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Plantar Fasciitis

Originally posted on June 24, 2010

What Is It?
Plantar fasciitis is a common and painful condition affecting the bottom of the heel.  If it is not treated early and aggressively, it can become chronic taking a year or more to resolve.  Plantar fasciitis is an inflammation and tearing of the ligament that supports your arch.  In runners, it tends to be caused by overuse, which results in micro tearing at the ligaments attachment on the calcaneus or heel.  In some people, the tension on the heel may create a bone spur, aggravating the pain.  Because we are hard on our feet, the plantar fascia rarely gets a rest.  But, there is a solution…

What Causes It?
When the foot is on the ground a tremendous amount of force is concentrated over the arch. This force stretches the plantar fascia as the arch of the foot tries to flatten (pronate) from the weight of your body. When you walk, 3X your body weight presses down on the arch. When you run, this force can increase to 9X your body weight.  This leads to small tears in the plantar fascia where it attaches to the heel bone.  If you don’t recover from your runs, the tearing will worsen over time until pain and inflammation encourage you to stop running all together.

  • High training volume, running on hard surfaces, too much intensity
  • Working on your feet all day, especially on hard floors with poor footwear
  • A foot that is too flexible (excess strain) or too stiff (poor shock absorption)
  • Poor muscle flexibility in your legs (especially the calves) and feet
  • A history of low back problems, especially disc injuries or sciatica symptoms
  • An inappropriate shoe for your foot type or a worn shoe that lack cushion
  • Weakness in certain leg muscles and in your core (abs and back)
  • Faulty running biomechanics in the back, hip, knee, ankle, and/or foot
  • A flattened fat pad under the heel bone (more common in older runners)

How Can Fix It?
Plantar fasciitis is very treatable but you have so many options that it becomes hard to prioritize which ones will be the most effective.  Getting evaluated by a Physical Therapist is extremely important because it will guide you toward how to prioritize your options.  Otherwise you are shooting in the dark and will end up frustrated.  Following are a few strategies to get you started on the road to recovery

  • Plantar fascia stretches – before getting out of bed and 3X/day
  • Calf stretches – knee straight, knee bent, foot straight, arch high
  • Hamstring, quadriceps, and hip flexor stretches
  • Deep tissue massage for calf muscles and feet if tolerated
  • Ice if acute and swollen, heat & ice if you’ve had it longer than 2 weeks
  • Night splints – At least 20 minutes/day with your knee straight
  • New and improved shoes and insoles (Superfeet)
  • Decrease training volume immediately and cross train if able
  • Keep cushioning underfoot from morning till night
  • Self massage using a rubber or golf ball
  • Foam roller for massaging calf muscles
  • Arch strengthening exercises
  • Circling your ankles before getting out of bed to avoid morning pain
  • A good Physical Therapist has even more tricks to get you back running fast

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