You've been ignoring it.
Hoping it would just go away on its own.
Maybe even thrown a few rest days at it.
But it's as stubborn as a black toenail.
(it's not going anywhere fast.)
Plantar Fasciitis.
It comes for us all.
But it doesn’t have to come back.
It also doesn’t need to stick around for long.
What do you say we fast track you out of pain and back into running?
Let's dive in!
OLD SCHOOL METHODS
Do you stretch it? But how do you stretch it?
Let's be clear right off: the research is murky when it comes to stretching your calf and the bottom of your foot when it comes to plantar fasciitis (PF) recovery.
Is it bad? No.
Will stretching ALONE solve all your problems? Also, no.
Have I prescribed various calf (gastroc vs soleus) stretches in the past for both patients, myself, and family members?
Yes; with varying degrees of success.
It all depends.
Stretching isn't a bad tool; it's just not THE tool.
That being said: here's a link to a GASTROC stretch vs a SOLEUS stretch.
(the end. Moving on.)
NEW SCHOOL METHODS
DISCLAIMER: recent meta-analysis and articles straight up say: "These findings…are likely to change with further research."
THEREFORE…we need the new school methods
Best sciency exercises for PF will be ones that address:
dynamic foot stability + whole body dynamic stability
altered neuromuscular control
intrinsic foot muscle volume
What the heck does that even mean?
The BEST exercises for PF will be ones that address:
Foot stability & balance
Your foot's ability to communicate with the rest of your body (glute + core)
Foot muscle strength (Stronger Feet Workshop, anyone?)
Let's break this down.
You Need Foot Stability and Balance
Last week's blog post we walked about what dynamic foot stability + whole body stability mean, big picture wise (missed it? Read it HERE!).
Briefly:
your foot is a fluid structure that flows between being stable and rigid to very malleable and powerful and capable of creating projectile force.
It's also the literal foundation of your body (we run on our feet, not our knees. That would be weird).
If that foundation is not strong and/or not communicating well with other teammates (glutes, core, etc), then the foundation is not as stable as it ought.
And injury occurs.
You Need Your Foot to Communicate with Your Whole Body
Part of potential injures come down to neuromotor control (mind-muscle communication)
When your foot muscles aren't communicating well with each other, the rest of the body, and your brain, you can imagine how difficult it is for your foot to remain stable.
…and then if your foot isn't stable, the rest of your body is going to have a hard to being solid also.
This is why your BEST exercises for preventing and fixing plantar fasciitis need to be MORE than just a billion toe scrunches and calf raises.
You can have strong calves, but that doesn't teach your body HOW to use that strength. It simply exists.
Same for any feet exercises.
Strength is good and important!
But purpose + strength is better.
With that in mind, let's find out what *kind* of strength you need.
You Need Strong Feet
But what kind of strength?
Digital Plantar Flexion
Two studies assessed hallux plantar flexion strength...In both studies, the mean difference indicated that those with plantar heel pain were weaker than those without plantar heel pain. However, the result from the McClinton et al study was not statistically significant…In all studies, the mean differences indicated that those with plantar heel pain were weaker than those without plantar heel pain. However, results from McClinton et al were not statistically significant.
Ankle Dorsiflexion, Inversion, and Eversion
The mean differences for ankle dorsiflexion, ankle inversion, and ankle eversion indicated that those with plantar heel pain had less ankle strength than those without plantar heel pain. However the journal of ankle dorsiflexion result was not statistically significant.
Ankle Plantar Flexion Torque
The mean differences between groups of –21.9 ft-lb at 60°/s and –7.9 ft-lb at 180°/s indicated that those with plantar heel pain produced less force than those without plantar heel pain. Insufficient data were reported to enable CIs and Co-hen’s d to be calculated.
MRI foot muscle size studies:
The second study, by Cheung et al, explored muscle volume normalized to body weight at 3 sites: the forefoot, rear-foot, and total foot. The mean difference at the forefoot was –49.6 mm3/kg, at the rearfoot was –195.7 mm3/kg, and for the total foot was –245.3 mm3/kg. The differences in volume for the rearfoot and total foot muscles were statistically significant. The Cohen’s d was small (0.30) for the forefoot, very large (1.11) for the rearfoot, and large (0.90) for the total foot.
BLAH BLAH BLAH…GET TO THE POINT!
THE POINT:
"People with plantar heel pain had weaker foot musculature than those without plantar heel pain. However, there was substantial heterogeneity between the studies and inconsistency in the findings, which indicates that further research is needed to improve the estimates and precision of the overall findings."
WHY NOT JUST SAY THIS IN ONE SENTENCE?
Because it's nuanced.
And you deserve the TRUTH and the FULL STORY.
Did you notice with all the quotes I pulled that at the end there was this lingering "but…"? It was usually in the words "not statistically significant".
Think of this phrase like a PR.
You're SO close to running a sub-2 hour marathon! You're coming in at 2:01:01.
Did you break 2 hours?
No.
The clock didn't read 1:59:59.
So did you make it?
Nope.
But weren't you FREAKING CLOSE?
Absolutely.
