Any experience with treating plantar fasciitis?

I sustained a mild hamstring strain about two months ago. To compensate for being unable to sprint while treating this injury, I did a lot of accels and (mainly vertical) plyos. Unfortunately, this resulted in plantar fasciitis including a small heel spur at the origin of the L plantar fascia. Has anyone had any experience with this injury? I’ve been doing a lot of foot and ankle stretching and strengthening exercises, and moved many workouts to bike tempo. I can walk and even run with minimal or no pain, but things always go downhill towards the end of or after workouts involving running. This has been going on for about a month now. I guess the next step would be to stop loading the foot for a few weeks while continuing the stretching and strengthening exercise. Just wondering if anyone has been able to fix this condition without stopping running altogether. I had just finished GPP and started SPP and was in great shape, so I’m worried that I’ll may have to start from scratch again after rehabing the foot. Any advice would be much appreciated. Thanks!

I just got over mine. Mine kicked in while running on concrete with my students. Hit me in november, got bad in december. Didnt heal till about june. It still bothers me here and there.

Your gonna have to stop training. I kept trying to run and it got worse.
But a plantar boot and sleep in it. Stretch the calves often. Ice and heat it often. Also get a hard ball and roll your foot.

No one thing will help.

There are some taping techniques that could be helpful. Also, you need to rule out nerve involvement.

Thanks for the replies thus far. I have tried a few different taping techniques. The only one that does anything for me is wrapping the tape around the middle of the foot to support the arch and push the plantar fascia against the bottom of the foot. This only helps when walking though, not when running.

I’ve also cut a whole into my insole to relieve pressure on the most tender area, which is helpful for walking and jogging but not sprinting (since there is no heel contact in sprinting).

Usually, tendinous structures don’t respond well to complete rest and heal better with (eccentric) strengthening and stretching. Research on achilles and patellar tendinopathy, for example, shows that loading the tendon during rehab even if it causes some discomfort is required for healing. I have, for example, successfully rehabed achilles and adductor tendinopathies while continuing to train. However, I haven’t seen any research applying this principle to plantar fasciitis. That’s why I was asking if anyone has had experience rehabing this condition without drastic changes to their training. Unfortunately, it seems like that’s not the case.

I wonder, for example, whether light, pain free exercise (eg. Jogging, skipping) will help or hinder the healing process and whether stretching or strengthening should only occur in the pain-free range or, as is the case with other tendinopathies, be a bit more aggressive.

I’ve also done regular cross-friction massage on the sore spot of the plantar fascia where the heel spur is located. This had a positive effect the first time I did it, but not really on subsequent attempts where it didn’t seem to make a difference.

If a heel spur is present, you may need surgery. I would try taping the whole bottom of your foot. I have done this before using hypafix and leucotape. Kinesio tape may work as well or even better but I haven’t had the chance to try it. One other thing that may be useful is the use of Graston technique.

I had a terrible plantar fasciitis that lasted 6 months. For me it seemed to be due to having too many contacts with hard surfaces. I had to pretty much not run or jump at all for about 2 months with minimal walking, and then as symptoms began to get better, I did my own little “rehab” where I did very light rudimantary hops (like single leg hops forward, backward, and sidewards) with bare feet on grass, progressing volume gradually. Pain went away I think about 4-6 weeks after I began the rehab.

I did a bit of toe curling (flexing) exercises, a lot of hand/ball massage, stretching, and night splint. I used ice when it was bad and NSAID when it was REALLY bad, but tried not to depend on those too much because I read somewhere that although too much inflammation is bad, some inflammation is necessary to promote healing of tissues.

I do not believe I was told anything about heel spur for my case when I had MRI done however.

Plantar fasciitis is a horrible condition that pretty much disables that person until that person is fully healed, which will require at least some period of complete rest. I really hope all the members here stays free of plantar fasciitis and all other injuries. Injuries are curse that is good for nothing.

I hope for your quick and complete recovery.

Thanks for sharing your experiences. My case seems to be a lot milder than what you guys describe, so hopefully it will heal quicker. I can walk barefoot or with shoes with (next to) no pain, even on my first few steps in the morning. I can do sets of about 10 slow, single leg eccentric or eccentric/concentric body weight heel drops. Once I go past 10 I start feeling slight discomfort. I used to do sets of 20 with 40kg added weight for those, so that’s what I’ll need to get back to. I can also do easy skipping exercises without problems. I think I’ll just try to keep fit with bike or pool tempo, weights and circuits while slowly building up the intensity of the heel drops and skipping. The PF and calf stretches as well as foot and ankle strength work will continue as well. I’ll also keep doing single-leg plyos on the unaffected leg.

