Stretching Achilles and Plantar Fascia for Plantar Fasciitis: You Have to Stretch Both

https://journals.sagepub.com/doi/10.1177/1071100717732762

Here is a helpful video!!

https://youtu.be/0eAqJ4-oKTM?si=t0NBhcIL1OsY_Oe_

Plantar Fasciitis: Stretching May Be Your Best Treatment

Stretching of the achilles for plantar fasciitis may be the best treatment overall per this article. I have attached a video on Plantar Fascia Stretching for your information. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134886/

https://youtu.be/0eAqJ4-oKTM?si=bXkfMjxZBGzE4Qqx

Dancer's Padding: How To Video

https://youtu.be/GG-mSjtSwj8

     Dancer's padding was introduced by the French studying ballet injuries in the 1700s. It has a modern term of "Reverse Morton's Extensions". The current supplier for my patients is Amazon, and I can only find the 1/4 inch which you will have to thin out. 

https://www.amazon.com/Felt-Adhesive-Orthopedic-Aetna-Corporation/dp/B071KTF794/ref=sr_1_14?crid=2AO6K692L8XR&keywords=self+adhesive+felt+roll+medical+use+1%2F8&qid=1664597257&qu=eyJxc2MiOiIwLjAwIiwicXNhIjoiMC4wMCIsInFzcCI6IjAuMDAifQ%3D%3D&sprefix=adhesive+felt+roll%2Caps%2C179&sr=8-14

     I use this material constantly in my Podiatry practice, and give supplies to my patients. Any problem with the big toe joint, and some cases of plantar fasciitis, and arch pain, you want to see if this padding helps the symptoms. 

This is demonstrating the Dr Jills Dancer's Padding with Adhesive Gel

Use of Sleeping Splints for Plantar Fasciitis

Good morning Readers, 

     It is a beautiful Sunday morning in San Francisco, although the Fires in the West of USA are frightful!

I pray for all those that have lost their homes to these fires. 

     The question today concerns the efficacy of the posterior sleeping splints for plantar fasciitis. I have attached a link to a video I did long ago still applicable.

https://youtu.be/lyd9HAv9e9o

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I use it for the patients with morning soreness when they wake up. It is important to find out how long they have symptoms when they arise. A simple case of plantar fasciitis normally hurts for 5 minutes or so. I am surprised when I ask when the patients say that it can take an hour or so. I have even had patients tell me the pain either never feels better, or they never have morning soreness. In both these cases, if your diagnosis is plantar fasciitis, you may be wrong. There are so many other causes of foot pain incorrectly diagnosed as Plantar Fasciitis. 

So, plantar fasciitis is normally diagnosed by historical review, but a good examination is also important. I have left the link from my video on Heel Pain Examination. 

https://youtu.be/plbBvPASXwM

<iframe width="560" height="315" src="https://www.youtube.com/embed/plbBvPASXwM" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

Can Plantar Fasciitis occur in other areas of the foot? For sure!! But, a non-heel diagnosis of plantar fasciitis is always suspect. 

How I Approach Problems: Plantar Fasciitis with Sudden Onset and No Obvious Swelling

    This is a new series of blog posts on various injuries entitled "How I Approach Problems". I will be going through common injuries to start and then the areas that prove more complex challenges. I hope my thought process will help you if you are treating this injury or have this injury or injured area.

           Plantar Fasciitis: Acute in Nature and without Swelling

Most heel pain is diagnosed as plantar fasciitis, and everyone knows the ice, stretch, and support protocol. But what if it is not plantar fasciitis. One subset of patients that I see have a sudden onset of pain (not plantar fasciitis), and without swelling that I can note on exam, and therefore fall into one of these 2 diagnoses.

With the acute (sudden) onset of pain, without noticeable swelling in the heel, the 2 common diagnoses are:

1. Heel Bursitis (only deep palpation away from the plantar fascia finds a painful bursal sac)
2. Heel Neuritis (this can cause heel rim pain or radiating pain or other neuropathic symptoms)

Plantar fasciitis can morph into bursitis due to chronic low grade inflammation, but this is not the type we are discussing. The heel pain that is sudden with a plantar heel painful palpable mass, is called infra calcaneal (heel) bursitis.  There may or may not be a reason for the bursae to swell causing the pain that the patient will remember (like stepping on a rock barefoot at the beach). There is a bursal sac that is there when needed to protect bony prominences (like side of hip, front of knee, under the metatarsals), and only gets sore and swollen when irritated.

