The Runners’ Guide to Plantar Fasciitis

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We regularly revisit this page to top up information for you regarding the Causes, Prevention & Treatment of Plantar Fasciitis, enjoy our 2021 article.

For many runners, there’s nothing worse than feeling the first twinge of pain that signals an oncoming injury.  One of the most common injuries that runners deal with is Plantar Fasciitis, a debilitating ailment that affects the lower leg.

When should you suspect you might have PF? For some, it may begin as a nagging pain in their heel. For other people, it presents as a dull ache that affects the entire bottom of their foot.

Yet another group of people experience numbness or face more serious complications, such as a partial or complete rupture or tear, which will stop them in their tracks. The pain experienced can become truly unbearable while running, which can lead to extended periods of rest and recovery.  This can end up sidelining and hampering your training schedule.

The most common symptom is heel pain first thing in the morning

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What Is Plantar Fasciitis?

Plantar Fasciitis is an inflammation or irritation within the foot. This is a band of ligament that runs from your heel to your toes, supporting the arch of your foot. Also known in the running community as PF, it is commonly thought to be an overuse or misuse injury.

In a healthy person, the tissue stretches as their foot strikes the ground while running or walking. In individuals experiencing PF, however, the ligament is unusually tight and causes tiny tears and strains.

After a period of time, these small injuries can be exacerbated and lead to swelling and pain in the ligament, typically felt in the heel.

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There is some research that shows that it may not be an inflammatory disease and may actually be a degenerative disease. This means that the tissue is beginning to wear away after repeated irritation, rather than getting inflamed. At the onset of the condition, there may be inflammation resulting from overuse or misuse. As the condition persists, it is thought that the tissue begins to degrade.

This is what causes the pain, rather than the tissue remaining inflamed as long as symptoms are present. This theory would lead to a chronic condition, as opposed to a condition that can be treated and will completely heal. After all, if the ligament is degenerating, there isn’t a way – without surgery – to get that tissue back and restore health to the tissue.

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Symptoms Breakdown

  1. Pain in the heel – especially if it is worse in the morning and seems to lessen with activity
  2. Swelling along the arch of the foot, in the heel, or on the ball of the foot
  3. Pain along the arch of the foot
  4. Weakness in the ankle or arch of the foot
  5. Tightness in the calf or Achilles tendon that doesn’t respond to moderate stretching

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What Does Plantar Fasciitis Feel Like?

Plantar Fasciitis feels like pain in your heel and you may notice swelling in that same area. It can also radiate as pain in the bottom of your foot. In addition, many people notice that the discomfort is much worse first thing in the morning. Often times the pain gets better after you move around and loosen up the muscles. 

You also might notice weakness in the ankle or tightness in the Achilles tendon that fails to respond to stretching.

PF Causes

Plantar Fasciitis thought to be an overuse or misuse injury, resulting from being too tight to support the pressure of walking. For some individuals, tight ligaments may be due to improper stretching or increasing activity too quickly, whereas for others it may be more of a mechanical/anatomical issue.

This can be prevented by stretching properly before beginning intensive workouts, or by incrementally increasing the intensity of your workout over time.

Posture plays a big role in overall body health. A properly aligned spine, neck, and shoulders when standing and running are paramount to good running form. Having improper posture can result in extra pressure being distributed throughout the body: from the pelvis to the knee, all the way down to the lower foot. This extra pressure flows down through the body and can cause your feet to react negatively as a result. This is why posture is a common culprit.

Women who frequently wear high heels may find that they are prone to the condition. This is because their calf muscles get tighter and shorter when wearing them, making it difficult to stretch when they are wearing flat shoes or sneakers. While this is an injury that can afflict men and women equally, women runners experience it more often if they wear shoes that lack proper arch support.

Another common cause is excessive pronation. This is where your body weight is disproportionately distributed to your feet. Signs of excessive pronation include excessive bending of the ankle and flatter arches. Overpronation has been cited as the culprit for many different running injuries, and studies have shown that the damage caused by it is exaggerated. However, it’s still a possible cause, and should be considered before any other causes.

