Disclaimer: In the article, I’ll be sharing my personal treatment plan for plantar fasciitis. However, please note that the information presented in this article should not be considered medical advice. Always consult with accredited medical professionals for your own diagnosis and treatment. Plantar fasciitis can be caused by a whole slew of things and should be addressed and treated on an individual basis.
If you’ve been following my ~healing journey~, you know that I’ve faced quite a laundry list of injuries this year, with plantar fasciitis being the most frustrating of all.
Although I’ve heard many runners complain about this condition over the years, I never paid much attention to it. I knew plantar fasciitis vaguely involved the foot, but since it didn’t affect me, I never bothered investigating further.
That all changed in February when I developed a pain in my left arch after a run. What started as a minor irritation gradually worsened as I continued to run on it like an idiot, eventually becoming so debilitating that modifying my activity was no longer going to cut it.
My daily runs, once a peaceful sanctuary, turned into a source of anxiety and pain. A visit to the physiotherapist and an ultrasound later confirmed my suspicion: plantar fasciitis.
What is Plantar Fasciitis Exactly?
Plantar fasciitis is an inflammatory condition in the plantar fascia, a thick band of tissue that extends from the heel of your foot to your toes.
The plantar fascia plays several crucial roles: it supports and stabilizes the arch of the foot, maintains proper biomechanics, distributes forces evenly across the foot during activities such as running, walking, or jumping, provides arch support, and absorbs shock.
Given its many roles & responsibilities, the plantar fascia can become overworked and stressed. When this happens, it becomes inflamed, telling us not-so-queitly that it needs (and deserves) a much-needed vacation.
Plantar fasciitis is quite common, affecting approximately 10% of the general population according to one journal. When I shared my diagnosis on Instagram and conducted a poll, an outstanding 70% of respondants reported having dealt with plantar fasciitis at some point in their lives.
What Causes Plantar Fasciitis?
From my research, plantar fasciitis can result from several different factors, with the most common being repetitive stress or overuse.
Other potential causes include:
- Pes planus (flat feet): a collapse of the arch of the foot.
- Pes cavus (high arches): abnormally high arches can affect the distribution of forces through the foot.
- Prolonged standing: occupations or activities that require long periods of standing can increase risk.
- Excessive pronation or supination: pronation refers to the foot rolling inward, while supination refers to the foot rolling outward.
Tight muscles can also contribute to plantar fasciitis by altering biomechanics—the way our body moves while walking/running which can affect our gait and restrict range of motion. This may lead to compensatory movements where other muscles and joints work harder, straining the plantar fascia.
Specifically, tight calf muscles, such as the gastrocnemius and soleus (involved in the planar flexion of the foot), and other posterior leg muscles can be significant culprits.
Certain populations are at higher risk, including athletes, inviduals with occupations that require prolonged standing, and those with genetic conditions like high arches or flat feet.
Runner’s are particularly at risk, with some research indicating that the incidence of plantar fasciitis is as high as 22% in this population.
Signs & Symptoms
Plantar fasciitis typically presents with one or more of the following symptoms: heel pain (the most common), arch pain, and/or swelling in the heel. The pain can be sharp and stabbing or a dull ache.
Many people experience excruciating pain with those first steps in the morning or after long periods of sitting. Activities like walking or light jogging might temporarily alleviate the discomfort, but it often returns once at rest.
The most challenging aspect of plantar fasciitis is the fact that it’s persistent as hell! It can take a very long time to go away and in severe cases, can be debilitating, affecting your ability to walk, stand, do your job, or perform daily activities effectively.
Healing Timelines
Healing timelines for plantar fasciitis can vary widely. According to my physiotherapist, most cases resolve on their own within 9 to 12 months with conservative, non-invasive treatment.
I’ve heard different recovery experiences from friends: some found relief in 3 months, others in 6 to 8 months, and a few took up to a year or longer. There are also cases where the condition is semi-chronic, meaning it “comes and goes.”
