Plantar fasciitis usually describes a chronic pain at the corner of the calcaneus bone (heel bone) or along the fascial tissue towards the toes.
Usually plantar fasciitis is first treated like any inflammation with the RICE method (Rest, Ice, Compression, Elevation) and anti-inflammatory medicine like ibuprofen etc.
I personally never liked the idea of the RICE method (see my blog the ice dilemma) Maybe because of my TCM background, where cold is seen as something constricting and blocking and rest or lack of movement causes stagnation of qi (life force) and blood. Also the use of anti-inflammatory medicine seems to delay the natural healing process.
Inflammation is a natural reaction of our immune system following a trauma. It is an important part of the self repair mechanism and shouldn’t be easily suppressed. But what is a better way to deal with plantar fasciitis? A common method nowadays is the MEAT protocol (Movement, Exercise, Analgesics and Treatment).
Heel pain or "plantar fasciitis" is a common problem among athletes, especially among runners. The pain can be severe, feeling like a nail driven into your heel. The typical pain is located at the insertion of the plantar fascia to the medial tuberosity calcaneus'
The healing can take from several weeks to several month. The worst time is usually in the morning, jumping out of bed and doing the first few steps. The pain than gets better the more you move, but will be back after each time you rest and start walking again.
So how to treat plantar fasciitis?
Below I listed some of the methods I tried and which showed to be effective for me and hopefully for you as well.
Be aware the following advices worked for me and doesn’t necessarily have to work for you. Also all the information here doesn't replace a proper diagnosis from a physician, especially if the pain is resistant and none of the following methods helps – let it check by a physician for other possible causes. So if you are sure you are suffering from plantar fasciitis (sometimes also diagnosed as heel spur - try the same methods) give these methods a try and see if it helps.
Before starting to treat your heel with all kinds of tools and methods, take a moment and look at the structure of the foot and where the pain is and what muscles, tendons and fascias are connected with this area. If you look at the pictures below you will see that the plantar fascia continues over the heel, up the backside of the leg, along the spine, over the neck and head till the upper, inner corner of the eyes. In Chinese Medicine this is related to the bladder meridian. Any problem along this way can cause a problem some where else or be caused by another connected structure.
For plantar fasciitis I would look at the calf muscles,(gastrocnemius, soleus), look for tender points. Along the hamstrings, buttock and especially the IS Joint (make sure they are not blocked). Follow the the spine and look for tender points an tightness along the back muscles (back extensors). Check the neck especially the occipital area around CW1 - 3 for tenderness and massage this area if painful. Pain is always a sign of something is not the way it should be. In order to deal with it efficiently you should try to find out what could be causing the problem. Overweight, ill fitting shoes, change in exercises, other problems along prescribed fascia pattern.
5 Step plantar fasciitis treatment plan
Step 1 – Anti inflamatory
I don’t recommend ice to treat plantar fasciitis (see my blog the ice dilemma)
If I like to use something for the swelling and pain I use chinese medicine. Either as poultice or as tincture. Tinctures can easily be bought in Chinese Pharmacies. One of the most often used herbal formulas for acute injuries is San Huang San also called “herbal ice”. But also good are Zheng Gu Shui, Yunnan Bai Yao, Die Da Wan Hua Oil etc. These herbs are usually rubbed into the affected area. Use the massage techniques described below to get extra benefit from it. The function of the herbs are to promote the flow of qi (life force) and blood and resolve stagnation in the meridians.
Loosing any extra weight is beneficial in treating plantar fasciitis. Studies showed that already 2 – 3 kg (about 5 pounds) can make a big difference. So if you are on the heavy side, try to loose some extra pounds by changing your diet a little bit (reduced daily calories intake) and increase your daily energy expenditure (cardio training). I would suggest as long as you have heel pain, use a stationary bike for the cardio workout. This puts the least stress on your heel. Also swimming is a good way to burn some calories without putting to much stress on the heel.
For the nutritions I would recommend a reduced carbs diet, as carbs are the fuel for inflammation. If you want to put out a fire, stop adding wood to it. By reducing carbohydrates you can reduce the inflammation processes in your body. If you use carbs, use mainly high quality carbs from fresh vegetables and berries. Choose a way of eating which increases your well being and doesn’t let you suffer and starve. There are a lot of diets around from which you could choose. Basically try to reduce carbs, increase protein and fat into your meals, but keep an eye on the daily calories you consume.
The following supplements showed to be beneficial for treating plantar fasciitis. So it might be worth including them into your daily nutrition.
- 300mg Magnesium (for loosening the tightness in the muscles)
- Vit. B complex (with Vit. B5 which showed beneficial effects on plantar fasciitis)
- 2 – 5000 mg Vitamin C as been shown to help improve the healing process and decrease scar tissue formation.
- Bromelain (pineapples enzymes)
- Fish Oil (Omega6) helps regulate the inflammatory process.
If I can, I will always stick a needle in it.
Don’t try to needle yourself with needles from your mothers sewing box, it might not end well!
Local points: 2 – 3 needles into the plantar fascia around the most tender points. Actually deeper needling is required for better results, so you have to go trough the fascia till to the tendons. These are not the most pleasant points, as you will definitely feel the needles. But it relieved my pain greatly, so it was definitely worth doing it.
Other points I used where more classical acupuncture points like: Ki5 Shuiqian, Ki7 Fuliu, Gb34 Yanglingquan, Bl57 Chengshan, Bl40 Weizhong, P7 Daling on the same side.