You can perhaps make the diagnosis with barefoot walking. Plantar fasciitis typically hurts the worse at push off, so walking on the toes may hurt. Heel bursitis hurts more when asked to walk on the heels alone (bursitis sufferers usually do not like this at all).

Heel neuritis can be local (Baxter's nerve entrapment) or referred pain from the tarsal tunnel or higher up (low back and even cervical issues). Like any peripheral nerve problem, you always have to think that it could be from higher up the chain (called Double Crush syndrome). In Double Crush, the nerve would be irritated at the heel (say a pes cavus foot with bony heel and no fat pad---the perfect storm), and is being irritated at the back, piriformis, behind the knee due to a baker's cyst, or in tight hamstrings or calves. What complicates this is that there is no test that confirms that the nerve is irritatable. Nerve tests like nerve conduction studies are looking for damaged nerves not excitable nerves.

 This photo may be alittle difficult, but it is of all the nerves on the bottom of your foot. Look at the nerves just under the heel bone. Any of these can get irritated locally or from a signal from higher.

So, when heel pain, initially diagnosed as plantar fasciitis is not getting better from plantar fascial treatment, you must start looking for another working diagnosis. When there is no obvious swelling, typically ruling out problems like plantar fascial tearing and heel stress fractures or bone bruises, you should look for heel bursitis and heel neuritis.

My next posts will go over the treatments for each separately.

New Series: How I Approach Problems: Plantar Fasciitis

     This is a new series of blog posts on various injuries entitled "How I Approach Problems". I will be going through common injuries to start and then the areas that proven more complex challenges. I hope my thought process will help you if you are treating this injury or have this injury or injured area.
                                                           Plantar Fasciitis

So, you have made (or been given) the diagnosis of plantar fasciitis (inflammation of the thick ligament under your arch that runs from your heel to your toes).

It is typically at its attachment at the heel where it is palpably sore on examination. If the soreness is somewhere else than its attachment, then the diagnosis should be in question. Since rare cases occur elsewhere, and if you are certain, the next diagnostic test will actually be the treatment to be prescribed. Plantar fasciitis should respond to this treatment.

The next test of the diagnosis is in the symptoms. Plantar fasciitis progressively gets sore over weeks and months. If the onset of pain is sudden, and the pain is under the heel bone, it is not plantar fasciitis. My next “How I Approach Problems” will be on sudden onset heel pain which is definitely not plantar fasciitis.

Plantar fasciitis also is always the worst in the morning when you get out of bed. Even though you should never use always in medicine, this is a pretty accurate rule. If the pain is not worse in the morning, it probably is something else. Again, we should see how it responds to treatment for plantar fasciitis.

Plantar fasciitis should have little to no soft tissue swelling. The patient typically can not feel heel swelling, but a doctor or therapist should. If there is significant swelling between the two sides of the body, it is probably not plantar fasciitis. Again, one of my next posts on “How I Approach Problems” will be on heel pain with swelling.

Plantar fasciitis should respond to typical treatments of ice massage, plantar fascial stretching, and taping. It can take a few months, but you should feel better and better each month. I love patients to continue doing activities that they can keep in the 0-2 pain range, even if it hurts more after. You do not run again until you are at the base line pain.

Treatment #1: Freeze a sport water bottle after filling 1/2 full of water. Roll over the painful area for 5 minutes 2-3 times a day with a towel on the floor as you sit and roll.

Treatment #2: I love the 2 achilles and 1 plantar fascial stretches described in the video below. These are typically done 3 times a day, especially before and after exercise like running.

https://youtu.be/0eAqJ4-oKTM



Treatment #3: Tape the arch to immobilize the pull of the plantar fascia. I have replaced the time-consuming, but wonderful, low dye taping with Quick Tape from Support the Foot. This is typically left on 5-7 days at a time.

https://youtu.be/41Or2rdpxbY



Plantar fasciitis always gets a lot better with this regimen. If there is little to no improvement, I doubt the patient (you) have plantar fasciitis at all. Next blog post will go over the decision making of no treatment response. If the patient gets 50% or so improvement but plateaus, we typically have to increase the treatment. Tomorrow I will discuss this scenario with partial success with plantar fascial treatment or no treatment success.

