Plantar Fasciitis/Fasciosis/Fasciopathy – A Primer
Plantar fasciitis is one of the most common and annoying problems with runners and walkers. At any point in time, 4-6% of the general population is dealing with heel pain, and about 80% of these cases are Plantar Fasciitis. I spoke with many people, including the noted biomechanics specialist Simon Bartold, asking for their input, as well as doing some research myself. While I’m not a medical professional by any means, I thought I’d give y’all a little crash course about what it is, how to know if you have it, and possible strategies to alleviate some symptoms. However, this is not intended as medical advice, just as some rules of thumb. If you’re hurting, go to a doctor! With that said, here’s my spiel:
What is Plantar Fasciitis?
Under your feet, there’s a thick, rubber band-like collection of tissue called the plantar fascia. The pain of Plantar Fasciitis originates from where the plantar fascia inserts into the heel. Back in the old days, they used to think PF was caused by inflammation of the fascia, but recent research seems to indicate that it’s caused by micro tears and scarring of the fascia itself. This is why some doctors prefer the term Plantar Fasciosis. Some new research seems to indicate that it’s a degenerative condition, which is why some doctors now refer to it as Plantar Fasciopathy. I’ll just refer to it by its most common name for this article.
Most people who have Plantar Fasciitis experience:
- Pain under the heel: This is the most common symptom, and one of the most leading indicators, as 80% of heel pain is later diagnosed as PF.
- The pain hurts worse in the morning (or after a long period of sitting) and fades as they walk around – that’s another tell-tale sign. In severe cases the pain might not go away even after walking around a bit.
- If there’s pain if you try to flex their toes upward, or when you flex your feet upward (dorsiflexion), then that’s another indicator of PF.
- If there’s radiating pain far up your leg, or if there’s clicking when you flex their foot along with heel pain, that could indicate other, (possibly more serious) issues and you need to get to a doctor pretty quickly for further diagnosis. Please do not use this post as a diagnostic tool, if you’re concerned at alll about your health, consult your medical professional.
- Tight Achilles tendons, calves, and hamstrings are a very common cause of PF, especially among athletes.
- If you’ve been increasing your running mileage a lot lately, you’re at greater risk for PF.
- If you’ve changed into a shoe with significantly different heel-toe drop than your previous shoes (e.g. you’re switching from Brooks to Altra without taking time to adjust) .
- Among non-athletes, higher body mass index is highly associated with PF. If you’re sitting out the summer heat, trail wise, but you’re still riding the summer barbecue circuit, then that will increase your chances of Plantar Fasciitis.
- Worn out or inappropriate footwear is another risk factor. If you’re not listening to your local shoe store, and you’re taping holes on the bottoms of your favorite shoes (This is the case with me and my Hoka Torrents at the moment) then you’re asking for plantar issues.
Shoes like this should probably be retired!
Ways You Can Help for Your Plantar Fasciitis:
We’re not doctors. Go to one if you suspect you have PF!
If you’ve been diagnosed, or if you want something that might help in the meantime:
- Stretch your calves, ham strings, etc. Working on increasing your flexibility up and down the dynamic chain can really help relieve the pulling on the fascia.
- Foam Roll: Get a Rollga or Original Worm, and again, focus on rolling out your calves and hamstrings. This may seem counter-intuitive because it’s your feet that hurt, but when it comes to rolling out your feet, evidence is mixed on whether that actually helps anything.
3. Change out your shoes regularly. Don’t let your shoes wear out and cause your feet more problems.
- When buying new shoes, don’t mess with the heel-toe differential too much. You can slightly lower it or raise it, but jumping from a 12mm drop shoe into a zero drop shoe (or the other way around) is asking your feet to get mad at you.
- The only time I’d mess a lot with the heel-toe drop is if you’re suffering from PF in a higher drop shoe and you have the option of hopping in a rocker style shoe like a Hoka brand shoe. Rocker style shoes seem to reduce plantar pressure and relieve loading on the Achilles tendon.
Consider investing in a rocker style shoe.
4. Orthotics are a treatment option that seems to be supported by current research. They aren’t exactly sure why, but it may be that having extra arch support disperses impact forces and supports the fascia.
https://elitefeetusa.com/ is the place you want to go for good orthotics.
5. Ultimately, you HAVE to start strengthening your muscles and increasing your flexibility. In my talks with Dr. Simon Bartold, noted biomechanic specialist and former consultant with Salomon footwear, he specified: “The bottom line here is that… plantar heel pain is like every other injury: it needs to be rehabbed properly with introduction of progressive load [strengthening]. if the client is not prepared to do that, they must be prepared to put up with the heel pain, because THAT IS the treatment!”
The good news is that 90% of PF cases resolve in 6 months or less with proper treatment. Get properly diagnosed and get working on recovering!