Updated: Mar 12
Plantar Heel Pain
A wise overplayed ad once told me that the best part of waking up was a cup of coffee. What they never talked about was the worst part of waking up. If you have ever woken up and dreaded your first step out of bed, then this blog is for you. Plantar fasciitis, plantar fasciopathy, plantar heel pain. Call it whatever you want, but pain in your heel is a pain in the ass.
While there can be a variety of causes for heel pain, plantar fasciitis tends to be the most common and may account for up to 8% of all running-related injuries (RRIs) (Lemont et al. 2003). When dealing with heel pain, it is important to understand the what and why.
What (is it) and Why (does it hurt)?
What is the plantar fascia? The plantar fascia is the tissue that helps support the arch of your foot. The plantar fascia connects to your heel which can contribute the heel pain you are experiencing. The plantar fascia also helps to provide shock absorption with running and walking.
Why am I experiencing plantar fasciitis? Plantar fasciitis is due to changes in the tissue of the plantar fascia. This condition can be set in motion by many different events. Examples include a rapid increase in running mileage or a return to activity following an extended period of rest.
Now that you have a better understanding of what you are dealing with, let's discuss the questions that are probably racing through your head.
How long does this last? Most cases of plantar fasciitis will resolve within 6-months with proper treatment. With that being said, depending on the severity and length of time that you have been dealing with this condition, it may be quicker or it may take longer.
What should I expect? While treating plantar fasciitis can be frustratingly slow, it is important to trust the process and have patience. Tissues take time to adapt. Also, you can expect to experience what may feel like setbacks. It is normal to feel like the pain is improving only to push the needle a bit too much and experience an increase in pain. THIS IS OKAY! The good news is you now know where the line is. Look at it as a yield sign vs. a set-back. Listen to your body, modify your activity, and continue to move forward.
Before we talk about what to do, let's quickly discuss what not to do.
Don't perform static stretching for hours on end
Don't sleep in a Strassburg sock
These two treatment options will only serve to irritate the tissue. As the saying goes, don't poke the bear......
Don't opt for injections
Don't use anti-inflammatories and continue the activity without modifications
While these two treatment options can help with short-term pain, they can have long-term effects including weakening of the tissue. Also, by using injections or medication to dull the pain and continuing with your regular activity, you may be setting yourself up for trouble.
What Should I Do?
What we have learned is that tissues respond to well to load. A study by Rathleff et al. in 2015 set out to assess strength training for plantar fasciopathy. The study compared a high-load strengthening program vs. a stretching program. The study included a simple progressive strengthening program (outlined below). At 3-months, participants were able to report improved outcomes vs. the stretching program. Take away: Stronger tissues = more resilient tissues; more resilient tissues = less pain! A key component to the strengthening program involved positioning the toes into extension. By doing this, it allows more load to be directed to the plantar fascia. You will see how this is accomplished with the use of a towel.
So we want to load the plantar fascia to make it more resilient. Let's start at the beginning. You will need the following equipment:
Platform or step
Backpack + Books, Weight, etc.
Fasciitis Fighter - Not necessary but for those who like exercise toys, this can be used in place of the towel
Modified Rathleff Heel Raise
Before we dive into the details, let's take a look at the exercise itself to get a better understanding.
The foot on the ground is the foot experiencing pain. The foot on the step is helping to provide balance. Think of it as a kickstand helping to provide support.
How to Perform the Exercise
First, roll up a towel like a piece of sushi and place it under your toes
Each rep consists of three phases: 3s up, hold at the top for 2s, and lower for 3s. You can also use a metronome at 30 bpm as this will help with control.
If you are unable to perform on a single leg, perform using both legs until you are able to tolerate performing on one leg.
Perform every other day - IMPORTANT! You need to allow time for the tissues to recover and adapt.
How much weight should I use? You should be able to complete each set with good form and control but feel as though you only had 1-2 reps left in the tank.
So why did I need a backpack? Progressive load!! As the tissues adapt, you want to continue to challenge the tissues through the use of an external load. You can use any various items around the house books, weight, a gallon of milk, etc.
I just do this until I get bored? While that is one way to go about it, I highly discourage it. Use the following program as a guide:
Weeks 1-2: 3 sets of 12 reps (3x12); begin with no extra load as seen in the first video
Week 3-4: 4 sets of 10 reps (4x10); add a backpack with books as you can tolerate
Week 5-6: 5 sets of 8 reps (5x8)
As you find yourself being able to complete this exercise with less pain, try performing it on a step to allow for additional range of motion.
Consistency and patience are key! Tissues take time to adapt. If you feel like you aren't ready for the next phase, don't be afraid to add an extra week at your current phase.
Don't let heel pain ruin your morning. Reach out if you have any questions, comments, or concerns. I'm here to be a resource for you!
1. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–7.
2. Rathleff, M. S. et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports, 2015: 25, e292-e300.