Plantar fascial treatment should allow full, but modified, activities. A non-response to treatment for plantar fasciitis, typically means that there is no plantar fasciitis but it can take a month of treatment to know that. A partial response to plantar fascial treatment typically means more specialized treatment is needed with inserts and PT.

Low Dye Taping for Plantar Fasciitis: New Video on Self Application

https://youtu.be/abPQnEC0aeM

Great Article on Running: Forefoot Strike more Prone for Plantar Fasciiits

Here is the link to "Foot arch deformation and plantar fascia loading during running with rearfoot strike and forefoot strike: A dynamic finite element analysis": https://www.sciencedirect.com/science/article/pii/S0021929018308959

Plantar Fasciitis: Support the Foot Taping

My patients know I love Quick Tape from www.supportthefoot.com for my plantar fasciitis treatment. It is meant to stay on up to 7 days. My wife just wore it every day in our 500 mile trek across Northern Spain to prevent her right plantar fasciitis from ruining the trip. I feel it is diagnostic also, since other problems that are not plantar fasciitis can mimic the symptoms. If you use Quick tape, and your symptoms improve, you definitely have some plantar fasciitis. 

Plantar Fasciitis: Success Email

Dr Blake,
Your patient with the left foot plantar fasciitis that is virtually gone with your 4 pronged approach.  😊
Dr. Blake’s comment: Simple first visit plantar fasciitis treatment is rolling ice massage for 5 minutes twice daily, plantar fascial wall stretches 3 times a day, Sole OTC inserts, and Quick Tape by supportthefoot.com. Works most of the time if it is pure plantar fasciitis. 

Got up the next day after tennis with oven baked Sole inserts and 0 pain. Just feeling a tiny 0.5/10 “this might return” sensation now that doesn’t limit my activities at all.

Found Quick TapeTM 3 pack on Amazon for $30 but only up to size 11, not my size 12.  I want to have them ready for use on day 1 of a flair.  Was I using regular size up to men’s size 11 from your office or is there a better source?
Dr. Blake’s comment: Use Quick Tape regular size on every one men’s 14 and smaller.

I’m stunned at how effective this has been. Thank you for this great combo treatment that isn’t on UpToDate or other reputable sources.

Look forward to celebrating over coffee, tea, meal and checking out the Sole fit at your convenience

Thanks,

Plantar Fasciitis:General Principles of Treatment

 Plantar Fasciitis is one of the most common problems facing podiatrists. 

Several Golden Rules of Foot are common.

Golden Rule of Foot: Plantar Fasciitis begins gradually over weeks and months before effecting athletic performance. It does not come on suddenly.

Golden Rule of Foot: Even bad cases of plantar fasciitis have no swelling. Heel swelling typically is a sign of something worse like an actual tear in the fascia or a stress fracture in the heel bone. 

This can be such a stubborn problem that it is easy to get very frustrated. Very few people need surgery for this since there are so many options for treatment. 30 years ago 1 in 10 patients required surgery, now surgery is less than 1%. The treatment options are so numerous that we are normally limited only by our time and imaginations to develop a successful treatment plan. Each week there should be improvement once active treatment begins. If improvement plateaus, a change in treatment options should be made, but not the basic conservative treatment protocol. Analyzing what is working and what is not working should be part of that process.

The patient and health care provider deal constantly with the 3 areas of treatment---anti-inflammatory, stretching or flexibility, and mechanics (one being the transference of pressure from the painful areas to non-painful areas). Most cases of plantar fasciitis need simple solutions like daily icing (anti-inflammatory), plantar fascial and achilles stretching 3 times daily (flexibility), and arch support (either custom orthotics or store-bought arch supports). Some of the more stubborn cases of plantar fasciitis need all of the above along with physical therapy to improve flexibility and anti-inflammatory measures, custom-made orthotics if not already manufactured, night splints to gentle stretch out the plantar fascia, cortisone shots if a bursitis under the heel bone is found, and many other options.

In resistant cases, 3 months in a removable cast can help calm down the inflammation. I presently would not recommend this unless I got an MRI. The MRI typically will show you why a case of stubborn plantar fasciitis is not improving. The moral of the story with plantar fasciitis is to never give up. Keep trying to find the right combination of anti-inflammatory, flexibility, and mechanical changes. Good luck. Also remember that 25 to 30% of all cases I see for plantar fasciitis for a second opinion, have something else. Neuritis, bursitis, stress fractures, and plantar fascial tears all head the list in the differential diagnosis. I hope this helps and gives you encouragement. Dr Rich Blake

Here is a video on the stretches to do and not do when you have plantar fasciitis.



