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Hot Water Soaks Helpful?

Posted by Jim H on 10/17/03 at 15:09 (134386)

I was diagnosed with plantars fasciitis by a podiatrist last July as the result of walking barefoot over some stones (about 4 yards) in June. I am 61 and have had no previous foot problems. I am in good health and not overweight. The podiatrist recommended using ice frequently. I am retired and fortunately I can stay off my feet most of the day. I am trying to stay in the house as much as possible and walk as little as possible. I am seeing an acupucturist for this 2 times a week. He recommended hot soaks.

What I am currently doing is iceing the feet at night about an hour before bed and soaking my feet in hot water right after I get up. I do not get out of the chair for about one half hour after I stop soaking. My logic is that the hot water will stretch the fascia and the muscles (making it less likely they will be further damaged by the walking I do during the day) and increase blood supply so it will heal faster.

Does his make sense in my case (where I'm not on my feet very much) or should I just use ice?

Thank you for your advice!

Jim Higgins

Re: Hot Water Soaks Helpful?

BrianJ on 10/17/03 at 15:14 (134389)

Jim --

I am not a doctor, but several doctors have advised me to do exactly what you are doing, i.e., heat before exercise and ice after exercise. I think it works well. You might also try taping before you exercise in order to limit the amount of stress imparted to your plantar fascia.

Re: Hot Water Soaks Helpful?

Dr. David S. Wander on 10/17/03 at 19:57 (134453)

Jim

I am not a big fan of using heat, but if you are going to soak your foot, I would not advise 'hot' soaks. In my experience, most patients that use hot soaks usually make the water as hot as they can tolerate. If you are going to use heat, my recommendation is to not use 'hot' water, but warm water. Once again, I'm not a big fan of heat. In my practice and experience I've seen better results with cold/ice therapy. There are many schools of thought, some like ice, some like heat and some like contrast baths which is alternating heat and ice. Don't use 'hot' water!

Re: Hot Water Soaks Helpful?

Dr. Z on 10/19/03 at 01:43 (134650)

Heat is great for increasing blood flow to the foot and your pf. What other treaments beside heat are you using. The heel pain book is a great source for educating yourself about pf treatments

Re: Hot Water Soaks Helpful?

Jim H on 10/19/03 at 12:42 (134670)

First I want to thank you, Dr Z, Dr Wander and Brian J, for replying and for the advice given.

I have printed the book from the website and have read it. I learned a lot from it. I started massaging my feet before getting out of bed as suggested in the book and it appears to stop the foot ache after getting out of bed, but I've only been doing it for a few days. I also have an over the counter orthotic (Mosquito brand) and a custom made orthotic from my podiatrist. Both cause pressure on the arch which eventually causes an ache. The Mosquito orthotic causes less of this and therefore I use that more than the custom made one. Is it counterproductive to switch types of shoes and orthotics during the day as this doesn't allow your feet to get used to the orthotic/shoes? As I mentioned earlier I am reducing the amount of time on my feet. I think I am on them about an hour or 2 a day. I am also seeing an acupuncturist (who was highly recommended to me) 2 times per week. I've been doing this for 3 weeks but I can't honestly say at this point if it is helping or not.

As to the hot soaks, I've received 3 replies: Brian J stated what I stated in my first message was what other doctors had suggested to him and it was working well for him; Dr Wander stated he preferred ice and if I was going to use soaks don't use hot water but warm; and your reply saying heat was a good idea. As there is a lot of controversy on this I think what I'll do is use only ice morning and evening for about a week and compare that result to my previous 5 days of hot soaks in the morning and ice in the evening. This should give me some idea of what works best for me. Does this sound like a reasonable way to proceed?

Thanks again for your help!

Jim Higgins

Re: Hot Water Soaks Helpful?

Dr. Z on 10/19/03 at 14:37 (134671)

try taping your feet. stretch three times per daily so long as your feet don't hurt more. Do a search engine on Heat and Ice. When we talk about hot we aren't talking about boiling water. There is an excellent post on heat and just how effective it is .

Re: Hot Water Soaks Helpful?

