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) Promote Blood Flow by Relaxing and Stretching the Plantar Fascia Area
Avoid re-injury! If you’re having bad pain in the morning or after sitting for a long time, you’re actually re-injuring the area. Make sure to get things warm and loose before moving around.
– Do NOT ice. 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. Remember,
– 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 warm, vibrating Meteor Mini Ball (preferable), Foot Rubz ball, 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
-Balance on one foot with your heel a 1/2″ or so off the ground. (P.S. If you struggle with this, you’ve just likely found a major source of your problem.)  Do this barefoot on carpet or grass, but also in shoes whenever and wherever you get the chance. When you get comfortable with it, try it eyes closed. Work up to 90 seconds.
-A recent research study revealed what I’ve been teaching for 2+ decades…spending dynamic time barefoot on the grass or carpet is the closest thing to a magic bullet for plantar fasciopathies: 95% of those who did barefoot running on grass had success with pain reduction! 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.
-Recent research indicates that doing single leg heel raises with about 1” of towel under the toes has a significant effect on healing. This is called the Rathleff Protocol (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.
– Balance on the affected foot whenever you get the chance: Waiting in line at the grocery store, standing at work, whenever, wherever! Work on spreading the toes and powering the big toe in to the ground.
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 Fasciosis. It stands to reason that if habitually barefoot people don’t experience Plantar Fasciosis 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 hard custom 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.
Natural footwear such as Altra, Topo, etc. 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