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The Dos & Don'ts Of Plantar Fasciitis
Plantar Fasciitis is the most common cause of foot and heel pain and many people who develop this condition suffer for much longer than they should. In fact, most of the cases that I have treated in my office have had pain for years.
This is primarily because there is a tremendous amount of misinformation out there about how to treat it effectively.
This injury is caused by the degeneration of the tissue from overloading or overuse. It is not an inflammatory condition as originally noted.
For this reason, most rehab efforts fail because treating with anti-inflammatory measures is a temporary remedy and not addressing the underlying root cause.
I specialize in foot and gait mechanics and I have treated hundreds of cases of plantar fasciitis. My goal is to arm you with the latest knowledge about the condition so that you can return to the activities you love.
Plantar fasciitis is already so painful the last thing you want is to make it worse. Let's take a look at the Dos & Don'ts regarding plantar fasciitis.
Dr. Angela Walk
The Plantar Fasciitis Doc
Specializing in Foot & Gait Mechanics
The DOs of Plantar Fasciitis:
1. Do Wear Natural Footwear
Ill-fitting footwear is the number one cause of foot and heel conditions. Most shoes are not designed to support the natural shape of our feet. It's baffling to me why most shoe manufacturers do not consider what truly makes a healthy shoe.
When discussing foot health, the design of your footwear should include critical criteria. The following design features to be foot-health-positive:
A wide toe box to encourage natural toe splay and spreading of the toes
A flexible sole to encourage enhanced foot strength
A completely flat support platform from heel to toe to encourage natural arch support
Our feet are inherently strong and do not need extra arch support or extra cushion. It seems that the less “technology” a shoe has, the better it is for the foot. The more a shoe externally “supports” the feet, the less internal strength the the feet develop.
The functional footwear brands that I recommend are Vivobarefoot shoes and Altra Running shoes. Both of these brands check all the foot healthy boxes. I am not an affiliate for these brands.
These are actually the brand I love for comfort, style, and foot health. I am an avid pickleball player and I play in both of these brands.
Want to know if your footwear is foot-positive? Try this test to see if your shoes are healthy for your feet. Remove the insole from your shoes and stand on it.
Does your entire foot and toes fit within the boundaries? If not, then your foot and toes will be unable to splay wide at the forefoot to distribute the load of your body and injury is likely.
2. Do Strengthen You Foot Core
Does your foot have a core? Yep! Weakness of these core intrinsic muscles of the foot are one of the most common causes of plantar fasciitis, Achilles tendinosis, and other lower extremity disorders.
Short foot exercises, also called foot doming, is one of the exercise I recommend to strengthen your arch muscles.
I have found over the years, that giving patients fewer exercises and simple homework increases compliance. So, this is ONE simple exercise that makes a huge difference in foot health!
First, stand on one foot, and evenly distribute your body weight over the plantar foot.
Then, spread the digits. Make sure all toes are in touch with the ground.
Press the toes into the ground, and contract the arch of that foot.
Hold the short foot exercise for about 10 seconds and repeat this 5 times. Perform daily!
Another simple way to increase foot strength is to walk barefoot with toe spacers. Barefoot walking is often discouraged for those with plantar fasciitis, however, it is actually one of the healthiest things you can do for your feet.
And toes spacers stretch and realign your toes and strengthen the smaller muscles of your feet and toes. Read more about the benefits of toe spacers here.
3. Do Increase Dorsiflexion & Ankle Mobility
People who develop plantar fasciitis typically have limited dorsiflexion (flexion of the foot). That’s the movement in which the foot is brought toward the shin. In other words, their ankles have limited range of motion and their calf muscles are too tight.
Dorsiflexion of the ankle must occur to complete a normal walking or running gait. When there is lack of normal mobility with this motion, the body will find a compensation.
This places the additional stress on the plantar fascia and it is not designed to withstand this type of force. This is the beginning of the breakdown or strain that leads to plantar fasciitis.
The exercise I recommend the most to increase dorsiflexion and calf strength is heel raises with a ball between your heels. Perform 3 sets of 15 each day. See image below.
4. Do Stretch Using Active Stretching vs. Static Stretching
One mistake many make when stretching is doing the wrong type of stretch. There are multiple styles of stretching that target different goals.
When most people hear the word “stretch,” they think about holding a stretching position for a prolonged period of time, most often recommended is 20-30 seconds. This is called static stretching.
The problem with static stretching is that if a muscle is stretched too far, too fast, or for too long, it elicits a protective action known as the myotatic reflex, causing it to automatically recoil in an attempt to prevent the muscle from tearing.
This occurs about three seconds into a stretch. Therefore, I recommend stretching to your natural range of motion (hold for 2 seconds), before the negative stretch reflex kicks in, then return to the start position and repeat 10 times.
This type of stretching is called Active Isolated Stretching (AIS) and is a type of dynamic stretch. The stretch feels more like repetitions than stretching, and it is the most effective type for for plantar fasciitis recovery. Read more about AIS here.
5. Do Remove Fascial Adhesions & Scar Tissue
If you've ever been one of my patients, you have heard the term fascia or fascial adhesions. Fascial adhesions are one of the most common causes of pain in the body.
The formation of adhesions is the body’s response to injury, trauma, and overuse. These adhesions form in the soft tissues of the body, and over time, can build up to limit mobility, decrease strength, and cause pain.
In my practice, addressing these adhesions is paramount to gain any real progress with resolving back pain, sciatica, neck pain, headaches, shoulder pain, and even plantar fasciitis.
The most effective way to remove scar tissue is with Instrument Assisted Soft Tissue Mobilization (IASTM). The most well known and most effective types of IASTM methods are Graston Technique and Gua Sha.
It involves the use of a stainless steel instrument or stone to "scrape" away scar tissue adhesions. These tools greatly assist in soft tissue mobilization and improve blood flow to the affected area.
I enjoy teaching my PF patients how to remove these fascial adhesions at home. Most of the adhesions are in the arch of the foot and calf muscles. It's important for healing long term to address these soft tissue restrictions.
6. Do Go Barefoot
One of the most common recommendations to resolve PF is to avoid walking barefoot, or wearing flats or flip flops. This information is wrong and prevents many sufferers from truly resolving their foot condition.
In order to restore healthy strength to the muscles of your feet, wearing minimalist shoes, and practicing barefoot walking is at the top of the list. I recommend starting slow and only going barefoot 20 minutes a day, then adding more time each week.
As you commit to foot work and foot strengthening, you will begin to feel more comfortable in your bare feet.
7. Do Listen To Your Body
The most common question I receive from patients who are physically active (especially runners), when can I return to the activity I love?
Continuing your exercise routine while dealing with plantar fasciitis is possible. I monitor my patients using a pain scale and advise them based on the following:
1 to 2 pain levels: Generally OK to continue to train
3 to 6 pain levels: Consider shifting gears to a less impactful exercise (aqua jogging, resistance training, cycling
7 and above pain levels: Rest and allow time to heal
Proper foot care is so important for every athlete. Follow this protocol to help you continue to train safely, avoid exacerbating your plantar fasciitis, and avoid other injuries like stress fractures, sprains, shin splints, or back pain.
The safest plantar fasciitis-friendly exercises include such as cycling, aqua jogging, rowing, weight training and yoga.
8. Do Wear Toe Spacers
Our toes need to be spaced and aligned properly in order to function and distribute our body weight as we walk and run.
Many people have foot deformity from wearing shoes that taper at the toe. This leads to bunion formation, weak intrinsic foot muscles, plantar fasciitis, and other lower extremity disorders.
Toe spacers help to spread the toes evenly so that as we walk, our toes "splay" and promote a more natural gait.
Start by wearing them 30 minutes per day and increase each week. Wearing shoes with a wide toe box can allow for you to wear them in your shoes.
Read more about proper use and the benefits of toe spacers here.
9. Do Be Patient
Rarely is there a quick fix for plantar fasciitis. Many people have suffered from this condition for years. So, I understand the frustration. However, if you make a commitment to follow these suggestions, you will get results.
Now, let's take a look at some of the inaccuracies and mistakes with treating plantar fasciitis.
The Don'ts Of Plantar Fasciitis
1. Don't Rely On Orthotics To Fix Your Feet
Orthotics have become a mainstay for treating foot conditions. Sadly, this type of orthosis only weakens the foot muscles long term and sets you up for more injuries.
Orthotics deny our feet the opportunity to work and creates "lazy feet". The muscles of our feet can begin to atrophy and not work as they were designed. Orthotics render the foot weak and dependent.
Extra orthotic support can be helpful in the acute phase of care where pain is more severe, however, beyond that, further weakening occurs.
