The Ultimate Guide to Plantar Fasciitis for Runners

Plantar fasciitis is the third most common injury found in runners, about 10% of runners suffer from it. (1) This injury causes pain at the bottom of the foot and can be very painful making running difficult or even impossible.

Running itself is considered a risk factor for plantar fasciitis. (2)

The plantar fascia is a thick band that runs along the bottom of the foot, from the heel to the toes. It is responsible for:

maintaining the longitudinal arch while standing,
providing proprioception (sending signals to the brain to sense the ground and movement) and
functions like a spring when running to provide passive energy for propulsion and shock absorption.

What is Plantar Fasciitis?

When the plantar fascia becomes irritated through micro-tears, scarring and breakdown of collagen it results in plantar fasciitis. Inflammation plays a lesser role, contrary to earlier beliefs.(3)

Symptoms of Plantar Fasciitis

Symptoms of plantar fasciitis include:

Pain in the heel or arch of the foot, especially when first getting up in the morning or after sitting for a long time.
Pain that gets worse with activity and improves with rest.
Stiffness in the foot.
Two thirds of cases affect one foot only, one third affects both feet simultaneously. (4)

It’s time to go and see a doctor if the pain is so severe it does not allow everyday activities, is causing a tingling feeling or numbness or if you suffer from diabetes – in which case foot problems can be more serious.

Causes of Plantar Fasciitis

Training Volume & Intensity

A too rapid increase in running volume or intensity is a common root cause for plantar fasciitis in runners. Runners that also spend excessive time on their feet while not running, e.g. during work, further increase their risk. (5)

Cardiovascular fitness tends to improve quicker than the strength of the musculoskeletal system, including the plantar fascia and supporting muscles. Therefore, to lower the risk of injury from overuse, runners should gradually increase their training load.

Running form

Poor running form can place excessive force on the plantar fascia triggering plantar fasciitis.Changes in form can redistribute the load away from the plantar fasciitis and avoid plantar fasciitis or contribute to healing.

A study found that forefoot runners are at higher risk of plantar fasciitis than those who heel strike. (6) While heel striking increases the risk for other injuries, moving from a forefoot to a midfoot strike pattern may be beneficial for runners experiencing plantar fasciitis.

There is also evidence that low cadence (step rate) increases loading on the plantar fascia. (7) This makes plantar fasciitis one more type of injury that can be alleviated with one of running forms most powerful tools – increasing one’s cadence.

The good news therefore is that adjustments in your running form can help to prevent or overcome plantar fasciitis.

Visiting a physiotherapist specialized in running form can bring clarity about your running form and limitations. The online running form analysis service Movaia is another way to adjust your running technique. Movaia’s running form reports also provide exercises to improve foot strike patterns and increasing cadence.

One way to improve cadence is to run to the sound of a metronome. The sweeps-and-swings exercise helps with changing foot strike patterns. Both running form drills are described in detail on Movaia’s blog.

Other root causes

Excessive pronation (inward rolling of the foot beyond what is natural and desirable), a flat or cavus foot, and tight achilles tendon are other commonly cited risk factors for plantar fasciitis. (8) More recent studies also identified a difference in limb length as well as limited hamstring flexibility as risk factors for plantar fasciitis. (9,10)

Other root causes of plantar fasciitis in runners include weakness in the intrinsic foot muscle, high body mass index (BMI), running on hard surfaces, worn out running shoes, or transitioning too quickly to minimalist shoes before the foot has built up sufficient strength.

Treating Plantar Fasciitis

Conservative options

Treatment options for plantar fasciitis in runners start with rest or a significant reduction in training volume, ice and elevation. A doctor may also prescribe pain medication and non-steroidal anti-inflammatories. This will manage pain and allow the plantar fascia to recover.

Stretching and strengthening exercises for foot and lower limb muscles can both prevent and help to overcome plantar fasciitis. Foam rolling is another technique that helps to reduce pain and increase range of motion in the calf and ankle. (11) Antipronation taping and taping with elastic therapeutic tape along the fascia and gastrocnemius (calf muscle) is also often successful in relieving pain. (12)

Medical professionals may prescribe physical therapy, shoe inserts and night splints, which stretch the achilles tendon and plantar fascia as you sleep.

A night splint is intended to streatch the fascia while sleeping.

Agressive treatment options

The next line of defense might be steroid injections to relieve pain for about a month. It is important to consider that steroid injections will not address the underlying issues so should be combined with other treatments. Platelet-rich plasma (PRP) injections on the other hand do not offer immediate pain relief but are meant to trigger regeneration and healing of the fascia. (13)

Also further along the treatment spectrum from conservative to aggressive is shockwave therapy. This method uses targeted acoustic energy to promote healing and reduce pain. Shockwave therapy sessions are typically performed with local anesthesia and last 10-20 minutes for each foot.

