How to fix Plantar Fasciitis (Scientifically proven)

Do you ask yourself how to fix plantar fasciitis because you are suffering from those uncomfortable, stabbing pains in your heel, especially when standing for long periods, walking, or jogging? Stay tuned as this article will present the current evidence on effective solutions.

https://youtu.be/Pvx4-cjQ6Kw

Is Plantar Fasciitis an Inflammation?

Firstly: Why is this important for you to know? Because most people associate inflammation with:

1. Needing to rest

2. Using ice

3. Taking anti-inflammatory medications

But none of these are recommended actions for treating plantar fasciitis.

Inflammation is actually NOT the driver of pain, which is why terms like “plantar heel pain” or “plantar fasciopathy” are now recommended (Riel et al. 2017 & 2019).

Are You Affected?

Plantar fasciopathy is quite common. One in ten people will experience it at some point in their lives.

Typically, it hurts, especially when you get up in the morning or after sitting for a long time, but it gets better once you move around a bit.

Standing and walking for long periods often trigger the problem. Later in the day, it usually gets worse again.

Who Usually Gets Plantar Fasciopathy?

We have two ends of the spectrum here:

On one end of the spectrum, runners are often affected by plantar fasciopathy.

At the other end of the spectrum, we have people between 40–60 years of age who are not very active or carry some extra weight.

If what I’ve mentioned sounds familiar to you, then there’s a high chance you’re affected.

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Causes of Plantar Fasciopathy

Many think a heel spur is the cause or problem behind this pain. However, this does not seem to be the case. This is shown by a study by Hansen et al. 2018.

They looked at people for 5 to 15 years after being diagnosed with “plantar fasciitis.”

The study aimed to look at the long-term prognosis of people with plantar fasciitis and find out if factors like age, gender, weight, physically demanding work, or sports activities could predict how the pain develops.

They found out that there was no connection between a heel spur and plantar heel pain.

Instead, the real cause seems to be poor load management.

What I mean by that is, that the volume, intensity, frequency or duration of the strain on the foot has been or currently is higher than what your plantar fascia can tolerate right now.

And what can we do about this load management issue? Let’s dive into the treatment options now.

Plantar Fasciitis – Therapy

Let’s talk about the most common treatment options for plantar fasciitis and discuss, whether they are useful or not.

Pressure (Manual Therapy or Foam Rolling)

You can do it if it brings you pain relief, but it won’t change anything in the plantar fascia.

There’s a well-known study by Chaudrhy et al. from 2008 which nicely demonstrated, that we can’t really deform the plantar fascia through manual therapy. Here’s a quote:

Our calculations show that the dense tissues of the plantar fascia and fascia lata require very large forces—well beyond the range that humans can normally achieve—to deform them even by 1%. – Chaudrhy et al. 2008

Orthotics

You can use things like heel lifts or orthotics to relieve your plantar fascia somewhat (not forever, of course, but as ADDITIONAL support).

As for shoes in general, I would choose ones that are comfortable for you.

Generally speaking, the less support a shoe provides, the more strain it puts on the plantar fascia. So barefoot shoes are a maximum load in terms of footwear.

Since the cause of the plantar fasciitis is most likely too much strain, then it might make sense to switch from a barefoot shoe to a more supportive shoe for a while, so that the plantar fascia has a bit less strain when you walk or stand.

Don’t get me wrong here – strain definitely isn’t necessarily bad. It might just be a bit too much strain for your foot right now.

Kinesio Tape

Current studies indicate that Kinesio tape does not help more than a placebo treatment for plantar fasciitis.

This is shown by a review by Carmo Silva Parreira et al. from 2014.

To be fair, only one study specifically looked at the plantar fascia. So I can’t take a firm stance here.

What I can say is this: If it helps you, feel free to use it.

Okay, these treatment options don’t look promising at all. Let’s now talk about what really helps long-term.

What helps long-term

Ensure that the tolerance of the plantar fascia is as high or higher than the load.

You can achieve this by reducing the strain or increasing your tolerance. You can easily check the strain on your plantar fascia from walking using the step counter on your phone or wearable if you have one.

A very important principle to remember regarding load management is the 24-hour rule. Your pain should not be higher than 5 out of 10 during and 24 hours after the activity.

Most people just look at the pain during an activity and that’s a big problem. Because oftentimes the pain increases the next day. That’s why it’s essential to keep a good eye on your pain levels.

Ideally, your pain level should be between 0-2 out of 10. 3-5 is acceptable as well. If your pain level goes above 5, then you’ve definitely done too much.

Your biggest takeaway here should be, that it’s absolutely okay to have some pain during training. This is super important, because many people are afraid of this.

Alright – let’s look at the best way to increase your tolerance to strain, which is doing a progressive exercise program.

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Exercises

I’m going to go through a few exercises now. The first exercises I’ll discuss are for symptom reduction, so these are not strength exercises yet. After that, we’ll go through some strength exercises.

For acute pain relief, studies recommend that you should stretch the plantar fascia. I’ll show you an illustration here of how you can do that (DiGiovanni et al. 2003 & 2006).

Simply extend your ankle and then, very importantly, mobilize the big toe into extension. Otherwise, you can of course also roll out the plantar fascia, as I mentioned earlier.

For pain relief, it’s perfectly fine if it helps you. And you can also do things like Toega, which is yoga for the toes.

For building up your long-term tolerance, calf raises are clearly recommended in the literature (see studies like Rathleff et al. 2014 and Riel et al. 2019).

You can follow this progression:

Start with double-leg floor calf raises, then single-leg floor calf raises, then double-leg on a step/stair, then single-leg on a step/stair, then double-leg with added weight, and finally single-leg with added weight.

I recommend doing slow repetitions where you take about 3 seconds going up and 3 seconds down. This type of training is called heavy slow resistance training and is recommended in the literature for tendon issues. And that’s exactly how we should look at plantar fasciitis (see Riel et al. 2019).

Another common tendon issue is the so-called tennis elbow. Check out this article to learn more about tendon issues.

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