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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 practice have had foot pain for years. This is primarily because there is a tremendous amount of misinformation out there about how to manage it effectively.
Sadly, most of the recommendations sufferers receive are for symptom relief and not long-term solutions for correction.
I specialize in foot and gait mechanics and I have seen hundreds of cases of plantar fasciitis. One of the most common questions I receive is, what am I doing to cause this? This prompted me to look into what NOT to do, or common mistakes to avoid.
Plantar fasciitis is already so painful the last thing you want is to make it worse. First, let's define plantar fasciitis, and then I will list the top 10 mistakes to avoid.
Dr. Angela Walk
The Plantar Fasciitis Doc
Specializing in Foot & Gait Mechanics
What Is Plantar Fasciitis?
Plantar Fasciitis is the most common cause of foot and heel pain, and the most prevalent condition I treat in my practice.
It involves a degeneration, or break down of the collagen fibers in 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. The most distinctive feature of plantar fasciitis is experiencing severe pain when you first get out of bed in the morning, making the first few steps of the day an agonizing experience.
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 number one biggest mistake foot pain sufferers make. Conventional footwear that narrows or tapers at the toe is the leading cause of foot and heel 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: Managing footwear is the first step to resolving plantar fasciitis. Transition to natural, functional footwear that are made to accommodate the normal shape of our feet.
The necessary criteria for healthy footwear is a wide toe box, no elevation of the heel, no heavy cushioning and a flexible, bendable sole.
I have compiled a list of approved footwear for plantar fasciitis. Following these recommendations will help prevent you from wearing shoes that may be are sabotaging your PF recovery. Dr. Angela's Recommended Shoe List.
Mistake 2: Using Foot Orthotics Long-Term
Orthotics have become a mainstay for the treatment of plantar fasciitis. Often, orthotics are the first line of defense sufferers seek for relief.
Unfortunately, wearing orthotics long-term weaken our foot core. 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 function 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: Practicing Static Stretching vs. Active Stretching
Most people who suffer with plantar fasciitis have researched the best remedies to resolve your pain. Stretching is always at the top of the list.
It seems reasonable as your arch, calf and Achilles tendon areas just feel tight. Yet, stretching is not as simple an undertaking as it seems. One mistake many make when stretching is doing the wrong type of stretch.
There are multiple styles of stretching that target different goals, and certain types of stretching can actually make your problem worse.
When most people hear the word “stretch,” they think about holding a stretching position for a prolonged period of time, most often recommended is 20-30 seconds. This is called static stretching.
The problem with static stretching is that if a muscle is stretched too far, too fast, or for too long, it elicits a protective action known as the myotatic reflex, causing it to automatically recoil in an attempt to prevent the muscle from tearing.
This occurs about three seconds into a stretch. Therefore, I recommend stretching to your natural range of motion (hold for 2 seconds), before the negative stretch reflex kicks in, then return to the start position and repeat 10 times.
This type of stretching is called Active Isolated Stretching (AIS) and is a type of active or dynamic stretch. The stretch feels more like repetitions than stretching, and it is the most effective type for for plantar fasciitis recovery.
Solution: Use active isolated stretching to increase range of motion and flexibility. Hold each stretch for only 2 seconds and perform 10 repetitions.
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: Expecting A Quick-Fix For Recovery
Rarely is there a quick fix for plantar fasciitis. Most cases have taken years to develop and will not resolve overnight.
Also, many plantar fasciitis sufferers only address the initial phase of the condition with symptom relief, and fail to address the underlying cause with proper rehabilitation. .
There are several phases of rehabilitation from an injury such as plantar fasciitis, and each phase requires and adequate amount of time to achieve results.
The initial phase of your injury is where pain is at it's worst and just getting out of bed becomes and agonizing experience.
The second phase is improving range of motion and flexibility of tight muscles and fascia. The third phase is increasing strength in your weakened foot core or calf muscle group, and the final phase is ultimately retiring to the activities you love .
Now that you are more familiar with the framework of a proper recovery process, you may have a better understanding of the time it will take to recover.
Solution: Rehabilitate from plantar fasciitis takes a daily commitment to do the necessary "foot work". 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.
Solution: Use muscle scraping every 2-3 days to remove accumulated scar tissue and adhesions to restore circulation and flexibility in the affected soft tissues (gastrocnemius, soleus, Achilles tendon and plantar fascia). .
Mistake 7: Rest Is Not Always The Answer
Many plantar fasciitis patients have been instructed to rest or take a few weeks off from all activities.
This news can be painful to hear for those of you who are avid walkers or runners. Especially if you are training for a race or marathon.
