A Good Insert This one has the most comfortable and natural cushion I've seen. The arch support is not too high and it seems to have the right amount of "give" in it. It is marketed as a diabetic insert, but it appears to be an excellent alternative for heel pain.
Custom Molded Orthotics made by Pro Support Systems. They send a package that's used to make a mold of your feet. The mold is used to form the orthotics. They are not too hard or soft, they have good arch support, and the material is durable. Dr. Small will resond to follow-up phone calls and they will modify the orthotics for free if you send them back for adjustments. I've seen several different brands and these are the best so far. $200.
Arch support is very important for many cases of plantar fasciitis. It can be accomplished with inserts, custom orthotics, or certain brands of shoes. However, too much arch support can cause the fascia to travel a longer distance. This causes the fascia to pull harder at its attachment to the heel, causing pain. It may be that runners, those who are overweight or on their feet alot, or those with flat feet may benefit the most from arch support. Orthotics and inserts do not usually have raised heels, so I place my heel lifts under my inserts. Arch supports do not always help, and sometimes hurt. Do not use them if they consistently cause pain. They may require getting used to. Arch support is less likely to work for those with a high arch. This paragraph applies to the next 3 sections on the products for arch support:
Spenco 3/4 Arch Support. $30. NOT the cushion, but the hard orthotic. Here are national stores that have Spenco products. You can try these on in the store, but the orthotic can be molded for better arch support by using boiling water. They seem to work O.K. Supporting the arch is supposed to relieve tension on the fascia. Call ahead to see if they have your size. It's a semi-rigid (or maybe semi-flexible) orthotic. It is probably the most common over-the-counter arch support and has been recommended by some doctors. The Superfeet are less common, but probably better.
FeetRelief.com $84. Expensive. They look almost identical to the Spenco. I sort of recommend the spenco instead because you can try it on in the store and it costs less.
Dr. Roth's Fabs. $29.95 a pair. 1-800-486-0325. This and the next two are straps around the midfoot (arch). All 3 are held in place by a velcro latch. They are thicker on the bottom providing arch support similar to an insert. Of the 3, this one probably my favorite, but Atleta would be better if it wasn't easier to get dirty (it's more of a fabric design). All three seem to have only a little bit of support.
Atleta. A soft support with straps. It works OK. $20 each + $5 S&H.
Fabrifoam's PSC. $29 each + $4 S&H. An elastic band about 1.5 feet long and 2 inches wide on the ends and 4 inches wide in the middle with a velcro strap on the end. You wrap it around your arch twice, then send it around the back of the heel and velcro it to itself at the arch. It's supposed to provide arch support. It provides some compression if you have a swelling problem. I think it works OK. Its elasticity is stronger than simply using an Ace bandage. I have seen "ankle supports" in the drug store that are similar, but less expensive. 1-800-577-1077
Dr. Scholl's has a new and mediocre insert made specifically for hell pain and is available at some drug stores. Look for "heel pain" in big lettering on the front of the package. Please let me know if you find a good Dr. Scholl's link or 1-800 number for nearest retailers.
These are all custom-sized inserts based on molds of your feet. They all first send you some sort of mold or impression to step on (usually for a small fee) that you mail back to them before getting the insert.
FootMaster Custom sizes, $90 a pair. They're sending me a free pair, so I'm in the process of evaluating them. They appear to be similar to the less expensive Spenco inserts, but they have more sizes to select from based on an impression of your feet (a carbon paper press).
Aerodyn Australian Based but can sell to the US. Custom sizes, about $160 US Dollars per pair.
Shoes
Some sufferers report success with Birkenstock sandals because they have a good arch support design. Others report they do harm or are no good. This can happen with any orthotic. A Birkenstock Sandals (starting at $70) Dansko shoes are also praised by some visitors. They also have a good raised heel. Mephisto sandals also have a raised heel and are similar to the Birkenstocks. They are all expensive. As with orthotics, these products often cause pain if worn too much too quickly. There is a notable breaking-in period (for both your feet and the new shoe) that requires wearing the product possibly only an hour a day when starting out. Different models of Birkenstocks and the others have different arch heights. It's by far best to get fitted in a local store before purchasing. Mephisto address: 1037 Segovia Circle, Placentia, CA, 92870. (714) 632-2570. One visitor stated the "Mobil" line of Mephistos has more arch support. It may be better to get good running shoes (i.e., New Balance), heel lifts, and the Superfeet arch supports (the total may come to less $$ than what some Birkenstocks cost). 1-800-761-1404 for the Birkenstock retailer nearest you. I've heard that there are a lot of inexpensive Birkenstock imitators - just look for shoes whose arch support is just as high, and let me know if you know of a shoe that has arch support as high as the Birkenstock AND has a heel lift. Northern Territory sandals (K-Mart) similate the Birks.