Acting quickly and reducing activity at the first sign of pain can increase the likelihood of a faster recovery.
Unfortunately, I did not do that.
When I first felt pain in my arch, I continued to run, which led to a worsening of the condition over time.
Most of the running-related injuries I’ve sustained resolved within a couple of months, so the 9-12 month timeline horrified me. However, I appreciate my physiotherapist’s honesty, as it set realistic expectations and helped me manage my own timelines; making it easier to cope when my recovery didn’t improve as quickly as I had hoped.
My Plantar Fasciitis Treatment Plan
Over the past several months, I’ve worked with a full medical team, including two physiotherapists, two sports medicine doctors, and a specialist. Researching recovery techniques has also become an almost daily practice for me.
One key observation from my research and first-hand experience is this: some very popular treatments that worked for others, didn’t necessarily work for me…
For instance, many people experience severe pain first thing in the morning and swear by the night splint, which gently stretches your fascia as you sleep. However, I found that my pain tends to worsen after activity vs. in the early AM hours. When I tried the night splint for a few weeks, I didn’t notice any relief, so I stopped using it.
I also pushed back on some prescribed exercises from my physiotherapists because they were either worsening my symptoms or the required equipment wasn’t readily available to me.
Through this process, I’ve learned that injury recovery often involves a degree of experimentation. When prescribed treatments didn’t work or made things worse, I had to revisit and adjust my approach.
Being open-minded and willing to try new things will improve the chance of finding what works for you. Healing is an individual journey.
If you’re looking for strategies and hot tips on managing plantar fasciitis symptoms, you’ve come to the right place.
This following section outlines my specific recovery plan, including treatments that have alleviated my pain and inflammation, exercises I’ve incorporated (and their frequency), and stretches that have supported my healing.
After six months of various treatments, my symptoms are almost completely resolved. I occasionally feel a dull ache in my left foot after heavy walking days, but overall, the pain is manageable, and I’ve finally started a return-to-run program.
At the peak of my injury, pain was persistent throughout the day, even at rest.
It’s important to note that alongside plantar fasciitis, I also had bilateral stress fractures (in my calcaneus and cuboid), a partial plantar tear in my left foot, and tendinitis in my ankles.
I’m not sure which came first—plantar fasciitis or the stress fractures—but an ultrasound and CT/bone scan confirmed the presence of both.
While stress fractures require a complete cessation of all activities and rest for 6-12 weeks, the treatment for plantar fasciitis differs significantly.
When I first felt the pain back in February and consulted my physio, she initially prescribed rest, and strongly advised me to stop running. She mentioned that some people can manage to run so long as the pain doesn’t worsen. In my case, the pain only intensified as the run progressed.
Ending a 6-year run streak was an agonizing decision, but I eventually complied, hoping that a full period of rest would get me back on my feet within a month. It’s now September, and I’m just returning to the walk/jog program, so my expected initial timelines were clearly aggressive.
Research shows that time-off from the activity causing PF is crucial for allowing the plantar fascia the break it needs to heal.
Unfortunately for most of us, we kind of need our feet.
Sure, athletes can stop doing their sport for a period of time, but what about people who work on their feet all day? You can see how PF not only affects our sport, but the quality of our lives and careers. It’s annoying AF.
The first phase of my treatment was straightforward. I stopped running and switched to the stationary bike.
Although my physiotherapist couldn’t pinpoint the exact cause, she suggested that the likely culprits were a 40% week-over-week increase in mileage and very tight calves.
My treatment plan focused on building leg strength, mobility, and flexibility. I was prescribed stretching exercises and instructed to foam roll/self-massage my calves daily.
