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Overuse injuries are the great equalizer, taking out the elite and weekend warrior alike. Most runners experience their share of injury, and although many of these conditions can be nagging, few are more so than plantar fasciitis.
But while plantar fasciitis is common—comprising 10 percent of all running injuries—its underlying cause is still a matter of debate and it remains very difficult to treat.
What Exactly is Plantar Faciitis, Anyways?
Plantar fasciitis is an inflammation of the thick tissue, or fascia, that runs along the bottom of the foot, and is characterized by either sharp or dull discomfort pain in the heel and arch of the foot.
What experts still don’t seem to completely agree on is whether or not the condition is the result of chronic inflammation as originally thought, or repetitive trauma that results in chromic degeneration or weakening of the tissue.
Because plantar fasciitis can strike a wide range of people and little is known for certain about its exact cause, the term can often be used as a catch-all when self-diagnosing injuries.
“There are a variety of other soft tissue disorders that can mimic plantar fasciitis,” said Daniel Riddle, a professor of physical therapy and orthopedic surgery at Virginia Commonwealth University, who has studied plantar fasciitis extensively.
Instead of plantar fasciitis, what you may really have is heel pain or a pulled muscle in the arch. Plantar fasciitis specifically refers to irritation of the plantar fascia where it attaches to the heel bone and runs along the bottom of the foot.
The tell-tale signs that you have plantar fasciitis, said Riddle, are pain on the bottom inside of the heel that often comes with pinpoint tenderness and pain during your first few steps after arising in the morning, because the fascia have stiffened and shortened overnight, which eventually subsides as you move around.
The belief has long been that inflammation in the fascia causes the notable pain at the insertion point on the heel—hence the “itis” in the name of the injury. But recent studies have actually found very few signs of inflammation in injured tissue. It’s now believed that the problem really is one where the plantar fascia thickens and the collagen fibers degenerate or weaken. This may be caused by tears and stress in the soft tissue.
All this confusion could help explain why asking your friends for advice or searching online for plantar fasciitis treatments yields a disturbingly varied wealth of suggestions. Some people swear that they switched to barefoot running and got better; others testify to the magic curing powers of super cushioned shoes.
That discrepancy, said Caleb Masland, a coach and elite runner, can simply be because what is important isn’t how you change your shoes, but that you change them. If you don’t vary shoes or don’t strengthen the muscles in your foot, then “that can become a weak point,” said Masland. Variety is important to prevent the exact same repetitive stress from happening over and over.
Although much of the research into the treatment of plantar fasciitis focuses on stretching, cortisone injections and orthotics, foot strengthening remains a largely unexplored topic.
One article that does address the subject, a 2013 study published in the British Journal of Sports Medicine, calls for increased use of “foot core” strengthening in the treatment of plantar fasciitis. The article concludes, “While temporary support (arch support) may be needed during the acute phase of an injury, it should be replaced as soon as possible with a strengthening program just as would be carried out for any other part of the body.”
The author of the article, Dr. Patrick McKeon, believes that strengthening the intrinsic muscles of the foot lessens the stress to the plantar fascia. “The plantar fascia has to passively stabilize the foot with every stride and strong foot muscles reduce that demand by adding an extra layer of support,” says Dr. McKeon.
The only problem is that while many of these are very popular, they don’t necessarily have scientific research to back them up or have been proven to be only minimally effective. And, most notably, plantar fasciitis tends to resolve itself eventually regardless of what you do, leading many people to run through it — possibly extending the injury — and ultimately swear by whatever treatment they tried last.
“The issue is that there are lots of treatments that might work but just haven’t been studied in much detail. Lack of evidence doesn’t always mean lack of effectiveness. Equally there are also a host of treatments that aren’t likely to make much difference but people try anyway,” said Tom Goom, a physical therapist at The Physio Rooms in the UK and creator of Running-physio.com.
As long as people reduce their training load, work on ankle and foot mobility, and strengthen the calf and foot muscles, then “I’m happy for them to use whatever treatments they find work for them,” said Goom.
Of course, one of the key treatments is figuring out what caused the problem in the first place; otherwise you might just end up right back on the injured reserve list. But when it comes to plantar fasciitis, it’s not always clear what causes the tissue degeneration, initial inflammation, or tearing.
