Plantar fasciitis is inflammation of the thick connective tissue at the bottom of the foot, running from the heel to the toes.  It affects on average anywhere from 2 Million¹ to about 3.2 million adults in the US per year, with 85% reporting pain stemming from their condition².  Fortunately, plantar fasciitis is in most cases preventable and manageable.  It often stems from chronic overuse, improper posture and lack of mobility of the musculature above and below the ankle. 

This article will define plantar fasciitis, explain it’s causes, and provide practical tips to prevent, manage, and alleviate plantar fasciitis.  

What is Plantar Fasciitis?

Plantar fascia is a connective tissue (fascia) spanning under the arch of the foot.  It runs from the bottom of your heel to all five toes.  Plantar fascia supports the small muscles and bones under your foot responsible for pushing off the ground and pointing the toes or “planting” the toes (plantar-flexing). 

Plantar fasciitis is inflammation or irritation of this thick connective tissue.  It often causes a pulling, aching, or sharp, stabbing pain in the heel, sometimes running under the arch of the foot to the toes.  This is the result of shearing pressure on the planter fascia tissue from being overextended, overloaded, and/or stretched too far.

Before moving on to the causes and how to prevent, manage, and treat plantar fasciitis, it’s very important to understand one thing:

Fascia is connective tissue, not muscle tissue. 

Connective tissue is thick and made up of collagen.  Tendons, ligaments, and fascia are types of connective tissue.  Connective tissue’s function is to support joints and prevent hyperextension.

Muscle tissue is made of bundles of elastic fibers.  Muscle tissue has contractile capabilities, meaning it can voluntarily lengthen or shorten.  The purpose of muscle tissue is to create movement by pulling on your bones.

The important distinction is that connective tissue has limited flexibility but does not have contractile properties.  Stretching inflamed connective tissue can exacerbate the problem, prolonging or aggravating the condition.  This is the most overlooked issue with most treatment recommendations, even by physical therapists and medical professionals.  Often, a person is instructed to stretch or foam roll the sole of the foot without understanding that aggressively putting pressure on the inflamed tissue can be counterproductive.  This amplifies the stretch and stress on the damaged tissue.  You should not aggressively stretch inflamed tissue! It is very important to consciously target stretching the musculature around the tissue while being gentle in regards to the plantar fascia.

With this said, let’s move on.

Causes

As previously stated, plantar fasciitis is the result of overuse, overextension and/or overloading of the tissue. 

Remember, plantar fascia is connective tissue and therefore does not have a large range of motion or ability to get “tight” like a muscle.  Often, the cause stems from the surrounding muscles becoming tight, which creates the environment where an injury can occur.

The cause can be acute, meaning from a triggering incident, or chronic, meaning from prolonged conditions, or a combination.  An example of an acute cause would be slipping and landing on your toes with all your weight causing a strong pull or tear of the plantar fascia.  An example of a chronic cause is a runner who runs every day but doesn’t eat well or stretch and slowly over time develops a mild ache in the heel which one day finally becomes a sharp, stabbing pain.  An example of both would be an athlete who trains intensely most days of the week exhausting their feet, then during a game pushes too hard off of one foot causing a micro tear or pull, such as a wrestler pushing off their toes trying to drive back an opponent.

Other common lifestyle causes include:

• Poor standing posture or foot mechanics 
• Limited mobility in the adjoining muscles, primarily the calves and soleous
• Overuse – common in runners, jumpers and athletes in general
• Improper or no warm up or cool down during exercise
• Poor arch support and/or uneven wear in shoes
• Bearing weight primarily on the toes for extended periods of times such as wearing heels or heavy use of exercise equipment such as stair climbers
• Inadequate recovery – sleep, nutrition, hydration
• Prolonged standing or exercise on hard surfaces
• Aggressive stretching or foam/trigger point rolling
• Obesity

This is by no means an exhaustive list, but the most common from our professional experience.  

Essentially, anything that loads or pulls your plantar facia beyond it’s normal range for extended periods of time can cause plantar fasciitis.

Prevention

The short answer is be aware and minimize or avoid the things listed under causes.  

Focus on keeping a neutral foot position and wear supportive shoes.  Avoid wearing heels and flat shoes when standing for long periods of time.  Change shoes when the tread is worn or there is uneven wear.  Examine how you walk one day to see if your foot turns out, in, rolls in either direction, or if you put more weight on your heel or toe(s).  Make sure your foot is tracking in line, meaning your knees and hips aren’t turned in or out, and you aren’t stepping on your insteps or outsides of your feet.  You can do this by recording yourself with your phone while walking or jogging on a treadmill.  You can also visit a running shoe store that offers a “gait analysis,” visit a sports physical therapist, or contact us here for a mobility screen and plan.

Avoid hyperextending your foot and exercising to the point of exhaustion regularly.  Allow time to warm up and cool down during exercise to avoid pulling cold tissue and stretch your legs after long activities to eliminate built up tension.  

Eat a healthy, balanced diet full of vitamins, with enough calories and protein to support your body.  Food is converted to energy and used to build tissue.  If you do not eat enough to support your level of activity, you are at risk for overuse injuries because your tissues are depleted.  Think of this, if you want to build a 3,500 square foot home, but only have enough materials for 3,200 square feet, well, the walls will be thinner and more prone to problems.  Same goes for your body.  What constitutes “proper nutrition” for you is relative and beyond the scope of this article.  For more information, check out our blog What is a Calorie or schedule a free phone consult here to learn how our certified nutritionists can help you create a healthy nutrition plan for your needs.

