Plantar Fasciitis: Heal Your Heel

Plantar fasciitis is a frustrating injury.  It takes a long time to heal and there isn’t a standard protocol for treatment.  However, with the combination of a strict morning routine, massage and some physical therapy exercises, you can soon be back on your (healthy) feet!

Disclaimer:  This post provides some background information but does not recommend any of the treatments without consulting with your doctor.  As always, doctors and physical therapists will be able to give accurate diagnoses and treatment advice.

Highlighting plantar fasciitis / image available CC0

Highlighting plantar fasciitis / Image available CC0

Zombie showing signs of advanced tissue death / image available via CC0

Zombie showing signs of advanced tissue death / image available via CC0

What is Plantar Fasciitis?

  • Severe pain in the bottom of your foot or heel, often noticed in the first few steps after getting out of bed in the morning
  • Common among people aged 40-60 years, but can affect any age [1]
  • Twice as common in women than men [1]
  • Common among athletes [1] [2]
  • Although the wording suggests an inflammation, it is actually more similar to chronic tissue necrosis.  Which is fancy description for ongoing tissue death [3].

What Causes Plantar Fasciitis?

Root causes for plantar fasciitis are hard to pinpoint, but many ideas have been suggested  Some of those are:

  • Overuse [3]
  • Sudden increase in amount of load bearing exercise [3]
  • Weak muscles in hips [3]
  • Tight muscles in calves [3]
  • Weak muscles in foot [3]
  • Leg length discrepancies [3]
  • Flat feet [4]
  • High arches [2]
  • Over pronating [2]
  • Standing on a hard floor much of the day [5]
  • Being overweight [3]

Treatments

Unfortunately the longer you have been battling plantar fasciitis, the longer it will take to heal [3].  The myriad of treatment suggestions available on the internet can be overwhelming, and there isn’t one exact answer.  As a massage therapist, I typically recommend a few things to do to help heal plantar fasciitis.  

First, and most important, NEVER stand up immediately after you wake up.  Healing has occurred overnight while you were sleeping.  The new healing is fragile and brittle.  Standing up before warming up the tissues ruins the healing.  If you MUST get somewhere right away after waking up (like needing to pee), crawl on the floor.  The first time I did this, my husband got up out of bed and chased me down, wanting know if I was okay or if I needed help.  Don’t put any weight on your feet until after warming up your foot and calf.  

Specialized foot massaging ball / Image by Bodymybody.com

Specialized foot massaging ball / Image by Bodymybody.com

To warm up your foot, swing your legs over so you are sitting on the edge of your bed and roll your arches on a golf ball.  Roll each foot until the tingling sensation dissipates–about 30-60 seconds for each foot–and then a few more rolls back and forth for good luck.  This warms and lengthens the plantar fascia and surrounding muscles and brings in blood and nutrients. Golf balls are easy to come by and inexpensive.  However, if you want to spoil yourself you can try a specialized foot massaging ball.  I really like this one (affiliate).  I got it for Christmas a few years ago and it really is a step up from a golf ball.  It doesn’t shoot out as easily on slippery or smooth floors and I feel like I am able to control the pressure and the location of the ball more accurately.

Then roll out of bed and crawl to your foam roller and foam roll your calves.  The calf muscles are connected to your feet muscles.  Foam rolling your calves will warm and lengthen the muscles, which will reduce the stress on your plantar fascia when you do stand up.  Now stand up and continue with your day.  Repeat these three steps after you have been stationary for a while–like sitting at your desk all day.  

I created an image to help you remember the Three Crucial Steps to Healing Plantar Fasciitis / Image by Bodymybody.com

I created an image to help you remember the Three Crucial Steps to Healing Plantar Fasciitis / Image by Bodymybody.com

Other Suggestions

Rest.  Stay off your feet if at all possible.  If you stand much of the day on a hard floor, consider investing in an anti fatigue mat [5].  A thoughtfully designed mat like this one (affiliate) is great for standing desks (the topography encourages leg movement and reduces standing fatigue), but a flat one like this (affiliate) might be better if you need to move back and forth and on and off the mat.  

Wear supportive shoes.  This will prevent your arch from stretching and moving too much while standing/walking/running.  

Roll your foot on a frozen water bottle.  This will ice the arch.  During icing, your capillaries shrink.  After icing, you will notice your skin becomes quite red from all of the blood rushing back to the area.  Blood carries healing nutrients and carries away waste, which can help encourage the healing process.

