Plantar Fasciitis Causes, Symptoms And Treatments Of This Nightmare Running Injury
Few things will derail your love of running quicker than heel pain caused by plantar fasciitis
Plantar fasciitis is one of the most common running injuries, and one of the most unpleasant. If you have the misfortune to suffer from plantar fasciitis it can take weeks or months to heal, which can completely derail a marathon training plan. It also makes every step you take a painful experience, especially first thing in the morning.
Like many running injuries, such as runner’s knee and shin splints, plantar fasciitis is a problem that usually arises from overuse. It’s common among newer runners who dive into the sport without an appropriate running training plan that builds up their mileage gradually, but it can also strike down runners of all levels who suddenly increase the amount and intensity of their running, perhaps after signing up for a running event.
Plantar fasciitis can be easily confused with achilles tendonitis, since one of the main symptoms you get with plantar fasciitis is pain around the heel. It’s important to get the right diagnosis because the treatments of these two injuries are very different – you generally need to rest with plantar fasciitis, and keep moving with achilles tendonitis.
We spoke to Tim Wright, sports physiotherapist and the creator of Virgin Active’s Beyond Movement service, to get more info on what causes plantar fasciitis, how you can reduce the risk of it happening to you, and how to treat it if it does.
Wright earned a BSc in physiotherapist from the University of Sydney and his career in professional sports physiotherapy has included London Irish RFC, Surrey County Cricket Club and the 2000 Olympics in Sydney.
What is plantar fasciitis?
“Plantar fasciitis is an overuse injury caused by repetitive over-stretching of the plantar fascia – the thick band of tissue that runs under the foot, forming the arch,” says Wright.
“This leads to possible inflammation and thickening of this tissue. Plantar fasciitis is the most common cause of heel pain but can be commonly confused with a diagnosis of achilles tendinitis.”
What are the symptoms of plantar fasciitis?
Pain. Horrible, horrible pain that makes you gasp when you step out of bed in the morning, as Wright explains.
“Symptoms of plantar fasciitis consist of a gradual onset of pain under the heel which may radiate forwards into the foot’s arch. There may be tenderness in the sole of your foot and on the inside of your heel when pressing in. It can make it difficult to fully bear your weight or walk.
“This can range from slightly uncomfortable to very painful, depending on how badly it is damaged.”
The pain tends to be particularly bad in the morning, easing slightly throughout the day.
“It’s usually worse first thing in the morning because the foot has been in a relaxed position all night and the plantar fascia temporarily shortens. Walking around usually helps ease the pain as the tissues warm up and gradually stretch out. Moving after a period of inactivity can also trigger the pain.”
What causes plantar fasciitis?
Like most common running injuries, plantar fasciitis is most likely to rear its ugly head when you suddenly increase the amount of activity you do, such as with a marathon training plan.
“Through overuse, the plantar fascia can become inflamed and painful at its attachment to the heel bone,” says Wright.
“Most commonly the inflammation is due to poor core stability and tight muscles in the foot and legs (particularly the achilles, calf and hamstrings), resulting in a biomechanical imbalance, particularly in the lower legs.
“It is more common in sports that involve running or jumping. Although overuse is ultimately the cause of injury, there are a number of factors which can increase the likelihood of developing it including overpronation (excessive rolling of the foot upon landing), a high arched foot, tight calf muscles, poor footwear, being overweight and previous injury of the lower legs.”
If you think you overpronate, try gait analysis and if you suspicions are confirmed one of out best stability running shoes will help correct overpronation.
How do you treat plantar fasciitis?
Although it’s annoying to miss out on training days, you’ll have little trouble convincing yourself to get some vital rest if you suffer plantar fasciitis, because it makes running very painful. Stretching exercises and taping can help ease the pain.
“According to research, a plantar fascia stretching programme produces significant improvements in pain, movement and increased physical activity,” says Wright.
We have five stretches for plantar fasciitis below, and these nine stretches for runners are easily added to your training routine.
How to roll the plantar fascia
If you have been struck down with plantar fasciitis then rolling is about to become a regular part of your daily routine. As Wright suggests, you can go pretty low-tech with what you use for your rolling – just grabbing a can of beans from the cupboard will do fine. Other rolling options you might have to hand include a rolling pin (do wash this well afterwards), a golf ball or a frozen water bottle, which has the added bonus of feeling nice and cool on your inflamed foot.
