I've had this question come up repeatedly from many plantar fasciitis sufferers. It's understandable as this condition seems to linger forever.
In fact, studies show that if you have had plantar fasciitis for longer than a year, there is a 45% chance you will have it for the next 10 years. Wow!
I've worked with thousands of patients with severe PF for over a decade. Based on my research and experience, the reason is because most rehab efforts are focused on symptom relief and not addressing the underlying cause.
This isn't your fault. Most of the advice you have been given is terrible and completely WRONG!
Orthotics, night splints, rolling your foot on a frozen water bottle, endless calf stretches, cortisone shots, and cushiony shoes are some of the biggest mistakes people make with plantar fasciitis.
All of these methods are short-term band-aids and do not produce lasting results. Until you correct the deficiency and weakness in your feet, you will continue to have recurring pain.
In this article, I wanted to share the most common causes of plantar fasciitis and offer solutions to get you on the road to PF recovery.
6 Common Causes of Plantar Fasciitis:
Limited ankle dorsiflexion and calf inflexibility
The presence of fascial adhesions
Wearing footwear with narrow toe boxes and elevated heels
Prolonged use of orthotics
Avoiding barefoot walking
Nutrition, supplementation & hydration
1. Limited Ankle Dorsiflexion And Calf Inflexibility:
When our calf muscle group is tight, it limits the normal movement of our ankles. We need proper mobility in our ankles to progress through our walking and running gaits.
Ankle dorsiflexion is the action of bringing the foot up toward the shin. If this movement is limited, it alters our normal gait cycle and places added stress and compensations on other parts of the body that were not designed to withstand this type of pressure, especially the plantar fascia (the bottom of the foot).
The way this compensation plays out is if your ankles are stuck, it causes your arch to collapse and causes overpronation in the forefoot which puts excessive stress on the plantar fascia. It eventually breaks down and shows up as a repetitive strain in the form of plantar fasciitis.
2. The Presence of Fascial Adhesions:
Most of us, when we feel tightness in our muscles, our first inclination is to stretch to increase inflexibility. However, only focusing on stretching is not actually getting to the root of the restricted movement.
You are disregarding one of the most important factors in increasing range of motion. Stretching without addressing this primary cause of your inflexibility, will be virtually ineffective.
This one thing that would allow us total freedom in movement is addressing our fascial system. Fascia is the connective tissue that wraps and surrounds every single thing inside of our body.
Most people with plantar fasciitis have very unhealthy, inflexible fascia in the calf muscles, Achilles area, and plantar fascia (bottom of the foot) and this restricts our normal movement patterns.
Fascia is incredibly important, and If it cannot stretch, it limits our overall mobility and leads to plantar fasciitis.
Fascial Release can briefly be described as targeted soft tissue technique that uses a stainless steel instrument to locate and release scar tissue and adhesions in your muscles and fascia.
When the technique is used properly, you feel noticeable, instant relief, and you are able to obtain a more efficient deeper stretch.
Using a fascial release tool, find areas in the calf and plantar fascia that feel tight, impinged, or tender and apply moderate pressure. When you find a tender area, spend 15-30 seconds releasing the fascia, then move to the next tender or restricted area.
Release the adhesions every 2-3 days. While you are scraping, incorporate movement by alternating plantar flexion and ankle dorsiflexion.
I offer detailed instructions on how to release fascial adhesion with a fascial release tool in my free guide.
3. Wearing the wrong shoes:
You MUST give up your footwear with narrow toe boxes and an elevated heel. Some of you are still holding on to your Hokas, New Balance, Brooks, and Asics shoes.
All of these brands have damaging features that are keeping you in pain. We need footwear that allows our feet to function normally.
The number one footwear mistake is wearing footwear that narrows or tapers at the toe, and I’m not just referring to women’s high heels. This includes men’s shoes, casual shoes, and even running shoes.
They all have narrow toe boxes. When we walk and run, our feet and toes should naturally spread and splay. When we are cramming our toes into footwear that narrows at the toe, it hinders the function of our feet and weakens our arch muscles overtime.
Also avoid elevation of the heel. It is one of the most damaging characteristics, and it is present in most all footwear.
You would think that if most shoe designers added this feature there would be solid evidence to support the presence, but there is none. Elevating the heel places excessive stress on the forefoot, and it also causes a chronic shortening of the heel cord (the Achilles tendon and calf muscles). So, it leads to tight calves and Achilles tendon issues.
Zero drop is the term used to describe a completely flat shoe from heel to toe. When a shoe has zero drop, it distributes body weight evenly across the foot and encourages natural arch support.
In my program, the first footwear transition I recommend is to a pair of Altras. They are widest at the toe and zero drop.
They have moderate cushioning for comfort for those in the early phase of plantar fasciitis when symptoms are the worst. Also, since most of you are accustomed to heavily cushioned shoes, they provide an easier transition.
