Plantar fasciitis

The Best Treatments for Plantar Fasciitis

It’s 6:30 am, and the alarm goes off! You wake up a little groggy, but ready to start planning your busy day. You are lying in bed thinking about all of the things that need to be done and then, nature calls. You quickly throw off the sheets and step out of bed to an unwelcome shot of pain in the bottom of your foot. It’s that same unforgettable pain you experienced yesterday, and the day before that, and the day before that. Ugh!

Pain in the bottom of your foot (near your heel), regularly referred to as plantar fasciitis, is extremely common. Approximately 2 million Americans suffer from plantar fasciitis each year. For runners, plantar fasciitis is the most common condition that is diagnosed around the foot, making up 8% of all running related injuries. Unfortunately, many people experience the painful symptoms and experiment with endless proposed treatment options.

I have heard a fair amount of plantar fasciitis treatments. They range from rolling a frozen bottle of ice on the foot, running barefoot, and using odd-looking massage tools.

Additionally, everyone has their special favorite stretch that gets passed around like a secret recipe for the best chocolate chip cookies. Sure, it is probably a good stretch or a good treatment option, but even the best chocolate chip cookie recipe doesn’t work for everyone. We all have different taste preferences, likewise, we all experience different forms of plantar fasciitis and different feet!

There are so many different thoughts and recommendations available that it is important to follow the research. Fortunately, there are great research reviews that summarize the best treatment options for plantar fasciitis.

I will split up the treatment options into 3 sections: Things you should try because research supports them, things you can do because some research supports them, and things you should do in more rare circumstances because research doesn’t really support them.

Treatments You Should Try

Plantar Fascia Stretch: Seated with the painful foot and leg crossed over the other leg and then pulling up on the toes to feel a stretch along the bottom of the foot. This stretch should be done 3 times a day with ten holds of 10 second duration. Ideally the first round of stretching would be done before getting out of bed in the morning.

PF Stretch Seated.png

Calf Stretching: Can be done in any number of styles. A traditional runners’ calf stretch, standing with the painful foot and leg behind the other and keeping the knee straight as you lean forward (towards the wall), can be an effective stretch. With this particular stretch, try placing a rolled-up towel under the toes which allows for more stretch of the plantar fascia. However, listen to your body because the stretch should be gentle to moderate, not severe. Calf stretching should be held for 60 seconds, for up to 5 repetitions a day.

Calf and Plantar Fascia Stretch.png

Taping: Certain taping styles have been found to be helpful for plantar fasciitis. For the most part the researched taping styles rely more on stability taping around the foot, and can include some antipronation strips. Low-dye taping is commonly used, though high-dye taping can also be effective. Taping is usually reserved for licensed professionals to perform, though anyone can be taught the techniques, and try to manage them on their own. In a general sense the taping is designed to help with the forces through the foot to relieve some pressure off the plantar fascia.

Orthotics: Custom made foot orthotics can be beneficial for those that suffer from plantar fasciitis. However, treatment options can become very expensive when you seek an orthotic.

Studies that have compared custom orthotics to over-the-counter orthotics found that both are helpful with no significant difference between the two besides the price point. When purchasing orthotics, I recommend you try them on before purchasing. It is important to get a good feel for what type of orthotic feels comfortable to you. Check out Super Feet insoles, which typically cost around $50 (available at most specialty shoe stores).

Night Splints: If the plantar fasciitis symptoms have been lasting for more than 3-6 months, and you are having pain with the first step in the morning, then I highly recommend consistently wearing a night splint for 1–3 months. While many people have a hard time wearing night splints, they are helpful. Night splints can be purchased at most major retailers for $20–$50. The most popular night splint is a Strassburg sock because of its high comfort reviews. Anything you find should work, though you do want the pull to be from the front of your foot.

Hands on Therapy: There is some research that shows that a professional helping with some ankle and foot joint mobility as well as some soft-tissue work in the calf and foot can reduce pain. Since the symptom reduction is usually temporary, this type of treatment option is usually an adjunct to other treatments.

Dry Needling: The research for dry needling for plantar fasciitis is growing. As a whole dry needling research is still in the early phases. However, it appears that dry needling can be an effective addition to treatment for plantar fasciitis. Consider dry needling if your symptoms have not improved with other treatments.

Treatments You Can Try

Shoe Wear: Despite the overwhelming amount of research and recommendations about shoe wear, it doesn’t seem to have much of an impact. First, the important thing to consider is comfort. The shoes you wear should feel good and not bother you. Beyond that, consider switching between at least 2 different pairs of shoes during the week, whether it be that you are running or standing. Having a shoe rotation can help reduce plantar fasciitis risk by upto 72%.

Strengthen Up the Chain: Our bodies are not strictly divided into different parts. There is connection from the bottom up and from the top down. There is some rationale for strengthening the muscles around your hips, thighs, as well as the muscles of the back and the abdominal region.

Treatments for Rare Circumstances

Ultrasound: Therapeutic ultrasound may have some value in other conditions, but is not effective as a primary treatment for plantar fasciitis.

Steroid Injections: Getting a steroid injection into the plantar fascia has not demonstrated clinical benefit in 2 systematic reviews done on the subject.

As you can see there are a lot of things that you should do, can do, and should only do in rare circumstances for the treatment of plantar fasciitis. It is not an all-inclusive list of treatment options. I have tried to include the list of things that have some evidence to back up claims being made. This does not mean that a frozen water bottle wouldn’t feel good on the bottom of your foot, only that there is no research to say that it is making a difference. So, keep doing your favorite treatments, and add some of the researched options into your rehabilitation and recovery.

It is also helpful to work with a licensed professional to help you modify your activity to avoid further irritation to the plantar fascia, and to help you work through the recovery process. Physical therapists can be very helpful in diagnosing and treating plantar fasciitis.

Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., ... & Davis, I. (2014). Heel pain—plantar fasciitis: revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.

He, C., & Ma, H. (2017). Effectiveness of trigger point dry needling for plantar heel pain: a meta-analysis of seven randomized controlled trials. Journal of Pain Research, 10, 1933.