I’m not too worried about the heel spur, and doubt it will require surgery. It’s quite small. Many people have asymptomatic heel spurs and don’t even know about them until they happen to get a foot X-ray.

I don’t believe in taping techniques that try to shorten the foot to relax the PF. I know this has been shown to give relief, but I don’t think it’s a good approach for athletes because a shortened PF from this type of taping will be more likely to play up again later. Approaches like stretching, night splints, rolling out and strengthening the PF seem to me to be the better way forward, as they result in a PF that is longer (rather than shortened) and stronger and thus better able to deal with the demands of running and jumping exercises.

This is similar to the treatment of achilles tendinopathy. Some people prescribe heel lifts to minimise pulling forces on the tendon. However, this will lead to shortening of the calf and tendon, which may make the tendon even more prone to tendinopathy later on. I actually bought shoes with a neutral heel (which are hard to find, since almost all running shoes these days have a postivie/high heel) when treating my achilles tendinopathy, as I wanted to lengthen my calf/achilles complex to avoid issues creeping up when wearing spikes that have a negative heel later on. This, together with daily stretching and regular eccentrics worked very well and I fixed up my achilles in about 6 weeks.

Kwave, how did you know that you were ready to start the jumping exercises?

Unfortunately, I had no real “guideline” or “criteria” to determine I was ready. I just went by gut feeling based on the fact that I was on my feet minimally for about 2 months and based on decrease in pain level. I decided to take risk at that point and start, knowing that I must make adjustments or regress to rest phase if pain got worse, which it did not. It stayed about same for about 4,5 weeks and then for a week or so I had on and off days with pain occurrence. After that week, pain went away.

Thanks. So what was your pain level at the point you started these exercises? Did the exercises hurt? What types of activities were still causing pain at this point?

I think (if I remember correctly) when I started those exercises it was at a level where I’d only have slight pain first thing in the morning (which I could reduce further with stretching and massaging before setting my foot on the ground) and during prolonged standing/walking. When I did the exercises, I don’t remember feeling pain doing it. I think it’s because of either being warmed up and having adrenaline or due to the itchiness I had on the skin of the bottom of the feet from being barefeet on grass. I think I did at some occasions have slight discomfort following the exercises, but most of those were less intense than pain I got from prolonged standing/walking.

When it did feel a bit too much, I took longer rest (days) between sessions and reduced volume of the subsequent session.

In case anyone is interested, here is an update on my condition and research regarding plantar fasciitis. One interesting thing I found in the scientific literature is the relationship between the toe flexor muscles and plantar fasciitis. People with PF often have weak toe flexors. A heel spur, which is commonly associated with PF, but is not its cause, usually involves the flexor digitorum brevis rather than the plantar fascia. When this muscle is weak and/or overworked, calcification can occur at its origin (attachment to the calcaneus) thus leading to a heel spur. The plantar fascia lies right on top of this muscle and has to compensate by taking extra force if the flexor digitorum brevis is weak. This can lead to micro injuries that accumulate over time, which ultimately results in PF. Just like other tendon injuries, PF is not actually inflammatory in nature and therefore shouldn’t technically be called fasciitis. Being basically an extension of the achilles tendon, the same type of stretching and eccentric strengthening programs that have been shown to be effective in achilles tendinopathy can be applied, while at the same time strengthening the toe flexor and other foot muscles.

Here is what I did, which is basically a combination of approaches that have either been shown to be effective in the literature or made logical sense to me:

  1. Daily stretching of gastrocs/soleus/achilles complex (i.e. stretch into ankle dorsiflexion with straight and bent knee)

  2. Daily stretching of the plantar fascia: Passively extend the big toe and dorsi flex the ankle with one hand (i.e. pull the big toe towards the knee/shin) while pushing onto the plantar fascia with the other hand to increase the intensity and specificity of the stretch. Stretches were held for 10-30s and repeated many times (10-20 times) throughout the day.

  3. Daily eccentric heel drops. These were also used as a diagnostic tool. Initially (one month into the injury, when I started this protocol) I could do 10 reps on the affected leg without added weight before the heel started to hurt. Today (about two weeks later) I did 20 reps with 28kg of added weight and still had no pain on the last rep.

