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Plantar Fasciitis is the most common cause of foot and heel pain and many people who develop this condition suffer for much longer than they should (1). In fact, most of the cases that I see in my office have had foot pain for years.
This is primarily because there is a tremendous amount of misinformation out there about how to treat it effectively. Sadly, most of the recommendations sufferers receive are for symptom relief and not long-term solutions for correction.
Plantar fasciitis is already so painful the last thing you want is to make it worse. Let's take a look at the top 10 mistakes to avoid.
Dr. Angela Walk
Chiropractic Physician
Specializing in Foot & Gait Analysis
What Is Plantar Fasciitis?
Plantar Fasciitis is the most common cause of foot and heel pain. It involves a strain or break down of the plantar fascia, a thick, fibrous band that runs from your heel to your forefoot.
Symptoms include pain at the inside portion of the heel that is worse after prolonged periods of rest and with the first steps in the morning.
The term fasciitis indicates tissue inflammation, however, evidence suggests that inflammation plays a lesser or no role at all in the condition and plantar fasciosis is a more appropriate name.
Because most people are familiar with the name plantar fasciitis, I tend to use this name most often to avoid confusion.
Mistake #1: Wearing Ill-Fitting Footwear
Wearing ill-fitting footwear is the #1 biggest mistake foot pain sufferers make. Conventional footwear that narrows or tapers at the toe is the leading cause of foot and ankle disorders. (2)
This poor, damaging feature is not just present in women's high heels, it's also running shoes, men's shoes, and casual shoes. Most all of them tapered at the toe and even have elevation of the heel.
When we cram our feet and toes into narrow toe boxes, our feet can not function normally, and overtime, begin to weaken and atrophy. This sets us up for conditions such as plantar fasciitis.
Feet are a product of their environment. The shape of the footwear that you wear most often can actually begin to change and shape the structure of your feet. Our toes shift and deform, and our muscles shorten and weaken.
Solution: Transition to natural, functional footwear that are made to accommodate the normal shape of our feet. The four necessary criteria for healthy footwear is a wide toe box, no elevation of the heel, no heavy cushioning and a flexible, bendable shoe.
Mistake #2: Using Foot Orthotics Long-Term
Orthotics have become a mainstay for the treatment of plantar fasciitis. Often, orthotics are the first thing prescribed by most practitioners. The belief is that flat feet and pronation alter foot and gait mechanics and lead to plantar fasciitis.
Orthotics deny our feet the opportunity to work and can create "lazy feet". The muscles of our feet can begin to weaken with the use of arch supports and not work as they were designed.
Orthotics can be helpful in the acute phase of care where pain is more severe, however, beyond that, further weakening can occur (3).
A good analogy would be casting a broken arm. The cast is essential in the initial phase of healing, but if left on too long, the muscles of your arm begin to atrophy and become weak.
Our feet are innately strong and do not need extra arch support or heavy cushioning. My belief is that the less material between your feet and the earth, the healthier the shoe is for your feet. Your feet can lose internal strength with more external support.
The feet actually become dependent and deconditioned by this type of support and footwear.
Mistake #3: Only Stretching, and NOT Strengthening
Along with foot orthotic and rolling a frozen water bottle on the bottom of your foot, stretching the calf muscle and plantar fascia is the most recommended remedy for plantar fasciitis.
One of the most common causes of plantar fasciitis is tight calf muscle and limited ankle mobility (3). So, stretching would seem to makes sense. However, research shows that strengthening may be the best option for increasing mobility within a muscle or reducing tightness.
I have seen this so many times where I recommend only strengthening exercises for restricted calf and soleus tightness and the increase in flexibility is remarkable.
Solution: Strengthening the gastrocnemius/soleus complex with calf raises and restoring strength to the intrinsic muscles of the arch is the long term solution instead only stretching.
Mistake #4: Treating plantar fasciitis as an inflammatory condition
This may surprise many people, but plantar fasciitis is NOT an inflammatory condition (3).
Within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process.