Physiotherapy Exercises
Here’s the exact plan my physiotherapist provided for treating my plantar fasciitis:
Foot Exercises
- Foot doming: 10 reps x 2-3 sets daily
- Toe lifts: Hold down your four little toes and lift your big toe, then hold your big toe down and lift your four little toes. Do 90 seconds each side daily
- Backwards walking: Focus on placing the big toe down first (~3 minutes per day)
Leg Exercises
- Calf raises: 12-15 reps x 2 sets, 3 days per week
- Weighted squats: 10-12 reps x 2 sets, 3 days per week
- Weighted reverse lunges: 10-12 reps x 2 sets, 3 days per week
- Apply progressive overload principles by gradually increasing the weight every few weeks
Stretches
- Fascia stretch with band
- Cross-leg calf stretch (standing + dynamic) – ~7:25 in the video (my daily stretch, except during a 6-week offloading period for the stress fracture diagnosis)
- Daily calf foam rolling
Non-Invasive Treatments
Shockwave Therapy
Shockwave therapy involves applying acoustic waves to the injured area to stimulate tissue healing and bone regeneration.
This treatment can improve blood flow, stimulate collagen production, break down calcifications or small bone spurs that may have formed, and reduce pain.
I’ve used shockwave therapy for past strain injuries, and it did wonders, so it was the first treatment I tried for plantar fasciitis.
The sensation of shockwave is kind of weird; it feels like a rapid pounding of pulses. Your PT can adjust the intensity of the electric current based on your pain tolerance. For me, it was uncomfortable, but not overly painful.
Shockwave creates controlled microtrauma in the administered areas, akin to a mild inflammatory response. This microtrauma stimulates your body’s natural healing process, increasing blood flow to the area and hopefully accelerating recovery.
The effectiveness of shockwave varies from person to person. Some find it beneficial, while others, not so much.
One study showed that shockwave therapy can reduce pain and improve quality of life, but several other studies didn’t find any conclusive results so it’s hard to say.
I underwent six sessions weekly in conjunction with the exercises listed above in March and April.
Unfortunately, I did not experience immediate relief. Whether it provided long-term benefits is difficult to ascertain due to the many various treatments I tried and injuries I was dealing with. It made a huge difference for past strain injuries in my calves, but for my plantar fasciitis, I didn’t notice much immediate relief.
Acupuncture
One afternoon, a good friend of mine sent me a photo of a sign outside her naturopath’s office with a testimonial for an acupuncturist:
Breno, R.A:
“He fixed my plantar fasciitis in just 3 visits. I’m already back running!”
Compelling.
I had never considered acupuncture as a possible treatment for plantar fasciitis, but I was desperate to have my normal life back again and willing to try anything.
Acupuncture, an ancient Chinese medicine practice, involves inserting small needles into specific points on the body to address various issues, including muscle and joint pain.
It is believed to release endorphins—natural painkillers produced by the body—that can help reduce PF pain. Acupuncture may also trigger neuromodulation, a process in which the nervous system alters pain signals, reducing discomfort.
The practice of inserting needles into specific points on the body can improve circulation and reduce inflammation.
While acupuncture may provide short term pain relief for plantar fasciitis, evidence supporting its long-term effectiveness is limited. My medical team was uncertain about its outcomes, but agreed it wouldn’t hurt to try, so I decided to go for it.
I’ve had four sessions so far, spread out into bi-weekly treatments. My acupuncturist mentioned that it usually takes 3-4 sessions to notice a difference, but I personally experienced a significant reduction in pain after just a few.
Cold Laser Therapy (Low-Level Laser Therapy, LLLT)
Over 40 years of research has demonstrated that Low-Level Laser Therapy (LLLT) can be effective in reducing inflammation, edema (swelling caused by fluid trapped in the body’s tissues), and pain, while encouraging recovery and tissue repair.
LLLT can treat a long laundry list of musculoskeletal conditions, including sprains, strains, fractures, arthritis, tendinopathy, carpal tunnel syndrome, neck and back pain, among others.
LLLT works by triggering biochemical changes within cells, similar to photosynthesis in plants. The light stimulates cellular photoreceptors, leading to chemical changes that promote healing.
My acupuncturist recommended LLLT immediately following my acupuncture session, which lasted about 15 minutes.
