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Corbin Holzapfel

Composition 11

Professor Cassel

Sinclair Community College

Research Essay

19 July 2020

 Plantar Fasciitis Treatments or Just Temporary Solutions? 

 
         Physical pain can originate in various parts of the body. A physical pain felt in both feet

can be caused by what is called Plantar Fasciitis or other foot problems. Many do not know that

they have this foot problem until pain starts to occur in the arches of the feet. This pain as

described by doctors causes a surge of pain and hurts to even stand in the morning or walk.

Some signs in various articles show deflated/lack of arches visible while standing. This meaning

that the arches touch the ground and there is little to no space there. Various treatments for this

issue veer toward shoe inserts, feet stretching, cortisone shots in the feet, and electroshock

therapy in the feet. Shoe inserts are found to be helpful with plantar Fasciitis by giving support

to the heel and lifting the arch area. This shoe insert is provided to provide less pain and should

be used after stretching and various physical therapy rather than the first remedy.

This pain of plantar Fasciitis is felt to be located in the arch region of the foot but can

originate elsewhere. From my own experience, I have felt the tingles and shoots of pain in the

morning as I am waking out of bed. I rise out of bed and cannot place my feet on the floor

without pain shooting up. I have had doctors prescribe me to place sandals or shoes with cushion

at the foot of my bed to slip on as soon as I got up. I had always wondered why or how shoes
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and shoe insoles would help this condition.  To give a background, Plantar fasciitis does not

originate in the foot area.

From reading articles like, “Plantar Fasciitis” from The Annals of The Royal College of

Surgeons of England, this condition occurs when “It locks the midfoot during toe-off to provide

a rigid structure for propulsion. The plantar fascia then tenses, converting the previously stored

potential energy into kinetic energy and aiding acceleration.” Simply put, the way that a person

steps off the ground has a lot to do with what happens in the feet. There could be an issue with

the person’s gait and how their hips move causing them to put pressure down in a certain area of

the feet to accommodate for the balancing of walking. The foot is also connected to the calf

muscle and if the leg is slightly off, then the way the foot lands could be wrong also.

From speaking to an athletic trainer at the local Tri-Village High School, Chelsea

Sweeney mentioned that, “shin splits or pain in the front bone of the shins is common for runners

who pronate.” Pronate meaning turning or rolling their feet in toward their arch as they walked.

This causes a person to use the inside ball of the feet and step more in to deflate the arch that is

there. While the person is stepping down, there is no built up muscle to cushion the weight that

the person stepping down has to carry. Therefore, when the shoe is off, the person is not

receiving any pressure relief.

Having this arch support to push the arch up when the person is stepping down on the

arch area gives less pressure and more cushion for comfort. Chelsea Sweeney mentioned that

this support in the shoe could encourage the foot to roll to the outside and fix posture or way the

weight is distributed. However, other studies have come to conclude that arch support shoe

inserts can only do so much. Pronating the feet inward as shown in the image below allows the
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arch to become more deflated from holding this particular standing stance. Pushing on these

arch muscles instead of balancing throughout the foot is causing pain.

Image of pronation visual vs. normal stance

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In research, the muscles inside of the plantar become inflamed from overuse and not

being cushioned right to step on frequently. This misstep or misuse of the foot causes tension in

the muscles and certain stretching and muscle relaxing has been an effective treatment. In more

severe cases, cortisone shots are given into the feet. However, it leads some to wonder why shots

are given in the foot if the muscles and other parts of the body also play a role. Even this

treatment like the shoe inserts is debatable. The shots in the foot show that the pain is being

relieved from the arch support area much like with the arch support cushion and heel cushion for

the shoe inserts.