When our feet become stronger from the strengthening and mobility protocols in my free guide, and from barefoot walking, I would like for you to consider a minimalist shoe.
In my program, the first type of footwear I recommend is a "transitional" shoe. A transitional shoe is a shoe that has all of the characteristics of a barefoot shoe such as zero drop and a wide toe box, but has a thicker sole/higher stack height.
This shoe can be a good option for someone new to my program, and who is accustomed to heavily cushioned shoes. Altra, Topo Athletic, and Flux Footwear offer great transitional shoe options.
4. Prolonged Use of Orthotics:
One of the biggest mistake people make with plantar fasciitis is wearing foot orthotics. I know, I know this is also confusing.
I’m sure that’s one of the first things you were told to do to provide support to your foot. Unfortunately, this is one of the biggest roadblocks in healing plantar fasciitis. Foot orthotics weaken your feet overtime
Our feet are inherently strong and do not need this type of support long term. A practitioner would never put you in a cast or prescribe crutches for the rest of your life. Once the tissues and bone heal, you remove the cast and begin to strengthen the muscles.
However, with foot orthotics, there is a neglect to implement an expiration date. Using an external device like an orthotic is a temporary solution. It is only addressing the symptoms (i.e., pain) but not the underlying cause.
You must feel strong in your feet before you can transition out of them, but we eventually must rely on our foot muscles and not external devices.
The newest wave of understanding is the importance of foot strength and the connection between the foot and the rest of the body. And implementing strengthening and mobility protocols to treat the underlying cause.
Until you correct the deficiency and weakness in your feet, you will continue to have recurring pain. Focus on the short foot exercise and calf raises with a ball between your heels, and slowly begin to walk barefoot with toe spacers.
Once your feet have become stronger, begin to slowly transition out of your orthotics and footwear with built-in arch supports.
5. Avoiding barefoot walking
I know most of you have been told to avoid walking barefoot if you have foot pain, but this is one of the healthiest things you can do for your feet and it naturally strengthens your foot core.
Many studies have shown that barefoot cultures have little to no foot problems and have significantly straighter, more aligned toes.
It takes time to train your feet to enjoy barefoot walking. You will need to slowly begin to introduce your feet to this new concept
Make a conscious effort to take your shoes off when you’re at your desk, or just walking around the house.
Because your feet can be tender, weak and accustomed to heavy cushioning and orthotics, you will need to start slowly with only a few minutes a day.
I recommend Starting with going barefoot for 10 minutes each day then increasing the time each week.
Also another way to naturally strengthen your feet is to wear toe spacers. Toe spacers helps to stretch and realign your toes from the damaging effects of narrow toe shoes
They also help broaden the base of your feet which allows you to use your foot core optimally and increases that much needed circulation and blood flow back to your feet .
6. Nutrition, Supplementation & Hydration:
When patients are not improving, the next step is to consider their diet or nutritional deficiencies. Nutrition is often an overlooked component to plantar fasciitis recovery.
I have spent countless hours reviewing the research around nutrition and how it affects the healing of connective tissues especially the plantar fascia.
My conclusion is that plantar fasciitis is greatly improved by consuming foods that reduce the amount of inflammation in the body and promote healing.
What we eat plays a huge role in our ability to heal and recover from an injury. I hope you will make an effort to give your body the best opportunity to heal.
Staying adequately hydrated is also crucial for recovery. Drink half your body weight in ounces of water per day.
Avoiding inflammatory foods such as processed foods, sugar, gluten, dairy, and trans fats can create a foundation for healing.
Increase your intake of whole, fresh, anti-inflammatory foods such as fruits, vegetables, and foods rich in magnesium, calcium, and omega 3's.To promote healing, eliminate sugar, gluten, processed foods, and trans fats.
Can I Treat Plantar Fasciitis At Home?
If you have this debilitating condition, here are my top 3 recommendations to get you started on your home rehabilitation.
1. Download my free guide. This is the first step on your PF recovery journey. I show you the exact steps to resolve plantar fasciitis at home.
3. Take a look at my approved footwear guide. Dr. Angela's Recommended Shoe List and make sure you are not sabotaging your recovery by wearing the wrong shoes.
Because there is so much misinformation out there about plantar fasciitis, I spend most of my time educating people on what NOT to do.
Most rehabilitation efforts fail because they are relying on cortisone shots, night splints, orthotics, ineffective stretching, thick, cushiony shoes, and rolling on a frozen water bottle.
These methods are either ineffective or just short-term band-aids, and do not provide long-term correction.
In my (6) step free guide, I offer solutions through addressing multiple factors. Improving footwear, identifying areas of weakness in the foot and ankle, and restoring proper foot function.
Improving footwear, identifying areas of weakness in the foot and ankle, and restoring proper foot function is the most important pieces of the plantar fasciitis puzzle.
If you have additional questions about heel pain and plantar fasciitis, don’t hesitate to reach out. We’re here to help get you back on your feet--literally.
Best of Health,