Plantar fasciitis

Dear Alice,

I have plantar faciitis which is heel pain often caused by bone spurs. In my case, an x-ray did not show that I have a bone spur. I've bought orthotic shoe inserts ($200), and received instructions from both my doctor and an orthopedic surgeon. I've been doing stretching exercises recommended by my orthopedist. I tried taking anti-inflammatories, but they all gave me symptoms. One even hurt my chest and heart. I've had a bi-pass.

My doctor recommended soaking my foot in hot water three times a day. The orthopedist disagreed with that and said after the foot was stressed to use ice but no heat. I haven't been using either. Do you think I should use heat?

Also, I ride my bike about three days a week. My doctor said don't ride, but my orthopedist said it was okay. I usually ride 30 to 40 miles.

Thanks for your opinion on heat or any advice I can get would be appreciated.


Dear Bob,

It sounds like your pain has been aggravated by the confusion of conflicting advice from your health care providers. Unfortunately, treating plantar fasciitis often requires trial and error, along with a dose of patience, because no two cases are identical. Each person may respond to various treatments differently. Hopefully this information will shed some light on the situation and help you determine what types of treatment will be most effective for you.

Plantar fasciitis is an inflammation of the plantar fascia, a band of connective tissue in the foot that provides arch support. Somewhat similar to a shock on a mountain bike, the plantar fascia absorbs much of the shock experienced by the foot. Some chronic cases of plantar fasciitis involve bone spurs, although they are generally not the primary source of pain, nor are they the cause of the plantar fasciitis. Usually the condition develops gradually, and patients do not seek help until it becomes quite painful. The majority of plantar fasciitis cases can be attributed to a number of factors, the primary one being a soft tissue injury due to overuse (repetitive weight bearing activities that stress, stretch, and wear out the plantar fascia). Very few cases are the direct result of a particular trauma or foot incident.

Your health care provider seems to be focusing your treatment on these specific goals: (1) alleviating your pain; (2) restoring flexibility to your ankle and arch; (3) strengthening the muscles in and around your foot; and, (4) allowing you to gradually take part in all of your usual activities again — pain free!

Ice has been suggested to help with pain and inflammation. Some tips include freezing a paper cup that is filled with water and then rolling it along your foot. Avoid using only heat on your foot, such as from a heating pad or a heat pack, for at least the first two or three days. This is because heat can make plantar fasciitis symptoms worse for some people. If you find that a heating pad helps relax your foot, use a low setting.

If you are experiencing a lot of pain, you can try walking or jogging as a replacement to biking. You can gradually restart your regular activities as the pain begins to subside. Another idea is to reduce your amount of biking until the pain is gone. Adding in arch support to your shoes can also help to take the tension off of the plantar fascia and help absorb shock.

Hopefully this information will help with your heel pain.  Remember, if you are not satisfied with your treatment, you can always seek out advice from another health care provider. Happy Heeling!

Last updated Jul 20, 2015
Originally published Sep 06, 1996