Many of you follow these recommendation and take time off, but when you return to your favorite activity, the same problem arises. This recurring pain pattern is a classic presentation of plantar fasciitis. If you want to fix the problem, you need a rehab plan involving structured exercises and progressive loading to rebuild your foot core strength and restore strength and flexibility to your calf and peroneal muscles.
There is a brief period where rest can be helpful and even necessary for healing, however, in most cases, starting a strengthening program quickly is the key.
The best plan is to get focused on how you can support your healing and get back to the activities you love.
Solution: Transition to low-impact, plantar fasciitis-friendly fitness options such as swimming, aqua jogging, cycling, rowing, or yoga.
Mistake 8: Icing Your Injury
The RICE protocol — Rest, Ice, Compression, Elevation — has been the most popular treatment method for acute musculoskeletal injuries for years.
RICE works well immediately following an injury to help temporarily numb the pain and slow down any potential excess bleeding into the surrounding tissues, but is this our best course for optimal healing?
The RICE protocol has been further researched by many to reveal that rest and ice can actually delay and diminish healing.
One of the main issues with RICE is that it aims to delay, reduce, or halt inflammation and swelling — which stems from another misinformed understanding of tissue healing.
Inflammation is often publicly perceived as a threat or a negative process that needs to be curbed before it wreaks havoc on the musculoskeletal system. In actuality, inflammation is a necessary and vital part of the body’s initial reaction to injury healing
We have also found that there is no real evidence to support the benefits of Rest, Elevation, and Compression as a post-injury measure.
Solution: Initiating heat and gentle movements to increase range-of-motion is a better option then, and as the injury heals, progress to dynamic movement exercises and actively strengthening the muscles.
Mistake 9: Avoiding Walking Barefoot
The benefits of going barefoot are numerous. Barefoot walking has been shown to naturally increase the strength of your foot muscles, provide better balance, and even prevent foot conditions such as plantar fasciitis, bunions, and hammer toes. (8)
Many studies have shown that barefoot cultures have fewer foot and knee problems. Physicians who performed the studies observed that people who lived barefoot, had significantly straighter, more aligned toes.
It takes time to train your feet to enjoy barefoot walking. You will need to slowly begin to introduce your feet to this new concept. Try to make a conscious effort to take your shoes off when you’re at your desk, or just walking around the house.
As you commit to foot work and foot strengthening, you will begin to feel more comfortable in your bare feet. This is something that I have made a habit of doing daily to increase natural foot strength.
Wearing toe spacers while walking barefoot further enhances the corrective benefits. Toe spacers help to realign and stretch the toes and creates a more natural gait and broader foundation.
Solution: Practice walking barefoot daily with toe spacers. 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 plantar fasciitis patients.
Night splints have been shown to be helpful for some plantar fasciitis sufferers, yet, there are a couple of problems with stretching the plantar fascia and surrounding musculature for such an extended length of time.
The main reason is that prolonged or extended stretching (static stretching) has been shown to be virtually ineffective and initiates our stretch reflex that is designed to prevent injuries of our muscle, tendons, and ligaments.
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: A better approach is to focus on strengthening your foot core and increasing calf inflexibility with proven, targeting strengthening exercises.
Can I Treat Plantar Fasciitis At Home?
If you have this debilitating condition, here are my top 3 recommendations to get you started on your home rehabilitation.
Download my free guide. This is the first step on your PF recovery journey. I show you the exact steps to resolve plantar fasciitis at home.
Follow my social media pages. I offer daily tips, exercises, and the latest insights on PF. You can also connect and learn from others with the same struggles. Join us: Facebook page & Instagram
Take a look at my approved footwear guide. Dr. Angela's Recommended Shoe List and make sure you are not sabotaging your recovery with wearing the wrong shoes.
Because there is a so much misinformation out there about plantar fasciitis, I spend most of my time educating people on what NOT to do.
Most rehabilitation efforts fail because they are relying on cortisone shots, night splints, orthotics, ineffective stretching, thick, cushiony shoes, and rolling on a frozen water bottle.
These methods are either ineffective or just short-term band-aids, and do not provide long-term correction.
In my (6) step free guide, I offer solutions through addressing multiple factors. Improving footwear, identifying areas of weakness in the foot and ankle, and restoring proper foot function.
Summary
I hope this article has provided you with an alternative perspective to most of the content out there about plantar fasciitis. Avoiding these 10 mistakes will allow you to effectively manage plantar fasciitis without making it worse.
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
I have written extensively on the topic of plantar fasciitis. Take a look at these other related articles:
Hi, I'm Dr. Angela Walk
I have been involved in the health and wellness industry for over 25 years as a wellness physician, sports chiropractor, and foot health coach. I have written for many 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
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