In the article, “LOW-COST ORTHOPEDIC SHOES BASED ON RECYCLED

MATERIALS: MANUFACTURING, PLANTAR CORRECTION EVALUATION,” it states

that “Wearing shoes for a length of time can lead to some correction and better posture

improvement for adults.” This article by Barbu Braun and all explains the results of how plantar

correction is had and can even improve posture with shoe inserts. The question that one doctor

has posed in another article refutes this argument that correction can be made by first doing the

insert. Dr. Patrick Deheer in his article, “Why Orthotics are Not the Answer for Plantar

Fasciitis,” explains that “shoe inserts are there not to treat the condition but to prevent the

condition from recurring once the patient is asymptomatic and the equinus deformity has

resolved.” Mr. Deheer is explaining that this two stage process occurs with other treatment first

before putting in a shoe insert. Once the foot is already in pain, it needs relief as well as a way to

heal for a short time. From learning about the pain coming from other areas in the body, other

treatments like physical therapy to train the muscles will help build the feet and stretch.
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The first article, “LOW COST…” tells that the insert can improve posture but does not

go deeper into what will happen when the orthotic shoe insert is tried first before any stretching

other treatment. What both of these articles seemed to capture was the attention of the muscles

and joints but forgot to focus on the rest of the body. Gutteck and others get deeper in the article,

“Pain on the Plantar Surface of the Foot.” Gutteck and all explain how the plantar is effecting

the rest of the body and explain that “around eighty-three percent of cases of Plantar Fasciitis

was associated with shortened calf muscles. The ankle joint forces the foot into excessive

pronation…increasing the distance between the knuckles and the toes.” This allows the

realization that other parts of the body are affected by the way one stands and steps when

walking. The gait changes and posture is a part of this as briefly mentioned by Braun and all.

Due to these gait changes and changes in the legs, Doctors are now prescribing stretching

exercises such as rolling of the arch with a rolling pin, a cool water bottle, and stretching the

entire foot by leaning the foot up against a wall and pushing forward. The way that these articles

have described the shoe insert as a treatment may be confusing to some readers or patients. The

shoe insert can help with posture and provides cushion for the inflamed foot. However, if just

treated with just an insole, the foot wouldn’t hurt while in the shoe but could have pain when out

of the footwear.

Once this support is gone, it is much like taking off a cast before being completely

healed or taking off the glasses for reading. Each person may get a new prescription of glasses

that are stronger if their vision gets worse. It is very rare to see a person’s vision improving at all

after wearing corrective lenses. The glasses help the eyes focus and adjust and provide this

essential crutch to make it easier. Essentially, shoe orthotic inserts do the same with not building

up that muscle to sustain the arch when the insert is not in use.
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In one article, “Plantar Fasciitis” from The Annals of The Royal College of Surgeons of

England, it states that, “Inflammation triggered by small trauma might also explain why the

condition sometimes responds to local steroid injection.” This smaller pain is caused from all of

the wear and tear done to the foot by stepping incorrectly with the whole body working together

to move each foot forward in the walking motion. There have been successful results from some

cases of steroid injection to relieve pain into the site of the pain. However, this still does not

validate all the other muscles that are getting that wear and tear from overuse of standing, sitting,

and walking while using the feet during the day. After discussing the gait changes and other

factors. One may consider physical therapy techniques. Building up the arch seems like a

suitable muscle to help strengthen if this muscle is getting most of the wear and tear anyway.

Now looking at the difference between different type of shoe orthotic inserts needs to be

recognized. There are pre-fabricated inserts that are relatively cheaply priced found in most shoe

or outlet stores. These are not custom in any way and do provide some arch support and gel heel

cushion inside of shoes. The custom orthotics are sometimes given extra heel cushion to

discourage the pronation and pressure at the heel. In one study, Gutteck and others shared in

their article, “Pain on the Plantar Surface of the Foot,” that, “raising of the second and third toe

heads by means of an individually molded insole with a ...cushion…relieves the pressure in up to

60 percent.” If this shoes that taping for individuals is helpful, are custom orthotics better? This

finding also qualifies the idea of taping. Some athletes get their feet taped by a personal trainer

for 4-5 days instead of a custom orthotic.