An easy way to loosen the fascia ligaments is by using a ball, (tennis ball, la cross ball, golf ball or anything round and about that size will do it). Just roll with your foot over the ball, first softly to get a feeling for the movement, than put more pressure on it to get a little bit deeper. Do this for about 5 min. 1 – 2 times a day. Don’t overdue it, by standing on the ball every hour, this would more irritate the fascia than relaxing it.
Slide along the plantar fascia with intermediate pressure of your thumb, from the toes to the calcaneum bone and slide crosswise from left to right. Do this for several minutes.
Use a foam roller (they are available in all sizes, colours and hardness), roll out your lower leg muscles, your IT band (lateral side of the upper leg), the quads, hamstrings and your back.
Kinesio taping helped me in the beginning to reduce the pain. Unfortunately I react sensitive to the tapes glue, so I had to stop it. I’m still trying to find a tape I’m not sensitive to. If you have sensitive skin you might have to try different brands of tapes as the glue used on the tapes might cause skin irritation in people with sensitive skins.
The taping technique I used is:
- 2 stripes of kinesio tape. Both about the same length
- First line along the plantar side from the toes over the heel into the achilles tendon (use about 50% stretch force).
- The second stripe you put crosswise over the painful area and over the malleolus bones to the side (again about 50% stretch force)
Flossing is a relatively new technique and is mainly used in the cross fit scene. By compressing certain extremity parts with a thick rubber band you cause shear force in the fascia and break down sticky fibrous structures and restore smooth gliding of the fascias over the muscles.
Some experts advice against doing stretching while having plantar fasciitis, because they claim it’s an inflammation and if you stretch it it will be more irritated. I don’t completely agree with this. As for me I couldn’t find any typical inflammation signs (pain, heat, redness, swelling, and loss of function) besides the pain I had none of the other symptoms. Also the peak time of the pain was in the morning still lying in bed and than the first couple steps.
My intention with the stretching was to help moving the fascia in the intended physiological direction, also to support any micro tears to heal in more longitudinal way instead crosswise.
For me the most beneficial stretch was, standing toward a pole or wall, lift your toes with heel on the ground and press the toes against pole, hold yourself at the pole and pull yourself closer with straight back and leg. Like this I have a stretch of the toes (direct stretch of the plantar fascia) and a stretch on the achilles tendons (which is an indirect stretch for the plantar fascia). This way you stretch more the Gastrocnemius Muscles instead of the Soleus muscle. To get the soleus more take a stance as if you like to push away a wall, with the back leg slightly bend and the foot flat on the ground, toes pointing straight forward.
Something most athletes and sports enthusiast forget or don’t pay so much attention to it is to strengthen the foot and lower leg. Most people I see, they just train their calf muscles and that’s all the lower leg training. A lot of athletes are not aware of their foot arch condition, often they have a collapsed arch when walking or running with a supination which causes extra stress on the calcaneum bone and the attached tissues.
One easy way to lift your foot arch is by embracing your stance. Means by activating your abs, contracting your glutes, rotate your hips outward and create torque down your leg and screw your feet into the ground. You can see immediately how this lifts your foot arch and how more stable your stance will be.
Also helpful are strength exercises of the foot and ankle itself. Especially the big toe shoed be paid more attention. Some exercises you might consider including into your therapy sessions are:
Foot Towel Kneading
Put a towel on the ground and start with your affected foot (barefoot) to knead the towel with your toes. Do this for approx. 1 -2 Min, do about 3 sets.
Weak supinator muscles (flexors hallucis longus and digitorum longus) leads to a collapsed arch – hyperpronation of the foot. This kind of foot mechanics puts more stress on the fascia around the the heel and can cause plantar fasciitis. By training these muscles use a cable, a long tube or thera band to train it.
- Position yourself in a 90° ankle to the cable/tube which are attached to your forefoot.
- Fixate your ankle over the other foot or on a bench.
- Move the foot in it’s full range of motion inward – like you want to swipe something away.
Calf raise helps you strengthen the calf muscles: gastrocnemius, soleus and flexor digitorum brevis (which lies beneath the plantar fascia). By training this muscles in full ROM you also strengthen the achilles tendon, which is one of the most injured parts in runners probably because it has to handle an immense amount of force with each jump. The plantar fascia continues at the heel further up along the achilles tendon, gastrocnemius, soleus muscles
- Stand with the forefoot on a stair, with the heels hanging down
- try to come into a toe stand, before lowering the weight again.
- If it feels easy with two feet and you can do easily 20 reps, start doing it with one foot.
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According to a study published in the Scand J Med Sci Sports. 2014 Aug 21, a high load strength training improved the outcome for plantar fasciitis patients.
Done was it with patients doing single leg calf raises with dorsiflexed toes (put a towel or something soft under the toes).
The study found that plantar fasciitis tends to respond to the same techniques used for treating tendopathies (mainly injuries of tendons).
For treating tendopathies I usually use eccentric training methods. Means in terms of calf raise, I would use no strength to lift the heel, hold the weight for about 2 seconds and let it slowly sink within the full range of motion and start over again. About 12 – 15 reps, 4 – 5 sets with 30 sec break between.
So which of these methods are the best ones? I listed several, which I tried and had some benefits. But what helped me most was the change of diet (loosing some pounds) and the high load strength training. I think these two where the most effective methods for me. But by no means try all of them, the ones you like or some different methods you heard about. It would be nice to hear what worked for you. Maybe some other methods?