Studies show that It is more of a degenerative condition involving the collagen in the fascia. Treating PF as an inflammatory condition typically involves cortisone shots, NSAIDS (anti-inflammatory meds), and repeated icing of the area.
Sadly, this type of treatment is just a short-term band aid and doesn't address the root cause. There can also be side effects of long term NSAID use and corticosteroid injections.
Plantar fasciitis more closely aligns with a tendinopathy than an inflammatory condition.
Solution: Implement treatments that include progressive loading such as strengthening exercises.
Mistake #5: Not Being Consistent With Rehab Efforts
Rarely is there a quick fix for plantar fasciitis. To rehabilitate from plantar fasciitis, it takes a daily commitment to do the necessary foot work.
For a complete roadmap to resolve plantar fasciitis at home, download my free guide and make a committed effort to include therapy on a daily basis.
Solution: Be consistent, stay positive, and commit to a foot-healthy program
Mistake #6: Failing to Address Scar Tissue and Adhesions
If you have plantar fasciitis, there is no doubt that you have accumulated scar tissue and adhesions. Scar tissue forms as a result of a repetitive stress.
It is also referred to as fascial adhesions, fascial restrictions, or simply “knots.” Think of scar tissue as the body’s duct tape.
For example, in the case of plantar fasciitis, if you walked too far in bad shoes, you overwhelmed the structural integrity of the plantar fascia and create small injuries also known as micro-trauma.
The body will lay down a quick "patch" to aid in healing these small injuries and that is known as scar tissue formation. Unfortunately, over time, this scar tissue will build-up and accumulate and they start to affect the normal function of the muscles and fascia.
In fact, they will often lead to pain, tightness, lack of flexibility, muscle weakness, compromised muscle endurance, restricted joint motion, and diminished blood flow.
One of the most effective ways to remove scar tissue is with Instrument Assisted Soft Tissue Mobilization (IASTM) (6). I have used IASTM in my practice for many years with great success.
It involves the use of a stainless steel instrument or stone to "scrape" away scar tissue adhesions. These tools greatly assist in soft tissue mobilization and improve blood flow to the affected area and in turn, release adhesions and scar tissue in the muscle tissue and create healing.
To read more about how to remove scar tissue and adhesions from you plantar fascia, calf muscles, read the full article here.
Solution: Use muscle scraping every 2-3 days to remove accumulated scar tissue and adhesions in the gastrocnemius, soleus, Achilles tendon and plantar fascia.
Mistake #7: Continuing High Impact Exercise
If you developed plantar fasciitis from a high impact exercise such as running or a jumping activity, discontinuing this activity is imperative until correction and healing occur.
High-impact exercises place three times the body weight on our feet, including the heel. The increase in weight on the heel can worsen plantar fasciitis by increasing the strain on the plantar fascia.
Solution: Transition to low-impact, plantar fasciitis-friendly fitness options such as swimming, aqua jogging, cycling, rowing, or yoga.
Mistake #8: Getting Dehydrated
Dehydration affects just about every system and part of your body, and your plantar fascia is no different (7). Dehydration can lead to diminishing the lubricant fluid around tendons and ligaments that prevent overuse injuries.
This translates to potential micro-tearing and scarring of the plantar fascia. Drink half of your body weight in ounces of pure water daily.
If you exercise, you may need more than that as sweating creates a loss of water in the body that needs to be replenished.
Solution: Drink half your body weight in ounces of water. For example, if you weigh 200 lbs., drink 100 ounces of water daily.
Mistake #9: Avoiding Walking Barefoot
One of the most common recommendations to resolve PF is to avoid walking barefoot, or wearing flats or flip flops. This information is wrong and prevents many sufferers from truly resolving their foot condition.
The best way to restore healthy strength to the muscles of your feet is by wearing minimalist shoes and practicing barefoot walking (8). I recommend starting slow and only going barefoot an hour or so a day, then adding more time each week.
As you commit to foot work and foot strengthening, you will begin to feel more comfortable in your bare feet, flats, flip flops and minimalist shoes.
