I needed to visit a nearby store. Google maps said it was just an 8 minute walk. It took me 30 minutes. Every step hurt. I wanted to cry in frustration. This should be easy for me, I was a healthy 28-year-old.
I went to my primary care physician for help, “Doctor, my feet hurt, I think it’s Plantar Fasciitis.”
She said, “Well, that’s a lifelong condition, so get used to it.” *shrug*
She then told me to ice my feet (wrong), and if that didn’t help, there was a surgery I could try (extra wrong).
I was in so much pain and could walk so little, I gained 50lbs.
No one told me my toe bunion surgery could cause Plantar Fasciitis.
That’s a story from one of my clients, and the sad thing is, it’s a common story.
I believe Plantar Fasciitis treatment is seriously lacking in traditional care settings, particularly primary care physicians, who aren’t used to dealing with fascia and generally recommend ineffective or even damaging treatment methods.
Well, working with fascia is what I do. (What is fascia? Read more)
I’ve helped many people get out of pain, and develop strategies so they’re pain-free year after year.
No one should feel resigned to being in pain every time they take a step for the rest of their lives. You can get through this and come out the other side.
Plantar Fasciitis is a difficult condition to manage because of how much we use our feet in our daily lives. During the healing phase, using your feet (even just standing up) will make it worse. So unless you use a wheelchair, your feet never have a chance to heal, and we get caught in a downward spiral of pain.
But Plantar Fasciitis is not lifelong.
You can fix it. Here’s how.
What is Plantar Fasciitis?
Plantar Fasciitis feels like a stabbing pain in your heel, with specific points that are very tender and painful when pressed on. It’s defined as inflammation of the connective tissue that runs on the underside of your heel. Excess stress on this tissue causes micro-tears, which a) hurts and b) causes inflammation. Inflammation makes the problem worse, and the cycle continues.
Plantar Fasciitis is usually diagnosed based on symptoms and a simple physical examination. It’s a very common condition with more than 3 million cases every year in the US alone. Lifestyles that put extra stress on the feet may lead to Plantar Fasciitis, such as running.
When you try to walk in a way that avoids the heel pain, you may trigger knee, hip, or back pain as a secondary complication. Let’s look at some better alternatives...
1. Use heat, not ice
Many people with Plantar Fasciitis dread that first step getting out of bed: you know it’s going to hurt. Or, standing up after working at your desk for a while.
The problem is that your tissue cools when you're inactive, and then when you stand up, the cold tissue is suddenly stretched and weight-bearing… so it tears. Ouch.
How can avoid this? One simple trick is to set up a heating pad at your desk or wherever you're stationary. By keeping your feet and calves warm, you’ll keep the tissue relaxed, pliable, and elastic.
In the morning, try to warm up your feet and calves before you get out of bed. You can spend a couple minutes roll your ankles and flexing your toes, or simply set up a heating pad in your bed, too.
Don't ice. The ice numbs you so you don't feel pain (seems good in the short term!), but it makes the tissue stiff, and when you stand up it will tear (which makes plantar fasciitis much worse in the long term). The old rationale is that icing will reducing inflammation, but if we go a step farther, what’s the source of inflammation? Tissue tearing. What’s causing that? Cold. Recent research suggests that icing isn’t nearly as effective at reducing inflammation as we used to think, anyway.
2. Shoes, shoes, shoes
There’s two things in your life that I believe you should never skimp on: your shoes and your mattress.
If you have Plantar Fasciitis, the first thing you should do is buy new shoes (even if you think you have a good pair right now), and buy high-support shoes. I don’t have any specific recommendations for you, because it’s really about getting shoes that fit your feet, and that’s a personal thing. Some factors to look for in your Plantar Fasciitis shoes, and why:
Thick, cushiony sole
Tall heel (this positions your feet in a slight plantar flex, which helps reduce the strain on the plantar fascia)
Wide toe box (so you can move your toes when you walk as nature intended... great for strengthening your plantar muscles)
Stiff toe section (the less the sole bends, the more protected your fascia is)
Consider trying shoes for "pronation" and "supination" and see which ones feel best as you walk around.
Wear high-support shoes even when you’re just hanging out at home. Why? The first goal of treatment is to stop the pain, because pain means tissue damage has occurred, and tissue damage prolongs the healing process. This is super important: don’t try to be tough. Take care of your feet. Wear comfy shoes 24/7.
How long it takes for your Plantar Fasciitis to get better is directly tied your pain prevention efforts. If you’re a runner, you should consider if running aggravates your Plantar Fasciitis, and look at temporary gentler alternatives if necessary.
If that means you need to buy a special “indoor shoes” pair, do it. Supportive flip-flops can be helpful because they’re easy to put on when you get up in the middle of the night to go to the bathroom.
Wear supportive shoes during a flare-up, and only after you’re out of pain, slowly (slowly!) work your way to less supportive shoes (natural-type shoes with thin soles). In the long term, "natural" shoes will help your feet stay strong and engaged, and prevent recurrence of Plantar Fasciitis. You can also work with a physical therapist to learn feet strengthening exercises, such as the Short Foot Exercise, which help with flat feet.
Performing The Short Foot Exercise Properly [0:53]
3. Soft tissue release (massage & stretching)
Plantar fascia is part of the lower leg soft tissue complex, along the calf and the sole of the foot. This whole area, muscles and connective tissue alike, needs to be relaxed. (This is why Plantar Fasciitis can also cause calf pain or leg pain, in addition to heel and foot pain.)
Massage and stretching are effective for this.
One great treatment is to soak in a warm bath for 20min and then, still in the bath, stretch your calves. Try to touch your toes, and then grab each toe individually and gently, slowly stretch it backwards. Never stretch to the point of pain. I’ve had clients do this a couple times a week and get great results from it.
Massage is also great; not only does it stretch tissue, but it can reduce inflammation (learn more about lymphatic massage) and ease pain signals for immediate relief.
Find someone who’s familiar with treating plantar fasciitis (that means you aren’t just seeing the next available person at your local chain). The massage should include everything except the shinbone: the feet, the calf, as well as the outside of the lower leg. Expect to spend as much time on the calf as the feet, if not more. Even if you only have symptoms on one foot, massaging both sides of the body maintains balance.
Massage Cupping is also very helpful. It’s a decompressive force, which is just heavenly on the feet, since they spend so much time weight-bearing. It’s one thing to push into the feet, it’s another thing entirely to pull out and open them up.
When you’re first beginning treatment you’ll go in for massage more often, perhaps once a week. You wouldn’t go to physical therapy once a month for a year and expect it to solve your problems, you’d go in weekly for two months. Same thing with massage.
It’s hard to break the cycle. You have to baby your feet for weeks or months until your pain goes away. When the pain is gone, it’s not over: it’s time to strengthen your feet for long-term prevention. If you take it seriously and work with your healthcare team, Plantar Fasciitis is not permanent.
I strongly recommend getting massage during the first, painful portion to jumpstart your healing and get over that initial hump. Massage releases the plantar fascia, reduces inflammation, and relieves pain. Those are all things you need to recover from Plantar Fasciitis.
If you developed Plantar Fasciitis after a surgery, you have an additional reason to try massage. Scar tissue, by its nature, is constantly contracting. If you don’t treat scar tissue, it could tighten up to the point of causing Plantar Fasciitis even years after the initial surgery. Massage can make scars more functional, by encouraging stretch and glide in the tissue around the scar.
Learn more about the bodywork I offer in Seattle or schedule an appointment online.
Take care of yourself and don’t give up. You deserve happy feet!