Plantar Fasciitis: Recent Research and Real World Tested Solutions to Heal the Root Cause of Plantar Fasciosis
Do you have heel or arch pain when you wake up or after challenging your feet? Below is a real-world tested and research backed multi-tiered approach to get to the root cause of plantar fascia problems. Before beginning, it is important to know that if you have had pain for more than a week or so, you are not dealing with plantar fasciitis---you're likely dealing with plantar fasciosis---and knowing that makes all the difference in how you treat it.
Various research(1) has shown that chronic Plantar Fascia problems and pain are NOT the result of inflammation, but rather from poor blood flow & weakness causing tissue degeneration. Because there is no inflammation present, the old term "plantar fasciitis" is inaccurate, and should more accurately be called "plantar fasciosis". This term denotes that the tissue is actually degenerating due to weakness and lack of blood flow. This knowledge and terminology completely changes the way this condition should be treated.
Research has also shown that chronic plantar fascia problems are basically non-existent in people that don't wear shoes with elevated heels and tapered toe boxes(3).Typical modern shoes with elevated heels, tapered toe boxes & support devices have been shown to significantly reduce bloodflow (2) & are believed to weaken the feet. One look at, or google search of the feet of people who don't wear modern footwear makes this quite obvious.
Treating the root cause of plantar fasciopathies and eliminating plantar fasciitis/plantar fasciosis forever comes down to:
Getting the affected area to relax
Promoting and restoring optimal blood flow for healing
Strengthening all the supporting musculature of the arch area
Now let's get down to how to accomplish those three things! Below are time-tested research based and/or real-world experience based interventions that thousands of people have found success with:
Temporarily use a 3/4 length insole with a soft deep heel cup, soft arch, and metatarsal pad to help relax the affected area and prevent overload that makes it difficult to recover. Why these features?
-A 3/4 length insole stacks with a stock insole to add cushion to your shoe without compromising toe room that is so critical for blood flow and healing.
-Soft is preferred since plantar fascia issues respond better to soft than firm, and don't restrict blood flow like a firm arch support does. Softness also decreases the body's landing response better, allowing the foot to stay more relaxed.
-A Met Pad helps to gently spread the metatarsals apart, providing more stability and blood flow, while pulling pressure off the arch.
Bridge Soles are 3/4 length insoles with a soft heel cup, soft arch, and a met pad. They were designed specifically with plantar fasciopathies in mind and are designed to help the plantar fascia relax when it would otherwise be stressed. Bridge Soles promote better blood flow without weakening the feet like most typical insoles & custom orthotics.Start the day with heat & research backed vibration frequencies, ideally using a device like the Myostorm Meteor Mini heated vibration ball. This is critical because when you have those painful first steps in the morning (or after demanding activity or long sitting breaks), the area is actually being re-injured. Heat and vibration promote blood flow and break up the adhesions to reduce both the pain and the re-injury. Additionally, the correct vibration frequencies can help wake up the supporting musculature. Massage extensively if you can't do heat and vibration.
Prioritize top of foot toe extensor (toes down) stretches to release the antagonist muscles---allowing the arch side of the foot to relax & heal. This is often the missing element for those that are doing everything else right.
Increase blood flow all day. Studies have shown that straightening the big toe increases blood flow 22%, and the best way to do this is with Correct Toes. Wearing Correct Toes in the shoes you wear the most will increase blood flow significantly and are likely the single most important tool for attacking the root cause of plantar fasciopathies. They align the bones of the foot to stabilize and take pressure off plantar fascia, while preventing excessive pronation. They also act as a shoe fitting tool---if a shoe isn't comfortable while wearing Correct Toes, it shouldn't be worn. Additionally, buy your socks a size bigger, as socks often don't allow full toe splay and hurt blood flow as a result.