When I talk about mechanical changes that effect plantar fasciitis, there are many Golden Rules of Foot and come into play.

Golden Rule of Foot: When designing an orthotic device, or using an OTC arch support, the patient must feel that the weight is being transferred into the arch (even borderline obnoxiously) and the heel is feeling protected. The patient should never feel that the majority of the pressure is in the heel. 



Golden Rule of Foot: The most stress on the plantar fascia and achilles is when the heel just comes off the ground. Treatment of plantar fasciitis therefore typically involves staying in elevated shoes, orthotic devices, clogs, and remaining flat footed in some exercises like the elliptical, and sometimes not getting off the seat in cycling. 

Golden Rule of Foot: A negative heel stretch (where the heel drops below the ball of the foot) can irritate the plantar fascia with all of the body weight suspended at its attachment. This is in stark contrast with the same position of the Downward Dog in Yoga which never seems to bother the plantar fascia as the body weight well in front of the plantar fascial attachment into the heel.

Golden Rule of Foot: Plantar Fasciitis patients hurt less walking on their heels than flat footed. If you think you have plantar fasciitis, try to walk barefoot normally, on the balls of your feet, and then on your heels. If you hurt the most on your heels, you probably do not have primary plantar fasciitis, and more bursitis, plantar fascial tears, or heel stress fractures. All three of these are diagnosed by MRI. 

The video below discusses heel evaluation.



My initial visit for plantar fasciitis typically includes:

1. Teaching the patient Support the Foot taping (www.supportthefoot.com) and giving them a few extra strips. Every podiatrist and PT will have some version of taping. 
2. Rolling ice massage with frozen sport bottle 5 minutes 3 times per day
3. Plantar fascial and achilles stretches (see video above) 3-5 times a day. Typically, gastroc and soleus stretches 1-2 times per day, and plantar fascial stretch 5 times. Nothing should hurt when you stretch however.
4. Mechanical changes based on their activities, like no barefoot around the house, and staying flat footed on the elliptical. 
5. Consideration of physical therapy, night splints, removable boot, all based on their symptoms, speed on healing needed, etc, or getting an MRI if a tear or stress fracture is suspected. 

I sure hope this helps. Rich

Plantar Fasciitis: Fun Video with helpful tips

Being a podiatrist, and having videos myself on stretching, strengthening, anti-inflammatory, I still really enjoyed this video. Thumbs up. I do not like the negative stretching where you lower your heels off the stair, but this is my only criticism. No matter what, you have to create that 0-2 pain level consistently. 2 of my youtube viewers independently recommended I review this. 

https://youtu.be/QE36ArOWg_c

Plantar Fasciitis Post Cortisone Shot Advice

Love your info! I received a celestone 5mg. injection into the spot that hurts me the most(from plantar fasciitis) in the center of my left heel on Tues.May 17th (Dr Blake is reading this on 5/21). I have had pain since Sept. 2015 (over8mos.)! I am an avid speed walker, zumba dancer, and tennis player at the ripe old age of 76 years old! Guess I wore my thin narrow feet out walking 5 miles a day on the beach along the waters edge for the past 35 years (plus all my other activities)! I had an MRI done in Dec. 2015 that showed "mild Plantar Fa sciitis". I then went to PT for several weeks and do many stretching exercises AM and PM every day icing  for 15 to 20 minutes after each session.

                               I had no  pain after shot for about 3 hrs (Dr Blake's comment: This tells you that the shot was in the right place). Then bad pain till late AM next day. No pain Wed. PM until Fri. Pm. Then slight tinge lasting into this afternoon(Sat.= 4th day. I am icing it as you said! My Dr. never told me to ice it! I am doing this 3 times a day for 15 to 20 minutes after reading your info.

Dr Blake's comment: This bad pain is unfortunate, but can happen and typically lasts for 4 days, so you were lucky. Celestone is a long acting cortisone that can take up to 2 weeks to completely start working. 

                               Questions: 

Can I start the PT stretching now 2 times a day (icing after)??? Dr Blake's comment: I would do no weight bearing stretching for 2 weeks. You can do active range of motion stretch by pulling your toes towards your nose non weight bearing. You can massage your calf. You can do the frozen sports bottle roll for 5 minutes from the heel into the arch with progressively more pressure over that period.

