By Charlotte Softly
In this article I’m going to attempt to give an overview of Plantar Fasciitis; what it is, what might make someone prone to develop it and what you can do about it at home without any need for fancy equipment.
So, what is it?
The term plantar fasciitis means “inflammation of the plantar fascia”, the plantar fascia being a thick band of connective tissue that runs from the calcaneous (heel bone) to the heads of the metatarsal bones (the base of the toes). However, it is now thought that it is probably not an inflammatory condition after all, but a degenerative process where the fibres become disorganised and the plantar fascia starts to become thickened and lose strength (1). It would, therefore, be more accurate to call it ‘Plantar Fasciopathy’ or ‘Chronic Heel Pain Syndrome’, but I’ll stick to Plantar Fasciitis here as that’s the term we are more familiar with.
What causes it?
Certain factors have been shown in the research to be associated with Plantar Fasciitis which doesn’t necessarily mean they cause it, but they can be considered ‘risk factors.’ These include: being older, having excessive foot pronation, being overweight, having limited ankle dorsiflexion (stiff calves) and tight hamstrings, spending prolonged periods on our feet, particularly on hard surfaces or in too firm shoes, or suddenly increasing the amount of walking or running we do (2). It’s common in athletes who take part in sports involving running and jumping and comprises 8% of all running injuries. It is often triggered in runners by new increases in training intensity or frequency (2). Weakness in the small ‘intrinsic’ muscles of our feet might also be a contributory factor (3).
How do I know if this is what I have?
Plantar fasciitis usually manifests as pain underneath your heel that may extend into the arch of the foot. The pain is generally worse on taking the first few steps in the morning or after periods of inactivity. It can also worsen towards the end of the day after time spent on feet. Most people have pain on one side, but in some unlucky people, both feet may be affected.
I think I have plantar fasciitis! What can I do?
I have laid out a basic plan for rehab below. Please watch the video too for demos of all the exercises. Work on both sides, even if only one foot is affected, so you don’t build in imbalances.
After reading, page down to Charlotte’s demonstration video.
1. Allow it to calm down.
This might mean a reduction in training and time spent on feet. If you can’t because it’s part of your job, for example, you can still do the exercises, but it will likely take longer to improve. If you usually wear flat shoes, consider switching to something more cushioned. Wearing a gel heel cup in your shoes might help by cushioning the heel. For runners who regularly train barefoot or in minimal shoes, you might want to consider temporarily switching to more cushioned shoes with a higher heel/ toe drop. The higher drop might reduce the load on the Achilles tendon and therefore the plantar fascia – you can transition back when your symptoms have improved.
2. Mobilise the calf/ Achilles/ plantar fascia complex
a) Foam roll your calves. Don’t go over the top! Around a minute on each calf, every day is better than hammering them for an hour and feeling bruised the next day. If you don’t have a foam roller, you can improvise with a rolling pin or a tennis ball.
b) Roll out the sole of your foot. Start with a tennis ball, and if you need more, you can progress to a small rubber ball or even a golf ball. Again, don’t overdo it. You should aim for satisfying discomfort, not eye-watering pain. Little and often is better.
c) Stretch the plantar fascia. Sit with the ankle of the affected foot on the opposite knee. Grab hold of the big toe and pull it back so that you feel the plantar fascia become taut. A 2006 research study (4) found this to be effective. In the study, the participants were instructed to hold the stretch for 10 seconds, repeat ten times and to do that three times a day.
Do these strengthening exercises as soon as you are able. Stop or reduce them if your pain level goes over a 3 or 4 out of 10, either during the exercise or if it flares up afterwards. A suggested frequency would be every other day or three days a week. You might want to build up to that first and then gradually reduce the frequency once you have become pain-free. Start on the affected side and do the same number of reps on the good side so that you are working on evening up any strength differences.
a) Calf raises. A 2015 study has shown that heavy strengthening can speed up recovery (5). In this case, calf raises are modified by putting a rolled-up towel underneath your toes. This tensions the plantar fascia and increases the load going through it. Start with your heel down as far as it can go below the edge of a step. Raise for a count of 3, hold for 2, and lower for 3. Work up to 3 sets of 8-12. If single calf raises are too hard, start with both legs together. If it gets too easy, throw some weights or heavy books in a rucksack and put that on while you do them.
b) Strengthen intrinsic foot muscles. Sit in a chair with a towel on the floor in front of you. Weight it down with a book or a shoe. Use your toes to pull the towel towards you. You can increase the difficulty by putting a heavier weight on the towel.
If you have a stubborn case, it can take some time to improve, so do persevere. If your symptoms are not improving or you have any questions then get in touch!
Charlotte Softly works at Natural Balance Therapies on Mondays, Tuesdays, Fridays and alternate Saturdays. You can read more about her here.
(1) Lemont, Harvey, Ammirati Krista M & Nsima BS (2003) Plantar Fasciitis A Degenerative Process (Fasciosis) Without Inflammation. J Am Podiatr Med Assoc 93(3): 234-237
(2) Beeson, P. (2014) Plantar fasciopathy: revisiting the risk factors. Foot & Ankle Surgery 20(3): 160-165. 1268-7731.
(23 Cheung R.T.H. Sze K.Y.S. Mok N.W. Ng G.Y.F. (2016) Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis, J Sci & Med Sport 19(9) 713-715
(4) Digiovanni, Bennedict F. et al (2006) Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis. A Prospective Clinical Trial with Two-Year Follow-Up. JBJS 88(8): 1775-1781.
(5) Rathleff, M. et al (2015) High‐load strength training improves outcome in patients with plantar fasciitis: A randomised controlled trial with 12‐month follow‐up. Scand J Med Sci Sports 25(3): 292-300