Although research on LLLT specifically for plantar fasciitis is limited, a meta-analysis suggests that it can significantly reduce heel pain, with effects lasting around three months.
The treatment itself was painless, and I observed a notable decrease in symptoms since starting the acupuncture/cold laser therapy combo.
Dry Needling
If you’ve ever wondered who the person with the tightest calves in human history was, look no further! It is I who holds this title.
It doesn’t seem to matter how much I foam roll and stretch, my calves remain perpetually tight. So tight, in fact, that my physiotherapist thought I might have been a toe walker as a child. I asked my mom about it, and she assured me I wasn’t, so the mystery of the incredibly tight calves remains unsolved.
The tightness in my calves was increasing the strain on my feet and exacerbating my foot pain. In addition to daily stretching and foam rolling, my physiotherapist recommended dry needling in the calf area. I’ve been stabbing my calves with needles weekly since March.
Dry needling is a technique where a thin needle is inserted into trigger points. The goal is to release muscle knots, reduce pain and improve range of motion. But my god, it does not feel great.
The process goes like this: a needle is inserted into the affected muscle(s) where the knots/taut muscle has formed, then the PT swirls it around eliciting muscle spasms or contractions. While this procedure certainly doesn’t feel great, many people, including myself, experience significant relief afterward.
Maybe I’m a masochist, but I look forward to my weekly calf stabbing. During the height of my injury when my foot pain was horrible, I’d get some needles shoved into my calves, and voila! My pain was reduced by ~80%.
The literature suggests that dry needling is effective in providing short-term pain relief across various bodily regions. Whether it’s superior to other treatments remains inconclusive. The cited study suggests that dry needling is most effective when combined with other forms of physiotherapeutic treatments.
It’s important to note that I only received needling in my calves, not the plantar fascia itself. When I inquired, my PT said she didn’t have specific training in that area so we steered clear, and as a result, I cannot comment on the effectiveness of dry needling in the plantar fascia region.
Overall, I found that dry needling helped loosen up my calf muscles and reduce my foot pain immediately after the session, especially when integrated with other physiotherapy treatments.
Toe Spacers
My feet need work.
I’ve never, in my entire existence, done a single foot strengthening exercises, but now was my time to shine! My PT noticed that my toes were cramped together and suggested giving toe spacers a try—another tool I’ve never heard of.
What are toe spacers?
Well, the name is pretty descriptive of what they do: they separate your toes. You know those little foam separators used in-between your toes during a pedicure? Toe spacers are similar, but are typically made from a softer, jelly-like material.
I bought a pair off Amazon and wore them for short spurts at a time (like 10-15 minute intervals), gradually working up to an hour which watching a movie or reading. Initially, it was uncomfortable, but my feet acclimatized pretty quickly.
The scientific evidence supporting the use of toe spacers, specifically for plantar fasciitis is limited. However, there is some benefit in strengthening intrinsic foot muscles and improving toe alignment, which may contribute to overall foot health.
I included toe spacers in my extensive list of “try literally anything to make this damn thing go away.”
Pain Management Tools
In addition to the various non-invasive treatments and exercises I tried, I explored several other products recommended by others or discovered on my own that significantly aided with symptom management.
[I’m going to link to some products below, but they are not affiliate links and this post is not sponsored content]
PF Massage Ball
Using a plantar fasciitis massage ball initially didn’t feel great, but it became a daily practice for me once I adapted. Rolling out my sore feet for ~2-5 minutes multiple times a day, was a very effective method in reducing my foot pain.
Night Splint
I tried a night splint, but didn’t find it very helpful. As mentioned, I didn’t experience significant foot pain first thing in the morning, which is when night splints are usually most effective. Night splints or Strassburg socks are generally recommended for individuals who suffer from severe morning pain during those first few steps of the day.