You can also buy rollers that are perfect for rolling the arch of the foot. A massage ball roller is great for this. Ignore the terrifying spiky options and get a firm, smooth ball which makes it easier to roll and get deep into the tissue. There are also small bar rollers designed for the foot, which are far better than trying to use a full-sized roller.
Neither of these will cost much, so if you are rolling twice a day it might be a worthwhile investment to get a dedicated roller. Below you’ll find a couple of great options that will give you change from a tenner.
Buy PROTONE Lacrosse Ball on Amazon (opens in new tab) | £6.99
Buy ResultSport Nano Foot Roller on Amazon (opens in new tab) | £7.38
How do you avoid plantar fasciitis?
Injuries like plantar fasciitis are one of the reasons it’s important to do more than running when you’re training for a marathon. Strength training that targets the muscles in your lower body and improving your flexibility will help you avoid it.
“Focusing on flexibility of the lower legs and strengthening leg and hip muscles helps,” says Wright. “Frequent sports massages can help as well, along with not carrying excessive weight.
“Having a biomechanical screen with a chartered physiotherapist or registered podiatrist will also help you avoid the injury.”
Our guide to strength training for runners will help you successfully integrate other exercise into your training as well as providing a sample workout. These two core workouts for runners are also well worth incorporating.
How much of a difference can the right shoes or insoles make to plantar fasciitis?
Wearing the appropriate gear can help a huge amount when it comes to avoiding the perils of plantar fasciitis. If you are having real issues with the injury, it’s wise to get advice on footwear from an expert.
“It’s worth trying taping first, and then slowly introducing an orthotic and insole gel is the next thing that’s recommended,” says Wright. “It’s best to seek professional help here from a physiotherapist or podiatrist.”
We’d echo Wright’s advice about getting in-person advice regarding insoles. Our deep dive into custom insoles agrees that they can help on one hand, but you have to make sure you’re not just transferring the load somewhere else, causing more problems.
How long will plantar fasciitis stop you from running for?
One reason plantar fasciitis is such a brutal injury is the way it can linger for weeks or months, ready to strike you down the moment you think you’re finally clear. It’s vital to rest when you first feel the pain, because it can rule you out for as much as a year if you exacerbate the injury.
“It’s very important not to let the condition become chronic, because then it’s much harder to resolve and can be stubborn – sometimes it can take six to 12 months to fully resolve,” says Wright.
Five Stretches To Prevent And Treat Plantar Fasciitis
Anyone who’s ever had the misfortune to suffer plantar fasciitis will know that you’re willing to try anything to ease the pain. These five foot stretches from Arthritis Research UK (opens in new tab), created in partnership with the Chartered Institute of Physiotherapy (opens in new tab), are a great place to start.
1. Achilles tendon and plantar fascia stretch
Loop a towel around the ball of your foot and use it to pull your toes towards your body, keeping your knee straight. Hold for 30 seconds. Repeat three times on each foot.
2. Plantar fascia stretch
Sit down and rest the arch of your foot on a round object (try a can of beans). Roll the arch in all directions for a few minutes. Repeat at least twice daily.
3. Towel pick-up
Sit on a chair with a towel on the floor in front of you. Keeping your heel on the ground, pick up the towel by scrunching it between your toes. Repeat ten to 20 times. Once you master this, try adding a small weight to the towel.
4. Seated plantar fascia stretch
Sit down and bring one foot up and over your other knee. Grab the base of your toes and pull them back towards your body until you feel a comfortable stretch. Hold for 15-20 seconds. Repeat three times.
5. Wall push
Facing a wall, put both hands on it at shoulder height and place one foot in front of the other. The front foot should be approximately 30cm from the wall. With your front knee bent and back knee straight, bend the front knee towards the wall until the calf in your back leg feels tight. Relax and repeat ten times on each side.
Repeat this stretch but bring the back foot forward a little so that the back knee is slightly bent. Repeat ten times on each side.
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Nick Harris-Fry is a journalist who has been covering health and fitness since 2015. Nick is an avid runner, covering 70-110km a week, which gives him ample opportunity to test a wide range of running shoes and running gear. He is also the chief tester for fitness trackers and running watches, treadmills and exercise bikes, and workout headphones.