Everything you need to know about Plantar Fasciitis

(pronounced fah-shee-eye'-tiss)

Posted by Danny Dreyer on Mon Jan 28th, 2008, 32 comments

There are a few things in this world I would not wish on my worst enemy. Plantar fasciitis is one of them. If you've ever had it, you know what I mean. When I feel it coming on I get a similar sensation in my gut as Harry Potter might when he knows the Death-eaters are after him … I'll do anything in my power to guard against it becoming a full-blown reality.

This debilitating (not to mention annoyingly persistent) injury can happen to runners and walkers alike. And, it's harder to get rid of than a condo in a recession. I've had my bouts with it and I'd like to offer anything I can to those of you who either wish to recover from PF or avoid it altogether.

My number one suggestion is, the moment you feel it coming on, study your Chi Walking and Chi Running DVD’s to make sure you’re walking and running in a way that will stop this condition from getting any worse. Prevention is truly the best method here. We make suggestions if you’re currently in acute pain, but the key is to avoid and prevent PF at all costs.

Where is the plantar tendon and what does it do?
plantar fasciitisThe plantar tendon runs the length of the bottom of your foot, spanning the area from the base of the toes to the front of your heel. If you think of the arch of your foot as a bow (as in bow and arrow), imagine the plantar tendon as the bowstring. The two ends of the bowstring attach at the base of the toes and at the front of the heel bone by means of fascia, a strong fibrous membrane. The bowstring (plantar tendon) keeps the arch of the foot from flattening completely when the foot is bearing weight, thus providing cushioning and shock absorption when you're walking, running or standing, (see diagram) This tendon also allows you to point your toes.

What is plantar fasciitis and what causes it?
Plantar fasciitis is an inflammation of the plantar fascia, where it connects the plantar tendon to either the heel bone or to the base of the toes.

It can be caused by any motion of your legs that creates a pull on the plantar tendon. That means walking or running up or down hills, climbing stairs, walking or running on your toes (yes, that includes wearing high heels), or dorsiflexing (pointing your toes up as your heel comes down with each stride).

It can also be caused by heel striking, which is usually a result of over-striding. If you're reaching forward with your legs (see page 166 in the Chi Running Book or page 32 in the Chi Walking book) with each stride, you're very likely to land on your heel. Landing in this way can create a force on your heels of up to 6 times your body weight with each footstep. That is a very small area to be absorbing that much weight. The surface area of your heel is about 2 square inches. If you weigh 125 lbs. and you're running with a heel strike, that means the force to your heel is … let's be conservative and say 4 times your body weight. That means that there is 250 lbs./sq. in. of force on your heel with each stride. With that kind of pressure, it's no wonder you end up bruising the spot where the plantar tendon attaches to the heel.

Here's another way you might end up with plantar fasciitis. On the rear side of your heel is the attachment of the Achilles tendon which runs up into your calf muscle. If your calves are tight and/or your achilles tendon is not flexible, you will be pulling and tightening the plantar tendon and weakening the attachment of the fascia to the bone. If for some reason the plantar tendon is pulled beyond what the fascia is capable of holding, the fascia forms micro-tears and begins to pull away from the bone. This will cause the fascia to become inflamed.

Here's a long-term situation to avoid. If the plantar tendon is consistently over-stretched for weeks or months, the body begins to add calcium where the attachment between the tendon and the heel bone takes place. Over time enough calcium is added to actually build more bone mass in that particular spot on the heel … and you end up with a heel spur, which is even more painful than plantar fasciitis. Imagine feeling pain every time you take a step. If the average person takes 5,000 – 8,000 steps each day, that means you'd be feeling pain thousands of times every day. No thanks. I'll do whatever I can to avoid that.

Other causes of plantar fasciitis are:

  • Inflexible shoes, worn out shoes, or shoes that bend in the middle instead of the ball of the foot, where they should.
  • Low arches … or high arches
  • Being overweight
  • Spending long hours on your feet
  • Tight calf muscles or tight/stiff ankle muscles
  • Walking barefoot in soft sand for long distances (sorry, no more romantic walks on the beach unless you're wearing your flip-flops)

What does plantar fasciitis feel like? Of course, this is a very subjective question, so I'll try to give you a range of sensations, progressing from nuance to agony. When plantar fasciitis first appears it can feel like you've got a lump in the heel of your sock. No big deal. No pain…just an uncomfortable "thick" feeling right under your heel.
I find myself taking out the insole to my shoe to see if there's maybe a rock trapped underneath. If, after replacing the insole and straightening my sock out, I still feel a lump under my heal, I take it very seriously. The Death-eaters are on their way if I don't do something!

