Note: We have an updated version of this post HERE
Plantar fasciitis is the most common cause of heel pain in adults and accounts for 10% of running injuries. I will show you the WHAT, WHY and HOW to treat it yourself!
How common is it really?
- Accounts for 15% of all podiatry visits
- Is bilateral (in both feet) in up to a 1/3 of cases!
- 10% of running injuries
That’s enough stats to show you just how common this is and how important it is that you can treat and rehabilitate this yourself. Unfortunately it is often looked at as a trivial injury and if not treated right can last for months to years, really stopping you doing what you love.
So what is it?
The plantar fascia is a strong band of connective tissue that starts at the bottom of your heel and runs along bottom of the foot, attaching into the toes. It is important for:
- Maintaining your arch when walking and running – tracking from your heel to the toes it stops them spreading apart as your land on and push off your foot.
- Stabilises your foot: as you push iff your toe the fascia is put on more stretch, raising up the arch into a more stable position so you can propel yourself forward!
- Provides proprioception – feedback to your brain about how your foot is moving
- Facilitates good foot motion/bio-mechanics – Check out this post for the plantar fascia’s role in running and walking.
Plantar fasciitis is degeneration and a small amount of localised inflammation of the proximal fascia (the part closest to the heel). The most common area of pain is near the origin of the fascia at the base of the heel. Fasciitis happens when the fascia is overloaded, whether this be from:
- Tight calves or Achilles.
- Sudden increase in activity or training.
- Poor footwear e.g. worn or over-flexible running shoes.
- Hard training surface.
- Arch being too high or too low
- Or increased weight.
This overload produces excessive stress on the fascia leading to a lot of tiny little tears in the fascia. This causes your body to go into protective mode, starting an inflammatory (healing) reaction, which makes the fascia thicker, less flexible, more sensitive AND painful. If this is not treated properly, it gets stuck in a chronic inflammatory phase and can be very frustrating.
Symptoms – to see if you do have it:
- Pain upon waking and taking your first few steps –This “start up pain” is because your plantar fascia and calves have been in a contracted, shortened position all night.
- Sharp stab or dull ache in your arch or at the heel.
- Pain after long period sitting.
- Pain that eases gradually in a walk or run as it warms up.
The big question, so how do you get rid of it?
It is important to address all aspects contributing to plantar fasciitis in order for it to heel strong, these include:
- Foot wear
- Calf tightness
- Training volume
- Inflammation and dysfunction of the fascia
- Lower limb and hip muscle weakness
And this is how we you will do it:
Rehab exercises for Plantar fasciitis:
1. PF rolling: In order to re-align the fibers in the plantar fascia and lengthen it out, it really needs a good deep massage. This works best with a hard ball (I use a lacrosse ball). The other option is to freeze a small water bottle full of water and roll this under your arch (the ice gives great pain relief at the end of a day!)
Roll the bottom of each arch between the heel and toes (not under the heel) for 2 minutes.
This should be done at least 2 times daily.
2. Calf stretch: Drop your heel off the edge of a step and hold it for 1-2 minutes.
This needs to be done 3 times daily (the more the better).
3. Hip strengthening: Often the foot gets more force put through it due to poor hip strength and control. Do this Quick test to see if you have hip weakness, and if you do, then you should also seriously rehab you hips also.
4. Ice: For ten minutes at a time after a long day, exercise of when hurting.
Taping: Taping to support the arch is great for unloading the plantar fascia. Using rigid strapping tape strap from the outside of the foot to the inside, pulling it tight up the arch. See this video for an example.
Footwear: This video shows how the plantar fascia works during walking and running. You can see from this that if your toe was pushed up less when Walking (In case you didn’t watch it: As your heel comes off the ground the toe is pushed up – putting your fascia on more stretch) there would be less repetitive stress on the fascia. So wearing supportive running shoes with arch and heel support and ditching minimalist of over flexible shoes will really help this. Wearing flats all day also aggravates the fasciitis as this puts the calf on stretch which wraps under the heel and pulls on your fascia – so having some heel support is great (but not high heels!)
Orthotics: Orthotics do help this condition a hue amount if your problem is with poor foot bio-mechanics – Head along and see your local Physio or Podiatrist for a foot and gait assessment.
Training volume: it is important to decrease the load for a short time to decrease the overload on the fascia while you sort out the contributing factors (above). This may involve:
- Walking or running halve your normal distance and then increasing this by 10% per week.
- Decreasing training on hard surfaces and hills/steps.
- Adding in time to stretch and warm up.
- Remember the training rule that you should not increase your distance by more than 10% per week – this is often a big cause.
This needs to be followed to 6-12 weeks for best results and when, better you should keep looking after it so that it doesn’t happen again. Keep stretching your calf, keep your hips strong and don’t have sudden increases in activity – build up to it.
You will also benefit from:
The importance of core stability on lower limb injuries
Shin splints: What why and how to sort it
Please like, comment, share and let me know how you get on.
More reading: A good scientific paper if are detail orientated.