Ed Stivala Personal Training

Alongside runner’s knee and achilles tendinopathy, plantar fasciitis is one of the most common running injuries. Although it’s a frustrating and, for some, slow-healing condition, there are several things you can do to hasten your recovery. Always get a proper diagnosis, but in this post you will find a few ideas to help you recover faster.

What is plantar fasciitis?

The plantar refers to the area on the bottom of the foot, and the plantar fascia is the thick band of connective tissue running from your heel bone to the front of your foot. This tissue helps support your foot’s arch and gives it shape, and it aids in stability when your foot strikes the ground and then pushes off. 

Historically, plantar fasciitis was thought of as an inflammatory condition, however, more recent studies have suggested that there is often a lack of any true inflammatory signs, and that it is, instead, a degenerative process that brings with it a thickening of the plantar fascia heel attachment. In a similar fashion to that of an achilles tendinitis injury, plantar fasciitis is more commonly known as plantar fasciopathy (like tendinopathy) in the medical world.

An injury to the fascia usually begins where the fascia connects to the bony bump on the bottom of the heel called the calcaneal tuberosity. The inflammation and pain come from excessive tension. The muscles above, and the shape of the foot below, contribute to its development. The calf muscles (specifically, the gastrocnemius and soleus) connect to the heel bone via the achilles tendon. When those muscles are tight, the tendon pulls on the bone from above, stretching the fascia and causing strain. People with high arches are especially prone to plantar fasciitis because the arch itself also contributes tension to the fascia.

A mild case can turn major very quickly if ignored. Tears, although less common, can also occur in the plantar fascia. These are a totally different injury. Tears to the plantar fascia will typically be much more acute and symptoms will be more severe. And there will often be a moment of sudden injury that a runner can quite clearly remember. 

To confuse things further you can also have a chronic, long standing plantar fasciitis (- fasciopathy) alongside an acute plantar fascia tear. If this sounds like your symptoms, visit a physiotherapist. 

What are the symptoms of plantar fasciitis? 

The main symptoms are a nasty pain in the bottom of the foot, especially at the inner attachment point into the heel, and usually felt when taking your first steps out of bed in the morning or those first few minutes of a run.

What causes plantar fasciitis?

Plantar fasciitis has many causes, so there is no definitive answer to that question, frustratingly. As ever, training errors are often to blame, for example, suddenly ramping your mileage up, or jumping into speedworkor hill intervals.

There are a number of biomechanics that also may predispose someone to developing plantar fascia type injuries, and especially around the foot-ankle complex. Stiffness in the ankle and big toe joints have been shown to have contribute to stress on the plantar fascia. Both the small intrinsic and larger extrinsic muscles of the foot and ankle have been shown to impact loads placed on the plantar fascia as well – and especially if these muscles are weak. Conversely, people with high arches often run into issues as well, with the raised arch of the foot stiffening the mid-foot and impacting it’s shock absorbing affect on landing, when running.

What is the best treatment for plantar fasciitis? 

Rest: Take a break from the activity causing the problem. The earlier you address plantar fasciitis, the better. How long you need to rest depends on the severity, but expect at least a couple of weeks. Stick with intense upper-body activity that doesn’t load your foot. This may be frustrating, but think long term – it’s better than being out of the game for months.

Stretch: Be gentle. Go slow. You’re trying to relieve the tightness in the area, not preparing for a race. As the injury heals, continue with this stretching routine permanently, it’s best practice that actually is ‘best’.

When ready, SLOWLY build back your training: Don’t restart training activity until you are pain-free for several days. You’ll just aggravate the injury and will take much longer to recover. 

What are the best exercises for plantar fasciitis? 

Stretch it…

Put your toes and the ball of your foot against the top of the vertical edge of a step with your heel on the floor and slowly lean forwards, keeping your leg straight, until you feel the stretch at the top of your calf. Repeat with your knee bent, feeling the stretch farther down the leg. Hold each stretch for 15 to 20 seconds and repeat several times in each position. Do this daily, before and after exercise.

Roll it

A simple preventative measure you can do anywhere, even sitting at your desk. Roll a tennis ball back and forth under each foot for a few minutes a day. The ball massages and loosens the fascia. Also, working into your lower calf. Some research has shown a continuous connection between the plantar fascia and the achilles through the achilles-calf complex can contribute to an increase in plantar fascia loads.

Load it

Just like an achilles tendinopathy, to expect a successful return to running you must ensure the tissues can tolerate the loads you are placing upon them. Try the following strength and movement control exercises.

Strength exercises 

Heel raise (perform with knee bent and with knee straight)

1. Stood on the floor off over the edge of a step (harder), place a towel under toes. 
2. Raise up onto tip toes so that you are roughly 50% of the way up.
3. Transfer your weight onto the affected leg and hold this position.
4. Hold for 10-15 seconds.
5. Repeat 5-6 times, 1-2 times daily.
6. As symptoms settle, work towards holding for 30-45 seconds and repeat this 3-4 times, 1-2 times daily.
7. Then, progress from bodyweight to adding in some external weight. Start with 5kg and increase weight from there – 15-20kg is a good aim.

Heel drop (perform with knee bent and knee straight)

Double leg raise to single leg lower

1. Stood on the floor or off the edge of a step (harder), place a towel under your toes.
2. Transfer all your weight onto the affected leg and then slowly (3-5 seconds) lower your heel towards the ground.
3. Perform 12-15 repetitions with just bodyweight x3 – and repeat once a day.
4. As symptoms settle, increase the amount of resistance while reducing the number of repetitions, for example: 10 repetitions with 10kg x3

Ankle inversion with resistance band

1. Sit on the floor with your legs straight out in front of you. Bend one leg and, with the other, place a band – securely tied to a stable piece of equipment out to your side – around the inside of your foot.
2. Turn your foot in against the band, using your ankle to perform the movement.
3. Slowly release and return to the starting position.
4. Repeat on both legs for 12-15 repetitions x3.

Movement control 

Reverse lunge

1. Stand with your legs shoulder-width apart.
2. Step back with your right foot and lower into a lunge – your right knee should almost touch the ground and your left thigh should be parallel to the ground.
3. Keep your back straight and your left knee over your toes.
4. Return to start position.
5. Repeat on both legs for 12-15 repetitions x3.

As with the running you must monitor your symptoms once you initiate any of these exercises. You want there to be no increase in symptoms immediately after or within the 24 hours following. Worsening of that morning stiffness is a sign you are pushing things too far / too fast, so stop and back off!

You will need to adjust the reps and sets in these exercises to be appropriate for yourself. They should be treated as guidelines. Get professional advice if you are unsure what would be appropriate for you.

Can insoles help with plantar fasciitis?

Over-the-counter insoles can be helpful, especially for high-arched runners. Prescription orthotics are another option – they are custom-made for your foot – but try the (much cheaper) over-the-counter orthotics first – and if they don’t work, see a qualified podiatrist. 

Will it help if I change my running shoes?

Running shoes with a higher heel-toe drop may help in the short-term, especially if you’re currently running in a shoe with a low drop (4-5mm) or have recently changed brand / style / drop.