When you feel it, you know that you’ve slipped into some old habits and that you need to practice the Chi Running and ChiWalking forms some more. Landing with a midfoot strike (Pg. 162 in the Chi Running Book or with a fore-heel strike (pg. 60 in the Chi Walking Book) will insure that you're ankles remain relaxed and your plantar tendon is not overstretched.

In the next level of PF your heel will feel a little tender when you first get up from a chair or get out of bed in the morning. In the early stages the discomfort will go away once your up and about on your feet. But, as the injury advances into later stages, the tenderness will linger and begin to turn into what feels like little needles sticking you in the bottom of your heel with each step. Sounds fun, huh? Trust me … it's not.

In the very advanced stages of plantar fasciitis, you find yourself surfing Amazon to find books on levitation. It aches all day, not just when you’re walking or running.

How in the world do I get rid of it?
I think I can safely say, there's no instant cure for PF, except for maybe Divine intervention. Believe me, I've wished many times there were. It takes time for the inflammation in the fascia to subside and to heal any tears in either the tendon or the fascia. In fact, right up front, when you feel the first symptoms of PF, I suggest you make an agreement with yourself that you will be more persistent than it. Any injury like this, where you can feel it with every step, is always a great opportunity to practice self-remembering and mindfulness in your movement. Be as consistent as possible with all of your Chi Running and ChiWalking form focuses to stave off PF, as it can take quite a while to heal.

Here are some preventive steps you can take at the first indication of soreness in your heel.

Prevention and early treatment:
Learn to relax your lower legs, especially your ankles and calves, whenever you're walking, running, sitting or standing. Tension held anywhere in your legs or glutes will pull on the plantar tendon when you move. Relax, relax, relax…or suffer the consequences. ALWAYS keep your entire lower legs as limp and relaxed as possible…through every phase of every stride.

If you're a runner, you should always be mindful of landing with a midfoot strike. If you're a walker you should land on the front of your heel and roll forward onto the balls of your feet. Never strike on the back of your heels when walking (see page 32 , Fig. 5b, Chi Walking Book). Confirm that you have a straight posture line and that your pelvis is level and that you are landing with your foot directly under your center of mass (Page 168, Chi Running Book).

Don't reach forward with your legs when walking or running. Let your upper body lead and let your legs follow (see page 32 , Fig. 5a, Chi Walking Book). This will help you maintain more of a midfoot strike and avoid all that pounding to your heel … one of the biggest culprits in plantar fasciitis.

Additional things to do:

  • Shorten your stride length when walking or running.
  • Walk and run on flat surfaces as much as possible.
  • Avoid hills, trails and uneven surfaces.
  • Avoid stairs … treat yourself to an elevator.
  • Improve the flexibility of the calf muscles and achilles tendon which pull on the plantar tendon. (see stretches below)
  • Get a foot massage … the deeper the better.
  • Consciously choose to move in a different way (see the Chi Running and Chi Walking books and DVD’s to learn how) so that you’ll never create PF again.

Treatment if you are in acute pain:

  • Soak your heel in a big bowl of ice water (5-10 minutes) twice daily until the pain subsides. It's excruciating, but well worth it.
  • Scrunch towels with your toes or pick up marbles with your toes.
  • If you do drugs, take Ibuprofen for treating inflammation, but PF can last a long time and you should not take Ibuprofen too often.
  • Walk barefoot across a coarse gravel surface. This is one of the best cures for PF I've ever used. If the idea makes you wince, do it in your stocking feet. This somewhat painful "therapy" will vastly accelerate the healing process because it helps keep the plantar tendon supple.
  • Orthotics can help reduce the pain on the bottom of the heel, but be mindful that they will not fix the reason why you have plantar fasciitis. If you don't want to be tied to orthotics for months or years, you'll need to change the movement habits that are causing the problem.