From speaking with Chelsea Sweeney, Sweeney’s recommendation is that “Taping may

cause the orthotic to fit differently and cause more pressure on the top of your foot due to the

shoe fitting tighter.” However, with a pre-fabricated insert or slide-in, Sweeney recommended
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this to work. With the convenience of the inserts in various stores, immediate relief will give

cushion to the feet for a short time until the shoes come off. However, what is being gained by

just looking at the foot area?

By looking at the toes, the way that the foot is made can show how much the foot is being

pronated. If the consumer starts with the orthotic first assuming the problem is just in the foot,

the consumer risks still hurting despite having a proper fitting pre-fabricated orthotic or even a

custom made orthotic. In these cases, both seem to provide pain relief and are a quick go to for

those who wish to alieve the pain. This is the most affordable with the insert being around

fifteen dollars or less. The next option is stretching that requires looking up a pamphlet online

like the one from American Family Physicans. A link is provided in the works cited with

information. In this pamphlet, description of the PF condition as well as various stretches are

shown to help. However, some experts even go further beyond stretching.

Can there be ways to change the gait in order to not step on the inside and not put any

pressure on the orthotic shoe insert? Some of the articles mention short term and long term

solutions. One short term solution was stretching that has to be done every 12 weeks according

to Michelle Drake and et al in the article “The short term effects of treating Plantar Fasciitis with

a temporary foot orthosis and stretching.” These were programs and solutions that were

combined rather than just recommended. With this combination many results can occur. Chelsea

Sweeney showed stretching exercises that extend into the calf area. However, for those with

already limited mobility; this may be difficult. These exercises with stretching take around five

minutes and Chelsea mentioned how she would imagine that “my athletes would not be patient

nor I would be to roll for more than one minute.” With keeping this in mind, inactive solutions

are also thought of that patients can wear during the night.
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These night splints are shown to be effective at reducing pain in the mornings. Orchard

provides the warning that night splints are not for everyone claiming that, “poor sleepers would

probably be wasting their time if they tried to use one of these devices, as they…do not promote

a good night’s rest.” This device at night will stretch the plantar in the foot providing more hours

of stretch keeping the feet in that stretched position during the night. If this does not affect sleep

much, this could also be a viable option. For those that do not stretch before sleeping, the splint

might help. Most choose not to do this due to comfort reasons.

In a consensus of most articles, most of these articles claim that stretching is done. Foot

strengthening and muscle repair have yet to be seen without corrective surgery. As based before,

the way that the foot wants to balance has to do with balance, stance, and how a person pushes

off of their feet is important. Many patients choose to go immediately to relieving pain and not

stretching. This stretching may feel painful and not feel relevant. The tightness will not go away

completely and need stretched again every four days. This making this stretching ongoing. This

self-care is a struggle for some, but worth it to many.

Some may struggle with this physical therapy and not want to accomplish this goal.

Orchard backs this up by saying, “because of the moderate expense of custom made orthotics

and their variable efficacy, it is suggested that they are not prescribed routinely but are used in

cases where patients report improvement with prefabricated orthotics or low-dye taping.

Kinesiotaping, involving both calf and foot, may work in a similar fashion.” This taping and

construction of a brace will help provide pain relief. However, taping without having

professional help can be frustrating to some. To others with a better range of motion, this taping

can be done themselves with the tape costing under 10 dollars. After this, a local athletic trainer
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can show someone who to tape themselves up to promote pain relief. This option can promote

pain relief when outside of the orthotic shoe and the wrap lasts 4-5 days.

Delving into the topic of physical therapy is not a common treatment and does not seem

like a suitable treatment due to the bones in the foot being the way that they are and the

shortened calf muscles. However, some exercises can build up the muscles surrounding these

bones to better support. The most intrusive form would be cutting into the foot and surrounding

areas to fix the plantar area. This is the last resort if cortisone and other methods do not work or

curb pain in some manner.

