Plantar fasciitis

Plantar fascia inflammation (medically known as fasciitis plantaris) is one of the most common causes of foot and heel pain. Beneath the skin of your sole runs a thick, connective tissue band (formerly called the fascia) stretching from the toes to the heel bone. Its inflammation mainly occurs where it meets the bone – at the heel or at the base of the toes. The first symptom is the stabbing pain experienced with the first steps in the morning. After a few steps it “warms up”, but over time it hurts for longer periods. It’s very hard to “get rid” of it. It can be treated at home, but be prepared for weeks, or rather months, of regular treatment to eradicate it completely.

What is the plantar fascia?

The plantar fascia (fascia plantaris) is a strong connective tissue sheet that extends from the heel to the heads of the metatarsal bones (the base of the toes). It plays an important role in supporting the arches of the foot. One of the main functions of the plantar fascia is to dampen the impact vibrations generated by walking. Its elasticity is crucial for this.

The plantar fascia (fascia plantaris) is a connective tissue sheet located on the sole of your foot. It runs from the heel bone to the toes.

Symptoms

The symptom of plantar fascia inflammation is a high sensitivity and pain in certain areas of the sole. It is strongest at the attachment to the heel bone or at the base of the toes (one or more). The inflammation causes the fascia to thicken and stiffen. This reduces its function and maintains the inflammation, which can become chronic. It can torment its “victim” for months, or even longer.

The problem of overuse

Plantar fascia inflammation is a consequence. It indicates that the fascia is subjected to too much stress, which leads to inflammation.

Obviously, athletes run and jump a lot, so this problem is particularly common among them.

However, it can occur not only in athletes. Anyone can develop it if the plantar ligament is exposed to increased demand. It is also common among people who spend all day on their feet, such as manual laborers, teachers, and waiters. They walk or stand on hard surfaces for most of their working hours.

Being overweight is itself a major risk. It increases the load on the foot arch and thus on the fascia, so obesity represents a heightened risk. Inadequately designed footwear can also cause it, for example thin slippers worn all summer or walking barefoot.

Repeated force impacts (running, pushing off, landing, etc.) or uneven loading can cause micro-injuries in the connective tissue even in healthy cases. Under continuous stress, especially if you neglect stretching and recovery, it can easily become chronic.

Strive for full recovery!

Treatment should not focus on the painful area, but on the cause that triggers the overload of the plantar fascia.

You should replace poorly supporting shoes. Reduce excess weight and overloading. Relax the tension in the calf muscles.

Neglected and persistent inflammation can cause many micro-injuries and small tears in the fascia. Its healing involves scar tissue formation, which has less elasticity, so the original function cannot be fully restored. The more scar tissue there is, the greater the potential loss of function.

If healing is partial, you cannot place your weight on your foot due to pain. You limp, and this causes improper loading of other joints in your leg. Over time, your ankle, knee, hip, and spine will also hurt!

Conservative treatment

Plantar fascia inflammation can usually be resolved in a few weeks to months. If you experience pain, start conservative treatment as early as possible! Here are some methods you can use to help your healing.

Alternating cold–hot therapy

Place an ice-filled bag on the painful area for 10–15 minutes. Do not apply it directly to the skin, as it may cause frostbite. You can read about the benefits of cooling here.

Cooling reduces inflammation, and when you remove the ice, the body warms the cooled area, leading to increased circulation. This supports the anti-inflammatory processes.

After 10–15 minutes of cooling, allow the muscles to warm up (rest for 1 hour). Repeat 3–4 times. Do not overcool: do not use this method for more than 2–3 days, and do not cool for more than 15 minutes at a time.

Another method is to fill a half-liter mineral water bottle with water and freeze it. Sit down on a chair, place the frozen bottle on the floor in front of you, and roll your sore sole over it. It will massage your sole while cooling it thoroughly. Do not place your full body weight on it, as the goal is not to cause pain but to stretch, relax, and cool the fascia. Do this exercise for 2 to 5 minutes at most.

Reduce the load

Pause exercises that involve running and jumping (but swimming or even cycling is allowed). If you do train, pay great attention to post-workout relaxation. Especially thoroughly relax your calf muscles. Also use a foam roller.

Replace your worn work shoes with ones that have a low heel, good arch support, and absorb shocks. Place a silicone insert under your heel in the shoe to “cushion” the painful spot. Do not wear high-heeled shoes. Do not walk barefoot, especially on hard surfaces, even indoors.

