Diagnose and Cure Your Plantar Fascia Pain

Are you suffering from foot pain?

Pain in the heel region or through the arch of the foot is very common in runners.

Plantar foot pain is usually an overuse type injury, which means the symptoms come on gradually. It often starts as a feeling of tension rather than pain, but can escalate quite quickly to being painful, and even debilitating.

The typical scenario of plantar fasciitis is a pain which is worst first thing in the morning when getting out of bed. It is also painful after any prolonged period of rest (sitting at work for example). Like most overuse injuries it usually "warms up" with exercise. It might be painful for the first couple of km's running, then starts to feel better for the rest of the run, but becomes painful again after the run once everything has started to cool down.

NB: It is possible to tear your plantar fascia. This is felt as a sudden and sharp pain usually at the base of the arch of your foot (just in front of your heel bone). With a plantar fascia tear, you may not necessarily experience any warning signs, it just happens. The pain is usually severe making it very difficult to put weight on your foot. If this sounds like your symptoms you should see your GP to organise an ultrasound scan. If you do have a tear in the plantar fascia you will normally need 4-6 weeks in a walking boot, before being able to start this rehab program.

There are a few different types of foot pain which collectively get lumped into the "Plantar Fasciitis" basket, but each responds slightly different with treatment so it is essential that you first establish what type of foot pain you actually have.

 

Diagnose your foot pain

Watch this video and be as accurate as you can with locating the actual source of your pain.

From watching the video above you have hopefully been able to isolate the main source of your pain. These different diagnoses are not mutually exclusive, so it is possible for you to have more than one of them going on at the same time.

Possible Diagnosis - which one(s) have you got?
  1. Plantar Fasciitis
  2. Central Heel Pain
  3. Achilles Insertional Tendinopathy
  4. Arch Pain

The root cause behind each of these problems is usually the same, too much tension somewhere further up the posterior chain (back of your leg).

A tight back, tight glutes, tight hamstrings and tight calves can all be contributing factors to foot pain.

The rehabilitation program and return-to-running program for each of the four types of pain are essentially the same, but the central heel pain and plantar fasciitis both have specific taping techniques which can be a great way to help manage the symptoms.

 

Types of Foot Pain
Plantar Fasciitis
  • This pain is usually felt at the front and inside of the heel bone which is where the plantar fascia attaches into the heel bone.
  • Plantar Fasciitis is thought to be a traction and overuse injury which usually occurs where the plantar fascia attaches into the heel bone. Over a period of time, small micro-tears in the plantar fascia accumulate and eventually start causing pain.
Achilles Insertional Tendinopathy
  • This pain tends to be felt either directly on the back of the heel, or on the rim around the inside or outside of the heel.
  • Achilles insertional tendinopathy can be categorised as either:
    1. Tendinitis - inflammation of the tendon resulting from micro-tears that happen when the calf muscle and achilles tendon is overloaded with a force that is too heavy and/or too sudden.
    2. Tendinosis - degeneration of the tendon in response to chronic overuse.
Central Heel Pain
  • This pain is felt right under the heel in the centre. It usually feels like you are standing on something sharp, or standing on a bruise.
  • Central heel pain can potentially be caused by:
    1. A bone spur - a bony growth on the calcaneus (heel bone) possibly caused by trauma or overuse and diagnosed by Xray
    2. Fat Pad Insufficiency - the breakdown or thinning of the protective cushioning fat pad that sits under the calcaneus
Arch Pain
  • Arch pain, as the name suggests, is felt through the arch of the foot - anywhere from just in front of the heel bone through to the base of the toes.
  • It usually occurs through the inside of the arch, but sometimes can be felt through the outer side of the foot as well.
  • This pain is usually caused by the smaller muscles in the lower leg being tight and overused (tibialis anterior, tibialis posterior, flexor digitorum longus, flexor hallicus)

 

What causes Plantar Foot Pain?

Unfortunately, there isn't an easy answer to this question. There are a number of potential contributing factors, and you may have one or more of these contributing to your pain.

  1. Overtraining (running more than your body is capable of repairing)
  2. Poor running technique
  3. Stiff ankle joints
  4. Stiff big toe joint / bunions
  5. Tight calf muscles
  6. Weak foot muscles
  7. Tight lower back and neural tension
  8. Poor shoe choice

What is the biggest running technique mistake to avoid?

A common assumption is that the repetitive impact caused by landing on your heel when running is what causes Plantar Fasciitis.

What I have found is that the most likely technique-related cause for Plantar Pain is landing on your forefoot with your foot in front of your body. A lot of people make the mistake of deliberately trying to land on their “forefoot” or “midfoot” when they are running. This tends to have the effect of dropping the forefoot and stiffening the foot which can quickly overload the plantar fascia, calf muscle and achilles tendon.

So if you have recently tried to adapt your running this may be the cause of your problem.

Training Strategies for managing plantar fascia pain
    • Adopt the “little and often” philosophy. Breaking your weekly distance into shorter but more regular runs will be easier for your body to cope with.
      • For example, running 5km every day will cause less trauma to your plantar fascia than doing three 10km runs in a week.
      • In an ideal training program, the long run is important, but it is counter-productive if you then have to miss 2-3 days of training because of it.
    • Speedwork – Don’t do any! Whether it is 1km reps, tempo sessions or even hill reps. If your plantar fascia is sore then you should leave any speed sessions out of your program until the niggle has settled.
      • You will get a lot more benefit out of being able to continue to train than you will from persevering with speedwork and potentially making the injury worse.
    • Running Technique - work on shortening your stride, increasing your cadence and landing with your foot under your body. A good Plantar Fasciitis rehab program will include improvements in your running technique, strength and stretching exercises, and a measured run/walk approach to help you safely return to running. (Learn more about Plantar Fasciitis Rehab Program For Runners)
How do you fix your plantar pain?

To fix your plantar fascia pain you need to identify and address any or all of the above contributing factors. For example, you might need to adjust your training load, fix your running technique, mobilise your ankles, strengthen your feet, and stretch your lower back, hamstrings and calves.

Start the Plantar Fasciitis Rehab Program

After treating thousands of runners, I understand how much runners want to run!

We have helped literally thousands of runners manage and fix their heel pain. Many practitioners will advise you to stop running altogether, but we believe, through careful management, taping techniques, and changes to your routine, there are alternatives that can keep you exercising.

Over 8 weeks we will guide you with daily rehabilitation plan to help you run pain-free.  Ultimately making you a more efficient, faster, injury-free runner.

  • Daily stretches to cure your plantar fasciitis heel pain
  • Taping techniques for immediate pain relief
  • Daily rehab exercises, to build run specific strength
  • Easy to follow videos to ensure each exercise is performed correctly
  • Guided Return To Running Program to get you back running safely as soon as possible
  • A detailed rehab checklist, to keep you on track
  • Run Technique videos to improve your form and avoid re injury