A good analogy would be casting your broken arm. The cast is necessary in the healing phase, but if left on too long, the muscles of your arm begin to atrophy and become weak.
2. Don't Treat Plantar Fasciitis As An Inflammatory Condition
This may surprise many people, but plantar fasciitis is NOT an inflammatory condition.
Within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process.
It is more of a degenerative condition involving the collagen in the fascia. Since inflammation plays either a lesser or no role, a review proposed it be renamed plantar fasciosis in light of these newer findings.
This is why so many plantar fasciitis patients sufferer for so long. Anti-inflammatory measures are only temporary band-aids and not addressing the underlying cause.
3. Don't Push Through The Pain
Avid runners and fitness junkies thrive on pushing through tough workouts. After all, few things are more rewarding than tackling an intense routine and coming out victorious,
However, at some point, pushing through a workout goes from admirable to just silly. No pain, no gain is not the best motto when it comes to foot pain.
Our pain receptors are there for a reason. There is a very clear difference between pushing through a good workout and ignoring our body’s signals to stop.
Please refer to the pain level protocol listed above for my best recommendations. Switching to another activity that puts less stress on the feet could be in order temporarily.
4. Don't Wear A Night Splint
Night splints are becoming increasingly popular as a treatment for plantar fasciitis. This prompted me to begin evaluating the effectiveness of wearing a night splint.
Many of my patients have begun to question, do night splints work for plantar fasciitis or can night splints make plantar fasciitis worse?
Over several years of the assessing night splints as an application for treatment, my conclusion is that although It is true that night splints have been shown to decrease pain in the short term; this application does not have a significant effect on prevention or recurrences long term.
Biomechanically, it just doesn't make sense. The most effective treatment for plantar fasciitis involves targeted strengthening exercises and progressive loading, not endless stretching.
5. Don't Get Discouraged
You may fee like this condition will never heal, but with consistent rehab efforts, you can resolve your foot pain and return to the activities you love. Be patient, and be strong!!!
Can I Treat Plantar Fasciitis At Home?
I specialize in foot and gait mechanics and I have seen hundreds of cases of plantar fasciitis. There is a tremendous amount of misinformation out there about the condition and sadly, this leads to many people suffering for longer than they should.
Most rehabilitation efforts fail because they are relying on cortisone shots, night splints, ineffective stretching, and rolling on a frozen water bottle. These methods are short-term band-aids and do not provide long-term correction.
I have created a six (6) step guide to resolve plantar fasciitis at home. I have found that the solution for most patients is through addressing multiple factors. I want to share a few insights that do work.
Transitioning to functional footwear
Strengthening your foot core
Strengthening weak calf and peroneal muscles
Increasing ankle dorsiflexion
Removing fascial adhesions
Barefoot walking with toe spacers
Rarely is there a quick fix for plantar fasciitis. Improving footwear, identifying areas of weakness in the foot and ankle, and restoring proper foot function is the most important pieces of the puzzle.
Take a look at my FREE GUIDE to resolve plantar fasciitis at home.
Summary
Dealing with the pain of plantar fasciitis can be life changing--but it doesn’t have to be a life sentence. By arming yourself with knowledge and taking charge of your healing, you can get back to the activities you love and feel like yourself again.
If you have additional questions about heel pain and plantar fasciitis, don’t hesitate to reach out. I'm here to help get you back on your feet--literally.
Discover more ways to improve your foot health by following my social media pages. I spend several hours a week connecting and answering questions. Find me here on Facebook & Instagram!
Best of Health,
Dr. Angela
I have also written extensively on the topic of Plantar Fasciitis. Take a look at these other related blog posts:
3 Main Causes of Plantar Fasciitis
Can Orthotics Make Plantar Fasciitis Worse?
Are Flip-Flops Bad For Your Feet?
Why Should I Wear Toe Spacers?
Can I Still Exercise with Plantar Fasciitis?
Dos & Don'ts of Plantar Fasciitis
Can Stretching Make Plantar Fasciitis Worse?
Hi, I'm Dr. Angela Walk
I have been involved in the health and wellness industry for over 20 years as a wellness physician, chiropractor, and foot health coach. I have written extensively for health publications and I am keenly aware of trends and new developments. I embrace an active lifestyle combining diet, exercise and healthy choices.
By working to inform readers of the options available to them, I hope to improve your health and quality of life.