Orthotics may help support and align your arch as it is healing [6].  They will also provide shock absorption.  Pre made orthotics like Dr. Scholl’s (affiliate) will work, but custom orthotics are better.  

Splinting your foot at night may help [7].  After you get used to your night splint (affiliate), you can add a small rolled up wash cloth under your toes to increase the stretch.  Splinting your foot allows your calves, Achilles, and arch to heal with the muscles in a lengthened position (A shortened position of your calves, Achilles, and foot is a normal sleeping position.  Who sleeps with their toes straight up to the ceiling?).  Since your foot is healing with the muscles in a lengthened position, walking may not cause as much damage, allowing your body to catch up the healing of your plantar fasciitis.

The yellow line shows the relaxed, shortened sleeping angle beside a lengthened L shaped splinted angle. You can especially notice a difference in the length of the achilles in this picture. / Image by Bodymybody.com

The yellow line shows the relaxed, shortened sleeping angle on the left beside a lengthened L shaped splinted angle on the right.  In this picture, you can especially notice a difference in the length of the Achilles. / Image by Bodymybody.com

Massage Might Help

Sometimes plantar fasciitis may be not actually be plantar fasciitis at all, but something called “referred pain.”  Referred pain is the phenomena that pain is felt somewhere other than the source of the pain.  For example, sometimes you will have a headache, but it turns out the reason your head hurts is because of knots in your neck muscles.  

Massaging the foot / Image available via CC0

Massaging the foot / Image available via CC0

Two of the main muscles that have referrals that mimic plantar fasciitis–tibialis posterior and the gastrocnemius–are in your calves, not your foot!  There are a couple more specific foot muscles that also mimic a common plantar fasciitis pattern, and they are found in the arch of your foot near your plantar fasciitis.

Tight muscles in your hips may alter your gait affecting your foot strike.  This change to your gait may also weaken the hamstrings or shorten the calves, both of which are culprits in plantar fasciitis.  

Massage is an all around solution.  Getting a complete lower body massage will cover all of your bases–it will address the tight muscles in hips, legs and feet, the knots creating referral patterns, and directly manipulate the soft tissues where the pain resides. 

Exercises

Elastic therapeutic taping to alleviate plantar fascia pain / Photo by Bodymybody.com

Elastic therapeutic taping to alleviate plantar fascia pain / Photo by Bodymybody.com

If you have a chronic case of plantar fasciitis, a good resource would be a physical therapist.  Physical therapists can administer treatments like ultrasound and dry needling (both of which have shown some promising results [8] [9]).  A physical therapist may also try elastic therapeutic taping (You can get your own tape here (affiliate) and the physical therapist might tape you in a pattern like this).  They will also be able to give you appropriate exercises to strengthen the muscular weaknesses that could be contributing to your plantar fasciitis.  The physical therapist will be able to identify the weaknesses through simple muscle testing.  

Your physical therapist might recommend a variety of exercises.  One that is commonly recommended is towel scrunching.  While sitting in a chair, place your foot on a flat small hand towel.  While keeping your heel on the towel, scrunch the towel with your toes toward your heel.  This increases the strength of the tiny muscles between the bones of your feet in addition to the flexors and extensors of your toes.  Another exercise that works similar muscles would be picking up marbles or stones with your toes and putting them in a mug nearby.  

Towel scrunching exercise / Image by Bodymybody.com

Towel scrunching exercise / Image by Bodymybody.com

Calf eccentric exercises like this one might also be recommended.  This will lengthen the Achilles and reduce tension of the fascia.  Doing exercises after deep massage may help realign scar tissue.  Aligned tissue is healthy, functional tissue.  Calf stretching will help elongate the calf, Achilles, and plantar fascia.  Make sure to do a calf stretch with a straight knee and then repeat with a bent knee.  Bending the knee will target different muscles in your calf than when your knee is straight, and all of those muscles need to be stretched.

If weak hips are a factor in your plantar fasciitis, strengthening your glutes (butt muscles) and piriformis (a muscle in your butt that helps rotate your leg outward) will help.  The physical therapist might give you homework with assignments of rollerblading, penguins or lateral resistance lunges.  

More Aggressive Treatments

If conservative treatment options don’t work, your doctor or physical therapist may discuss more aggressive treatment options.  Keep in mind that more aggressive treatments have potential for more severe side effects and typically cost considerably more money than conservative treatments.  Additionally, cures are not guaranteed and success rates are variable.  Your doctor may suggest extracorporeal shockwave therapy, coblation therapy, or plantar fasciotomy.

