Plantar fasciitis, a very painful and debilitating condition, is commonly experienced by runners in the spring as many runners begin to taper up mileage in preparation for the spring and early summer racing season.
A sudden increase in mileage along with a transition from indoor running (either on a track or treadmill) onto harder surfaces (such as concrete or asphalt) can cause microscopic injury to the plantar fascia.
This results in swelling and pain. Plantar fasciitis is more common in older runners, but it can occur to anyone at any age. It typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, and especially run.
In this post you will discover the risk factors for plantar fasciitis, and learn how to quickly return to your running routine with these self-treatment techniques.
What is Plantar Fasciitis?
Risk factors for developing plantar fasciitis include:
- Sudden increase in running mileage.
- Excessive speed or hill work.
- Sudden change to running on harder surfaces, such as concrete or asphalt.
- Excessive foot pronation. Your feet tend to roll inward as you stand, walk, and/or run.
- Either excessively high arches or overly flat feet.
- Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
- Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.
- Obesity. Additional force is placed on the plantar fascia while running or walking.
- Poorly fitting shoes or wearing shoes that are worn out.
- Sudden transition from a more built up running shoe into a minimalistic style.
Identifying the Cause of PF
Fortunately, plantar fasciitis can be managed without formal medical treatment. The key is to intervene quickly, and identify the actual cause or causes that led to the inflammation and pain. Consider the following as you begin your rehabilitation:
- Check your shoes. Often, worn out shoes are causing the pain. The inner cushion could be worn out so that the foot is not adequately supported. This could cause over pronation. Shoes typically only last 350-500 miles. If you are nearing those miles, then it may be time to change even if the outer appearance of the shoe still looks good. If you are unsure if your shoes are performing correctly, visit your local running shoe store. The trained staff can inspect your shoes for wear and tear. They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe.
- Add an orthotic. Additional foot control is often needed to normalize gait mechanics. Many running stores sell an over-the-counter orthotic such as Superfeet premium insoles. The blue tends to fit most feet, but a variety of options are available for customization. In my experience, these insoles can last 1,000 to 1,500 miles easily. Custom orthotics may be necessary to correctly support and insure proper foot mechanics.
- Did you progress too quickly into a minimalistic shoe? If you are used to a standard built up shoe, progressing into a minimalistic shoe may be more difficult than you expect and will take more time. Expect a safe transition to take at least three months. I highly recommend waiting until the off season as progressing slowly is always a better choice. Based on your body size, structure, and your foot’s alignment in the shoe, a minimalistic shoe may not be the right choice. It may be better to continue with a traditional shoe or slowly transition from a more supportive and built up shoe to less support over the course of many months.
- Check your running surface. The best and most natural surfaces to run on are dirt, bark or grass. If you are suffering from plantar fasciitis, try to find a softer yet even surface. Otherwise, an asphalt surface is preferable over concrete. For prevention and a cross training strategy, vary your running surface to increase the strength of your feet.
- How is your lower extremity mobility? Mobility issues and myofascial restrictions in your lower legs can be correlated to the development of plantar fasciitis. Try using a foam roller to address any lower leg tightness or restrictions.
7 Tips to Self-Treat Plantar Fasciitis:
- Begin your rehabilitation. Plantar fasciitis will not go away by ignoring it. The longer you wait to treat it, the harder it will be to feel pain free. Start with these Plantar Fasciitis Rehabilitation Exercises.pdf. Complete with instructions and photos, this guide outlines how to safely self-treat your plantar fasciitis.
- Mobilize the tissue. Depending on how aggressive you want to be, a tennis ball, lacrosse ball or golf ball can be used to mobilize the tissue. I recommend mobilizing once or twice per day for 2-3 minutes. Then perform additional stretching of the plantar fascia and calves.
- Use ice. My favorite technique for icing this area is to use a frozen water bottle. Roll your foot over the bottle for 3-4 minutes until your foot starts to feel numb and the pain subsides. It’s possible to frost bite your foot, so be mindful of the length of time you’re icing.
- Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the plantar fasciitis. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises.pdf.
- Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia. Improving your balance can help to reduce the risk of plantar fasciitis and is an important part of rehabilitation.
- Start a supplement. I am a supporter of natural supplements and remedies. Many supplements, such as Phenocane Natural Pain Management and Mt. Capra’s CapraFlex, include herbs which are designed to help reduce inflammation. Phenocane Natural Pain Management combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. Mt. Capra’s CapraFlex combines an organic glucosamine and chondroitin supplement along with several other natural herbs designed to reduce inflammation. It can be taken long term or intermittently to help heal from an injury. I recommend trying either supplement for 30 days. (If you are taking blood thinners, please consult with your physician or pharmacist prior to use as the herbs could interact with some medications.)
- Use a plantar fasciitis night splint. Although a little cumbersome and annoying, night splints can be helpful. While lying, the natural tendency is to flex the foot to point your toes (plantarflex). This position causes the plantar fascia to shorten and tighten, which explains the pain you might experience during the first few steps after sleeping or resting. The night splint helps you to heal by maintaining a neutral position which doesn’t allow the fibers to shorten.
Prior to returning to your normal training activities, insure the following:
- Your involved foot/leg is as flexible as the other (particularly into dorsiflexion, which is flexing your ankle, so that your toes move toward your shin) as well as your calves and Achilles tendon.
- Your involved foot/leg is as strong as the other leg.
- Your ability to balance on one foot is equal in both legs.
- You can jog, run, sprint, and jump without pain. Be careful with a quick toe off or push when attempting to sprint.
With proper treatment, this condition should resolve in 3-4 weeks. Severe cases will take longer. As you taper back into your running program, follow these guidelines:
- Although you will need to progress and train on uneven ground and hills, initially start with level terrain only.
- Initially limit your running distance. I recommend starting with a distance approximately 50-75% of your pre-injury distance.
- Initially start with a slower pace. Don’t immediately progress back into very intense running activities, such as interval or hill training, until you have worked back up to your previous running distances and paces without pain.
- Continue with the rehabilitation protocol until you are performing all of the exercises and running normally without pain.
Plantar fasciitis can be very debilitating and demoralizing, but it can be self-treated if addressed quickly. I recommend following this rehabilitation protocol for 2-3 weeks. If you’re not experiencing relief, please speak with your medical professional. Early management is important for a timely recovery.
For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.
Very informative. Worth the time to read Ben’s article.
Thank you Merri. I’m glad you found it informative.
I sometimes have foot pain after walking or running a distance over 2 miles. The pain tends to be located at the base of my toes. Based on what I just read, I don’t think I have PF. Is there another foot problem common to runners?
Miriam. I agree with you. That does not sound like plantar fasciitis. I would need a little more information to offer more specific suggestions. But based on this information it sounds a lot like metatarsalgia. There are a lot of causes for this type of pain and many of them can be addressed by working through the same suggestions listed in the plantar fasciitis program. I would particularly look at getting different footwear and possibly an orthotic as well as working on using a ball to mobilize the foot. Other possible causes for the pain would be a neuroma or a stress fracture to name a few. I hope that helps!
Great information. After my back surgery I needed to do an abundance of walking on flat, even surfaces. (sidewalks/concrete). I found the frozen water bottle a huge relief from the pain. Thank you Ben for sharing this informative piece.
Thanks for the comment Terry. Your are definitely correct. Sidewalks are a common culprit for all sorts of foot and lower leg pain. The frozen water bottle is a great way to get pain relief. It is also a fantastic way to cool down after being on your feet on a hot day!
Excellent info. My wife had plantar fasciitis a couple of winters ago. A friend of ours is a podiatrist and he suggested the frozen water ball therapy along with stretching your calves. This all worked out very well.
And by the way, he said he’s normally see 60-80 plantar fasciitis patients per week.
Thanks for the comment Brain! Dang, that’s a lot of pf patients.
