did two things (and I don't know if it was one or the other, or BOTH combined:

1. I was fitted with "real" orthotics. At first when they inserted them, I said, "NO WAY! These are too hard." To which they said, "Trust us, we know what we're doing."

2. Took two aspirins three times a day (with food, of course, to minimize stomach irritation).

I SWEAR TO YOU, I was completely well within three weeks after having suffered for over a year!!! It was truly a miracle. I do encourage you to try this. Seems too simple, but I know from experience.

From David W., Chevy Chase, MD:

I've got the world's greatest physical therapist who always seems to find a cure to keep me on the court.

For my plantar fasciitis, he had me tape up my foot by first putting a piece of heavy athletic tape from the ball of my foot to my heel. Then we took four 10-inch tape strips and placed the tape across the arch and pulled up on the arch while securing the tape to the top of my foot. I left the tape on for two to three days (slept with it on and played with it on) and then would replace the tape for three to four weeks. He recommended cleaning and letting the foot breath awhile in between tapings.

I still will tape it up whenever playing on a hard court or when I have a difficult match. He also recommends custom orthotics, which I wear all the time. Try it, and you'll be playing without pain soon.

From Don M.:

Never walking anywhere without an arch support, even getting up in the night, helps. In addition to orthotics, I think the velcro band around the arch sold by Road Runner Sports as "Arch Pro Tech" helped me get over PF.

From Peg K.:

I was in a similar situation and finally resorted to surgery after struggling with all other options for about two years. I will say now I think it was a good choice.

Good luck. Let me know if you have any other questions.

From Hilary N.:

There is a lengthy but exceptional website that goes into every aspect, from exercises, tape, calcium, insets and the NO NO of surgery. It will take you about 80 minutes to learn all you can on this topic!!!

Do not go for surgery! Fifty percent of the time it doesn't work, plus it puts you off the court minimally for a good eight weeks.

Ironically, heel spurs don't hurt! The muscles around them hurt, not the spur itself. Therefore, stretching and getting the muscles calloused to the spur are helpful. Hard rubbing of the spur may break down the calcium crystallization but may be too painful to do. There is some new one-day technology to use sonar vibrations to break up the heel spur. But short of the removal route there is much you can do.

If the troubles began with new tennis shoes, get rid of them immediately (return them if you can). With old tennis shoes, get heavy-duty athletic inserts, Dr. Scholls or replace the tennis shoes, as they probably are worn out. The inner cushion within a month often compresses conforming to your foot, and it can wear out if you repeatedly wear the same shoe.

Calf-stretching exercises are a must in the morning and especially before and, most importantly, AFTER tennis. If it helps to tape the foot (to relieve tightness on the foot muscles -- the plantar fasciitis muscles), then inserts help.

There are 1/2 soles made of plastic that are advertised on TV for about $20. You can get special orthotics made of leather for $200 or metal, but they take a month to get, so try the cheap ones first, as they usually work fine. Basically they are putting different pressure on the foot and putting pressure of the heel spur into different areas.

From Andrea F., Plainsboro, NJ:

My husband had the same condition, and he wasn't going to give up tennis for awhile for anything. So he got specially fitted orthopedic insoles, and the pain went away. It was a slow process, over a few weeks. At first he wore them all the time. Now he just keeps them in his tennis sneakers. It certainly did the job for him.

From Steve, Williamston, MI:

Like you, I suffered for a year with plantar fasciitis. I tried all the recommended treatments (except cortisone shots). Finally, a friend recommended custom insoles.

My insoles were designed by a professional who specializes in working with amputees. I have high arches, and the other treatments didn’t get to the source of the problem, which was lack of support for the arches when putting stress on them during tennis play, especially the serve in my case. It took about a month to get the insoles adjusted to my arches. Once the support was where it needed to be, it still took awhile for the plantar fasciitis to settle down.

Now, six months later, I’m playing two hours of tennis a couple of days a week and can get up the next morning after playing and only feel a little tightness, rather than the excruciating pain I had before. Good luck!

From Hilary S., USTA NorCal:

I had it for a year. I got new orthotics and stretched it like crazy every single day like five times a day by hanging my heel down on a stair, step or curb and holding the stretch for two minutes.

From Rob C., Danville:

I've suffered with this and know how crippling the pain is, for simply walking and standing. The most miraculous thing happened after I went up a shoe size and put expensive inserts in EVERY shoe I own – my plantar fasciitis went away after three to four months. My doctor told me I basically had two choices to relieve the pain, either have the surgery or lose some weight.

You can stretch and strengthen your tendon by rotating your foot out and in, pivoting on your heel. I know you will bounce back soon. It's troubling and persistent like tennis elbow but will eventually be manageable.

From John M., North Scituate, RI:

I have the magical cure that you are looking for. I, too, had plantar fasciitis problems that plagued me for over a year. I refused to give up tennis, so I scoured the internet for a solution that would allow me to continue playing tennis while it was healing.

I found a website that has a method for taping your foot to prevent further plantar fasciitis damage and also allow you to play tennis while you heal.

I used this taping method for a solid year and it healed while I was playing tennis. It has now been over a year since I last used the tape on my plantar fasciitis, and I am still problem free. It was truly a miracle cure.

