Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain in runners, affecting approximately 10 percent of recreational runners in the U.S. every year. While the foot is in motion during running, the plantar fascia, a thick elastic tissue that stretches from the heel to the base of the toes, works with the Achilles tendon to store and return energy. Because of this powerful attachment, the plantar fascia stabilizes the inner forefoot as forces peak during push-off at the end of a stride. Unlike bone spurs and stress fractures of the heel, plantar fasciitis tends to produce pain during the push-off phase while running, not during initial contact when the foot lands on the ground.

The plantar fascia is a thick elastic tissue that stretches from the heel to the base of the toes. Illustration: Oliver Baker

Symptoms of Plantar Fasciitis

• A sharp stabbing pain or deep ache in the arch of your foot or in the middle of the bottom of your heel.
• Stiffness or pain first thing in the morning (especially when you first get out of bed) that tends to lessen a bit with a few steps, but also tends to worsen as the day progresses and your body fatigues.
• Pain that worsens when climbing the stairs or standing on one’s toes.
• At the beginning of a run, pain may go away or lessen, but it can return towards the end of a run—especially on longer runs.

Causes of Plantar Fasciitis

Plantar fasciitis may result from a variety of factors, such as overtraining, doing vigorous repeat hill workouts or speed work, neglecting to stretch tight calf muscles, wearing unsupportive shoes, starting a running program too aggressively or a general lack of foot strength.
It can also be attributed to biomechanical factors such as fallen arches. The excessive lowering of the arch in flat-footed runners increases tension in the plantar fascia and overloads the attachment of the plantar fascia to the heel bone, leading to eventual inflammation. Other biomechanical factors include an inward twisting or rolling of the foot (pronation) and tight tendons at the back of the heel (Achilles tendon).

Plantar Fasciitis Treatment

There are several do-it-yourself remedies when it comes to treating plantar fasciitis. The first is to massage the arch of your foot with a golf ball, rolling it back-and-forth along the foot’s bottom, and then rolling a frozen water bottle under the foot for about 10 minutes.
Lightly stretching the fascia and the Achilles tendon three times a day and first thing in the morning also helps. One way to stretch the fascia involves sitting down and placing the affected foot across your knee. Then pulling your toes back toward the shin. You should feel a stretch in the arch and some tension when running your thumb along the foot. Hold for a count of 10.
More importantly, wear supportive footwear with enough shock-absorbing cushion and the right arch support for your foot, or invest in insoles that will push on the plantar and keep it from flexing. If you need help determining what is best for you, visit a sport podiatrist or physical therapist or stop by your local running specialty shop and ask for advice.
If pain still persists for more than three weeks, see a sports podiatrist or physical therapist who can prescribe custom-made orthotics, cortisone injections, anti-inflammatories, night splints (including the acclaimed Strassburg Sock), which holds the foot with the toes pointed up and the ankle at a 90-degree angle, or a walking cast if very serious. These methods can decrease symptoms in about 95 percent of sufferers within six weeks.
For severe cases—no improvement after 6 to 12 months of treatment—then your doctor may recommend plantar fascia release surgery, which involves cutting part of the plantar fascia ligament in order to release tension and relieve inflammation. However, only 5 percent of people who suffer from plantar fasciitis need this surgery, and 95 percent usually recover by implementing the nonsurgical treatments outlined above.

Preventing Plantar Fasciitis

To prevent plantar fasciitis, run on a variety of surfaces, especially softer surfaces such as dirt paths or trails, rather than concrete or asphalt. Make sure your running shoes are the right fit and support for your gait by going to a specialty running store and getting properly fitted. Lastly, foot-strengthening exercises can go a long way in reducing future injuries.