Solution: Practice walking barefoot daily with toe spacers. Toe spaces stretch and realign your toes and creates a more natural gait. Walking barefoot naturally strengthens the intrinsic muscles of the feet. Start with 20 minutes and work up to 2 hours a day.
Mistake #10: Wearing Night Splints
Night splints are becoming increasingly popular as a treatment for plantar fasciitis.
This prompted me to begin evaluating the effectiveness of wearing a night splint with my PF patients.
Over several years of the assessing night splints as an application for treatment, my conclusion is that although it is true that night splints have been shown to decrease pain in the short term; this application does not have a significant effect on prevention or recurrences long term (10).
Solution: Shifting your focus from endless stretching to strengthening the calf muscles and foot muscles is the key!
Can I Treat Plantar Fasciitis At Home?
As a chiropractor and foot specialist, I often see patients with plantar fasciitis after they’ve tried everything. Cortisone shots, night splints, ineffective stretching, and rolling on a frozen water bottle are a few of their failed remedies.
If you’re wondering how to treat plantar fasciitis at home, I want to share a few insights that have worked for my patients. The solution for most of my patients is through addressing multiple factors.
Improving limited ankle mobility and dorsiflexion
Strengthening weak intrinsic foot muscles
Strengthening weak calf, soleus, and peroneal muscles
Rarely is there a quick fix for PF. Identifying areas of weakness in the foot and ankle and restoring proper foot function is the most important piece of the puzzle.
I have created a step-by-step comprehensive guide on how to resolve Plantar Fasciitis at Home. Take a look at my FREE GUIDE here.
Summary
Dealing with the pain of plantar fasciitis can be life changing--but it doesn’t have to be a life sentence. By arming yourself with knowledge and taking charge of your healing, you can get back to the activities you love and feel like yourself again.
If you have additional questions about heel pain and plantar fasciitis, don’t hesitate to reach out. I'm here to help get you back on your feet--literally.
Best of Health,
Dr. Angela
P.S. If you would like daily tips on how to resolve plantar fasciitis, join my Instagram and Facebook pages.
I have also written extensively on the topic of Plantar Fasciitis. Take a look at these other related blog posts:
Hi, I'm Dr. Angela Walk
I have been involved in the health and wellness industry for over 20 years as a wellness physician, chiropractor, and foot health coach. I have written extensively for health publications and I am keenly aware of trends and new developments.
I embrace an active lifestyle combining diet, exercise and healthy choices. By working to inform readers of the options available to them, I hope to improve your health and quality of life.
GET FREE ACCESS! Dr. Angela Walk is on a mission to provide you and your family with the highest quality nutrition tips and organic products...Join me on my Facebook Page or Instagram Page.
REFERENCE:
(1.) Capt. Danielle L. Scher, MD; Lt. Col. Philip J. Belmont, Jr., MD; and Maj. Brett D. Owens, MD. The Epidemiology of Plantar Fasciitis. Lerma Magazine 2010 p. 1
(2.) William A. Rossi, DPM Why Shoes Make Normal Gait Impossible Podiatry Management 1999 p.1-8, 10.
(3.) Lemont H, Ammirati KM, Usen N. Plantar fasciitis. A degenerative process (fasciosis) without inflammation. J Am Podiatry Med Association 2003;93(3):234-237.
(4.) Garrett, Troy Richard, "A follow-up of patient reported outcomes in chronic plantar heel pain participants treated with Graston Technique: A mixed methods approach" (2016). Dissertations and Theses @ UNI. 344.
(5.) Daniel R Bonanno, Karl B Landorf, Shannon E Munteanu, George S Murley, Hylton B Menz Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: a systematic review and meta-analysis Br J Sports Med 2017 Jan;51(2):86-96.
doi: 10.1136/bjsports-2016-096671.Epub 2016 Dec 5
I just found out I have tarsal tunnel. Is there anyway to avoid surgery? Can you talk about this in one of your emails