Stretches:

  • Stand facing a wall an arm's length away. Keeping your lower legs and ankles completely relaxed, lean into the wall by putting your hands on the wall directly in front of your shoulders and lowering yourself toward the wall. Hold this stretch for 30 seconds and repeat at least 3 times.
  • Stand on a curb facing away from the street with the midfoot of the sore foot resting on the edge of the curb and your heel extending out beyond the curb. Keeping the healthy foot completely on the sidewalk for stability. Then, slowly lower your heel enough to give your achilles tendon and calf muscle a good stretch. Hold this for 20-30 seconds and repeat 3 times.
  • If you're sitting for an extended period of time (at your desk or anywhere else), dorsiflex your foot (point your toes toward your knee) as often as you can remember to do so. It'll be much less tender when you get up to walk and it will stretch your calves and achilles tendon.

All of this should set you well on your way to either preventing plantar fasciitis or gradually ridding yourself of this all-too-common-but-avoidable problem. With this particular injury there's an old saying that absolutely pertains. "An ounce of prevention is worth a pound of cure."

32 CommentsLeave a comment below

Can I still run? I haven’t ran in 2 months and I’m losing my mind. Running is my life. I haven’t noticed an improvement since stopping the runs. Am I avoiding running for no reason? Will it heel whether or not I run. Please and thanks! Ill run mid foot I promise!-Ian Tobias

Hi Tobias,

Plantar Fasciitis can take a long time to heal depending on the severity, which is what makes it such a frustrating injury. While you’re taking the time off from running, we’d suggest practicing the exercises and treatments described in the article. Generally, it’s not a good idea to continue running with plantar, as the fascia can become more and more stressed. Whether or not you should run is something you have to Body Sense. If it’s in the very early stages and the pain is very mild, try practicing the technique fixes in the article. If the pain worsens at all, stop running and follow the instructions given in the article.

Thanks,
Casey Colahan, ChiRunning

Having dry needling done can help - this essentially puts little holes through the fascia which then has to heal itself correctly instead of too thick as it did the first time. Will chi running really prevent it coming back? I am just at the beginning of a re re recurrence of PF.

Hi Tricia,
If your Plantar is caused by how you run, ChiRunning can prevent it from coming back. Plantar can be caused from other things as well (standing for prolonged periods of time, having very low or high arches, etc.) However, if it’s from pushing off or holding tension in your lower legs/ankles, practicing ChiRunning correctly will remedy it.

Thanks,
Casey Colahan, ChiRunning

my thoughts are I hate my planters fasciitis….it has taken my life and happiness away…just when I think it’s gone it comes back worse than it was. I’m so sad.

joann mcinerney Jul 5th, 2013 10:04pm

what is a course gravel surface(you suggested)? feet been real stiff and painful lasi 6 months, quit work and lay all day. i was said to have pf by 2 doctors. tried everything to no avail thinking of getting the shots,(right foot the worst),just scared. just read a site that says go barefoot? that inserts and corrective shoes no good? HELP PLEASE wasting life, suffering. joann

gloria lennon Aug 6th, 2013 08:50pm

Is a thickening under the toes related to plantar faciitis?

Jeff Carnivale Aug 7th, 2013 01:31pm

Gloria,

The research I have done does indicate a correlation between what you describe and plantar faciitis. The foot is complicated and important - take it to your doctor for a look, especially if it is causing pain.

Plantar Faciitis has stopped me in my tracks.  I have avoided running for 4 months, which is breaking my heart.  The pain in my heal is now gone but I still have stiffness centrally right at the back of my toes.  Is this related to the Plantar Fasciitis?  Should I run?

Jeff Carnivale Sep 23rd, 2013 11:11am

Ryan,

This is a tough one, but it could be that the stiffness in your toes has come from the act of pushing (toeing) off at the finish of your stride. This over-activation of the small muscles in the feet and lower legs are connected through the fascia. Try concentrating on walking with a gentle peeling motion, just lifting rather than pushing off the foot. Body-sense if this lessons the pain to determine if running will be okay or if it may need to be checked out.