After all of this information, some patients question whether changing the way that they

walk with physical therapy and thinking about foot placement could be an option to pronate less

while wearing orthotics. From speaking to Chelsea Sweeney, she informed that, “Trying to walk

in a different way from usual to train your feet is going to hurt and cause worse pain.” From

learning this, research on the pamphlet and from various physical therapists, these experts

mention exercises to strengthen the arch muscle and surrounding areas. From other research,

some may question about building up the calf muscles to better support the foot. While stretching

every day, physical therapy exercises found in various books and consulting doctors can show

patients how to build up muscles in the foot and surrounding areas. Looking up calf muscle

exercises particularly affecting shortened calf muscles show that building up the calf muscles by

building strong legs and making sure to stretch the muscle with toe-lift exercises and rolling

relief.

In conclusion, when looking for relief, going to an athletic trainer for free or consulting a

health professional is first on the list. Second would be the fit of a pre-fabricated arch support

shoe insole for some pain relief. Looking for shoes with proper arch support is done to support
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this. Regular tennis shoes with a pre-fabricated insole can be achieved. Meanwhile, sandals and

high heels need proper support built in. Specific brands cater to plantar groups with giving arch

support in the form of the sandal. These shoes are generally more expensive as an option. The

least expensive option would be wearing tennis shoes or other shoes with the pre-fabricated shoe

insole. While finding proper shoes with insoles, stretches should be performed before stepping

into the shoes for the day. These stretches in the morning combined with muscle strengthening

during the day can allow the foot to be better supported. Although the insole only provides relief,

prevention of more deflation can happen with strengthening the areas surrounding. This requires

weekly exercise of strengthening and stretching. This harder part leads up to relief for up to

twelve weeks. These are all temporary solutions that need to be implemented before going to

shots or surgery. There is no direct cure for this and more research with questions toward hip

movement and foot placement can be used to eventually see if there is a type of therapy to walk

in a different way. Some physical therapists recommend patients to start to walk in a different

way to support their gait better for balance. Not much research has been done about those whose

bones naturally want to pronate. There are still questions about how changing the gait can affect

those areas and potentially create more problems.

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Works Cited

Braun, Barbu, et al. “LOW-COST ORTHOPEDIC SHOES BASED ON RECYCLED

MATERIALS: MANUFACTURING, PLANTAR CORRECTION EVALUATION.”
Shibboleth Authentication Request Sinclair University, Environmental Engineering &
Management Journal, Aug. 2018, eds-b-ebscohost-
com.sinclair.ohionet.org/eds/pdfviewer/pdfviewer?vid=5.

Cutts, S, et al. “Plantar Fasciitis.” The Annals of The Royal College of Surgeons of England, Mar.
2015, publishing.rcseng.ac.uk/doi/citedby/10.1308/003588412X13171221592456.

DeHeer DPM, Patrick. “Why Orthotics Are Not The Answer For Plantar Fasciitis.” Podiatry
Today, 23 May 2011, www.podiatrytoday.com/blogged/why-orthotics-are-not-answer-
plantar-fasciitis.

 Drake and et al. Jospt.org. 2011. The short term effects of treating Plantar Fasciitis with a
temporary foot orthosis and stretching.”
https://www.jospt.org/doi/abs/10.2519/jospt.2011.3348

Gutteck, Natalia, et al. “Pain on the Plantar Surface of the Foot” Deutsches Aerzteblatt Online,
2019, doi:10.3238/arztebl.2019.0083.
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 Orchard, John. “Plantar Fasciitis” British Medical Journal. 13 October 2012, Vol. 345, No.
7878, pp. 35-40. http://www.jstor.com/stable/23278994. Accessed 1 July 2020.

 
 “Plantar Fasciitis: What You Should Know?” American Family Physician. December 1, 2005.
https://www.aafp.org/afp/2005/1201/p2247.html. Accessed 1 July 2020.

Sweeney Chelsea, AT. Personal Interview. Tri-Village Local Schools. Accessed 1 July 2020.
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