From Debbie F.:

After teaching roller skating for years, I suffered terribly from this problem. After shots and splints and meds, I finally got shock wave therapy on my heel spurs, which relieved the whole problem. It is non-invasive, so there is little time off, and many podiatrists do this procedure now. It had been used in foreign countries for awhile on feet and elbows and originally was used to break up kidney stones. Check it out on-line and ask your doc.

From Helen B., CA:

You must realize that not every podiatrist knows how to treat plantar fasciitis. If the cortisone shot is not put in the exact right spot, it is of limited value in reducing pain. I went numerous times to two different podiatrists and got no relief. They tried physical therapy, a special boot to sleep in, acupuncture, as well as cortisone shots. None of that worked. I researched and found the best podiatrist in the area. I got immediate good results! He gave a cortisone shot that relieved the pain and fitted me for custom orthotics. I wear the orthotics every day without exception and have not had a recurrence in four years.

From Kenny S., Highland Park, IL:

Well, I can relate. I am in a lot of pain at the moment and have been for 10 weeks. I have only played once, and I have an undiagnosed problem. Pain sucks, and learning to live with it on a daily basis is very hard. Missing things you love due to pain is a tough task. My mother has given up on most tennis because of serious back pain and really misses the friendships she had out in the USTA leagues. I am going rather crazy dealing with the pain I am in. Hold on, listen to the doctors, pray, meditate and do what you have to do to live a good life. There usually are no magical cures. You might have to stop playing, and I am sorry about that. Don't stop having fun and living due to your pain. Life is tough, and that’s how you grow. Good luck to you, and feel better.

From Gloria, Newport Beach, CA:

I came down with that diagnosis myself a couple of years ago. A shot of cortisone got me through the tournament that weekend. We won! However, I was fitted immediately for orthodics. A mold was made of my feet with a type of gel that set to my shape. I picked up my custom fit orthodics a week later and have worn them in my tennis shoes ever since. After a week of wearing them, my pain went away – and has never returned. Best wishes to you.

From Linda, Indianapolis, IN:

I also had this condition, and nothing worked until I started doing the following exercise:

Prop your bare foot up on your leg. With one hand, pull your toes forward as far as you can to stretch the fascia. With the other hand, stroke the bottom of your foot firmly at least 10 times.

Do this before getting out of bed in the morning and several times throughout the day. It sounds simple, and it is, but it made a huge difference for me. My podiatrist's stretch did nothing for me, but another doctor had read about this exercise and recommended it to me. Give it a try!

From Aaron R.:

I would see a prolo therapist. A prolo therapist specializes in all kinds of cartilage and tendon injuries, as well as muscle injuries. It is a holistic approach but for me who plays USTA Pro Circuit and plays serve-and-volley tennis ends up having a lot of injuries every year from playing at that level and also a habit of over training. It is not well known but has been used by people of all walks of life, from professional athletes to everyday people who live with chronic pain.

One of the top doctors in this field is Dr. Ross Hauser in Oak Park, Ill. He runs a clinic called Caring Medical. You can find more information at www.ProloTherapy.com and www.CaringMedical.com. One top tennis player who used this treatment was David Wheaton. His brother, a doctor, does this treatment. Dr. Ross has 10 best selling books for his work. By contacting him, he may be able to tell you who he can recommend in your area to see. All the best.

From Kelly C., Orlando, FL:

I, too, suffered from this condition a few years ago. I basically stopped playing for a year, wore supports and braces on my feet each night and each day for that year, and slowly the pain went away. I am now back playing tennis and have not had any trouble with my arches since (fingers crossed). Good luck to you.

From Nancy O., Madison, NH:

My husband and I have both had pf, and it's no fun! We finally solved it by doing a lot of stretching and some stretching while in the hot tub (nice!), and I went to an acupuncturist. You have to stretch not only the foot itself but the ankle and calf muscles, and even the hamstring is involved. Using a stretchy band, you lie on your back and put your feet up in the air in the band and pull down on it. You're pushing against the band with your feet and holding onto it with your hands. Doing a lot of reps with a two- to three-second hold is good for when you're going to be active, and afterward a longer hold is good. As many times a day as you can do it really is necessary to getting over the condition. The acupuncture helps release the tension so the muscles can relax and stretch better.

From Twyla T., Fredericksburg, TX:

My advice to you first is to try acupuncture, which will help relieve the pain. A really good acupuncturist can also determine if there are some other systemic problems that may be contributing to the continuing problem with plantar fasciitis.

Second, you need to find a physiologist. Some orthopedic doctors are also physiologists but most of them are not so you need to make sure that you find a true "physiologist." The physiologist can measure your legs and body and can determine where your biomechanics are off. In particular, the physiologist can measure the length of your legs because chances are good that one leg is shorter than the other, which is throwing off your biomechanics and other muscles are compensating for it. That could easily be the continuing cause of the plantar faciitis.

From Melissa, Alexandria, VA:

What worked for me was having a trainer do hard, deep tissue massage. I also bought a sock to sleep in that kept the toe forward. Don't forget to freeze ice in a water bottle and roll your foot on it after you get off the court. Good luck. It hurts, but mine is 100 percent gone now.

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