Causes Breakdown

  1. Uncomfortably high level of activity
  2. Tightness of calves and Achilles tendons
  3. Excessive foot pronation
  4. Wearing shoes with poor support
  5. Weak leg muscles
  6. Degrading tissue

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What Aggravates Plantar Fasciitis?

There are certain plantar fasciitis triggers to avoid. 

  • Starting a new fitness routine.
  • Changing your exercise intensity.
  • New shoes: sometimes a new kind of shoe can trigger a flare-up. 
  • Old shoes: Don’t let shoes get too old and broken down. 
  • High heels can irritate your PF.
  • Tight calf muscles.
  • Injury: Injuring another part of your leg can lead to a PF flare-up. Don’t make the mistake of trying to run through injury. 

As you can see, there are a number of risk factors, although experts debate as to which ones are the true culprits. It may be that individuals who have a combination of these traits develop Plantar Fasciitis. An example would be someone who frequently wears high heels, is overweight, and has tight calves. 

On the other hand, it may simply be dumb luck; some who overpronate will get it, while others won’t. Regardless, it’s important to know the signs and symptoms.

What Can You Not Do With Plantar Fasciitis?

Exercises that can make Plantar Fasciitis worse include jumping, running, plyometrics, burpees, etc.

Anything that is high impact should be avoided.

Diagnostic Practices

Typically, medical imaging (x-ray, CT scan, etc.) is not needed as a diagnostic tool; a simple physical examination will suffice. However, a doctor may decide to order imaging tests if there is a possibility of a fracture or break.

This is especially common if the pain is very sharp or presenting in an atypical manner. In the absence of any issues with the bones, it will be diagnosed based on the presentation of physical symptoms.

In order to achieve an accurate diagnosis, doctors will review current symptoms experienced by their patient. This is done by pressing along the bottom of the foot and heel looking for tender spots, swelling, or any portion of the leg that feels unusual.

The doctor may also ask the patient to walk or run a bit so that they can examine the patient’s stride and see if there are any mechanical issues which may have contributed to their injury.

They may ask questions related to the patient’s exercise habits: whether they are stretching properly before working out, whether they’re wearing the appropriate sneakers, and what type and length of workouts they’re putting in every week.

You may think that these diagnostic procedures are invasive and excessive, but it’s very important to rule out any false positives. According to this practicing podiatrist, heel pain can be caused by a number of ailments, including cysts, tears, gout, or a full-on stress fracture.

Even if you experience very mild heel pain, it is highly recommended to seek a thorough diagnosis, as these injuries can worsen over time.

False Positives

Not all cases of foot pain are related to Plantar Fasciitis. While it is a common running injury, there are other potential causes of foot pain.

A big reason why it’s important to receive a proper diagnosis is that it requires different treatment methods than other foot injuries. Be sure to rule out these other ailments before beginning treatment to avoid wasting your time and money:

  1. Achilles Tendonitis: This is the injury most frequently confused with Plantar Fasciitis, causing pain and swelling in the back of the ankle.
  2. Heel Spurs: Often found in patients with this condition, this is not the cause of that injury nor a symptom of it. It is a buildup of calcium that causes a protrusion in the heel.
  3. Heel Bursitis: A swelling of the bursa, or cushion found near the ankle. Often associated with Achilles Tendonitis.
  4. Heel Stress Fracture: One or more small cracks in the bones near the heel. Has similar causes and pain, but is a different condition entirely.
  5. Bone Cysts: Also known as an intraosseous lipoma. While scary sounding, these are non-cancerous and easily treated fluid pockets in the bones.
  6. Arthritis: Commonly afflicting older people, this autoimmune disease causes joint pain in several locations on the body.

Plantar Fasciitis Treatment

What Is the Best Way to Relieve Plantar Fasciitis?

1. Anti-Inflammatory Medicine: Something like Advil or Ibuprofen can decrease swelling from foot damage and will numb some of the pain. There are stronger anti-inflammatory drugs and topical creams you can use for more serious cases, but you’ll need to get a prescription from a doctor to obtain them.

