Hello and welcome to the Tread & Butter Foot Health Journal, wherein we share information, research, and insight from trusted experts on all things foot-related—starting with this in-depth guide to preventing and treating plantar fasciitis!
For our Foot Health Journal, we’ve walked the walk, done our homework, and spoken with some of the best physical therapists in Bend, Oregon (where Tread & Butter headquarters is located🤘). Combining their insight and knowledge of foot health with our background and research in arch support, we present to you the ultimate guide to plantar fasciitis causes, symptoms, treatment, and prevention.
We hope it brings you the information you need, the plantar fasciitis relief you deserve, and the time back on the trails you long for.
One of the most common causes of heel pain and foot discomfort, plantar fasciitis stems from an inflammation of the plantar fascia (a band of tissue that runs along the bottom of the foot and connects your toes to your heel bone). While there are a number of ways to prevent and treat the heel pain associated withplantar fasciitis—including specific stretching and strengthening, targeted arch support, rest, and daily exercises for plantar fasciitis—recovery time can often take up to 6 months.
Yes, half a year of plantar fasciitis sounds like a long (and painful) time. We get it. But we want you to take a deep breath, read on, and know that you’re in good hands with our in-depth guide to preventing and treating plantar fasciitis.
While we already defined plantar fasciitis, what we didn’t do is include a little graphic (we see you, visual learners). Below is a graphic we threw together showing where plantar fasciitis pain typically occurs—the bottom of the heel, around the heel, and across the bottom of the foot (though not necessarily in the arch, mind you—more on this later).
Feel the pain. Image: Adobe Stock
Now that you’ve got a visual for where plantar fasciitis heel pain typically shows up, you can connect the dots as to how this pain is caused by an inflammation of the plantar fascia—that band of tissue that supports the arch of your foot and runs from heel to toe.
According to Tim Evens, one of the physical therapists and foot health experts we consulted with for this article, “When you have plantar fasciitis you start your day with adhesions along your plantar fascia, and it’s very painful. You wake up, start to move your feet around (which begins to break up the adhesions) and the pain can be almost unbearable.”
What’s with the adhesions, Tim? “Well, when our feet see too much use and not enough rest, the fascia (a thin casing of connective tissue) can become inflamed. While the connective tissue in our feet experiences microscopic tears all the time, it usually heals up tougher once we give our feet the rest they need. If we repeatedly deny our feet rest, however, the fascia experiences more breakdown than healing over time, and adhesions and inflammation occur.”
Tell us more—give us a visual on what causes plantar fasciitis pain.
“Sure. The connective tissue runs in one direction and, under a microscope, looks like a rope. When this rope gets pulled on, microscopic tears occur. Over time, and without proper rest and care, chronic plantar fasciitis sets in and causes this ‘rope’ to look as though it’s full of little pock marks. These jelly-like pock marks (glycosaminoglycans, or, GAGs for short) are what feel crunchy and need to be broken up in order for plantar fasciitis pain to start to lessen.
Basically, plantar fasciitis is caused by too much physical stress for the amount of rest your feet are getting. If you’re a runner, or work on your feet all day, or put in any kind of hiking or walking mileage, you start to create an imbalance between what your feet can actually handle and what you put them through. Too much of an imbalance between standing, walking, running, and rest leads to zero downtown for your connective tissue. Which leads to adhesions and inflammation. Which, in turn, leads to the heel pain associated withplantar fasciitis.”
So, when we don’t allow our feet to heal well enough before we push them again, this is what causes plantar fasciitis?
“Yes! Chronic overload—walking, running, standing all day every day—with not enough rest built in is a surefire way to point your feet in the direction ofplantar fasciitis.”
“As far as plantar fasciitis symptoms go, one of the biggest things is that the heel pain is usually worse in the morning, after your feet have rested in a somewhat pointed position and you take your first steps. These first steps break up all the adhesions that had occurred overnight along the fascia. And this breaking up of adhesions is why plantar fasciitis is so painful.”
Yup, the research we’ve done on plantar fasciitis symptoms says the same. It also notes how this pain can feel like a stiffness along the bottom of the heel (not the arch), and can develop slowly over time or come on suddenly.
Other things to keep in mind? Plantar fasciitis pain can either be dull or sharp, a deep ache or a kind of burning sensation. The key to determining whether ornot your pain is the direct result of plantar fasciitis is to remember when (first thing in the morning) and where (bottom, inside of heel) it’s occurring.