I don’t really know if i have Plantar Fasciitis but I have a sharp pain in the bottom of my foot and every time I stand up or walk it hurts and it feels like i am being stabbed. I run cross country and I go to high school but I was wondering if I should stop running for a while even though running is what I love to do. What should I do.

Should I keep running if I have planters fasciitis? I dont really know if I have it or not but the bottom of my foot hurts like my arch area and its not my heal. I run cross country and I go to high school. What should I do?

Jeff Carnivale Oct 22nd, 2013 01:02pm

Rachael,

If you have a sharp pain when running, stop. There are aches or pains that can be managed and run through, however when pain is acute, your body is telling you something in an urgent manner. Often when you experience pain somewhere, you make accommodations elsewhere in your body leading to other (and potentially worse) problems. Taking a break from running and treating this immediately will keep you on the sidelines for a shorter amount of time. It does sound like you may have plantar fasciitis, get it checked out and start doing the therapies listed above.

I fell in the shower 3 weeks ago and finally got into the dr. The dr. stated that I had Planters even though I told him that I fell hard and that this was not a running injury. I am on anti-inflams and as long as I wear a running shoe, I have no pain when walking. However, I tried a slow jog for a few minutes and it literally feels like I am running on my heel bone. I fear I was diagnosed incorrectly. I’ve heard Planters is super painful and I have tenderness and the swelling has gone down but again, I am worried about how it feels when I try to run. Should it feel like you are on your bone?

I play basketball a lot and also go to the gym 5 days a week,I had PF for about month now, can I go back to playing basketball in the long run or should I just forget about it??

Jeff Carnivale Nov 12th, 2013 12:11pm

Sarah,

Sorry to hear about the fall. The pain you describe could possibly be plantar faciitis, but it is not the classic feeling that is typically experienced (the pain does not usually feel as deep as the bone). Keep doing your plantar exercises, but a second opinion seems appropriate. Maybe you can find a doctor who is also a runner.

Jeff Carnivale Nov 12th, 2013 12:13pm

Marc,

Once you have given yourself time to heal and the acute part of the injury cycle is gone, you should be able to go back to playing basketball. Often times plantar faciitis starts from tight calf muscles and the achilles tendon getting stretched which can happen with all the pushing off and jumping in basketball. Make sure to take care of those areas and keep doing the plantar exercises for maintenance.

Hi. I’m morbitly obese and I bas been working out for about 6 mths on the eliptical and treadmill.  I got on the steppers for the first time and 10 lbs weights on each hand going up and down while lifting my knees up as a landed my opposite foot on the ground.  I hit my heel so many times on tu ground repeatly I was in extreme pain but I didn’t wanna be a quitter To a point that I just couldn’t take it anymore I’ve been away from the gym for about 3 mths.  I recently tried to do a 30 min walk and was I scrutiating pain.  I was diagnosed with PF I feel like I’m handycap.  Even performing the simplest tasks have became a huge problem to me.  My dr prescribed me spenco Rx inserts and I bought very expensive arch support sandals.  Any movement Is a pain I the ass.  I’m in pain even standing up in the kitchen to wash dishes or cook.  I can not walk without my sandals so its a problem for me to wear more dressy clothes for work bc the sandals are basically the sin thing I can use.  The inserts don’t work on the majority of my existing shoes I used to wear a lot of open toes flat female sandals and flipflaps are gladiators style sandals.  I don’t really know what to do please help.  Im despered :(.  I got to loose weight I’m diabetic as well.

The bottom of my foot where my instep meets my heel started hurting while I was playing tennis 3 days ago.It hurts bad when I walk and does not get better after doing all the remedies you’ve mentioned.Do you think this is pf? Does it ever get better faster than a few months?

I have been doing a combination from both of these two sites and after two years of PF in both feet and a partial tear(mri) in my right foot. I am finally back to running at pace. Thank you for your information on shortening stride and foot strike. This other article has a great diagram of prevention and treatment options.
  http://bridgerridgerun.wordpress.com/2011/10/28/plantar-fasciitis-prevention-treatment-and-healing-techniques/

I have a very high arch and have suffered PF to the extreme.  I have bones spurs and have had a stem cell treatment which has helped the PF.  I am currently starting to walk to improve my health and have noticed sensitivity in my arch and ankle.  I pretty sure I am not walking at my optimal when I go for my 2 miles walk.  Suggestions.

