Plantar fasciitis, an irritation to the fibrous tissue at the base of the heel, is one of the most annoying and bothersome injuries for runners due to its stubborn nature. Heel pain caused by plantar fasciitis can last for months and years before the fascia finally heals.
Because of this grueling recovery process, it’s important to identify and start treating plantar fasciitis quickly. Fortunately, most cases are resolved in weeks with proper treatment.
Treatment options for plantar fasciitis
The first goal of treating plantar fasciitis should be to protect the plantar fascia from additional strain. While having the “-itis” suffix is usually indicative of inflammation, research has found that the real problem in this condition is the damage and degeneration of the fascial fibers. While it’s good to ice, that ice doesn’t give you free reign to continue to strain the fascia with intense workouts or inadequate shoes. Aggressive rehabilitation, and avoiding exercises that irritate the injury, is the way to recover from this condition quickly.
Scientific research supports a few conservative treatment methods. These treatments are designed to protect the arch or stretch the plantar fascia/calf muscle combination.
Several studies advocate arch-taping, also called “low-Dye taping” after Ralph W. Dye, the innovator of the technique. There are several varieties to low-Dye taping, but keeping it simple can be very effective. However, low-Dye taping is just one step in the biggest rehabilitation plan.
When one is low-Dye taping, the lateral straps (lower left and lower right) should be pulled firmly and should always be pulled from the outside of the foot to the inside. That is a must.
Another strategy to support the arch is using an over-the-counter or custom orthotic, which protects the arch while it heals. The difference between custom orthotics or ones that can be purchased over the counter, such as SuperGreen or Powerstep insoles, is unclear. Over-the-counter insoles aren’t specially tailored to your foot, but they are inexpensive and immediately available unlike custom insoles, which take weeks to deliver. It’s important to avoid soft gel arch supports, as they are largely ineffective.
However, wearing casual shoes and sandals with more arch support (such as Birkenstocks) can relieve symptoms.
Conservative Options for Treatment
The final three conservative options vetted by research options are calf stretching, foot stretching, and using a night splint. All three techniques are designed to stretch out the calf, Achilles and plantar fascia complex to reduce tension and strain on the arch.
Calf stretching is the mainstay of most plantar fasciitis treatments and should be done several times a day. Start right away in the morning and add two other sessions during the day. Make sure to do three sets of 30 seconds each during the session, stretching with the knee straight and bent each time.
One study compared a calf-stretching protocol to a plantar fascia-specific foot stretch, held 10 times for 10 seconds each time, done three times a day and illustrated below. Note that all toes are stretched, not just the big toe.
This study found better results from the plantar fascia-specific stretch; the authors hypothesized that the foot stretch recreates the Windlass mechanism, which is the pulley-like connection between the plantar fascia, heel, Achilles tendon and calf. This creates an advantage over the calf stretch.
Night-splinting is another treatment that aims to stretch out the plantar fascia. As the name suggests, a night splint is a device you wear while sleeping that keeps your ankle dorsiflexed. The theory behind this treatment is that the first-step pain of the morning is caused by the arch healing at night without tension. If that tension is applied at night, then the first-step pain is lessened. Solid, cast-like night splints are available online and at specialty stores, but the Strassburg Sock is an easier, more practical solution.
Also available online and in specialty stores, “The Sock” is more affordable. It’s basically a regular knee-high sock with a strap that runs from toe to kneecap. When the strap is gently tightened (this is important, do not make the strap too tight), the ankle and toes are both dorsiflexed like a splint.
Other Treatment Options
Manipulating the plantar fascia tissue has become popular among runners recently. By using a hard object such as a golf ball, you can “roll out” your arch in the same manner as you would roll out your quads or calves. More aggressive soft-tissue techniques such as Active Release Technique (ART) or Graston Technique are also popular. None of these techniques are scientifically tested, so there are no guarantees, but icing your foot afterwards is a good idea.
Injections of corticosteroids are a common second-line treatment option among podiatrists. Success rates are varied and studies on them are mixed, as a complete rupture of the fascia is possible. Application of a corticosteroid such as dexamethasone through the skin via iontophoresis – an electric charge-driven process – might be more helpful and have fewer complications than a direct injection.
Chronic, long-standing cases of plantar fasciitis can be particularly tricky. Two new treatments, extracorporeal shockwave therapy (ESWT) and platelet-rich plasma therapy (PRP) show good promise in treating these cases, especially in runners. Because of their recent development, access to them might be tricky, and their effectiveness isn’t solidly vetted yet.
Many proponents of minimalist or barefoot running have cured fascia problems by transitioning to a flexible training shoe that allows the arch to flex out and strengthen itself. Unfortunately, there haven’t been any studies linking barefoot running to the treatment of plantar fasciitis. That’s why it’s listed here, and we recommend listening to our in-depth interview with Dr. Mark Cucuzzella for more information.
Outline of treatments
Conservative treatments that are fairly inexpensive include wearing comfortable plantar fasciitis shoes with arch support, icing your foot several times a day – especially after running — stretching your calves and plantar fascia three times a day, low-Dye taping, over-the-counter orthotics, night-time splints or a Strassburg Sock, or rolling out your plantar fascia with a golf ball.
More aggressive treatments for more stubborn plantar fasciitis cases include getting a custom orthotic designed for you, corticosteroid injections, seeing an A.R.T. or Graston Technique practitioner, extracorporeal shockwave therapy or platelet-rich plasma injections.
Return to running
How quickly you can resume running depends on the severity of the injury and how quickly that injury heals. Some runners can gradually work their way back into running even with residual arch stiffness, but if you find the pain becoming worse, more time off and more rehab are advised.
As you return to running, consider a 10 percent increase in stride frequency to reduce your impact loading rate, a factor that contributes to the development of plantar fasciitis in runners. Keep stretching your calves even after you’ve recovered to stave off future reoccurrences of plantar fasciitis.