Comfort shoe vendors.
Thera-Wedge. $30. Prostretch. $30. These devices help stretch the calf muscles. I do well by just leaning
against a wall. Flexing the calf muscles while stretching greatly improves the stretch and shortens the time necessary to stretch. I am careful to not reinjure my fascia. I tape my feet to prevent from injuring the fascia during stretching and walking. Most stretching articles I have read recommend 30 seconds of stretching repeated at least 3 times, 3 times per day.
Strassburg Sock
About $22. Here is a picture of it. This looks like a less expensive alternative to the night splint
below. A big difference between
the two devices is that the sock keeps my toes as well as my ankle
bent backwards. When it hurts my heel while using this product, I use tape.
As with the night splint below, this device gives calf muscles more flexibility, which is an important cause of heel pain. I used either the sock or a splint for about an hour 3 nights in a row and got a bad case of Achille's tendoniitis that prevented me from stretching good for several months. I have heard of others using it for an hour or two for a few nights. Others can use it all night. Be careful: achilles tendonitis can be almost as bad as plantar fasciitis. The treatment for achilles heel is similar: rest, heel lifts (hard, not soft), stretching (as long as it does not hurt), and shoes that bend easy where the toes join the foot. There has not been a good study to determine the effectiveness of night splints or the Strassburg Sock, but they were rated moderately well in our survey. I have received 1 or 2 complaints about these type of products causing harm. Be careful.
Night
Splints for sale. About $65 each. I bought this before I knew about the Strassburg Sock. $65 mistake. Here's a
faster loading picture. The angle is at 10 degrees back. I have to
tape my foot to prevent the fascia from being injured.
Miscellaneous
Heel Lifts. Before buying heel lifts, try placing folded
paper 1/2" to 1" thick under your heel or under your insert's heel area to see if they will help. My doctor gave me thin, soft heel lifts that did not work. If you already have thin (1/4") heel lifts that are not working, try placing 1/4" or more of carefully folded paper under them to make them higher. Viscolas Heel Spur Cushions
were great for me. Others have emailed to say they were not as good as the soft kind of heel lifts. $12 per pair + $4.50 S&H. Order online. Unlike other heel lifts, the Viscolas are firm, 1/2"
thick, and worked great for me. I felt relief immediately.
I continue to use some folded paper under the lift to raise it even more. Your calf muscles may become less flexible (frequently the cause of plantar fasciitis) with heel lifts, so I still stretch (as long as it does NOT hurt). Sorbothane also has heel lifts for sale. Sorbothane heel insert for $12 pair at Campmor Site. See also Sorbothane heel inserts at IEM Medical. I have not tried these out yet. Here are the Visoelastic heel lifts that are too thin. I do not recommend them unless you put a 1/4" of folded paper under them. $27 for the heel pad and $50 for the full insert.
Athletic Tape. Can help some people to walk again. Available from sporting goods stores and some drug stores. See here and herefor how I tape. Use in conjunction with heel lifts to help prevent damage to the achilles tendon. It sticks best after cleaning the feet with soap and water. It can hurt the skin.
Foot Log. $23. A neat little
device for massaging the feet. I just use an old massager that is very powerful. Massaging is supposed to speed up the heeling process by promoting blood and edema (?) flow. I massage first thing in the morning which seems to help a lot.
Dr. Scholl's Massager. $40. If I was rich, I'd buy it. Otherwise, hand massaging does good.
Thorlos Socks About $10. They are specially-designed socks that provide cushion and are supposed to provide support.
Daypro and Prednisone are the best anti-inflamation prescription drugs
for me.