The treatment is noninvasive but can be painful and does not work for everyone. However if successful it can be a step to avoid surgery, which is often considered after 6 months of more conservative treatments without improvement. (14)

Surgery eliminated pain for 76% of patients according to a 2014 study, 88% in a 2017 study , and is only necessary for about 5% of those suffering from plantar fasciitis. The surgery can be open or endoscopic and detaches your fascia from your heel bone in order to relieve tension. In some cases damaged parts of the fascia area also removed. As the fascia heals, new connective tissue grows, encouraging the lengthening of your fascia. (15, 16)

The combinaton of multiple treatment options usually achieves the best and quickest results. (17)

Best Exercises for Plantar Fasciitis

Stretches

Stretches and massages aim to improve flexibility of the fascia and supporting muscles.

Plantar Fascia Stretch

Sit down and cross your leg with plantar fasciitis over your other leg.
Grab your affected foot and pull your toes back towards the shin to stretch the arch of the foot. The fascia below the arch should feel firm, like a guitar string.
Hold the stretch for 30 seconds.
Aim for at least 3 sets of stretches per day, ideally after periods of rest before getting on your feet.

Gastrocnemius Stretches

Face a wall at arm’s length and place your hands on the wall.
Step back with your leg suffering from plantar fasciitis and keep it straight and extended. Make sure to keep the foot flat on the ground without raising your heel.
Bend your front leg and lean into the wall until you feel a stretch in the calf of your back leg.
Keep both heels on the ground as you do this.
Hold for 30 seconds and repeat 3 times.
Repeat on your other leg to avoid imbalances

Calf (Soleus) Stretch

Face a wall at arm’s length and place your hands on the wall.
Step forward with your leg suffering from plantar fasciitis pointing your toes towards the wall.
Move your knee forwards towards the wall as far as possible trying to touch the wall with your knee.
Keep your heel on the ground.
Hold the maximum stretch position for 30 seconds.
Noticed the distance between your toes and the wall and aim to increase the distance over time.
Rest for 10 seconds and repeat for a total of 3 stretches on each foot.

Ankle Mobility Circles

This exercise improves the mobility of joints, foot muscles and the fascia.

Sit on a chair with your feet off the ground
Pull your toes upwards, towards you
Point your toes downwards, away from you
Rotate your ankle in a circular motion
Repeat this sequence 10x rotating left, then 10x rotating right.
Repeat for both legs

Foam rolling

The following two exercises are self-myofascial release techniques. By applying your bodyweight to the plantar and calf this breaks down adhesions and increases the flexibility of the tissue.

Plantar Fascia Massage

Stand or sit while placing one foot on a small ball (tennis ball, lacrosse ball, …) or frozen water bottle
Move your foot to roll the ball or bottle along and across your fascia.
Adjust the pressure so you feel a gentle stretch but no pain.

Foam rolling the calf

Sit on the floor with the affected leg extended and place on a foam roller. Rest the other leg on the floor.
Use your arms to place your body weight on the lower leg while it is place don the foam roller. Move along the foam roller to massage the area from your ankle to just below your knee.
Do this for about a minute, focusing on tight spots.
Modify the exercise according to your pain levels. As you progress you can use a ball instead of a foam roller or place the unaffected leg on the leg affected to increase the weight.

Strength Exercises for Plantar fasciitis

Plantar fasciitis is mostly the result of the load placed on the fascia exceeding the capacity of the fascia and supporting muscles to accept this load.

Therefore strengthening exercises are key to preventing plantar fasciitis and also are critical for recovery. Keep in mind that for acute plantar fasciitis it may be necessary to reduce the load first for recovery before increasing load to build resilience.

Heel Raises

Stand on the edge of a step with your heels hanging off the edge.
Slowly lower your heels down (about 3 sec), hold (about 2 sec), then raise them (about 3 sec) up as high as you can.
Repeat 12 times, and repeat the set.
Focus on slow, controlled movements and hold on to a wall or other object for balance if needed.
Start with raising both feet at the same time and progress to single leg calf raises. Slowly increase the number of reps until you can perform 12.
To increase plantar fascial loading you can place a rolled up towel under your toes.

Toe Curl (Towel Curl)

Toe curls are a very effective exercise that simultaneously strengthens and stretches the foot. By doing this it improves your balance and strength of your arches and overall foot muscles.

Sit on a chair with your feet flat on the floor.
Unfold a towel in front of your feet and place one feet on the side of the towel closest to you.
Lift your toes and reach out straight ahead with your toes.
Grab the towel with all five of your toes and pull back.
Keep your heel firmly planted on the towel and create a dome-shape with your arch while doing this.
Repeat 10 times for one set and repeat the set 3 times. (You might have to start over if your towel is fully pulled back before completing ten reps). Repeat this exercise 3 times a day.

Plantar fasciitis can be a frustrating injury to deal with recovery times typically stretching from one to six months, with some cases lasting even longer.

There is hope in avoiding plantar fasciitis by increasing training volume and intensity slowly and building stretching and strengthehing exercises described above into your training.

A runner suffering from plantar fasciitis already can shorten recovery times with the treatments and exercises described above and by seeking professional help early on.

After a bout of plantar fasciitis it is crucial to not immediatly jump back into prior training plan but building up slowly. This is the time to complement training with low impact sports to maintain overall fitness.

Checking and improving your running form can help in avoiding plantar fasciitis as well as addressing underlying causes during the recovery process.

If you are unsure about your running form check out the Movaia run form analysis which will give you insight in footstrike, cadence and other potential predictors of injury and performance.