Pain Cream
My fiance’s sister makes an incredible pain relief cream called Harvest Botanicals, which I routinely applied every morning and before bed. Its long list of natural anti-inflammatory ingredients, such as arnica and menthol, provided soothing relief, reduced pain, and improved circulation. While I also tried Voltaren (a topical NSAID), I found Harvest Botanicals to be more effective for pain management.
Arch Massager by Alleviate
Since most of my pain was localized in the arch of my foot, I found the arch massager by Alleviate particularly helpful. Alleviate also offers a full system for plantar fasciitis that includes compression socks, braces, the arch massager and a balm (to apply to your foot before using the massager).
Compression Sleeves
Shortly after my PF diagnoses, I discovered these compression foot sleeves on Amazon and bought 4 pairs. They are AMAZING! I’ve been wearing them daily for months and they’ve made a huge difference, reducing my symptoms during daily activity.
HOKAs!
I’m not going to lie, I was initially pretty resistant to the idea of trying HOKA shoes, but man oh man, I’m so glad I caved. Too many people reported huge differences in their symptoms after jumping on the HOKA train for me to ignore.
I paid a visit to Kintec, a footwear & orthotics store in Vancouver to help fit me properly and recommend the right shoes for moi. I tried a few different brands, but fell in love with Hoka’s Bondi 8. According to many reviews, this model is often recommended for plantar fasciitis due to its plush cushioning and support. I bought a few pairs and eventually switched my trail runners from Saucony’s Peregrines to the Hoka Challenger 7 GTX, which provide a hell of a lot more support.
OOFOS® Sandals
Most people I spoke to recommended wearing some sort of footwear around the house. I didn’t want to wear runners so instead, went on a hunt for a sandal or slipper.
A friend of mine who’s been battling plantar fasciitis for quite some time recommended the OOFOS® Slide Sandal, which were comfy and supportive. For the first several months I wore these sandals puttering around the house, which was much more comfortable then walking barefoot.
NSAIDs
I try to limit my use of ibuprofen because in the past, it gave me a false sense of confidence, where I would overdo it and pay the price later.
Even though research has shown that NSAIDs may help with pain associated with plantar fasciitis, I personally tried to limit my use. A reminder to consult with a medical professional regarding the use of NSAIDs for pain management.
Orthotics
I’ve never worn orthotics in my life and didn’t think I needed them. However, my super sweet fiancé bought me the Dr. Scholl’s Orthotics for plantar fasciitis which was a more affordable version of a custom-made orthotic to try out.
Personally, I didn’t really notice much difference. Combined with the Hokas, it kind of felt like overkill so I stopped using them after a few weeks. My sports medicine doctor examined my feet and determined I didn’t need orthotics, but I never consulted a podiatrist for a second opinion.
Although my symptoms improved without orthotics, some studies have shown that both prefabricated and custom orthotics can help with pain management and improve function in the short term for plantar fasciitis.
Icing
One consistent part of my recovery routine over the past 6 months has been icing.
I initially tried the frozen water bottle method, where you gently roll a frozen water bottle under your foot (a popular recommendation for relieving plantar fasciitis pain).
However, I found that using the Cryopak Cold + Hot Flexible Gel Compress worked better for me. I used the ice packs under my feet while sitting at my desk or with my feet elevated for 15-20 minutes 2-3x per day. It did wonders for my foot pain.
While I wasn’t able to find much literature comparing the different methods of icing, the efficacy of icing to reduce inflammation is well-supported.
One study concluded that icing for 20 minutes before bed, reduced the thickness of the plantar fascia and the accompanying irritation. Laymon et. al found that icing at night reduced pain by 44%.
Invasive Treatments
While most of the population with plantar fasciitis can fully recover with conservative treatments such as rest, icing, stretching, and strengthening exercises, about 5% of the population require more invasive treatments, which may include surgery.
I had discussed a few different forms of invasive treatments with my doctors including a cortisone shot and the PRP treatment, neither of which I decided to go for.
