Plantar Fasciitis (or more accurately plantar fasciopathy) is a common condition in runners. It is characterised by pain along the bottom of the foot, usually localised near the heel. It is also know as “Runner’s Heel”. Plantar fasciitis can be debilitating for some runners and can remain for years if not managed properly.
What Causes Plantar Fasciitis
Plantar fasciitis is caused by either inflammation of plantar fascia (connective tissues under the foot) or by degeneration of this connective tissues. The exact aetiology is still unknown. However, we do know the most common causative factors that increase your risk of plantar fasciitis. These include:
- Sudden increase in running load. This can be an increase in total volume, hill work or speed work. It is overloading the tissues in your feet before they have time to adapt.
- Walking on hard surfaces at work consistently
- Change in foot strike pattern or transition to minimalist shoes
- Reduced ankle and big toe range of motion
- Increased BMI (Body Mass Index)
How to Manage Plantar Fasciitis
Treating plantar fasciitis and preventing it’s return is possible when done right. There is no quick fix for true plantar fasciitis and runner’s cannot expect to be cured overnight. However, you don’t have to stop running for 6 months either.
The plantar fascia works similar to a tendon. It helps us absorb and release energy whilst running. Research shows that tendons and fascia heels best when under load, as load stimulates production of collagen which these structures consist of.
Below we outline the 3 stages of plantar fasciitis management. If you follow these principles, you will be running pain free in no time!
Stage 1: Pain Dominant (Week 1-2)
- Running must cause minimal pain. We recommend avoiding running once your pain is over about 3-4/10, or you have a flair up of pain the day after running.
- Limit walking and other activities to keep pain below 3-4/10.
- Wear your most comfortable shoes. Avoid thongs and high heels.
- Gel heel cups may provide pain relief for some, however evidence suggest they are not helpful for most people (Rasenburg et al., 2018). You can find these at your local pharmacy or online (Wild Earth sell them online).
- Pain management: We recommend avoiding anti-inflammatories as evidence shows most people show little signs of inflammation with plantar fasciopathy. Try rolling a frozen bottle of water under your foot to help relieve pain.
- Start basic non painful rehab. Try static toe curls. See video below
Stage 2: Initial Rehab (Week 2-4)
This stage begins once the initial intense pain subsides. You should be able to walk reasonable distances at this point without excessive pain. The rehab process will commence at this point. Our aim is to stimulate collagen production without excessive irritation of the fascia.
The video above explains the following exercises.
- Isometric toe flexion
- Plantar stretch
- Calf raise of a step with towel/T-shirt under toes
Stage 3: Strength and Conditioning (Week 4+)
- Single leg squats. Start with quarter squats, add weights as able
- Step ups +-weights.
- Continue calf raise exercises from stage 2. Aim to increase weight by filling a backpack with books or using dumbbells/ smith machine at your local gym.
- Skipping with rope. Start with 1 x minute and increase each session.
Pain Guide
You will experience pain during some of these exercises. However, some pain is good for us! Use this guide to ensure you are within the limits of good and helpful pain.
- Pain does not go over 3-4/10 during the exercise
- Pain reduces to baseline levels within 24 hours of exercising
- The pain does is not sharp or burning
Preventing Plantar Fasciitis From Recurring
- Avoid a sudden or excessive increase in volume, speed or hill work.
- Continue regular strengthening exercises including seated and standing calf raises.
- Avoid a large change in shoe type such as a quick transition to minimalist shoes.
Best Running Shoes for Plantar Fasciitis
This is a question we are commonly asked in our day to day work. Unfortunately, changing shoes will not cure your plantar fasciitis. However, shoes with increased a larger heel – toe drop >10mm will help reduce fascia loads. Also, shoes with increased cushioning may help reduce heel pain when running, especially in runners who currently use minimalist low cushioned shoes.
References
Rasenberg, N., Riel, H., Rathleff, M. S., Bierma-Zeinstra, S. M., & van Middelkoop, M. (2018). Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis. Br J Sports Med, 52(16), 1040-1046.
Caratun, R., Rutkowski, N. A., & Finestone, H. M. (2018). Stubborn heel pain: Treatment of plantar fasciitis using high-load strength training. Canadian Family Physician, 64(1), 44-46.