When shall I try walking and tennis??? Dr Blake's comment: You can walk, but no impact activities for 2 weeks like running, tennis, basketball. 

When shall I contact my Doc again???He said shot should last 2 to 4 mos.? I'm to get appt. after that time if no problem. I am seeing a Sports Medicine Ortho Doc. who has helped me with ankle tendinitis and sole problems with PT in the past!! I really trust him but am getting frustrated over my PF. Dr Blake's comment: The goal of cortisone therapy is to get the pain down to level 2, and then ice and physical therapy can take it from there. Typically you rest for 2 weeks, then spend a week or two testing it, and if you are not consistently between pain levels 0-2, get a booster shot. I do not like to give more than 3, and again, never get the shot where the plantar fascia attaches into the heel bone, just under the heel bone in the relatively fatty area. 

What else can I try before another shot or any drastic treatment? ( extracorporeal pulse activation treatment or ultra sound therapy)??? Dr Blake's comment: There are so many treatments that should be used before injections with plantar fasciitis: orthotic devices, taping, icing, sleeping splints, physical therapy, acupuncture, calf stretches, deep calf massage, topical creams, various shoes, no barefoot walking, boots, etc. So, without knowing anything else you have tried or are using, it is hard to advise you. Hope this helps. Rich

                                               Thanks so much for your time,

The patient's response:

Thank you so much for responding so quickly! Just some clarification. 1.  Does it sound like my shot was in the heel bone? I believe it was where my worst pain was and where the facials come together in the heel? Dr Blake's comment: Typically the shot is under the heel bone in the fatty area that can form a bursae. This is the safest spot to inject. See my video below. 

https://youtu.be/plbBvPASXwM

 Is 2-0 pain very little pain on 0-10 scale?Dr Blake's comment: Yes, you are still smiling. 

 3.When should I go back to my full 11 stretch Pt program 2 times a day? Dr Blake's comment: You can do intense plantar fascial stretches starting at 2 weeks. 

 4.Can I use a towel and sit up on floor to do the toes to nose stretch you said? Dr Blake's comment: As long as it is gentle. 3 times daily for 30 seconds only---1 rep.

How many sets and how many times shall I do these? And how many times a day? I believe I should do this for 9 more days?

                                              Wish you were in Phila. area! I would certainly be one of your patients!!!

                                                           Thanks again,

Patient's comments:

Dr Blake,

Thank you SO much!  I feel a lot more confident about the future after reading your response.

I've been using your taping method on and off for months.  I've been doing a lot of resistance band exercises but after watching your video, I think I was letting the tendon on the front of the ankle do all the work.  I'm also doing a lot of arch exercises, picking up marbles, bands, doming my arch, etc.

How often should I use the tape?  I was a little nervous that I may have been weakening the PTT by wearing it too regularly.  Will the exercises offset that?

Dr Blake's comment: As long as you are doing the exercises, the taping is fine. Every 4th or 5th day go without the tape and see how you feel. Do it intentionally on days you will be alittle less active. 

Would you be able to recommend a podiatrist in New York City who has experience with PTTD?  As you can see, I haven't had the best luck here.

Dr Blake's comment: I would travel to Long Island to see my buddy Dr Karen Langone. She is wonderful. 

Again, thank you so much!  

Plantar Fasciitis: Email Advice

Hi Dr. Blake,

You were referred to me by a physical therapist here in SF I was seeing for a while for what I think I have is Plantar Fasciitis.  

I do quite a bit of walking and used to jog periodically until this pain developed in my left heel approx. 1 year ago. Over that time, I've seen two different physical therapists including a podiatrist in San Luis Obispo and all pretty much concluded the same diagnosis.  However my new PT seems to feel since I did suffer a severe sprain in the same foot a few years prior that I have scar tissue remaining from injury and possibly even a torn ligament that might be the root of problem.  She recommend I get x-rayed and that's how you came in to the picture.  

I'd be happy to get further evaluated by another person, however my issue is I've already spent well over a thousand dollars in doctor visits and I'm pretty much at the same discomfort as when the problem first arose.  I have insurance, but a 5k deductible, so any expenses for this I'm paying for out of pocket.  