2. Massage: Some physical stimulation to the affected area can help to reduce a lot of the swelling and pain  in milder cases. Something as simple as a foam roller, a tennis ball or a towel can be effective, but what works even better is something cold, like an ice-cold bottle of water.

This is best done in conjunction with other methods, such as anti-inflammatory medicine and KT tape. 

3. Kinesio Tape: KT tape is an elastic material that can provide additional support to the foot as well as reducing inflammation. By limiting the movement, properly applied KT tape will prevent the issues that cause and worsen the inflammation.

However, this is only a temporary fix for the problem, and shouldn’t be used very frequently. 

4. Night Splints: The night splint is used to keep the foot in a neutral position over night. Since so often the terrible pain is first thing in the morning, this can be helpful.

5. Physical Therapy: Seeing a professional to learn exercises and stretches to help alleviate your pain and problem is for sure time well spent. If you cannot fix your problem at home with anti-inflammatories, a bit of rest and some massage, consider getting professional advice.

6. Shock Waves: Extracorporeal Shock Wave Theory, or ESWT, is a method of relieving pain from Plantar Fasciitis by generating vibrations from sound waves.

7. Acupuncture: Selective use of acupuncture can greatly decrease foot pain in a majority of cases.

Breakdown of Steps for Treating Plantar Fasciitis

These are ordered from least to most severe.

  1. Resting affected foot while applying ice
  2. Stretching and physical therapy
  3. Ultrasound therapy
  4. Wearing a splint
  5. Steroid Injections
  6. Surgery

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Plantar Fasciitis Prevention

Plantar Fasciitis can be treated when it comes up, but it’s equally important to take measures in order to prevent it from ever occurring. This is especially the case if you’ve just recovered from a bout of it since your likelihood of repeat injury is high.

Keep these techniques in mind and you should be able to prevent any future occurrences of Plantar Fasciitis.

Method 1: Proper Stretching

The first line of defense in preventing Plantar Fasciitis is to make sure you’ve thoroughly stretched your calves and ankles before every workout. If you wear high heels often, you may also want to stretch during the day and at night before bed. This will prevent your calf muscles from tightening or shortening, which can cause problems down the line.

The most commonly held belief is that Plantar Fasciitis is caused by excessive tightness in your calf muscles, Achilles tendons, or toe muscles. If these are too tight, they pull at your plantar fascia in an effort to maintain normal range of motion.

Therefore, stretching these groups of muscles will help lengthen them and eliminate the strain on the plantar fascia.

8 Stretches to Prevent Plantar Fasciitis

These are some simple stretches you can do to help reduce tightness in trouble spots, such as the calf and Achilles tendon. Some of these stretches may require additional materials, such as a step, towel or resistance band.

Plantar Fasciitis stretches
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1. Step Stretch: While standing on the edge of a step with your heels hanging off, slowly lower and then raise your heels. Do three sets of 10 or two sets of 15.

2. Domes: Stand flat on a floor and press your toes down into the ground, forming a dome with your entire foot. Hold and release for three sets of 10 or two sets of 15.

3. Calf Raises: While standing flat on a floor or on the edge of a step, raise and then slowly lower your heels. This movement is essentially the opposite of the step stretch. Do three sets of 10 or two sets of 15.

4. Marble Pickups: Place a cup on the floor next to a pile of small marbles. Use your toes to pick up the marbles and place them in the cup. Do this with both feet.

5. Toe Stretches: While seated, grab your big toe with your hand and pull it back, toward your ankle. Hold for 20 to 30 seconds and release. Do this with both feet, 3 or 4 times a day.

6. Achilles Tendon Stretch: With one leg behind the other, extend your front knee while keeping the bag leg straight. Hold this lunge position for 10 seconds and then release. Do this ten times for each foot, up to three times a day.

7. Rolling Foot Massage: Using a foam roller, roll the sole of your foot back and forth across while seated for one minute. Repeat with your other foot. This can also be performed with a cold water bottle or metal can.

