“Plantar fasciitis” is an annoying and often stubborn injury that most people who run are familiar with to some extent. It’s more accurately termed plantar fasciopathy or plantar heel pain as it has a different mechanism and management from traditional “itis” inflammation related conditions. It’s very similar to typical tendon overload injuries in that the best ways to treat it are going to be a combination of resistance training, proper load management, and supplemental recovery work. This article will act as a no-nonsense summary of how to approach these tools.

Resistance training

Strength training is useful for building tissue capacity of the foot and lower leg to tolerate running impact. It also provides specific pain-relieving effects which can help you get back quicker and with less annoying pain. All of these exercises are designed to load the plantar fascia in various positions and ways in order to build well-rounded, comprehensive capacity. They can and should eventually be progressively loaded using dumbbells, barbells or weight vests.

Towel heel raise

Perform barefoot with toes elevated on a rolled up towel. Can be performed with isometric hold at the top.

Plantar flexed squat

Perform with or without hand assistance, focusing on control and keeping the heels as high as possible throughout.

Squatting heel raise

Focus on elevating the heels as far off the ground as you can, find the balance using a hand for support and progress to no hands.

Sample Template

3x/week
A1. 3×15 Towel heel raise (single or double leg) with 3s isometric hold at the top
A2. 3x60s of slow, controlled plantar flexed squat practice
A3. 3×20 Squatting heel raise

Load management

Running style

Don’t make dramatic changes in running style in short time periods. Recognize that technique changes involve altered force distributions to different structures and our body’s structures need time to adapt to these changes. A mid or forefoot strike will likely place greater tensile loads on the plantar fascia while a heel strike may result in greater compressive forces at its origin in the heel. Our bodies are capable of adapting to either but require time and proper progression to do so.

Cadence (steps per minute)

A faster cadence is the one biomechanical variable that has been demonstrated to consistently decrease ground reaction forces when running. A cadence between 170-190 steps per minute may be good to aim for initially to reduce extra unnecessary load.

Footwear

Don’t make rapid changes in footwear types. A good trick to prevent load related overuse injuries when running greater weekly mileages is to pick 2 similar pairs of shoes and alternate between them. Even buying the exact same shoe but having one pair that has been worn for 6 months longer will offer enough variability in load distribution to reduce overuse injuries.

Training mileage and intensity

Make sure you are following a program that gradually builds how fast and how far you are running, as well as the total mileage. Systematic programming with planned deload weeks is useful for both injury prevention and performance.

Surfaces

Same principles apply, no large changes over small time periods. Grass, sand, concrete, trails, incline, decline all change load distribution and timing so make sure you give yourself enough time and practice to adapt to big changes in these.

Supplemental recover work

Sleep and Stress

Lack of sleep and increased stress have been shown to correlate with a number of overuse injuries. If there is something that is temporarily affecting these in your life, scale back the volume and intensity of training a bit until you can recover more effectively.

Nutrition and hydration

This is a given. Consumption of adequate calories, appropriate macronutrients and enough water to support training will have positive effects on injury prevention and recovery.

Soft tissue work and Stretching

There are mixed opinions in the physiotherapy world on how compression (soft tissue work like stepping on a golf or cricket ball for self massage) and prolonged stretching affect tendons and tendon-like structures (this includes the plantar fascia).[1] A good general recommendation is if it feels good and alleviates symptoms, go ahead and do it, but also understand that it is going to have a generally small affect in the grand scheme of things.

[1] See http://www.greglehman.ca/blog/2015/11/27/stretching-tendons-what-can-we-do-and-why-we-should-challenge-our-biases-part-2 for an interesting write up