What is Plantar Fasciitis?

Plantar fasciitis is technically inflammation of the plantar fascia. Usually this is experienced as pain in the base of the heel especially on the inside of the heel, see picture above. Plantar fasciitis can be debilitating and last for a long time without proper management and treatment. For runners it is often called the kiss of death as when you get plantar fasciitis badly you won't be able to run for a long time.

This doesn't have to be the case though. If you can identify why you’re getting heel pain in the first place and get some early treatment on it then your outcomes should be very positive and we often see clients with heel pain recover very quickly or at least be able to manage it whilst still enjoying the activities they do such as running, soccer and gym.

So first things first. What is the plantar fascia?

The plantar fascia is a thick band of connective tissue that basically connects your heel bone (calcaneus) to the base of the toes. The plantar fascia is one of the most important evolutionary parts of our anatomy. People are always banging on about the opposable thumbs but without the plantar fascia we wouldn’t be able to stand on two legs. Now as the only mammal that can do this we have become much more advanced than the rest, plus our brain and yes the opposable thumbs. But no one every talks about the plantar fascia. You see its job is to support the arch and transmit forces through the base of the foot. It is kind of like arch on a bridge and how that supports the structure and makes it smaller than it needs to be. Without the plantar fascia humans would need to have massive clown feet to support our height. Think about how small our feet are relative to the height of us. Our feet don't make any sense, unless you understand the plantar fascia.

The plantar fascia acts like a spring to maintain the arch in the foot and also absorbs shock from walking or running. When running the ground force can be 2-3 times the body weight so impairment of the plantar fascia can lead to stress fractures, joint issues or shin splints due to the extra shock going through the leg.

The Windlass mechanism

This mechanism is how the plantar fascia creates the arch of the foot to support our body weight during load bearing activities like walking. If you lift your toes up you will see the windlass mechanism at play as the arch will be exaggerated. In fact one of the easiest arch raising exercises you can do is to raise your toes. If you do this 30 times a few times a day you’re on your way to a strong arch my friend.

Is it and itis, opathy or osis or…?

The age old questions raging with Physio’s, Myotherapists, Remedial Massage therapists, researchers, Chiro’s, Doctor’s, Osteo’s and Podiatrists is what these injuries actually are and what we should call them.

Itis - means inflammation ie: fasciitis means inflammation of the fascia. Arthritis means inflammation of a joint.

Opathy - Not apathy…. Although these arguments can make some people feel apathetic… opathy just means disease or disorder. You many have heard of a neuropathy or a tendonopathy? These just mean nerve disorder or tendon disorder respectively.

Osis on the other hand just means condition, so for all of the risk averse practitioners out there many nowadays prefer to say plantar fasciosis or for other injuries they may say you have tendinosis rather than tendinitis. As who know if you have an inflamed tendon??? But we do know you have a tendon condition.

So anyway, that was a long way of saying these days we are more shying away from saying plantar fasciitis as we don't really know if the tissue is inflamed and it is a big assumption to say it is. So the safest bet is to say you have Plantar Fasciosis or Plantar Fasciopathy. But for the sake of ease we tend to just stick with plantar fasciitis.

Moving right along….

What causes plantar fascia pain?

This is a controversial and many faceted question so here for the purposes of keeping this article relatively short I am not going to go into too much detail on all of the causes but the short answer is there are many causes and they are unique to you, like most injuries, so you have to find out what is causing “your” plantar pain and not just what your friend had or Dr Google says, or what I say for that matter.

Common causes:

tightness in the plantar fascia. Generally this happens when you have high arches and the pull on the attachment of the plantar fascia at the heel over time irritates it.
Tightness in the calves, hamstrings or whole superior back line of the body. These muscles and fascia can cause the plantar to be tight and irritate the attachment.
Weakness of the supporting muscles. If the foot muscles are weak (lets face it, if you are wearing shoes all of the time they likely are) then the plantar fascia takes all of the force going through the foot.
Over pronation or over supination. Basically if your foot is unstable and either falls in too much or falls out too much when you walk or worse, run, then this can be a major contributor to pain at the base of the heel.
Weak hips primarily gluteus medius. If the hip stabilisers are weak then the knees with drop in and the feet will also. This can lead to excess rubbing on the heels and plantar.
Poor running style. If you are a runner have you ever had a running coach or been shown how to run? I am always surprised at how many runners have never had a running coach, seems like most. Most people have swimming lessons, or tennis lessons or golf lessons, but few have running lessons. If you are a runner and have any chronic pain you should definitely seek out a trained running coach, running physio, sports podiatrist or exercise physiologist to assess your running style
Increase in activity you are not used to.
A tear. Now this is the kiss of death. As with any tear you have to respect your bodies healing process. Things you can do to speed up the healing include massage to the tear site to increase blood flow and to move on by products. Strengthen the plantar fascia with some isometric holds such as toe curls can be effective.
New footwear. New shoes may be irritating the heel. High heels can also irritate the plantar fascia especially if you don't wear them very often and start wearing them a lot.
Walking bare foot all the time. Especially if this is a new thing. If you have tiles in your house or polished concrete it may be a good idea to wear thongs or slippers sometimes around the house just to take some pressure off the heels.
Bone spur?? In the good old days when injury diagnosis seemed simpler and more clear cut bone spurs were often cited as the cause of plantar fasciitis. These days that idea has been poo pooed by studies showing that bone spurs have little effect on the plantar fascia as they are so thin and fragile like a wafer biscuit that it wouldn’t really damage the thick, tough fascia. Someone should have told Donald Trumps doctor this before they let him use the bone spur as an excuse to get out of military duty.
Death to the tissue. There have been studies that have suggested that chronic plantar fascia injuries are actually dead tissue cells. Not a lot you can do here if this is the case, but I haven’t actually every seen this in the clinic so I am thinking it is quite rare and still a theory. The theory is suggesting that blood supply may not be getting to the plantar fascia causing it to die and then causing pain.

If you are having plantar pain or heel pain then it is important to have it assessed by a qualified professional. We can help you at Muscle Therapy Australia to assess whether it is a tightness issues or more bio-mechanical issue. Or whether it may require a scan to determine if there is a tear.

Common exercises to help:

Often it is a tightness/weakness issue so here are a few exercises you can try to see if they help.

Calves stretching - The calves are actually 3 muscles (Triceps Surae) 2 heads of the Gastrocnemius and one Soleus.

Gastrocnemius (the long calf that crosses the knee)

Stand against a wall with the leg you want to stretch back. Go into a lunge but keep the back foot on the ground. Push against the wall to really increase the stretch. Hold for 1 minute each side. You should so this multiple times per day, especially if the tightness is the issue.

Soleus (the short calf that doesn't cross the knee)

To stretch and isolate Soleus you need to bend the knee Game of Thrones style. This stretch shown is one of the best, also known as the Achilles stretch as you may feel it more there. Make sure to have the heel planted and then lean your weight forward over the knee to increase the stretch. Hold for as long as comfortable but at least a minute. Try to increase your range every time you do it. And do this multiple times per day.

Plantar stretching

Toes pressing back into a door or step which basically pulls the toes back and stretches the plantar. hold for at least a minute.

This is the easiest and possibly most effective stretch. Just sit back unto your toes as in the picture and hold for at least a minute.

Plantar/Foot rolling

Get yourself a tennis ball, lacrosse ball, spikes ball or if you are a sucker for pain a golf ball. Simply roll up and down the plantar fascia for a few minutes. Especially into the heel. You can do this a few times a day.

Isometric calf raises with band around ankles or tennis ball squeezed between heels

The band here should be tight enough that it pulls the ankles inward so that you have to overcompensate and keep them squeezed outward. Hold for 30-45 seconds for 3-5 sets. You can do these multiple times per day.

Have feet about a tennis ball width apart. Place a tennis ball just above the heel. The feet should remain straight and in alignment, not pointing out to the sides. Squeezing the ball helps to stop the ankles dropping in and helps to strengthen the muscles that keep your arch up and stop your feet dropping in. Again hold for 30-45 seconds 3-5 times.

Isometric toe curls

Curl your toes being careful not to curl so hard you give yourself a foot cramp. Hold for 30 seconds and repeat 3 times. You can build up to doing 1 minute each. You can do these multiple times per day and the beauty is you can do them in your shoes sitting down at work or in front of the T.V.

Isometric Toe raises

This is another easy one. All you have to do is keep your feet on the ground, either seated or standing and then simply raise your toes. Keep the ball of your feet on the floor so only the toes are lifting. This is the windlass mechanism remember?? hold for 30-45 secs for 3-5 sets. You can do this at work, in front of the T.V or whilst reading other amazing blogs on Muscle Therapy Australia website ;)

If any of these exercises aggravate your plantar pain then cease them immediately and seek professional help.

These are just some basic exercises. Obviously the hips need to be assessed and hip exercises such as crab walks, glute bridges, clams and monster walks would be advised.

References and further reading: