Heel Pain when you wake up? Here’s a 3 step approach to help heal and beat Plantar Fasciosis/Fasciitis in distance runners
What is it: Heel or Arch pain due to weak and dying Plantar Fascia tissue.
Cause: Weak feet and lack of blood flow due to the feet being weakened and forced out of their natural position by shoes with elevated heels, excessive arch support, and tapered toe boxes.
Solution: Strengthen the feet and restore blood flow to the dying tissue by restoring natural foot position and function.
Do you have heel pain when you first wake up in the morning? Is that first step just a killer? Plantar Fasciosis is a common running injury and is also common among people who spend a lot of time on their feet in shoes. Where it isn’t common is among habitual barefoot populations…in fact, it simply doesn’t exist among people that don’t wear shoes. It does, however, build up over a lifetime of wearing shoes and supporting—and thus weakening—the feet. It is often “set off” by over-stressing the feet, ironically, by doing something like going barefoot more than you’re used to on hard surfaces or by running longer or harder than you’re used to.
In 20+ years of working with people with Plantar Fasciosis, I’ve seen a good deal of what works and what doesn’t. Sure, getting arch supports or wearing a night splint may provide some immediate relief, but they usually don’t end up being a long term solution because they don’t address the root of the problem.
New research shows us that this chronic condition is not inflammation related after a week or two and is actually due to the decaying of the Plantar Fascia and surrounding tissue due to weakness and lack of blood flow—hence the new designation as Plantar Fasciosis instead of Plantar Fasciitis (Lamont, 2005). Therefore, treatment protocols focusing on reducing inflammation are many years behind on the science. Strengthening the feet and restoring blood flow and proper foot positioning is the key to successful rehabilitation. Despite what many believe, it can absolutely be cured long term, it just takes a bit of commitment…
Plantar Fasciosis Treatment
Step 1) Stretch & Relax the Plantar Fascia to Promote Blood Flow
– Use heat & vibration for a few minutes before getting out of bed in the morning to minimize micro-tears & prevent re-injury. I recommend the Myostorm Meteor Mini ball as the best tool for this. It provides heat and vibration with the push of a button.
– Use very soft 3/4 length Arch Supports with a Metatarsal Pad, such as these inexpensive Bridge Soles, to relax and support the foot temporarily, until the foot is strong enough to support itself (This usually takes a few weeks to a few months)
-Stretch toes down (Toe Extensor Stretch) regularly, as well as the rest of the foot and lower leg
– Stretch the big toe away from the other toes
– Relax the foot tissue and encourage blood flow by rolling a Foot Rubz ball (preferable) or Golf/Tennis Ball regularly
– Deep tissue massage for the entire foot and lower leg every 3rd day
Step 2) Restore Proper & Natural Foot Function
The main cause of Plantar Fascia tissue decay is blood supply being cut off by the toes being forced inward and upward by modern footwear. For this reason it is imperative to:
-Eliminate shoes with elevated heels, toe spring (toe lift), and tapered toe boxes as these features force the toes inward and upward
-Wear shoes with toe boxes that are shaped like a healthy foot, and shoes that have little toe spring and no heel elevation.
-When not stressing the feet, go barefoot (on soft surfaces) or wear shoes that are super flexible as this will allow the foot to gain function and strengthen.
-Wear Correct Toes athletic toe spacers while walking, working out, driving, and standing to immediately restore blood flow (proven!) and help reduce bunions and restore the feet to their natural, healthy shape.
-Wear a metatarsal pad in your shoes to help combat the effects of toe spring (toe lift)
Step 3) Strengthen & Realign
– Start with 30 seconds of barefoot walking or running on soft or natural surfaces such as the grass, carpet, or a treadmill. Add 30 seconds every few days—doing this is probably the single most effective way to eradicate PF. Subtract this time from your regular workout, i.e. 30 Minute Regular Workout = 29 minutes in shoes, 1 minute barefoot. Wearing toe spacers while doing this will enhance the results. A recent research study showed that 95% of those who did barefoot running treatment experienced improvement in their Plantar Fascia.
– Pick up a hacky sack or marbles w/toes and spell the alphabet (advanced exercise!)
– Pull in a towel w/toes and repeat
– AFX makes a great foot strengthening system, see www.afx-online.com
-New research indicates that doing single leg heel raises with about 1” of towel under the toes has a significant effect on healing (http://www.running-physio.com/pf-new-research/):
1) Place about 1 to 1 ½ inches of towel under the toes on a step
2) Take 3 seconds to raise the heel, hold for 2 seconds at the top, and lower for 3 seconds. The greater the range of motion the better. Do 3 separate sets of 10+ repetitions. After a couple of weeks, add weight in a backpack and slightly lower the # of reps. Continue to add weight to the backpack and lower the reps slightly as time goes on.
– Stand on one foot (affected foot)
1) Waiting in line, standing at work, whenever, wherever
2) As an exercise: barefoot eyes closed on carpet—work on keeping the toes spread
Notes: -The goal is to inversely fade out the need for support while slowly fading in foot strengthening, thus making the foot strong and independent.
-Stay away from being barefoot on hard, flat, surfaces, etc. if that causes any pain, until feet are strong enough to handle it. In most cases, feet have been weakened by years of shoes and arch support, it will take some time to get them strong enough to reverse those effects. Some twitching or small cramps often occur as the muscles of the foot are changing and becoming strong.
-In many people, foot splint devices like the Strassburg Sock drastically reduce the “first step in the morning” pain, but do not really treat the cause of the problem aside from preventing re-injury pain each morning.
-Continue strengthening/barefoot running once or twice a week
In my experience, the closest thing to a magic bullet for curing PF is the one thing runners & walkers tell me the doctor or podiatrist never told them: strengthen your feet. In conjunction with restoring the blood flow and proper foot position and function, making the feet strong seems to be the long term solution to curing Plantar Fasciitis. It stands to reason that if habitually barefoot people don’t experience Plantar Fasciitis while those of us with shoes and arch supports do, there has to be a reason. That reason is likely that their feet are healthy and strong while ours are weak and contorted in shape.
In theory, wearing corrective or “supportive” shoes and arch supports do for our feet what our feet should be doing for themselves, which ultimately ends up weakening our feet. As our feet become weaker, we need more and more support, and a cycle of dependence is in place. This is the reason people may feel some relief when getting arch supports or orthotics, but a few months to a few years later, the pain comes back worse than ever. I rarely, if ever, meet people who love their orthotics, and even most that say they like them admit that they are dependent on them and wish they didn’t “have to” wear them. In essence, they don’t. Even dependence on arch support can be reduced by returning the feet to their natural state. To say that the average person “needs” support is to argue that we weren’t created right or that evolution didn’t work.
Returning our feet to a more natural state by reducing the inflammation that has built up, breaking up the scar tissue, and then strengthening the feet will have very positive effects with arch and heel pain and throughout the body.
Altra footwear can help with Plantar Fasciosis because the Zero Drop platform and foot shaped design put the foot in a cushioned but “barefoot” position (thereby mimicking barefoot on grass) to encourage blood flow and help to elongate and stretch the entire Plantar Fascia-Calf complex while relaxing the foot and arch muscles.
More great info:
–Toe Extensor Stretch Video
–Dr. Ray McClanahan on recent research on Plantar Fasciosis/Plantar Fasciitis
Solution: or just do yoga with a good instructor who emphasizes the movements and positioning of the feet and toes during class to help strengthen the arches….
Yoga definitely helped a bunch, especially with foot muscle strengthening. Great suggestion.
Hi Golden, I am hoping you can help me. I saw your interview on Runs for Cookies website/Blog.
I was training for my first marathon 12 months ago, wearing nike vomero 6, running 6 days a week 36km then I got a stack of injuries.
Started with plantar fasciitis in both heels, (I have high arches) then it moved up my feet and after seeing 3 specialist sports doctors, numerous x-rays and ultra sounds,
showed plantar facscia thickening both feet, metatarsalgia 2/3 toes left foot and bursitis left foot, very sharp pain in ball of left foot.
I tried 3 kinds of brooks running shoes, none worked all too hard on the sole, switched to
“Hoka one one bondi 3” womens shoe, no running/walking long distance both too painful.
After changing doctors again to another sports specialist and an MRI left foot he gave me 2 rounds of cortisone in the top of the left foot with temporary relief and the addition of a moon boot for 3 months and told me it was bursitis left foot.
I took the moon boot off to go to Thailand only wearing haviana thongs which relieved allot of the pain. Returned home to winter wearing boots with small heel and other normal shoes and the pain in the ball of the feet especially on the left foot has returned.
Now 12 months later, another round of ultra sounds, x-rays and advised mortons neuroma in left foot.
I just found the NW Foot ankle clinic in Oregon via the internet and bought their “Correct Toes” product from them and meta pads. Just started to wear them, they recommended your Altra shoes. (Cannot wear the meta pads too painful)
Can you please tell me which model Altra would be best?
I have High arches, very wide fore-foot, I managed to find one shop here in Sydney Australia that carries your shoes, I tried on the intuition 2 and the Torin 1 original model. Which I liked the feel of, more than the intuition.
But I wanted to check with you first which is better for my foot?
I tend to like the cushioning, but since I already have the hoka one one bondi 3 is another model of your shoes better for me? The NW foot clinic only recommended the one 2.5 shoe but I am concerned its not enough cushion to relieve the pain in the neuroma at the ball of foot?
I want to get back to my walking first then running. I run mostly on road sometimes dirt/park trail.
Have a great day,
Sorry for the slow reply. I think a Torin 2 or Paradigm would likely be a good fit for you. Also, keep in mind that your everyday shoes will probably have more of an effect than anything!
The OS1st FS6 compression foot sleeve works well with all of the above products and promotes blood flow while supporting the plantar fascia.
I’ve been running barefoot and in minimalist footwear (first five fingers and now XERO for the last several years) my entire running career (about 9 years). I love being barefoot and in minimalist footwear which I credit with Manning me a runner. But this fall I’ve developed plantar fasciitis in my left foot and family, friends and partner are all telling me it’s time to switch to “good scores.” I’m 42 and I’m really struggling with the idea of going back to typical shows. I’m interested in trying the healing program above but I’ve not been wearing shoes with support. Even my everyday/work shoes are XEROs. I’m registered to run Big Sur 2023 (muy second time, first being 2017) and I’m worried I’ll have to drop out. Any advice? Thanks!
You’re an outlier for sure, but I do occasionally see this from those who go with non-cushioned minimalist shoes on hard, flat, man-made surfaces. PF can often come from overloading the foot and can be due to circumstances from wearing traditional shoes earlier in your life. Overload can also come from wearing shoes with no cushioning on hard, flat, man-made surfaces. In my opinion, it’s more natural to wear a shoe with an amount of cushioning to simulate the feeling of being on a natural surface like grass or dirt. Something like the Altra Torin or Escalante could be good for that right now. For now, I’d also add a Profoot Triad insert (from Walmart) under the stock insoles to pull pressure off the Plantar Fascia. It’s soft and light enough that it doesn’t drive you nuts if you have strong feet and are barefoot adapted. Also, Correct Toes are super helpful with Plantar Fascia issues. Hope this helps!