“Anything that can cause repetitive stress or impact [can lead to plantar fasciitis],” said Masland. That includes sudden increases in running mileage or intensity, as well as sudden changes in foot strike or shoes, but it can also come from increases in standing or walking. There have been studies showing that foot structure (really high or really low arches) can contribute to plantar fasciitis, said Riddle, as well as shortening of the calf muscles and Achilles tendon. That’s why strengthening and stretching those areas is an important part of treatment and prevention, but it may not be a golden ticket to being pain free.
“There are a host of reasons,” said Goom.
What’s important: a lasting fix requires more than just anti-inflammatories and ice. And while the underlying cause may seem unimportant to the average sufferer of plantar fascia injury, fixing the problem relies on determining the responsible process.
While most runners try to self-treat and self-diagnose plantar fasciitis, if it’s chronic or fails to get better with multiple weeks of test, then it’s important to see a doctor to make sure you diagnosed and treated the injury correctly. Taking the time to implement all the components of successful treatment increases the odds that the problem won’t become chronic.
“Sometimes you’ll get lucky and it’ll help, but you’re more likely to see success if you seek help,” said Riddle.
5 Expert-Vetted Plantar Fasciitis Home Remedies
In addition to reducing run volume or resting, the most commonly recommended treatments include:
- Arch support and wearing inserts in your shoes
- Changing shoes
- Taping the arch of the foot when walking or running
- ART or massage
- Rolling and stretching the foot
- Rolling and stretching the calves
- Strengthening exercises
- Wearing a splint at night to hold the foot in a semi-stretched position
- Medical treatments like cortisone injections or electro-stimulation
Currently feeling the pain from plantar fasciitis? Clemens recommends completing this daily regime until it subsides.
1. Stretch the fascia.
Prop your toes up against a wall, keeping your arch and heel flat so the toes stretch. Hold for a count of 10. Repeat 10 times three or four times per day.
“Stretching, particularly the plantar fascia, and foot strengthening play an important role in the prevention of future foot problems,” says Dr. Fredericson.
2. Roll a frozen water bottle under the arch.
“Stretch first then roll out the arch for 10 minutes; you don’t want to stretch the tendon when it’s ice cold,” Clemens said.
3. Freeze a golf ball and massage the fascia.
Roll the frozen golf ball under the foot, starting from the front and working your way back. Put good pressure on each spot—the medial, center and lateral positions—for 15 seconds before moving to the next area. Then, roll the ball back and forth over the entire foot.
4. Foam roll all muscles on the body above the plantar.
Common among distance runners with chronically tight hamstrings, back, calves and Achilles tendons, the condition may also be caused by a muscular imbalance in the hips or pelvis. This imbalance can cause slight compensations in the stride that place more stress on one leg than the other, according to San Diego-based running coach Jon Clemens, who has a master’s degree in exercise physiology.
“Even tight shoulders can cause the condition, as your arm swing can throw off proper hip alignment and footstrike,” Clemens said.
While correcting the imbalance permanently requires a strength program that focuses on balance, calf- and pelvis-strengthening drills, said Clemens, treatment to temporarily relieve the inflammation can be performed easily at home.
RELATED: The Right and Wrong Way to Foam Roll
5. Bump your arch.
“Get a commercial insole with an arch bump to push on the plantar and keep it from flexing—it doesn’t matter if you’re an under or overpronator; the plantar needs to be supported and strengthened,” Clemens advised. “Wear the support in all shoes, if possible.”
But it’s important to remember, that one treatment alone isn’t enough. According to a recent review article in the journal, Physical Medicine and Rehabilitation by Dr. Fredericson, the most effective treatment includes stretching of the calf and plantar fascia itself. The article goes on to recommend another common treatment—arch support—stating, “Good evidence exists that foot orthotics may be useful as a treatment for plantar fasciopathy.” In the research summarized by the article, arch support was most effective when combined with stretching.
Addressing both the mobility and stability of the foot will hopefully allow most to recover without any injections, surgeries or other invasive treatments.
RELATED: How to Prevent and Fix Foot Pain