What I Wouldn’t Do

I probably wouldn’t do the surgeries referenced above, and definitely wouldn’t do steroid injections or platelet rich plasma (PRP) injections.  Steroid injections are typically used for chronic inflammation, and plantar fasciitis does not exhibit characteristics of inflammation[10].  They aren’t effective and have potential to rip your plantar fasciitis[10] [11].

Steroid injections have the potential to cause plantar fascia rupture. / Image via available CC0

Steroid injections have the potential to cause plantar fascia rupture. / Image via available CC0

In Conclusion

Plantar fasciitis will be quite the battle.  Follow the 3 Crucial Steps of Plantar Fasciitis and consult a physical therapist for other exercises–and then do your assigned homework!  Supplement physical therapy with rest, massage, icing, orthotics and night splinting.


References:

[1]     Kenny, Tim, and Nick Imm. “Heel and Foot Pain (Plantar Fasciitis).” Patient. EMIS Group Plc., 02 Feb. 2016. Web. 23 Oct. 2016.

[2]     Bolgla, Lori A., and Terry R. Malone. “Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice.” Journal of Athletic Training. National Athletic Trainers’ Association, Inc., 2004. Web. 20 Oct. 2016.

[3]     Young, Craig C., MD, Darin S. Rutherford, MD, and Mark W. Niedfeldt, MD. “Treatment of Plantar Fasciitis.Am Fam Physician 63.3 (2001): 467-75. American Family Physician. American Academy of Family Physicians, 2001. Web. 19 Oct. 2016.10

[4]     Wearing, Scott, James Smeathers, Stephen R. Urry, Ewald M. Hennig, and Andrew P. Hills. “The Pathomechanics of Plantar Fasciitis.” Sports Medicine 36.7 (2006): 585-611. Springer Link. Springer International Publishing, 2012. Web. 19 Oct. 2016.

[5]     Werner, Robert A., MD MS, Nancy Gell, PT, Anne Hartigan, MD, Neal Wiggerman, MS, and William M. Keyserling, PhD. “Risk Factors for Plantar Fasciitis among Assembly Plant Workers.” PM&R: The Journal of Injury, Function, and Rehabilitation 2.2 (2010): 110-16. American Academy of Physical Medicine and Rehabilitation. Elsevier Inc, 2010. Web. 20 Oct. 2016.

[6]     Lewis, Rebecca D., Paul Wright, and Laine H. McCarthy. “Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis.” The Journal of the Oklahoma State Medical Association. U.S. National Library of Medicine, Dec. 2015. Web. 23 Oct. 2016.

[7]     Beyzadeoğlu, T., A. Gökçe, and H. Bekler. “The Effectiveness of Dorsiflexion Night Splint Added to Conservative Treatment for Plantar Fasciitis.” Acta Orthopaedica Et Traumatologica Turcica 41.3 (2007): 220-24. National Center for Biotechnology Information. U.S. National Library of Medicine. Web. 23 Oct. 2016.

[8]     Yu, Hainan, MBBS, MSc, Kristi Randhawa, BHSc, MPH, and Pierre Côté, DC, PhD. “The Effectiveness of Physical Agents for Lower-Limb Soft Tissue Injuries: A Systematic Review.” Journal of Orthopaedic & Sports Physical Therapy 46.7 (2016): 523-54. JOSPT. Journal of Orthopaedic & Sports Physical Therapy. Web. 19 Oct. 2016.

[9]     Cotchett, Matthew P., BPod, Shannon E. Munteanu, PhD, and Karl B. Landorf, PhD. “Effectiveness of Trigger Point Dry Needling for Plantar Heel Pain: A Randomized Controlled Trial.” Physical Therapy 94.8 (2014): 1083-094.Physical Therapy. American Physical Therapy Association. Web. 20 Oct. 2016.

[10]    Lemont, Harvey, Krista Ammirati, and Nsima Usen. “Plantar Fasciitis: A Degenerative Process (fasciosis) without Inflammation.” Journal of the American Podiatric Medical Association 93.3 (2003): 234-37. National Center for Biotechnology Information. U.S. National Library of Medicine. Web. 19 Oct. 2016.

[11]    Lee, H. S., Y. R. Choi, S. W. Kim, J. Y. Lee, J. H. Seo, and J. J. Jeong. “Risk Factors Affecting Chronic Rupture of the Plantar Fascia.” Foot & Ankle International 35.3 (2014): 258-63. National Center for Biotechnology Information. U.S. National Library of Medicine. Web. 20 Oct. 2016.

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