Tim, does that sound about right?
“Yes. But do keep in mind that while pain can decrease after the adhesions have been broken up a little in the morning, you can still experience pain from plantar fasciitis after prolonged periods of standing or sitting, when walking up stairs, or after intense activity (like walking, running, jumping, or dancing).”
Just say to no to plantar fasciitis. Image: Adobe Stock
Whether you visit an experienced physical therapist like Tim Evens, or address your plantar fasciitis with at-home treatment, it’s important to make a plan and stick with it in order to achieve the best possible outcome for your feet.
To start reducing heel pain and experiencing plantar fasciitis relief, you’ll want to think about how you can reduce inflammation while stretching and strengthening your feet, ankles, and calves. Protecting your plantar fascia from retraumatization is also essential.
Here’s how to do all of the above while still staying active (while you should avoid running, as well as an abundance of walking and standing while trying to heal your plantar fasciitis, total inactivity is not a good idea—it causes stiffening of the fascia, which, as you know by now, is painful to break up once you start moving around again).
Not quite RICE, but… Rest, ice, and give yourself (or get) foot massages to help break up the adhesions occurring on your plantar fascia. Painful, yes, but very worth it in the long run. To help lessen the pain you feel in the morning, you can purchase one of those dorsal night splints for plantar fasciitis (these help keep your toes pointed up and your feet at a 90-degree angle, thus reducing the potential for more adhesions to form overnight).
For icing, you can rest your arch and heel on an ice pack or a bag of frozen vegetables—whichever will most conform to your foot and arch. Either way, it’s best to ice 15-20 minutes at a time, several times a day.
Place a lacrosse ball beneath your plantar fascia and roll your foot across the top of the ball. Along with deep-tissue massage and walking around barefoot for short periods of time throughout the day (Tim endorses periods of barefoot walking as being integral to overall foot health), using a lacrosse ball under foot will help break up adhesions and prevent stiffness.
Because it’s one of the most important components of healing plantar fasciitis, we’re going to say it again: REST. This can and should include some active rest like swimming, biking, or any other non-impact activities you can think of.
We’re going to segue this portion of our guide to healing plantar fasciitis into the next section (how to prevent plantar fasciitis) because stretching and strengthening are both huge components of plantar fasciitis treatment and prevention.
Keep reading and we’ll see you in a second.
We’re still here and so are you—great news! Now onto the kinds of stretches and strengthening exercises that will help treat and prevent plantar fasciitis. With stretching, you loosen up the plantar fascia, tendons, and muscles. And with strengthening, well, you strengthen your feet and everything else that goes into supporting them.
While doing the following plantar fasciitis stretches and exercises 2-4 times a day is ideal, what’s most ideal is what you can organically fit into your busy schedule (yes, you can multitask here) and make work for you. Without further ado, here are some of the best stretches for plantar fasciitis (start slowly and listen to your body)!
Stand at an arm’s length from a wall and place one in front of the other (about 12 inches between both feet). Keep the toes of the back foot pointed toward the front heel. Lean towards the wall and gently bend your back leg forward while keeping the knee straight. Both heels should remain on the floor. Hold for 10-15 seconds and repeat on the other side.
Stand on the edge of a step and slowly begin to relax your calf muscles, letting your heels move down and over the edge of the step. Hold there for 10-15 seconds, rise back up to neutral, and gently repeat several times.
When it comes to preventing and treating plantar fasciitis, a solid pair of shoes [including nice insoles] and the right kind of support go a long way. In fact, according to The American Academy of Orthopaedic Surgeons, “adequate support and proper fit are... important to avoid heel pain and prevent other running-related injuries. Be sure to buy new shoes as frequently as you need to so that they provide the support and cushion your body needs to stay free of injury.”
Looking for high-quality arch support for heel pain and plantar fasciitis? Tread & Butter has your back. Well, ok, we have your feet—but your feet support your back and you might as well start with the foundation, right?
And from us to you: May your plantar fasciitis heal and you once again experience the joys of pain-free running, hiking, walking, and standing. We’re rooting for you and your feet, every mile of the way.
Tim Evens is the owner and physical therapist extraordinaire behind Evens Physical Therapy in Bend, Oregon. As someone who analyzes running for a living, Tim will wax poetic any old time about the ins and outs of foot health, foot biomechanics, and plantar fasciitis. Got questions? Give him a shout or book a PT session with him.