Plantar Fasciitis: The cause and common treatments

by Dr. Alice Holland, guest community blogger

Plantar Fasciitis is the inflammation of a band of fibrous tissue at the bottom of your foot. Aching or sharp pain usually occurs on the inside arches of your foot, and/or sometimes is focused around the bottom aspect of the heel bone. Stretching pain is usually most prominent upon the first step in morning, and usually feels worse the day after bouts of increased running mileage.


Using a tennis ball to do self-massage can help with plantar fasciitis pain. Here, Melissa Cox of Stride Strong Physical Therapy demonstrates at their clinic.

What causes it?

Excessive loading of the foot usually is the main cause of plantar fascia pain. The excessive loading could be a result of increasing mileage more aggressively than the foot can handle, wearing poorly supportive footwear for those with low arches, or excessive strain on the forefoot during the running gait – as seen in folks who are starting to wear minimalist shoes or those who are practicing pose running (i.e. running on your forefoot).

What you can do about it:

1) The easiest first-measure solution is to move into more supportive shoes. Look for shoes with inner arch support, or look for over-the-counter arch inserts like Superfeet. Be sure to try them out first in the store as there is sometimes an adjustment period before you feel completely comfortable with them.

2) Stretch, stretch, stretch. Plantar fasciitis is worse at night because the fibrous tissue can get scarred down and contract overnight as your foot is pointed downwards when sleeping. Upon the first step, that fibrous tissue is stretched the load of your body weight and would cause pain. Using a tennis ball to massage the bottom of your feet before standing up would help soften up the tissue so the stretch at first step would not be so hard to bear. Stretching or foam-rolling your calves would also have a direct effect on the plantar fascia by keeping the whole system soft and supple.

3) Manual therapy by a physical therapist can help with softening up fibrotic tissue and reduce inflammation of the fascia. ASTYM is a very popular approach with excellent results. It may be uncomfortable at first, but effects and relief are felt immediately. Over-pronation is sometimes a culprit to plantar fascia, which can be corrected by changing the landing angles of the foot and knee in walking and running – strengthening the gluteus muscles would help correct this loading angle. Physical Therapy for plantar fasciitis need not be a long stint of rehab – 4 weeks is the usual timeframe of PT needed.

3) Accessorize: if the plantar fasciitis is stubborn, there are several over-the-counter accessories that may help you. Some of my patients have said good things about the Strassburg sock (a soft night splint to keep your toes from pointing downwards), night splint boots, and arch supports. Reviews are mixed, but some of my patients tout that they were an overnight remedy.

4) In some serious cases, a podiatrist’s intervention may be what you need. They will prescribe PT as the first conservative approach and may move into cortisone injections when warranted, or suggest surgery options. But usually this option is left to those who weren’t listening to their aches and pains.

Dr. Alice Holland DPT, is a practicing physical therapist and director of Stride Strong Physical Therapy Portland, a specialized running physical therapy clinic in Sellwood.

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