Heel Pain 101

Understanding and Treating Plantar Fasciitis

Nick, Jason & Zac
May 04, 2023

In this episode of the podcast/newsletter, we are diving into a problem that according to estimates, as much as 10% of the population will struggle with at some point, heel pain/plantar fasciitis. This can be a very frustrating ailment as it can linger for a while, can appear without any discernable reason, and can very very debilitating. We wanted to give people a more thorough understanding of this issue as well as arm them with some easy things to try at home to help if they are struggling with it.

Plantar Fasciitis is a fairly easy thing to diagnose. It is essentially sharp pain on the inside of the heel right near where the arch of your foot begins. It is very sharp in the morning upon waking. It will usually then ease up a bit during the day and then possibly come screaming back at night. For a long time it was thought that this was an inflammatory process, but recent studies dispute this as being the cause. It is essentially just irritation of the tight band of fascia on the bottom of your foot. The question is why is it getting aggravated. Here are several mechanisms that we see commonly.

1) Your ankle doesn’t flex far enough and your foot is flattening to compensate. In order for there to be normal gait, you need to have enough ankle bending. If this is too tight, then you will flatten your foot and this will tilt your shin forward and get you from A to B. Unfortunately this over-flattening tugs on your plantar fascia.

2) Your intrinsic foot muscles are simply too weak. Your foot functions like the tripod of a camera. The 3 points of contact are the ball of your foot under your big toe, the ball of your foot under your 5th toe, and your heel. If you have foot weakness, the arch of the foot can collapse and these points begin to splay away from each other. This will pull on the plantar fascia.

3) You have a weak glute max (butt) muscle. Your glute max needs to extend your hip (push your leg back) when you walk. If it is weak (usually because we sit too much) then you can start flaring your foot out when you walk to compensate. This can yank on your plantar fascia.

4) You have a crossover style of gait. This means when you walk, it looks like you are walking a tight rope and crossing one foot in front of the other. This is usually the result of weak hip muscles and core muscles, but the result is it will twist your plantar fascia like a dish rag.

Here are some exercises we give that are easy to try at home and we have found to be very helpful:

1) Seated with your feet flat on the ground, curl your toes down and then lift your foot off the ground keeping your heel on the ground (flexing the ankle).

2) Standing, lift your toes as high as you can and balance your weight evenly on the tripod points described above. Splay your toes apart as best you can, and then slowly lower them to the ground.

3) Lying on your back with you knees bent and a towel (or rubber ball or pillow) between your knees, lift your hips up in the air and squeeze the towel between your knees and feel the burn in your glute muscles. Hold for 10 seconds.

4) Lying on your side, lift your leg up in the air while keeping your leg straight feeling the burn in your hip muscles.

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Simplified Takeaways…

Usually there is a mechanical reason for your heel pain/plantar fasciitis. See some of the above mechanisms.
Usually your foot is flattening too much, the question is why is it doing that.
Stretching for treatment of plantar fasciitis has very low evidence supporting it.
If you are going to wear flip flops, try to have a strap on the back/heel. This will help prevent toe curling and future foot issues.
When you find the correct exercise prescription, this very often can aid in healing plantar fasciitis. See above exercises.

Heel Pain 101

Understanding and Treating Plantar Fasciitis

Simplified Takeaways…

Further Reading…