Jim H. on 10/19/03 at 15:34 (134673)

To avoid a conflict with Dr. Z, you will probably find a great article on the advantages of heat, and I'll produce 100 stating the advantages of ice. Once again, if you do use heat do not use 'hot' water. The use of topical heat does not penetrate very deeply and does not produce a great increase in circulation. The majority of the increase is via dilation of superficial capillaries and blood vessels, not deeper vessels. On the other hand, if you use ice to decrease pain (ice has an analgesic effect) and inflammation, there is a condition called 'reflex hyperemia'. When you use ice, the area begins to 'freeze' for lack of a better term. As a result, the body reacts by sending blood to the area to help protect the area. This is why your hands or feet get very red several minutes after coming in from the cold or from cold exposure. Search the internet and look for information regarding heat and ice. Remember, anyone can place anything on the internet. Make sure that any article you read is a legitimate study in a well recognized journal, not just someone's opinion. Additionally, speak with your treating doctor.

Re: Sorry about error-Dr. W

Dr. David S. Wander on 10/19/03 at 15:37 (134674)

I posted the previous post, not Jim H. Sorry, Dr. Wander

Re: Hot Water Soaks Helpful?

Dr. Z on 10/19/03 at 15:59 (134675)

Jim,

Follow your own logic especially if your are getting good results. Don't drive yourself crazy with research over ice vs heat.

Re: Hot Water Soaks Helpful?

Jim H on 10/21/03 at 13:14 (134811)

Dr Wander and Dr Z:

Thank you both for again taking time to reply to my message. I especially want to thank Dr Wander for giving the rationale for how ice increases circulation in the area. To know the reason why you should do something is always better than just being told what you should do. Originally from the North East, I am well aware of how hands turn red and are warm after being outside unprotected in the winter.

I have been using frozen water bottles for the last 3 days and I have had no pain to speak of, but then I have done little else than sit around the house. (I have used a stop watch to record the amount of time I am on my feet and it seems to be about 2 to 2.5 hours per day.)

I have another question, if anyone is willing to respond. As I've said I am trying to stay off my feet. However I have heard from 2 medical professionals that being on your feet doesn't do any furthur damage to the PF. After I heard this I went for a long walk and my feet hurt as much as they ever did. What is your opinion on that?

My podiatrist says the next step is shots. I am reluctant to do that if I don't need to and I have heard that shots don't help the healing they just cover the pain. I want my feet to heal not just be pain free for a few months at best. At this point I don't know if I'll see her again or not. I have an appointment to see my GP in early November and I'll bring up any questions I have with her at that time.

Thanks again for your time and advice.

Jim Higgins

Re: Hot Water Soaks Helpful?

Aly on 10/21/03 at 13:30 (134813)

Hi Jim,

Re. the 2 people who think that won't cause any harm to be on your feet - baloney! Ignoring my PF and proceeding 'as normal' has put me in a wheelchair. Please do not stay on your feet, the fact that you currently have 2 to 2.5 hours on your feet at a time sounds like heaven to me. Take care of them, no matter what those 'experts' think. Obviously they haven't had chronic PF themselves!

Good luck,

Aly

Re: Hot Water Soaks Helpful?

nancy s. on 10/21/03 at 14:25 (134824)

jim, aly is right -- avoid walking or other activities that aggravate your feet and bring on the pain, as much as possible. (too many professionals, unfortunately, know little about pf.) if you overdo it by accident (bound to happen, but try to avoid), follow your usual conservative regimen, which you can also find in the heel pain book you printed out. for me, that included ice as opposed to heat. heat helped me, and really just as a temporary comfort, only after developing other tendonitises (achilles, post tib, and peroneal), and even then only in small doses. ice brought down inflammation and swelling and increased circulation; i found it far more healing in the long run.

you'll find in the history of posts on this site that cortisone shots, for most pf sufferers, usually help only temporarily at best. often they do nothing at all (that was my experience as well as many others'), and if overdone they can actually cause damage.

perhaps the docs here can add to this. in the meantime, you'll find plenty about the pros and cons of cortisone by typing 'cortisone' into the search engine on the main message board page.

nancy (not a doc)
.

Re: Hot Water Soaks Helpful?

Jim H on 10/22/03 at 15:20 (135010)

Hi Aly and Nancy S!

Thank you both for writing. I didn't think what the MD's told me about walking not doing any furthur harm for PF was right but it helps to get opinions from people who have the same thing. I'll continue staying off my feet as much as possible.

Nancy S suggested searching for cortisone on the website and through that I found the message from Kathy (I know Aly has read it) about using Vit C, MSM and Coenzyme Q-10 (Message No: 134732). I am anxious to try that.

Jim H