The plantar fascia is a band of connective tissue (rather like a ligament) which runs from the heel, along the bottom of the foot to the base of each of the toes. It fans out from the heel as it moves forwards to the toes and is a tough, fibrous structure.  Its role changes depending upon at what part of the gait cycle your foot is in contact with the ground.  Initially at impact it helps shock absorption and it stabilizes the metatarsals as you absorb shock by pronating your foot.  Then from mid-stance to push off it its helps to re-supinate the foot to make it more of a rigid leaver to improve the mechanical leverage to help propel you forwards.

The plantar fascia bears an immense amount of load when you run, in fact it has to deal with loads of up to 3 times body weight with each step and you can take as many as 90 steps per foot per minute when you run.  So an injury to the Planter Fascia can be very painful and difficult to rest, it is even loaded when you walk and stand.  It is therefore quite a common injury and occurs in about 5-10% of all running injuries and about 10% of those who see a doctor for the condition have the problem for more than a year.  It is therefore quite important to discuss how you can recognize it and the ways that you can help to manage it yourself.

Outside of athletics, it affects mainly over 40’s and mainly women, but in athletics there are a number of causes that mean it can affect anyone.

The extrinsic (external) causes of plantar fasciitis include running on different surfaces, wearing inappropriate shoes, increases in body weight, as well as increased pressure through the plantar fascia as with a sudden increase in speed or hill training or block work.  Outside of athletics, if your job requires that you stand for prolonged periods, this can have a profound affect on the plantar fascia, as can being over weight, these are the two main causes of plantar faciitis in non-athletes.

Intrinsic causes (internal factors within your body) of plantar faciitis consist of poor foot biomechanics (typically too much pronation or pronation that is too quick), tight calves (which can increase the amount of pronation in the foot), leg length discrepancies (which can cause the foot to over pronate), abnormal pelvic rotations (which can cause leg length discrepancies) and even tight sciatic nerves (which can cause a protective spasm of the calf muscles which can cause them to become inflexible).

The pain is usually felt just in front of your heel.  It is usually tender to touch and it is felt often in the mornings or after long periods without bearing weight through the foot.  As you walk about gently the pain usually subsides, but any over activity often aggravates it again.  On a day to day basis you can often feel pain if you misjudge a step and take weight through your forefoot rather than the whole of your foot, as the load is taken straight through the plantar fascia.  If you walk abnormally to avoid loading the plantar fascia, you can then get other symptoms as you load other structures abnormally, typically you can get pain on the outside of the foot, your knee and even your hip for this reason.

When you have plantar fasciitis you can also develop a heel spur.  This is an area of calcium which is deposited within the plantar fascia where it suffers most damage, usually at the front of the heel bone.

There are a number of ways that you can help your plantar faciitis.  Some of these suggestions will help and others won’t, see which are best for you.  Calf stretching (with your knee bent and additionally with it straight), a temporary heel raise, applying ice to the affected area and massaging the plantar fascia can all help.  You may find it difficult to reach the sole of your foot to massage it yourself, so try sitting and putting your foot on a cricket ball pressing down on that while you roll the ball under the sole of your foot.  You can also try rolling your foot on a wine bottle or rolling pin in the same way.

Stretching the plantar fascia can also help.  Remember though, the plantar fascia is not a flexible structure, it stretches an additional 2% of its overall length when you take weight through your foot as you run, and it is this rigid spring-like action that is critical to its correct function.  So while we don’t particularly want to increase the flexibility of the plantar fascia, stretching can be helpful to improve its pliability and so its ability to accept load at higher speeds. Stretching the big toe upwards, while you are stretching the calf with your knee bent, can help with this.

Orthotics can be very helpful when trying to manage plantar fasciitis, but do make sure you see a podiatrist who works closely with therapists who understand the biomechanics of the pelvis and spine.

Anti-inflammatories, cortisone injections and surgery can sometimes be helpful but are not the first choice and all other possible options should be tried first.  In more severe cases there can be some relief from pain by using splints at night to gently stretch the Achilles tendon and the plantar fascia.

Prevention is obviously important and you need to check the extrinsic and intrinsic causes listed above and deal with any of them that may be relevant to you.  You may also find that managing them will help if you currently have plantar fasciitis as this can reduce the load on the foot considerably.

Martin Haines
Specialist Biomechanics Coach™
Chartered Physiotherapist

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