  4. Daily foot and ankle strengthening consisting of toe flexion and extension, ankle flexion and extension, calf raises, toe curls, raising up onto the big toe to strengthen the big toe flexors and an exercise where you shorten the foot and raise the arch by activating the intrinsic foot muscles. They were all done once or twice a day for one set of 30 reps. Doing the ankle flexion and extension exercise, I noticed that the dorsiflexors on the affected leg (which is also the one where I have had achilles tendinopathy) were rather weak. I think Boldwarrior has referred to this relationship in the past. I also found that the intrinsic foot muscles were weaker and/or harder to activate/target on the affected side. I’m glad to have discovered these weaknesses, as I’m sure correcting them now will help prevent new or repeat injuries in the future.

  5. Wearing a Strassburg sock at night. This really did wonders and may well have been the most important aspect of my rehab program. A Strassburg sock forces your toes into extension and your ankle into dorsiflexion, thus basically stretching the PF all night long. You can buy them, but I made mine myself by stitching a strip of cloth to the tip and the top edge of a long sock. They are cheaper, less bulky and more comfortable than a splint and more effectively stretch the PF as they also extend the toes.

I also did a few other things such as taping the arch for a while, rolling a ball under the foot, cross friction massage, cutting a hole into my insole to take pressure off the sore spot on the calcaneus and inserting a slight medial heel wedge to distribute force away from the PF and towards the lateral foot, but I don’t think these had much of an effect compared to the stretching and strengthening exercises.

In terms of training, I’ve been doing rather intense circuits two to three times a week (consisting of deadlifts, ham curls, adductor exercises, one-legged squats, glute bridges, split squats, calf raises and arm swings to simulate sprinting), bike tempo, upper body weights and bounding on the unaffected leg. I also did very easy skipping exercises involving the affected leg, which I progressed slowly, always checking that the number of pain-free eccentric heel drops I was able to do the day after stayed at least the same (they actually improved pretty much every day). After less than two weeks, I was able to do some easy bounding on the affected leg and some on-the-spot tempo running on a mattress. After about two weeks I was able to do low impact depth jumps and slightly more intense bounding. I’m planning to try some normal tempo running tomorrow.

I believe that my main problem was that I initially thought I had a heel bruise, as I didn’t have the typical morning pain that is usually associated with PF. I initially only had pain when weight bearing on the heel, which tempted me to continue doing anything in training that didn’t involve heel contact to the ground (accelerations, depth jumps). I wouldn’t have done this had I known it was PF. Once I had a diagnosis of PF and realised I needed to stop running for a while after one month of worsening symptoms, it only took 2.5 weeks to see substantial improvements. Had I started the right type of protocol straight away, I would have probably been back to normal after about two weeks.

Mike ( Forgraves who is featured in project jane and recently passed away) also pushed me to do all the strengthening and stretching and toe grabbing exercises but I rarely did them. I was always too busy which sounds like an excuse and it is but no one has all day. I prioritized what I could do and training usually took precedent over therapy unless there was a fairly quick feedback loop. I also used Tens units during class but that’ a bandaid not a remedy and you could use sim on the foot too if you were motivated enough. Waldemar also told me to get a foot bath and I did that too and they are not expensive( check out DR. Scholls online)

Mike Foregrave recommended the Strassburg sock.

The Strassburg sock is amazing. I noticed a significant improvement after the first night of wearing it (1.5 weeks ago) and have been getting better every day since then. Was able to do some pain-free tempo running (at 15s pace) today and am back to full load on the eccentric heel drops.

Old koori remedy.

Bathe the foot in some eucalyptus oil.
My son calls it koala oil.

You mean pure eucalyptus oil or a footbath with some eucalyptus oil in it?

Pure, just keep saturating it for 10 mins or so. You can buy it in a spray can.

Our forefathers used to get the leaves, crush them and continually rub the oil in

I love Eucalyptus. It’s what they use for Vicks vapor rub.
We were training in California one staying with Charlie’s former roommate from Stanford ( John ) and I had a very bad cold and could not breath through my nose.
We used an oil that was smelling like Eucalyptus on the neck, throat, back and lymphs under the arms and I could breathe again. I never forgot that and while I rarely get colds I use this method to alleviate the annoyance of congestions.
I suspect it has a thermal effect? Is that why the foot bathing works?

Vicks vapour rub, know it well.
Not really soothing just stops pain.