Look at your shoes...most are hindering blood flow, weakening your feet, and contributing to the problem. Most importantly, look at the shoes you wear the most hours of the day. Research has shown that 98% of all running and casual shoes have a tapered toe box that bends the big toe in towards the other toes---this reduces blood flow to the Plantar Fascia by 22% (2). The elevated heel in nearly all shoes reduces blood flow an additional 29%. Wear shoes with true foot-shaped toe boxes to improve blood flow, ideally with Correct Toes---which should also be worn as often as possible---with or without shoes. If you've never worn foot-shaped shoes before, they should feel "too big" or uncomfortably loose in the toes at first. Examples of foot-shaped shoes with no heel elevation would be Lems, Altra, Splay, Topo (some), Xero Shoes (for average to narrower feet), Tolos, etc.
Although many have had success with this for a couple of decades, and experts have recommended this for 20+ years, new research(4) has shown that 95% of those who did barefoot running on grass for 6 weeks experienced improvements in their plantar fascia pain. Start with 30 seconds of barefoot running (on soft ground like grass or carpet) & add 30 seconds every few days (as long as it is pain free). Many years of experience has shown that slowly working up to 20 minutes of regular barefoot running seems to be as close to a magic bullet as is known for long term healing of plantar fasciosis.
Increase blood flow and strengthen the weak tissue by going barefoot whenever possible on carpet & grass (as long as pain free).
Balance on one foot in shoes whenever possible, such as when standing in line at the store, etc.. Also balance on one foot as an exercise barefoot with the eyes closed. For most effectiveness, pull the heel slightly off the ground (about 1/2") and work up to being able to hold that for 90 seconds. Don't overload & slowly work up.
Use the Fasciitis Fighter to perform the proven, research backed exercises of the Rathleff Protocol (and more). This is an exciting treatment gaining more recent notoriety. It is essentially single leg heel-raises with the toes raised and has shown effectiveness in recent research (5) (running-physio.com/pf-new-research). Web search "Rathleff Protocol"
Check out this Plantar Fasciitis Relief & Restoration Kit designed with the best tools known to relax, promote optimal blood flow, and help strengthen the foot.
See GoldenHarper.NET/PF for more Plantar Fascia detail & information
In most cases, many cutting edge medical professionals recommend avoiding:
Cortisone or other steroid shots. These may help things feel better temporarily, but do not treat the root cause of the problem, and are known to cause loose/floppy ligaments---and can even result in accelerating the necrosis/death of the affected tissue.
Overly supportive or motion control footwear. Any type of shoe that is stiff with a strong arch and/or thick sole and elevated heel will restrict blood flow and prevent the foot from goin through its natural range of motion. This also results in the supporting musculature of the foot becoming weak, which leads to more dysfunction.
Firm, aggressive arch supports or custom orthotics. Insoles like this hurt blood flow and weaken the feet over time, and also don't allow the foot to relax as much as softer insoles.
Ice. Dr. Gabe Mirkin, who popularized Icing and the RICE protocol recommends against icing because it hurts blood flow and delays healing.
A cautionary note: Often when people have their "plantar fasciitis" stop hurting using the old school approach (shots, orthotics, big shoes, ice, etc.), it actually stops hurting because the affected tissue has died due to being starved for blood and being weakened. Unfortunately, those feet will likely never function the same again, and the PF may come back again in a different area or the other foot in the years to come because the root cause was not treated.
Research References:
1) Lemont H, Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7.
2) Jacobs, J.L., et al. J Foot Ankle Res 12, 50 (2019).
3)*Shulman, S. 1949 Journal of the Natl Assoc. of Chiropodists
4) MacGabhann, S.; Kearney, D.; Perrem, N.; Francis, P. Barefoot Running on Grass as a Potential Treatment for Plantar Fasciitis: A Prospective Case Series. Int. J. Environ. Res. Public Health 2022, 19, 15466. https://doi.org/10.3390/ijerph192315466
5) Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Spor 2014:n/a-n/a doi: 10.1111/sms.12313[published Online First: Epub Date]|.
Original Article: https://prgear.co/pages/plantarfasciitis