Something very similar is happening here.
All these studies are demonstrating a consistent trend of foot weakness.
(this is in full awareness that we know this evidence isn’t the strongest ever due to the heterogeneity of the studies, small sample sizes, poor stats analysis etc etc…blah blah blah).
I'm being FULLY transparent!
(stats is not always sexy. It's just how it be, folks.)
As to what specific-muscle weakness causes plantar fasciitis: we straight up DON'T KNOW.
But you did see for yourself with all of those quotes: Runner's with plantar fasciitis tend to have WEAK FEET.
Don't let this be YOU!
How to PREVENT & FIX Plantar Fasciitis
"The digital plantar flexor muscles acting on the foot generate force in the toes and provide stability and support to the medial longitudinal arch. Therefore, if the muscles acting on the foot are weakened, non-contractile tissues such as the plantar fascia and the plantar fat pad of the heel are subject to increased load, which may contribute to plantar heel pain."
I could literally make a montage of all the different foot exercises I've put together over the past couple years
…but to avoid the confusion, I'll link them below.
General Reps + Sets:
Perform each section below for 1-2 weeks prior to moving on to the exercises in the next session. (yes, even the foot doming. It might take you a week to master 1 exercise. Trust the process)
FOOT DOMING:
Reps + Sets:
"When performed 3 minutes a day for 4 wk, this exercise can reduce navicular drop (arch collapse) by 14.2% "
I would start here because this is on the most BASIC and somewhat-research backed exercise that has proven to strength feet
Yes, I'm biased because I "made" these based off of recent research.
Great follow up to the foot doming exercise: they directly activate your forefoot & those digital plantar flexor muscles (the ones that point your toes down).
I've used these repeatedly in the clinic with massive, immediate success and decrease in heal pain!
And if you're scared to the pull trigger and get the workshop, don't worry. I still want you to succeed. Here are several exercises you can "steal" directly from the STRONGER FEET WORKSHOP:
He didn't know I was recording him...ssshh! Click HERE
Credit to Andi and Zach from AtoZ Running for this rendition of my exercises:
Want the full Workshop and unstoppable STRONG FEET? Click HERE!
Time to Add Resistance:
I originally created these banded exercises for peroneal tendonitis.
WHY use them for plantar fasciitis?
Because having strong feet is about being well-rounded.
One plantar flexor muscle does not a strong foot make.
Your foot and ankle are a system that is part of your entire body.
QUICK REFERENCE:
Tip toe lateral band walking with resistance band around ankles
Added core activation: Both arms straight overhead, biceps to your ears
Tip toe lateral band walking with resistance band around arches
Added core activation: Both arms straight overhead, biceps to your ears
Tip toe walking with carries with high knee marching
For the FULL CIRCUIT And DEMO video: CLICK HERE!
By starting out very specifically with foot doming and progressively working more and more of your foot and body as a system, teaches your entire body how to use the strength that you're creating.
All because you're Daring to Train Differently.
Toe Spacers: Will They Help?
They can't hurt.
The research hasn't looked at runners + toe spacers yet…
However, I'm not against them.
Story time.
I do my weight work at home, barefoot, on my yoga mat with these cheap-o jelly toe spacers I got off of amazon.
Do I recommend them?
Meh.
If I were you, I'd splurge and get the ones by @gaitmatters on IG. (I'm huge a fan; even if they don't know I exist.)
Using toe spacers, I notice they help create a better, wider, more activated foundation (especially when I'm doing single leg exercises) by requiring my foot to stabilize in a new, broadened way it doesn't normally lived in.
(my foot's usual environment: squished into a foot coffin…ie. a shoe.)
So toe spacers: yet another TOOL to help create strong feet
WRAPPING UP:
You now have a step by step plan to tell that plantar fasciitis to get lost for good!
All you need to do now…is put in the work.
But that won't be hard for you;)
You're a runner.
And you Dare to Train Differently.
Until next time…
Dare to Train Differently,
Marie Whitt, PT, DPT //@dr.whitt.fit
DON'T FORGET: Sign up for the Stronger Feet Workshop HERE!
References
Cheung, R. et al. (2015) “Intrinsic foot muscle volume in runners with and without chronic bilateral plantar fasciitis,” Physiotherapy, 101. Available at: https://doi.org/10.1016/j.physio.2015.03.414.
Kelly, D.K., Wiegand, K. and Freedman Silvernail, J. (2022) “Dynamic Stability in runners with and without plantar fasciitis,” Gait & Posture, 96, pp. 301–305. Available at:
Osborne, J.W.A. et al. (2019) “Muscle function and muscle size differences in people with and without plantar heel pain: A systematic review,” Journal of Orthopaedic & Sports Physical Therapy, 49(12), pp. 925–933. Available at: https://doi.org/10.2519/jospt.2019.8588.
Wiegand, K., Tandy, R. and Freedman Silvernail, J. (2022) “Plantar fasciitis injury status influences foot mechanics during running,” Clinical Biomechanics, 97, p. 105712. Available at: https://doi.org/10.1016/j.clinbiomech.2022.105712.