Plantar fasciitis: How to Deal with Pain in the Heel

Shoes beside your bed in the morning

Okay, so this is a big one and we can't emphasize this point enough.  For 6-8hrs, we lie in bed with the muscles along the bottom of our foot and back of our leg shortened.  When we stand out of bed in the morning, the heel drops and the arch falls, which will often result in the re-tearing of an already injured plantar fascia.  Things will often deceivingly start to feel better after walking around barefoot for a few minutes but only because it's warming up.  But don't let that fool you, unfortunately the damage has already been done by that first step out of bed.  So here's what you do.  Try taking 30sec - 1min when you wake up in the morning to massage out the bottom of your foot and lower leg.  Follow this by stepping immediately into a shoe or sandal with a slightly elevated heel and ideally a bit of arch support.  This prevents that initial re-irritation of the sore spot.  Many a treatment plan has been undone by standing up out of bed barefoot.  And yes, it needs to be THE FIRST STEP!  It's not enough to shuffle down to the end of the bed and put on the shoes.  Don't be deceived by the simplicity of this treatment - it can make a huge difference!

Soft Tissue Treatment

Many of the plantar fasciitis cases that we see coming through are triggered by tight/restricted muscles along the back of the leg and up into the hip.  The achilles tendon and the plantar fascia both attach onto the same bone (calcaneous).  Tightness in the calf muscles will pull up on the achilles which lifts the heel which can put extra strain on the already irritated plantar fascia.  Try using a heating pad to warm up your calves for a couple of minutes and then massage out the muscles around the sore spot with your hands, a ball, a stick, or a foam roller.  It's also a great time to check in with your favourite massage therapist/physio/chiro/athletic therapist/osteopath to have them loosen things up.  This also works great to deal with any compensation type problems that might be developing as a result of favouring the sore foot.  We see quite a few new sore spots develop on the outer side of the foot after compensating from the medial foot pain. 

Stretching can also be very beneficial but be careful not to stretch too aggressively when the muscles are cold (to prevent re-tearing).

Don't be Barefoot

To be barefoot or not to be barefoot?  To the confusion of many patients, both are correct and as with many things, timing is everything!  We are huge fans of being barefoot (see our article here about the benefits of being barefoot!).  However, when suffering from plantar fasciitis, it's NOT the best time to be barefoot.  At the first signs of plantar fasciitis, turn to the protective tools (that we mention in the next point), treat the source (often soft tissue management), and once the injury is healed, slowly return to barefoot.  It's especially important not to be barefoot when getting out of bed in the morning and after sitting for a long period of time.  

Support the Arch of your Foot

A fallen arch does not mean you will develop plantar fasciitis but the action of the arch falling can irritate the tissues along the bottom of your foot when you're dealing with plantar fasciitis.  By taping the arch (see our video on how to tape for plantar fasciitis) or using off-the-shelf or custom arch supports, we can effectively shorten the tissues along the bottom of the foot and help protect them from re-tearing.   Taping can provide some fantastic short term relief while the arch supports are a more convenient option.  Again timing is everything with using the 'bandaids'.  Especially in the early stages of plantar fasciitis, we want the area to be unloaded and protected.  Once the injury is healed and the assuming that the source of the problem has been addressed, we can slowly start to remove the arch supports.  This is the perfect blend of short term protection with a long term fix!

Strengthening Work

In many cases, lack of strength in muscles surrounding the plantar fascia (or further up the chain) can be a trigger for plantar fasciitis.  However, we find that the best time to do specific foot strengthening exercises is after the plantar fasciitis has healed.  We see quite a few plantar fasciitis cases coming through that have been irritated by overly enthusiastic strengthening work.  We find this to be especially important in more acute, early stages of plantar fasciitis.  With longer running cases of plantar fasciitis, strengthening work may be prioritized higher.