Ice, night splints and barefoot walking for plantar fasciitis

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Today we're covering plantar fasciitis and we're going over a few questions with a running expert that we have.

Hopefully you guys get good information from it. So the three questions that we're going to cover are, does icing actually help with plantar fasciitis? Are night splints worth it? And barefoot or supportive shoes, what works the best? All right, this is Mandy Riehl. We're going to cover three more questions here about plantar fasciitis. This is the one that probably everybody wants to know first when they get it is, do you think I should ice this thing? Probably not. Icing recently has, more research has gone away from icing because it decreases inflammation, which is solid long-term, but short-term say this is your first day having it.

Most people jump to ice. It can decrease inflammation, which inflammation basically brings the trash men, the garbage men to bring the crap out. So inflammation is a good thing. It is in short term. And for something like this, you're not going to get enough inflammation to cause problems in other areas versus like if you tore your ACL, it gets huge and then it can cause issues in the tissues nearby. For plantar fasciitis, it doesn't usually. I haven't seen any cases where it does. But medium and long-term being a couple weeks, you probably want that inflammation. It's there for a reason. It does help with things.

So I've heard people say that they don't want chronic inflammation. Yeah. Is there a difference? Is there like why one, not the other? Yeah. This is a topic of much debate. Yeah, I figure. For right now, in 2026, right? The chronicity of inflammation can point to the fact that you're not addressing the problem. So if you are triggering whatever is causing the inflammation over and over again, say you tore your plantar fascia just a little bit and you keep re-tearing it, so to speak, or re-stretching it, over-stretching it, it can re-trigger the inflammation cycle. But if it's just there for a long time, at some point it just becomes pain control.

So we've talked about this in another video, but if the inflammation is just sitting there and say it's been weeks and weeks, then getting it out will just help the pain. But for the first few days, you might want it. Yeah. I know that there was, I have to look backwards for this. I might be speaking out of turn, but there was the guy who came up with the Ress Ice Heat, said the Rice method. I think it last seems sort of the M. But you can look online. I think he put out something about like 10 years ago saying, I think I misspoke. At least about like, I think about the ice part, if I recall. Yeah.

But I think it was on the same terms that you're talking about. I know the people that I've seen, the most uncomfortable thing, at least with ankle turns, let's just say, is the swelling. Yeah, yeah. It's not the other parts of the inflammatory process. So why arrest those if we just want the one gone? Right, right. And so this is where folks who've had PRP before, part of the theory behind PRP is it restarts the inflammation cycle, which for chronic injuries, you might want. Because if you didn't let that cycle do its job and bring the crap out, you may want to kickstart it back in. Don't do this on your own, right?

Don't like just pound on your heel to restart it. This is a medical injection procedure. But to restart the inflammation cycle may help the, it's restarting the healing cycle, so to speak. So then I think when people are really looking for ice, what they're looking for is how do I manage the pain? I think that's the answer they're trying to get. Yeah. So is there other means to do that without arresting this inflammatory process? Yeah. So PRICE or RICE, Rest Size Compression Elevation has shifted now to Peace and Love, which I love. You can look it up too. It's a big research study that's starting to get into the mainstream now.

But Peace and Love, you can follow those protocols. The most important ones that stick out to me on that is to avoid NSAIDs, which is different than previous, protecting the area. So that doesn't necessarily mean putting yourself in a boot. But, you know, don't go kick rocks. Don't seek problems. Yeah. So stop poking it. That's the main one. And I've done this too, of like, hey, does this still hurt? Does this still hurt? Does this... Stop. Where do you think the term poking the bear came from? Yeah. Maybe the foot is the bear. But yeah, look up Peace and Love. That's the most common kind of pain control thing for a musculoskeletal injury.

More importantly, you need to figure out why it showed up in the first place. Because you can do all the Peace and Love you want. But if you didn't figure out why it happened in the first place, and this is frankly like where we come in, and you don't figure out what started that injury cycle, you might get it feeling pretty good. But the minute you go back to running, it gets pissed off again. Yeah. There seems to be like common attributes or deficiencies that people have with the condition, but everybody's a little bit more unique and everyone has different training variables and body types, etc.

Yeah. Mandy Riehl wrote a book which covers a lot of these parts too, which is the generality of it. But yeah, if you want specifics, like something like a telehealth or something like that, or even in person, it'll cut through all the BS really quickly. We are real people who do telehealth, so not just YouTubers. But yeah. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. The next question then, if we're going, so it's going to be about those night socks. Do you have any good or bad success stories? Do you suggest night socks? Yeah, don't come for me, but I hate them. Yeah. Well, let's start with, have you ever met anyone who had a success story with it? Because I'm sure that somebody has. Like, that's why they're around, right? Yeah. It can't just be a gimmick that never worked. I'm thinking of my patients in the last year. Two cases have had some success with it, but keep in mind, they ended up with me, so they didn't have total success.

Yeah, that's fair. We have a population who did not succeed. Right. But a ton of people, a ton of my patients have used them. So what I usually hear is if they are beneficial for them, it helps for feeling it when you're stepping out of bed sometimes. But like, first step. More commonly, I hear that people use them because it sounds preventative or it sounds like a treatment or somebody told them to use it, and then they're just using it because they think they should, and it still hurts. So this should just be a pain modulation technique. If it is not modulating the pain, don't use it. Yeah, there's like, there's plenty of things that probably wouldn't want long-term, like crutches, knee braces.

This is the same thing. Yeah. The thing with the sock too is one of the theories is that it's stretching out the plantar fascia. Fascia does not really stretch that much. It does a little bit, but it's kind of like the casing you see on a sausage. You can't stretch that much. So if you're putting it in a sock to stretch it and say it's strained, which is an overstretch injury, that might not be great. Even if it feels stiff, you may not want to stretch it. Yeah. Well, in taking this a different way with the, there are other things that create heel pain, which is things that you don't want to stretch down there, like tarsal tunnel is one of them.

