The ultimate guide to beating plantar fasciitis: how to prevent, treat and recover

Struggling with sore feet? Our in-depth guide to beating plantar fasciitis should get you on the road again.

The ultimate guide to beating plantar fasciitis: how to prevent, treat and recover

Heel pain - or plantar fasciitis - is one of the most common and painful running injuries, and can be caused by anything from the constant stress or pressure as your heels hit the ground at speed, to badly fitting trainers, to poor foot structure.

To keep you putting in the miles, we asked PhysioMed for the best tips on how to prevent, treat, and recover from heel pain.

What is plantar fasciitis?

Plantar fasciitis causes pain under the heel and along the bottom of the foot.
The plantar fascia is a thick band of connective tissue. It runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps support the arch of the foot by acting something like the string on an archer’s bow.

Both the plantar fascia and the Achilles’ tendon attach to the calcaneus. The connections are separate in the adult foot. Although they function separately, there is an indirect relationship. If the toes are pulled back toward the face, the plantar fascia tightens up. This position is very painful for someone with plantar fasciitis. Force generated in the Achilles’ tendon increases the strain on the plantar fascia. This is why it is important to stretch both the calf and the Achilles tendon when healing.

Causes and prevention

Plantar fasciitis can come from a number of underlying causes so finding the precise reason can be difficult.

When the foot is on the ground, a tremendous amount of force (the full weight of the body) is concentrated on the plantar fascia. This force stretches the plantar fascia as the arch of the foot tries to flatten from the weight of your body. This is just how the string on a bow is stretched by the force of the bow trying to straighten. This leads to stress on the plantar fascia where it attaches to the heel bone which can result in small tears in the tissue.

Although these tears are normally repaired by the body, this process of injury and repair can lead to irritation and inflammation, as it repeats itself over and over again.

As we age, the very important fat pad that makes up the fleshy portion of the heel becomes thinner and starts to break down. This can lead to inadequate padding on the heel. With less of a protective pad on the heel, your feet have less natural shock absorption.

Other causes of plantar fasciitis:

  • A stiff big toe
  • Reduced heel pad thickness (usually age related)
  • Increased plantar fascia thickness
  • Flat feet or excessive overpronation
  • Reduced calf strength
  • Prolonged standing
  • Badly fitting shoes
  • Previous injury
  • Running on very hard surfaces

If you recognise any of the points above, ensure you are running in well cushioned and well supportive shoes, and incorporate gentle calf and foot stretches to help prevent further heel pain.

Symptoms and treatment

Symptoms include:

  • Pain along the inside edge of the heel near the arch of the foot
  • Pain worsens when weight is placed on the foot, usually most pronounced in the morning when the foot is first placed on the floor
  • Increased pain after prolonged standing
  • Pressing on this part of the heel causes tenderness
  • Pulling the toes back toward the face can be very painful

At-home recovery

The healing of plantar fasciitis is often slow, especially when compared with other injuries. This is mostly because of poor blood supply, so the body’s tissues need a good supply of the oxygen and nutrients carried in the blood to help the repair process. Ice, heat, massage, and gentle stretching of the bottom of the foot and calf can also help to promote blood flow.

In order to reverse the degenerative aspect of plantar fasciitis, rehabilitation needs to include loading and strengthening of the area at the appropriate time as well as stretching.

To help relieve pain and encourage recovery follow these steps:

  • Apply ice - (do not apply directly to your skin, instead wrap the ice in a towel and apply to the bottom of your foot for approximately 20 minutes)
  • Self-massage of the bottom of the foot using a tennis ball or rolling pin, by rolling it along the floor with the affected foot. Gently press on the tennis ball as you do the movement. Start by doing this for 1-2 minutes and build up gradually to five minutes on either foot.
  • Self-massage of the calf. This may be painful initially, but will increase blood flow and improve calf length – both of which aid healing of the foot and should become easier as you go. Remember to give yourself time with the massage as the tissue needs time to relax and let go as you massage the knots away.
  • Maintain ankle range of movement with large foot circles, and pointing and flexing the foot, especially when getting out of bed in the morning or after sitting for long periods.
  • Relative rest, especially from standing, high-impact or repetitive exercise involving the ‘push-off’ action of the foot.
  • Wear shoes (or use an insole) that provide good arch support and shock absorption. 
Trainers or rubber-soled shoes are good options. Choose footwear that does not put pressure on the painful area and avoid shoes which do not fasten securely to your feet, such as flip-flops or sandals without a heel strap/support.
  • If you are overweight, losing weight can help reduce the strain on your feet