Wow Brian! I guess spread the word in your community about this post, 60-80 plantar fasciitis patients a week is a ton. Glad to hear your wife recovered well from her bout. It is definitely no fun.
Great stuff on Plantar fasciitis. I had it three years ago and was dealing with the pain for most of the three years. I tried the cold water bottle thing it is effective for some relief just as well as other products and tips that I have found online, but I wanted the pain to be completely gone, especially in the morning. There is a site that I invested about $40 in and I was pain free after 2 weeks on implementing it. I encourage anyone who is dealing with the pain to have a look at this site. http:///www.howtocureplantarfasciitis.org
Excellent. My wife had plantar fasciitis a couple of winters ago. A friend of ours is a podiatrist and he suggested the frozen water ball therapy along with stretching your calves. This all worked out very well.
Hi Ben, your detailed articles on these common injuries always provide with extremely useful and enlightening information, thank you so much indeed. I hope you are safe and sound during this period of pandemic. Here’s my question: After having had a 2-month resting during my recovery period from PTTD, a few days ago I began to get back to running activities on asphalt and probably in higher milage than I should have done, and I have developed pain in the medial arch of my right foot, the same one where I had developed PTTD. It is not a sharp pain near my heel as some docs indicate when defining plantar fasciitis pain, but rather a sense of strain and mild pain in the inner arch. When I get off the bed, it is not that painful but I just feel some mild sensation of stiffness. Do you think it is anything related to plantar fascia ligament and do you still consider useful to follow the protocol that you indicate and, most importantly, do you it is still safe to run with lesser intensity and milage? Once again thank you so much and looking forward to hearing from you. All the best from Turkey
Hi Barish, with your history of PTTD and pain in this location it is very probable they are related. The Posterior tibialis tendon attaches on the bottom of the foot near the navicular bone. This has a direct relationship to the arch of the foot and the plantar fascia. I would utilize both the plantar fasciitis protocol and the PTTD protocol. For now back off the mileage till the pain subsides. And you need to taper up your running extremely slowly to prevent set backs. Usually a 10% increase per week is appropriate, you may need a 5% or less. Slow and steady is a much better idea then a major set back. Hope that helps. Ben
Thank you so much for your prompt response and all the information Ben. I will keep all your advices in mind and hope to overcome all PTTD-related set backs. All the best.
I’ve dealt with Plantar Fasciitis twice in the past year, once in each foot. When it happened for the second time, I had been back to running for about 5 months. So this was quite demoralizing. Strengthening the foot and everything up the kinetic chain really helped. I think the biggest difference came from taking a more conservative approach to increasing mileage, once the foot was feeling better.
Basically, I started out with slow and easy runs that weren’t very long (around 20 minutes), running 4 times a week (aqua jogging twice a week to give the foot a break). I would run in the morning. As long as the foot felt good by that afternoon, I was OK to add 5 minutes to the same run the following week. If the foot felt beat up for the rest of the day, I just repeated the same run the following week and reevaluated.
It was only slow and easy the first month. After this, I slowly began incorporating some speed work. This took some adjustment as I ended up repeating one of the workouts 3 times before I was ready to progress. But the foot adapted and I’ve been able to increase. At this point, I’m at around 70 minutes on Saturday and 55 minutes for each of the other weekly runs. I had a bad habit of increasing mileage too quickly. There were warning signs with both injuries that I ignored. Not anymore. This approach seems much better. It has kept me ahead of the curve so that I’m always stressing the foot at a slower rate than it can recover. Thanks for the great article and helpful information!
Alan…thank you for sharing what has worked so well for you. You offer some very good advice on mileage and proper tapering up. I liked your suggestions on time based off of how you felt and the importance of being okay just repeating workout until your body says its time to progress. Thanks again for sharing. All the best! Ben
Enjoyed looking through this, very good stuff, thankyou . “All of our dreams can come true — if we have the courage to pursue them.” by Walt Disney.
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