Cortisone Shots
I was pretty skeptical of cortisone shots for plantar fasciitis…
From what I’ve read (and heard), cortisone shots were a band aid solution, providing pain relief for up to 4 months, only for the pain to return because the root cause wasn’t addressed.
There were also some significant risks to consider.
Cortisone shots could cause several complications including a plantar fascia rupture (where tissues tear), degeneration or wear of the plantar fat pad (a cushioning under the heel and balls of the feet that absorbs shock and protect the bones and tissues), lateral plantar nerve injury which causes tingling, numbness or pain, (caused by improper administration of the shot), and calcaneal osteomyelitis, an infection of the calcaneus (heel bone)—a serious condition where bacteria invade the bone, leading to inflammation and potentially severe complications if untreated.
Platelet Rich Plasma (PRP) Treatment
In my particular case, my sports med doctor advised against cortisone shorts and instead recommended the Platelet Rich Plasma (PRP) treatment as a safer alternative.
What is the PRP treatment?
PRP is a a regenerative therapy that works as follows:
- A small amount of your own blood is drawn
- The PRP is then prepared using a centrifuge— separating the platelets from other components of your blood, making a concentrated form of platelets (which can help stimulate healing and tissue regeneration)
- Once the platelets are prepared, they are injected into the area of your plantar fascia that’s damaged.
- After the injection, a bit of downtime is involved. For rough guidelines on PRP rehabilitation, what to expect, and healing timelines, check out this link.
There isn’t a ton of research out there that conclusively states that PRP is an effective treatment for plantar fasciitis. A meta-analysis by Yang et. al, which reviewed nine randomized controlled trials, found that “Limited evidence supports the conclusion that PRP is superior to steroid treatments for long-term pain relief.” Despite the lack of support, PRP has gained popularity.
Aside from the downtime, there’s another big downside and that’s the price tag. PRP is considered experimental for many insurance providers and isn’t covered in most plans.
The out-of-pocket expense is signifcant; my doctor quoted me for $900 for a single vile, which could be used for both feet. Treating larger muscle groups would likely require multiple sessions, setting the price tag even higher.
I was seriously considering PRP as my next step if my PF didn’t go away on its own. I’ve already been out for long enough though and my symptoms have significantly improved so decided against it for now.
Surgery
When exploring invasive treatment options, surgery is typically considered a last resort if other treatments fail.
The most common type of surgery for plantar fasciitis is a fasciotomy, which involves detaching a portion of your plantar fascia from the heel bone, to relieve tension.
Success rates vary widely, ranging from 50-90% according to one journal article. The procedure, like most surgeries, have some risks and disadvantages including longer recovery time and the chance of developing complex regional pain syndrome (CRPS)—a not-so-fun type of chronic pain condition which causes severe pain and swelling.
I didn’t even consider surgery given the availability of PRP and cortisone injections, but for some folks, surgery may be the only way to go to achieve long term relief from the demon itself: plantar fasciitis.
Summing It All Up
Throughout this article, I’ve overtly hinted that it’s impossible to pinpoint the exact cause(s) of my plantar fasciitis. Identifying the exact formula which ultimately led to my recovery is also an impossible task. Even the science isn’t certain (as we saw).
The physio exercises, pain management tools, and acupuncture/cold laser therapy were the treatments that made the most significant impact— alleviating my symptoms and allowing me to finally return to running.
This is me! Running again after 6-months on one of my favourite trails this week!🎉
Plantar fasciitis can take a very long time to go away as know…Its persistence and variability make it a unique challenge for anyone that has to suffer the wrath of the swollen fascia.
The treatments I explored were based on my circumstances. If you’ve been struggling with PF for a while and are feeling desperate to find relief (like I was), you’re not alone.
Hold on to hope that you will eventually get better and and don’t hesitate to explore different treatment options if something isn’t working for ya.
Always consult with a medical professional (or multiple) and conduct your own research when considering treatment options.
I hope you found this article helpful and insightful as you recover from this annoying as hell, but manageable injury.
You will get through this 🙂