Stretch it out

Stretching and strengthening is important to keep the area mobile and flexible, to promote good blood flow to aid healing, and ensure future pain and injury is prevented. Stretches should not cause pain, although a little discomfort initially is fine.

Calf stretch

  • Stand and place both hands on a wall, with your feet about half a metre from the wall
  • Place one leg behind the other and lean your body forwards until you feel a stretch in your calf and Achilles, and hold for 30 seconds. Visualise your calf relaxing and lengthening
  • Whilst stretching the calf, keep your knee straight and your heel on the floor as you lean forwards
  • After this, if you then slowly bend the knee while keeping the heel on the floor, you may feel a stretch in the lower Achilles area, hold this for a further 30 seconds and visualise your calf relaxing and lengthening
  • Repeat twice on both legs

Achilles and foot stretch

  • Stand and place both hands on a wall, with your feet about half a metre from the wall
  • Place your right foot against the wall with your toes curled upwards on the wall, most of your weight will be on your left foot at this stage
  • You will feel a gentle stretch on the bottom of your right foot
  • Bend your right knee towards the wall; you will feel a stretch over your Achilles tendon and through the bottom of your foot
  • Hold 30 seconds and visualise your calf and Achilles tendon relaxing and lengthening
  • Stretches should not cause pain, although a little discomfort initially is fine
  • Repeat twice on both legs

Seated plantar fascia stretch

  • Sit down and cross the affected foot over your other knee, so that the foot is almost resting on the knee
  • Grab the base of your toes and pull them back towards your body until you feel a comfortable stretch
  • Hold for 15-20 seconds
  • Repeat three times

Stair stretches for Achilles tendon and plantar fascia

  • Stand facing upstairs using the stair-rail for support
  • The feet should be positioned so that both heels are off the end of the step, with the legs slightly apart
  • The heels are lowered, keeping the knees straight, until a tightening is felt in the calf
  • The position is held for 20–60 seconds (feel the stretch sensation relax), and then the heels are raised back to neutral
  • Repeat twice

Towel pick-up exercise

  • Sit down with a towel on the floor in front of you
  • Keeping your heel to the ground, pick up the towel by scrunching it between your toes
  • Repeat 10 times
  • As you improve, increase to 20 times. When this is easy, add a small weight such as a tin of beans to the towel

Eccentric loading exercises

Eccentric training of the calf and Achilles tendon is important for full rehabilitation - eccentric loading means working and loading the calf while it is lengthening. This activity both stimulates regeneration of the injured tissue and its correct alignment within the structure. This exercise is to done once your pain has lessened to an easier level but is still present. It may cause some increased pain in the short term. This is normal and is a sign that the tissue is loading correctly.

The pain can be managed by icing the area after the exercise. If the exercise becomes too painful, reduce the number of the repetitions initially, then aim to increase to the three sets of 15. The protocol is shown below:

  1. Step onto the bottom step of the stairs with your unaffected foot. Hold on to the wall or banister for balance.
  2. Lift up onto your toes on both feet putting most of your weight on your unaffected foot
  3. Lift up your unaffected foot so that all your weight is on your affected foot, keeping your heel lifted up
  4. With all your weight on your affected foot, drop your heel down as low as you can below the step

Repeat steps two, three and four 15 times. This is one set. Do three sets twice a day.

Please remember to use this advice under the guidance of your physiotherapist. For more tips and advice, visit PhysioMed online.

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