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Plantar fasciitis: Your Recovery Guide

By on Jun 30, 2014
Image illustrating plantar fasciitis injury

It’s the injury that most runners dread. But what exactly is plantar fasciitis? And how should you set yourself on the road to recovery? This RunningInjury guide provides the lowdown.

Do I have plantar fasciitis?

If you’re suffering from plantar fasciitis, then you’ll know about it. It really is an injury that’s hard to ignore.

Plantar fasciitis is characterised by pain on the sole of the foot and near the heel, reflecting inflammation of the plantar fascia. This is the connective tissue that extends from the heel bone to the base of each toe – and it is at its thinnest, and most, vulnerable, near the heel.

The pain is often most acute with the first steps each morning upon waking. Even a light touch to the underside of the heel can be painful.

For many, the pain associated with plantar fasciitis prevents any running at all. Some find that the pain is reduced as they warm-up for a session and then during the session itself – before increasing again, sometimes quite sharply, as soon as they cool down.

What causes plantar fasciitis?

Plantar fasciitis is astoundingly common in the population at large. An estimated 10% of the US population will suffer from plantar fasciitis during their life. Each year, it is thought to account for more than one million medical visits.

In the vast majority of cases, the origins of the injury are unknown. But a variety of factors are thought to increase the likelihood of suffering plantar fasciitis. In addition to the pregnant and obese, those with low foot arches, and indeed those with high arches, are at increased risk. That’s also the case for people with different leg lengths, as well as those with inflexible calves.

The problem also appears to be especially prevalent among runners. One estimate, from the early 1990s, suggests that around 1 in 10 runners are affected. Other evidence suggests that long-distance runners account for a disproportionate proportion of serious cases that result in surgery. And those who overpronate, with their running characterised by excessive inward rolling of the foot and ankle, might also be particularly susceptible to plantar fasciitis.

Consistent with this finding, one review concluded that the most common cause of plantar fasciitis is overuse rather than anatomy. More generally, the condition is typically ascribed to repetitive pounding on the heel during running.

How can I speed my recovery from plantar fasciitis?

Take a look at our dedicated plantar fasciitis store for the full RunningInjury range of recovery products. In addition, the following recovery methods may be of use.

1. Rest

It may not be the most attractive option for keen runners, but there’s a lot to be said for simple rest. In one study, a quarter of patients reported rest as the most effective treatment.

…more than four in five patients undertaking stretching programmes were successfully treated…

2. Stretching

There’s a wide array of different stretching programmes you could undertake to help speed your recovery. One study found that more than four in five patients undertaking stretching programmes were successfully treated.

Some have highlighted the importance of incorporating stretching movements that both shorten and lengthen the calf muscle. As highlighted by Joe Puleo and Patrick Milroy in ‘Running Anatomy‘ — which provides detailed discussion on how and why your body works as it does during the movements of running — studies have suggested that this approach can speed recovery time.

There’s little hard evidence to favour one programme over another — or indeed how frequently stretches should be performed and for how many repetitions. Whatever the stretching programme, however, it’s important to have a clear idea of proper form when performing the stretch. Poorly performed stretches could do more harm than good.

Below you’ll find a few videos, courtesy of Runner’s World, that show clearly how to perform the following stretches: arch raisers; calf drops; toe curls; and toe pick-ups. These often form a core part of successful stretching programmes.

Arch raisers

Calf drops

Toe curls

Toe pickups

3. Running shoes (men’s; women’s)

In a study in the mid-1990s, 1 in 7 patients found a change of shoes to be the most effective treatment. For those with relatively flat feet, motion control shoes (designed to limit excessive inward rolling of the foot and ankle) can be effective.

4. Night splints

Night splints may also help recovery from plantar pain. They can avoid the shortening of the fascia that typically occurs during sleep and so maintain the proper length of the plantar fascia. And, in one study, a third of patients reported that nights splints provided the best treatment for plantar fasciitis.

5. Orthotics

More than a quarter of patients reported orthotics as the most effective form of treatment in one study.

6. Steroid injection

Given the uncertainty around the effectiveness of the treatments discussed above, it’s striking that there’s a clear consensus on use of steroid injections. A range of studies have found that, in the short term, steroid injections can provide pain relief. But, over the longer term, steroid injections do not appear to alleviate pain to any greater extent than a placebo.

It’s also important to note that in the case of a rupture of the plantar fascia, where the ligament is actually torn rather than inflamed, steroids can actually hinder recovery.

7. Surgery

Surgery to resolve plantar fasciitis problems is rarely necessary. Indeed, it is only undertaken in around 5% of cases.

Nonetheless, studies have found extremely high success rates from plantar fascia release surgery. This involves cutting part of the fascia to release tension and relieve inflammation. In more than three out of every four cases, patients report reduced pain levels after the surgery, though complications can arise.

When will I recover from plantar fasciitis?

Described by Danny Dreyer, author of Chi Running, as an injury to be avoided at all costs, plantar fasciitis can be a tremendously frustrating injury. And the length of time that it takes to recover can vary significantly from case to case.

The good news, though, is that, for reasons not yet well understood, runners can typically expect a full recovery from plantar fasciitis. And, in around 80% of cases, plantar fasciitis problems clear up within a year.

More information about plantar fasciitis

For those interested in the research on plantar fasciitis, the academic literature in this area is extensive. But, by and large, it is also fairly inconclusive.

Here’s one paper that provides a useful overview of previous studies, focusing on the key issue of how stretching can aid recovery from plantar fasciitis.

We hope that this article has provided useful information. But it is important to note that no two running injuries are identical. If in any doubt, please consult your doctor or sports injury specialist for a personal assessment of your injury.

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