8. Arch Stretch: Loop a resistance band under the arch of your foot while seated. Full the band toward your body, stretching your toes. Hold for 15 to 30 seconds. Do this for both feet, three times a day. You can also use a rolled up towel for this exercise.

Method 2: Appropriate Footwear

You’ve probably already asked yourself what would be the best option for plantar fasciitis.  Wearing supportive footwear will help to decrease pressure on the plantar fascia, thus preventing inflammation. The main cause is a swollen or degenerated tissue.  

Therefore, shoes that support the arch of your foot will distribute the pressure caused by your body weight, helping to alleviate pain and prevent further injury. In addition, using orthotics such as gel inserts can also decrease stress on your lower foot, even in shoes without adequate arch support.

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Top Shoe Models for PF: Asics Gel Kayano 27 | Brooks Adrenaline GTS 21 | Asics GT 2000 9

While these aren’t to be worn during the day, night splints are also a very effective form of footwear that can prevent Plantar Fasciitis. If you have abnormal sleep habits and feel sore in the morning, you may want to consider wearing a night splint when you go to sleep.

These will gently stretch your plantar fascia and Achilles tendon, preventing stress while sleeping. They are generally meant to be worn temporarily, but you may want to wear it from time to time if you find your heel acting up.

Method 3: Incremental Training

One of the most common causes is overexertion. This can occur when runners increase their level of activity to a level too high for their body to adjust to. If you’ve started running several miles a day after a long period of inactivity, this is the most likely cause of any heel pain that may occur.

This common culprit for Plantar Fasciitis is confirmed by medical professionals, and slowly acclimating the body to working out is the proposed solution. A good rule of thumb to adhere to is that you should increase the length of your workout by 10% every week.

When first starting to run seriously, it’s a good idea to run on softer surfaces. If you have access to an Olympic-style track with a rubbery material, that is an ideal training surface for running. If that isn’t available, try running on grass or soft dirt.

Some surfaces to avoid (at first) are cement sidewalks and asphalt, as these are harder and can cause more shock to lesser developed knees and feet.

While studies have shown that the effects of surfaces on running injury are mostly circumstantial, it’s still a good idea to start with softer surfaces, as it can help develop muscles and proper running form.

Running Surfaces, Soft to Hard:

These are some of the different running surfaces you may encounter when training, ordered from softest to hardest. It’s a good idea to train on all types of surfaces eventually, but in order to avoid injury, you should start with the softer surfaces first.

  1. Olympic-style running track
  2. Carpet
  3. Grass
  4. Soft Dirt
  5. Gravel
  6. Asphalt
  7. Hard dirt
  8. Hardwood floor
  9. Cement

Method 4: Correcting Anomalies

For some people with Plantar Fasciitis – especially those who have it as a result of an anatomical abnormality – the best preventative measure is to correct those abnormalities. This ensures that your running form is correct, and is more effective than simply using orthotics.

Orthotics can help in the short term, but correcting the underlying problem with your gait or posture is an effective long-term solution. After all, wearing orthotics doesn’t solve the underlying problems; it simply relieves pain associated with these problems.

There are slight physical deformities that can cause Plantar Fasciitis: for example, having a twisted bone structure or one leg being slightly shorter than the other. In these cases, you should consult with a medical professional in order to identify the most effective solution.

For example, those that have pronated feet may find that a specific orthotic is helpful, while those with a slightly shorter leg may use padded cushions in their shoe to accommodate the height difference.

Don’t Lose Hope

Injuries such as Plantar Fasciitis are inconvenient at best, and unbearably painful at worst. If improperly treated, it can cause setbacks in a runner’s workout, forcing you to lose weeks of effort due to downtime.

In the worst cases, left untreated can lead to serious crippling injuries, permanently affecting your ability to run. Understanding how this injury happens and what areas of your body it affects is paramount to properly treating it.

With the information presented in this article, you should be able to effectively treat any instances of Plantar Fasciitis, as well as prevent future bouts of heel pain from occurring

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Co-written by Eddy Mihai

Curated by Diana Rangaves, PharmD, Rph

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