Hi Jeff

I find it a relief to hear the acknowledgement of how painful is plantar fasciitis. Your information on causes is really helpful and it’s the only thing I have read that comes close to understanding how my fascia was inflamed by the whiplash injury I suffered, saving an adult from a backwards fall. I understand it better now. My question is to do with the extreme nerve pain I experience, which just does not get any better and is not helped by pain killers or anti-inflammatories. Any thoughts would be welcome.  Many thanks

Hi Jeff
thanks for the acknowledgement of just how painful Plantar Fasciitis can be. I also find your description of causes is the clearest which explains how a whiplash injury [bearing someone else’s weight whilst he fell] can have inflamed by PF. I find nothing relieves the nerve pain in my foot—constant pain not touched by anti-inflammatories or pain killers. If you have any advice I would be grateful. It is a mind-wiping kind of pain and telling on the rest of my nerves. Many thanks, thanks for your website

Sorry—thanks to Danny for the blog, and Jeff for your replies! [I’m new to this site]. Best, Zsuzsi

Jeff Carnivale Jan 2nd, 2014 11:42am

Sue,

As you start this new walking routine, the muscles in your arch and around your ankle are starting to work again for stabilization and balance. They will need some time to get accustom to working again (like any muscle that has had time off). Add time/distance gradually and concentrate on your good posture, short strides and level pelvis. Leveling the pelvis not only activates the lower abs, but also the entire medial chain of muscles down to your arches.

I’ve got a rather unique situation.  I think I’ve developed plantar fasciitis in my right foot,  which I call my ‘good’ leg.  That’s because my left knee had dislocated,  my peroneal nerve severed,  and I lost 95% of movement in my left leg,  resulting in me wearing an AFO.  Therefore,  I don’t know how I can coddle my good leg while trying to rely on my bad one.

I was just wondering if wearing Insoles will make it worse in the long run as now I cannot go anywhere without them as I am in too much pain?

Jeff Carnivale Feb 14th, 2014 12:35pm

Sarah,

No. While the pain is acute, wear the insoles.

Everything I’ve read about PF indicates a slow onset starting with the classic pain-and-stiffness-in-the-morning symptoms.  My pain came on acutely, 5k into a run, where I had such severe pain in the arch of my foot that I rolled on to the outside of my foot, causing a slight sprain.  Physio says that it’s PF, but not anywhere have I read about it happening suddenly.  Any thoughts???

patricia young Feb 21st, 2014 08:31am

I fracture my heel and have a plate with srews in it about 5 yrs ago,Im in more pain now from this tendon/bone sticking out of the center of the bottom of heel.I just cant take it no more, I did some of them exercising after the       operation. I don’t know what to do !! TIRED OF BEING IN PAIN andnot even being able to walk that far! Just got two cortisone shots yesterday!!!

I am so pleased to find this website. I am totally fed up with this awful plantar Fasciitis-I look out at people merrily walking to the station , or elderly people all striding out and I feel like shouting ” lucky lucky you, you can walk without pain ” in my bleaker moments I think I will never be able to walk properly again. -6 months now-is there anyone out there who has actually recovered who can spur me on? “

My pain is right behind the big toe.  It definitely feels like a pulling.  Uncomfortable when I walk.  Had PF before and have a very high instep.  Does it have to start in the heel?  I could have it even if It starts behind the toe?  I will do he stretching exercises.  Ice doesn’t help?  I think the last time I HAD IT, IT WAS ACCUPUNCTURE THAT CURED IT.  ANY OTHERS SAYING THAT?

I found out that my mom has Plantar Fasciitis on her left foot. The thing is, my mom is the only one that can drive and go to place, like the store or driving my brother and me to our Colleges. I already told things she can do for her foot and I’ve helped out in taking care of her. My question is, is it alright if my mom continues to walk from here to there (but less frequently than usual), even if she has PF?

Yes, of course. Keeping following the recommended treatments, don’t walk with minimal or barefoot shoes, or high heels, but comfy cushioned shoes until it heals.

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