Heel Pain: Plantar Fasciitis

Plantar fasciitis is, by far, the most common cause of foot or heel pain in active individuals.  The plantar fascia is a band of tissue, a ligament, that spans from your heel to the base of your toes on the bottom of your foot.  Its job is to help maintain your longitudinal arch especially in the push-off phase of walking or running.

Plantar fasciitis can occur as a result of overuse, unsupportive shoes, a tight calf, excess body weight, activity on hard surfaces like concrete, or from systemic diseases like diabetes, gout, Lyme disease, or rheumatism.  Most often, it presents as heel pain at the origin of the plantar fascia.  Start-up pain on the bottom of the heel upon rising in the morning or after sitting for long periods is a common complaint.  Further, the pain is exacerbated by being on your feet for long periods of time; especially on hard surfaces.

If you think about your foot as though it is an ice cube tray, the job of the plantar fascia is to keep the cubes in the tray. The calf pulls up in one side (back of the heel) and the ground pushes up on the other (ball of your foot). Protecting the flexion and strain on the tray is critical to getting plantar faciitis under control.  A rigid yet cushioned running shoe is the first step. One that if you pick it up you can’t bend it, like a New Balance 1540, Mizuno Wave Prophecy, or Hoka shoe.  An orthotic with arch support and a cushioned heel can help as well.

Stretching the calf and the plantar fascia is also important.  By stretching the gastrocnemius muscle within the calf (stretching with the knee straight) you offloads the Achilles pull on the ice cube tray. Night splints limit the tightness that develops in the calf overnight that subsequently pulls on the heel giving you that first step pain.  Deep tissue massage of the plantar fascia while pulling your toes up with your hand also helps loosen painfully contracted fascia.   Rolling your foot on lacrosse ball and/or an ice bottle can help symptoms as well.

Modify your activities to avoid added stress on the plantar fascia. Climbing, jumping, running, or any activity that makes the calf tight (e.g. being on the ball of the foot) can worsen the condition. If you are limping from the pain, why walk for exercise?  You may need a CAM boot to let the foot rest.  Cross train for a while on a bike, yoga, swim, weights, etc.  Build up slowly again when the pain and limp are gone with ellipticals and a level treadmill. Walk comfortably before you run, climb, or jump.