Therefore before I schedule appointment, wanted to ask if you think an x-ray would even be able to determine if I have a torn ligament or do I need something more in dept like an MRI?  Also, because I'd be paying cash not going through insurance is there any break I could get, and if so what would be the cost for exam/x-ray?

Lastly, I did some research and found a company online www.aidmyplantar.com  There were two particular products that when I called in the rep said they've had very high success rate with especially if used in combination: Plantar/spur Inferno wrap and Ultrasound therapy system.  The combined price for both these products with tax is just over $200 which is fine, IF IT WORKS, but hate to spend additional money on something that is a novelty with little or no results.  Are you familiar with this company/products or any products in particular that could aid in healing my foot if in fact I do have just the plantar fasciitis and not additional issues?  Also, do you think either of these products would help with healing scar tissue or a torn ligament if it turns out I have that as well?  

I'm anxious to get resolution to this ASAP.  I'm a physically active person and although this has not been a "debilitating" injury/symptom, its definitely hindered my abilities to do the things I enjoy pain free. 

Look forward to your response, thank you.

Dr Blake's response:

     Thank you so very much for your email. Plantar fasciitis rarely lasts this long, and can not be diagnosed by x ray. You would need a MRI. If you saw a podiatrist, or your family doc, a RX for Rearfoot MRI could be given to you and then you could call around to the hundreds of local facilities for their self pay rate. Without a diagnosis, and physical examination findings, it is hard to recommend anything to you right now. When you come to my facility, within Saint Francis Hospital, your current insurance will be charged an office visit and facility fee. Even with your deductible, your insurance will tell us what you owe. We can not do that. If it helps, my standard new patient office visit code is 99203. If it helps, you can go to the label section of the blog and open up the Playlist for Plantar Fasciitis.  Hope this helps. Rich

Plantar Fasciitis: Essentially a Flexibility Issue

Dear Dr. Blake,  I just wanted to tell you that, after a week of doing the stretches you recommended, the plantar fascitis is essentially gone!  Thank you so much!  E

Dr Blake's comment: This email I just received shows that the basic treatment for plantar fasciitis is flexibility. Mechanical support and anti-inflammatory measures can be important also, but flexibility is crucial for most. 

The 4 approaches patients use to gain flexibility are:

1. Rolling ice massage with a frozen sport bottle, or with other arch massage techniques, for 5 minutes 3 times per day.
2. A posterior rest or sleeping splint to give a prolonged gentle stretch for an hour minimum.
3. The achilles and plantar fascial stretches seen in my videos in this blog done 30 seconds each 3-5 times per day.
4. Physical therapy with some form of deep tissue work (like ART or Graston). 

Plantar Fasciitis Video Playlist

New Website for Heel Pain Sufferers: I hope it helps millions!!

Hi-

I wrote to you a couple of months ago and asked if you would mind if I embed one of your videos onto a website I was building about heel pain. The one showing the plantar fasciitis wall stretch is the one that I wanted to use.

Just letting you know that the website is up and running if you want to see how it came out. Your video is located at:

http://heelpainrelief.net/physical-therapy-videos/

Hope you like the way it turned out. I have a link to your site also. I could add another one or two videos if you want; let me know if there is one specifically that would fit.

Again, thanks for your help. I really like your work...

Sincerely,

Plantar Fasciitis: Key Points

Plantar Fasciitis: A.R.T. and Graston to help move out the stubborn scar tissue

For any one that has suffered from plantar fasciitis, there are two important manual techniques that can really help. These techniques are A.R.T.(Active Release Technique) and Graston. These 2 short videos adequately demonstrate the techniques. Most Chiropractors and some PTs are certified in these techniques. So, if the going is slow, consider these techniques, designed to break down chronic scar tissue, as possible help for your sore feet.

Heel Pain: Early Signs of Developing Plantar Fasciitis

Richard 

 I hope this email finds you well.  I have  foot question.  I am having sharp pain in my left heel upon getting out of bed barefoot  in the morning. It improves once I put on shoes and the day progresses.  Is this an immediate ah ha moment for you as a podiatrist and is it simply fixed?  thanks 

Hey Barbara (name changed),

 That is normally the start of plantar fasciitis. I will send you a link on stretching 5-10 times per day, and 2 times a day roll your foot on a frozen sports bottle. You are catching it early. Rich

http://www.drblakeshealingsole.com/2013/07/plantar-fasciitis-educational-video-on.html