And if you stretch the nerve and it doesn't tolerate tension and you have that sock on all night, it's actually probably going to not make it feel very good at all. Yeah. So coming down to the correct diagnosis doesn't really matter, but I think you're right. Don't use it forever, right? Yeah. If it helps, use it while it helps. If it doesn't help, don't use it. Yeah. I heard a story with somebody that they found success with the, I don't think it was a sock, it was a boot. And they had like, they were trying to be a minimalist. They want to get rid of stuff and they looked at this boot and they said, well, I've used this thing twice in my life.

Yeah. It helped out, but I needed it 10 years apart. Should I keep this or just return, like get rid of it and buy a new one? Yeah, yeah. But anyways, I guess it helped them for a little bit. Yeah. Like I said, if it helps use it for things like that that are crutches basically taking away load, it can be useful for a short while. So this is orthopedic boot. If you were, say like an ankle sprain case, that's the most common of like put an ankle brace on it or use crutches. Um, decreasing the load temporarily can help bring down the pain, but doing that for a long time, you might just be like fueling that injury cycle more because you're not stressing the area enough to strengthen it.

Yeah. I think what people don't always like grasp is that there is, there's a trade-off or a side effect of everything. Yeah. And so let's just say we put yourself, let's just say a boot, like I had a patient with a boot that they were, they were post-operative boot and we didn't use it for a while. And I said, can we just stop using that boot twice so much? And they said, why? I said, well, your foot's going to get weaker. And they said, well, what about the repair? I said, that's whatever, whatever trade-off you want. It's up to you, but you're going to end up with a weaker foot if you keep wearing that boot that much.

Yeah. And so, right. It's a trade-off. Like I've mentioned in the past, but traumatic plantar fasciitis rupture case, you use the crutches, use the boot for a while when there is physiologic reasons why you have to decrease the load. If you completely severed your plantar fascia, yeah, okay. If you've been using a boot for four months and it's not getting better, you're doing more harm than good before you're trying to get out of the recovery, the injury hole, so to speak. Well, next question then is kind of going the other way is barefoot. We'll just say barefoot, not barefoot shoes. It wasn't clear on the question.

And then the supportive shoes. Yeah. Like, do you have a preference of people who are in current plantar fasciitis pain versus people who had passed plantar fasciitis pain? Yeah. Current plantar fasciitis pain, it comes down to what's comfortable to a degree. So you don't want to go full boot if you don't have to and there's no medical reason to. And parsing that out takes a medical professional. It just, doing it on your own is just not sufficient. I, as a medical professional, go to you to get an objective view on it. Yeah, we actually see each other. Yeah, yeah. It's just very hard to manage your own condition.

Yeah, yeah. I've run into that multiple times. Doctor YouTube is helpful for information but can be hard on your own. But you don't want to go all the way boot if you're in total pain but there's no realistic medical reason to use it. But you don't want to jump to barefoot if you're in a ton of pain too. So people who have had issues in the past, getting to walk around barefoot and live life to a normal degree barefoot I think is helpful. So you shouldn't be wearing shoes in your own home. But people who are in active pain, it comes down to what's comfortable and then moving them into something that feels more natural to them.

So it doesn't need to go full like Vibram five-finger shoes if that's what's comfortable for you and you don't have issues, great. But moving people towards what feels natural to them is more important than keeping them in clunky shoes as like a protective mechanism. And the last thing before we leave this video then is what do you think is an acceptable timeline for say somebody who's had plantar fasciitis and they've had it for say two months and there's not getting better? Like how long should they be waiting this thing out and how long should it take to get better in your experience? Yeah, so for most tissues if there is one insulting incident and it's not a huge crazy injury, again, didn't tear your ACL, six to ten weeks is usually the timeline of the tissue actually healing successfully.

Most people are pain-free I would say about halfway through. Do you agree in your experience? I think they still have temperamentalness to it. Like they'll feel better on day-to-day things. Like first step out of bed should be probably the first thing to go. And then things where they have not exposed themselves to like that challenging more. Like they haven't run in two months. Right. So it's like, well, yeah, we may have a little bit of flare up as we start to build in miles. But yeah, generally they should feel better very like within under a month probably. Yeah, yeah. But then the other stuff comes with some temperamentalness.

Yeah, so that middle stage is the hardest once you get it feeling a little bit better and you don't know what pisses it off and what doesn't. That's the hard part. But we're talking on the order of weeks to a couple months, not years. So when people run into trouble, it's because they've had it for six months. They don't know what triggers it. They're protecting it or they're trying a ton of stuff to fix it and they're not, they're inadvertently triggering it again. That's when something's not working. Well, I've seen people on our, like monitor some of the comments on YouTube and there's people who say they've had this for 15 years.

Yeah, it's so brutal. Yeah, it's a long time and I don't know if they mean daily. That is very long but if you've had like reoccurrence like every year for 15 years it's probably a little bit more understandable but still there's probably something more deep-seated there that should be addressed rather than just socks and boots and whatever that means they take. Right. And like not to, you know, not to toot our own horns here but we've both seen it a lot where you get it right and they're more than 50% less pain within a week or two. With like first contact, like simple stuff, right? Yeah, yeah.

I've had a couple cases who granted they were like big, like good responders that are back to relatively full training in the sense of they are building back into running from their rest period within three weeks. So it can be very quick but if you're, again, if you're like months and months and months and nothing's changing or you're still kind of feeling it like something is missing there. Yeah, I agree. If anything in today's episode resonated with you, visit the link in your podcast player. There you'll find any free resource that we mentioned in the show, any guest links and a link for a free discovery call with us.

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