As always, make sure you hydrate, sleep well and manage your stress.

Treatment

The first thing to do when creating a treatment plan is identifying the probable causes.  Use our list above as a starting point and spend a few minutes mindfully examining your daily life and any exercise or activities you regularly do.  Knowing the contributing factors of the issue and doing your best to reduce or stop them is step one.  As the saying goes, you can’t fix a leak by constantly pouring out water, you first need to plug the hole, then fix the damage.  Same applies here.  You can’t keep treating the inflamed tissue if you don’t alleviate the conditions that are causing it.

After you’ve mitigated the causes as best as you can, it’s time to address the issue.  Follow these steps:

1. Rest
   
   Take time off.  Simply put, stop overloading the tissue.  We get it, you have to work.  Do your best to sit, wear supportive shoes, stand on an ergonomic pad or soft surface.  Tune down your exercise, take a few days off, focus on upper body and core for a period of time.  
   
2. Relief
   
   Alleviate pain, discomfort and pressure.
   
   • Ice – Use an ice cube or gently roll your foot over a cold can for 5-10 minutes, several times per day.  The cold will alleviate the inflammation. 
   • NSAID – Non-steroidal anti-inflammatory drugs can temporarily reduce inflammation.  Please consult your medical professional prior to taking any medications.  Please use this option sparingly and only if absolutely needed.
3. Support
   
   The purpose of fascia is to support the structure of the foot.  When it is injured, it is compromised and cannot bear the weight as well as perfect tissue.  Wearing supportive items reduces the load on the plantar fascia, giving it time to heal.
   
   • Shoes – Wear shoes that fit, provide adequate arch support and cushion, and that are not worn.
   • Splints – Ankle splints and splints designed specifically for plantar fasciitis during the day or night can help support the irritated tissue allowing it to heal faster.
   • Kinesiology Tape – This is a type of athletic tape used in physical therapy to provide support to injured areas, or areas prone to injury.  They have a strong adhesive with small amount of flexibility to provide support where applied.  A simple search online will show you exactly how to apply this tape.
4. Release
   
   Improving the range of motion of the surrounding musculature is imperative for recovery and preventing another flare-up.  The calves and soleus are two of the strongest muscles in the body (relative to their size), and pull on the heel vertically and back.  These are almost always tight and shortened on people suffering from plantar fasciitis.  This causes  the heel to be statically pulled back, which in turn pulls the plantar fascia on the other end of the heel, exacerbating inflammation. This applies to the smaller musculature between the toes and heel.
   
   • Manual Manipulation – Sit comfortably and use your fingers to gently but firmly massage the bottom of your feet.  Start from the heel and slowly massage from heel to the end of your little toe.  Repeat for all toes to your big toe.  Do this to your calves from behind as well as from the sides.
   • Trigger Point – Use a golf ball, lacrosse ball, tennis ball, or small ball less than 3 inches to gently roll your foot.  The key here is gently.  Remember plantar fascia is connective tissue and cannot stretch far.  Pressing too hard will irritate planter fasciitis, not help it!  Follow the same pattern as manual manipulation with the ball.  You may also slowly curl and extend your toes as you gently roll to stretch the small muscles under the foot.  Imagine holding a fret down on a guitar.
   • Foam Rolling  – Use a foam roller for the larger muscles of the leg, above the ankle.  Roll your calves, shins, quads and hamstrings.  Alleviating the larger muscles will alleviate the muscles connected down in your foot as well.  
   • Stretching – Gently stretch your toes by lightly pulling back on each one while breathing.  Stretch your calves, thighs, and backs of your legs regularly with any combination of stretches you like.  Just keep in mind to gently stretch.  If you feel pain or irritation in your plantar fascia, ease up!
5. Physical Therapy
   
   Depending on the severity of your condition, consider seeing a physical therapist, or sports physical therapist.  We recommend the latter as they deal with this issue regularly and are able to provide more lifestyle recommendations alongside actual therapy.  This option is recommended if your plantar fasciitis was caused by an acute injury, if you have severe pain, or if you feel you may not have good posture or form during exercise which contributed to your condition.  
   
6. Medical Treatment
   
   Often times plantar fasciitis can be alleviated with rest, correcting the contributing factors, and being more mindful of your activity and recovery.  In severe cases such as acute injury, compound injuries, or leaving the condition untreated for an extended period of time, you may have minor tearing or other issues such as a heel spur that is being masked by or mistaken as plantar fasciitis.  We recommend consulting with your doctor, a podiatrist or an orthopedist for further treatment options.

Everything in prevention applies to treatment. Make sure you are mindful of your posture, diet, activity and recovery, along with wearing proper footwear as you go through your treatment protocol.

Conclusion

We hope you’ve found this article useful.  We made an effort to provide a substantial explanation of plantar fasciitis and recommendations for preventing, managing and fixing it. Of course there is more that can be said, and every person is unique. 

If you are not suffering from extreme discomfort, you can start going through our treatment recommendations.  Hopefully this helps.  If you’re interested in streamlining the process and having a specialist look at your gait and movement, and to provide a comprehensive, personalized plan specific to you and your lifestyle, please schedule a free phone consult at cygmaperformance.com/contact.  We look forward to chatting with you! 

References

1 – https://orthoinfo.aaos.org/en/diseases–conditions/plantar-fasciitis-and-bone-spurs

2 – https://www.nccih.nih.gov/research/research-results/analysis-of-data-on-the-prevalence-and-pharmacologic-treatment-of-plantar-fasciitis-pain

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