Plantar fasciitis is one of those disorders that affects individuals across all activity levels, body types, ages, and genders. Yes, it tends to affect women ages 40-60 with a higher prevalence, but I’ve also seen plenty of runners and dancers in their 20’s with debilitating symptoms, as well. It is one of those “great equalizers” in medicine.

Given the high incidence/prevalence of PF, there is no shortage of treatments ranging from shoe inserts and Shark Tank-style home devices to exotic injections of stem cells and “exosome” therapy. Unless you’ve got a centrifuge handy to prepare and inject platelet rich plasma (PRP) into an aching foot, there are home therapies worth considering to break the cycle of nagging foot pain before stepping foot—oops, had to—into a doctor's office or therapy gym.

As always, this is intended only for educational purposes and is not medical advice. Before trying anything written below, you must speak with your own medical team. They know you and your feet well and can determine if any of the following therapies are relevant to your specific situation. You should not delay seeking medical treatment when necessary. These ramblings of mine are not meant to diagnose, treat, or cure any disease or ailment.

Case:  

Tiny Dancer was a 20-something year old woman who presented to a sports medicine clinic with feet pain that had been going on for several years. The pain came on gradually but now affects her daily- essentially with each step.

She came from a background with "extensive financial resources," so by the time she found us, she'd already roughly invested in:

• At least two corticosteroid injections
• Platelet-rich plasma injections (blood plasma gets concentrated with platelets and othe rinflammatory and growth factors to stimulate healing)
• Stem cells (which can "differentiate" or turn into the necessary cells to repair an injury)
• Prolotherapy (sugar water that jumpstarts an acute inflammatory response to promote healing of chronic, nagging inflammation)
• Exosome therapy (like fancier PRP and stem cell therapy)

Total out of pocket cost: $1000s

Result: Worse than when she started

Based on the story alone, we had suspicion of what we’d find. Mind you, I am not a sports medicine specialized physician. In PM&R we get quite a bit of training in sports medicine, but docs who want to do this sort of thing exclusively go through additional fellowship training. Part of that training involves the fellow becoming “one” with their ultrasound wand; I swear some of them would have an easier time finding the carpal tunnel with an ultrasound than the Lincoln Tunnel with Waze and Google Maps guiding their way.

What I’m saying is when my supervising physician put that ultrasound wand to the patient’s feet—revealing what appeared to be multiple visible tears in her plantar fascia—we had no doubt what we were seeing was accurate. In “normal” fasciitis, the pain is caused by microtears and inflammation; in this case, we saw significant sections of where the fascia had actually torn on a larger scale.

Rule #1: If you must get a steroid injection for plantar fasciitis, ya get one and only one. For life. More than that and the risk of rupture (large tearing) is too high. But, if “microtears” are the cause of standard fasciitis pain, what actually predisposes someone to develop PF in the first place?

We'll start from the microtears and work backwards. If repetitive stress causes these tears, then what factors would logically increase that stress?

1. Excessive “pronation”: Not exactly the same as flat feet, “over pronation” is more about how your ankle/foot behaves when walking. In other words, when your foot lands, the shinbone moves excessively towards the inside of your foot. From behind, it looks like your Achilles is bowing in as your foot flattens out. So, yes, I know what you’re thinking, how is that not flat feet? They are related, no need to overthink it.
2. Extra body weight: It’s physics. More body mass pressing down on imperfect foot/ankle mechanics is going to put more stress on the structures trying to hold it all together.
3. Weak lower leg muscles: A lot of the offloading/mechanics is actually done by muscles in the lower leg with the tendons wrapping around the ankle for stability. These weak muscles then force the plantar fascia to stretch (when planting the foot) and contract (when pushing off) for that extra spring in your step
4. Improper running mechanics/rapid increase in activity: These two are related. If you go from modest activity to marathon training, the muscles, tendons, and ligaments may not be prepared for the extra work. If you then don’t have proper recovery after - adequate nutrition, rest time between sessions, and good restorative sleep - then injury risk increases.

If you run like a gazelle with a splinter in his toe (like yours truly), mechanics that weren’t an issue during a half mile warmup jog can compound into real injuries over the course of a few miles.

So what can you do?

Home based treatments

1. Relative Rest: If you’re the athlete who ramped up their activity too aggressively, take a step back and rest to allow time for the affected foot to heal. If your feet are figuratively hot (freshly inflamed), apply ice directly to the foot to decrease inflammation and associated pain. Some find it helpful to get one of those round ice cubes and roll their foot over it for a little ice and pressure. NSAIDs like ibuprofen or naproxen may take the edge off in minor cases, as well.
2. Orthotics (shoe inserts) and night splints: Over the counter shoe inserts can effectively treat the underlying biomechanics that predispose some to plantar fasciitis, such as such as flat feet or high arches. When paired with night splints, individuals may see results faster, as they effectively help stretch the foot/ankle to prevent sleeping positions from “undoing” all the stretching done in the daytime. Night splints may affect sleep quality at first—it may be tough to fall asleep with your ankles in a constant stretch—though typically this is less of an issue after the first week.
3. Stretching: This is actually the mainstay of non-invasive treatments. For some, plantar fasciitis is triggered by overly tight Achilles Tendons. Visualize this: essentially, if the tight Achilles is pulling on the heel of a foot with an excessively high/flat arch, the tight plantar fascia bears the extra stress right where it connects to the heel. Some doctors/therapists preach to stretch the Achilles, others the plantar fascia. Research suggests stretching both is helpful, and likely better than either alone.

Strengthening:

This is the “easy” stuff, which strengthens the muscles within the foot. I’ve included a link to a video in each of these- I do not know these folks, so if news comes out about one of them doing something terrible, please do not see this as an endorsement of their character. These videos are just helpful.

• Toe Tapping: While sitting, tap your toes on the ground for 1-2 minutes. Progress by using a resistance band around the forefoot.
• Marble Pickup: Place marbles on the floor, and use your toes to pick them up and place them in a container. Perform for 5 minutes, gradually increasing duration.
• Other Intrinsic (inside the foot) Muscle Strengthening: Perform toe curls by scrunching a towel with your toes. Do 2 sets of 10-15 repetitions.
• Yoga Toes: Strengthens the muscles that help support the arch of the foot. Complete 2 sets of 10-15 repetitions.

When it comes to the these “easy” plantar fasciitis exercises, I’ve chosen these four because they’re ones with simple techniques that actually challenge the muscles in the feet and ankle. You can do most of them at work, you know, provided you carry a few marbles around and won’t get an HR call for being barefoot when no one’s looking.

The “tougher” stuff, starting with eccentric loading, which helps both strengthen the calf muscles and improve any tendon issues with the Achilles.

• Eccentric Loading- Heel Raises:  Stand on a step or elevated surface with heels hanging off the edge. Lower heels below the step and then rise onto toes. Perform 2 sets of 15 repetitions.

Once you’ve gotten over the worst of the fasciitis, and you’re ready to really put one foot in front of the other, toe grabs are one final series I’ll include here. They’re kind of like a dynamic version of the toe curls that you perform first while standing, then walking, and finally while “jumping.” The jumping part gives you another eccentric benefit, but this time it is borne more in the feet than the calf.

To wrap up, first get checked out by your personal “medical/therapy person” (no doctor bias here). Make sure that you’re not missing something before starting to put a load on painful, inflamed feet. Then, once the fasciitis calms down, try addressing some of the risk factors introduced at the top - improper arch support, running mechanics, weight loss, etc.- so you can... get off on the right foot.

Ok, now I'm actually done with the puns.