Replace worn-out running shoes. Running shoes should be replaced after about 600–800 km of use.

Overloading due to excess weight alone can trigger plantar fascia inflammation. Maintain or restore your healthy body weight.

Stretch and massage your calves!!!!

VERY IMPORTANT! In many cases, plantar fascia inflammation is caused by stiff calf muscles (due to standing all day or heavy sports loads). Through the Achilles tendon attachment, the tight calf pulls up and tilts the heel bone forward, placing tension on the plantar fascia even at rest. When you step down, the tension increases to the point where fascia fibers tear, leading to persistent inflammation.

By relaxing the stiff calf muscles, the heel bone realigns, the tension on the plantar fascia is relieved, and thus the cause of the inflammation is eliminated. Then you “only” need to help the inflammation subside.

The relaxation of the calf muscles can be aided by massage, foam rolling, and muscle stimulation. I consider muscle stimulation the most effective.

Massaging the plantar fascia itself can also help. Sit cross-legged, hold your sore foot in your palms, and massage the painful area with your thumbs. No strong pressure is needed; the goal of plantar fascia massage is to stimulate blood circulation, which has a healing effect. Five minutes of massage 2–3 times a day is sufficient.

The Fit Strech device, for example, was specifically designed to relax the foot muscles and improve ankle mobility. Just a few days of exercises can reduce tension.

Another tool for relaxing the calf muscles is the foam roller. It can be used to alleviate muscle pain, release muscle stiffness and knots, for stretching, warming up, and improving muscle recovery.

The greatest benefit of the foam roller is that it provides many advantages of physiotherapy and massage. Meanwhile, the foam roller is cheaper than a single therapy session or massage, and can be used for years. Of course, it does not replace physiotherapy or massage. But for those who can afford only a few treatments, choosing and using a foam roller is very worthwhile.

During foam rolling, the muscles stretch and loosen. The foam roller squeezes blood out of the muscles while fresh blood flows in, bringing vital nutrients like oxygen and glycogen to the muscles, fascia, and tendons. You can control the “pressure” of the roller—the more of your body weight you apply, the greater the pressure.

Better blood flow and looser muscles cause less pain during movement. Increased circulation flushes out accumulated waste products. Muscles receive the necessary nutrients faster, resulting in better recovery.

Drug-free treatment methods

Inflammation is a physiological response aimed at healing. However, if it persists for a prolonged period, it can limit cellular functions, halt energy production, and prevent sufficient protein synthesis needed for regeneration.

In the case of plantar fascia inflammation, the first step is to reduce the symptoms of inflammation.

This is not easy, since you continuously load your foot with every step, working against the healing process.

Another problem is that the blood supply to ligaments and tendons is worse than to other tissues.

Those physiotherapy methods that increase blood circulation in the sole speed up healing.
Stimulating blood circulation above all

The basis for healing inflammation is good blood circulation—it transports waste products away and brings in healing substances. The more methods you combine, the more they support each other’s effects and speed up healing.

Treat with therapeutic ultrasound

Use a therapeutic ultrasound device at a frequency of 1 MHz. Ultrasound has an excellent anti-inflammatory effect. It heats the treated tissues, relaxes the stiff ligament, and accelerates blood circulation, thereby resolving the inflammation.

For example, the M-Sonic 950 or the Sonostim 1032 therapeutic ultrasound devices are suitable for this purpose. One treatment per day is sufficient. Use low intensity (because the plantar fascia is close to the surface). Treat above the painful area for 5–8 minutes. Always use ultrasound gel and move the applicator head slowly and continuously! Continue treatment even after the pain subsides, until full recovery.

Use a muscle stimulator!

With an electrical muscle stimulator device, you can indirectly promote healing by improving blood circulation.

Treat the calf muscles on the affected side with programs for capillarization, warming up, or relieving muscle stiffness. It has been proven that muscle stimulation can increase blood circulation in the treated muscle by up to 300%. Thus, improved circulation in the lower leg will have a beneficial effect on the nearby area, including the plantar fascia. You can apply the treatment at least once daily, but even multiple times if desired.

Use microcurrent!

Microcurrent is still a less widespread electrotherapy method. Yet it is one of the most effective pain-relieving and anti-inflammatory methods you can use at home. You can read about the effects of microcurrent here.

Apply treatment 2–3 times a day to the painful area by placing electrodes around it, each session lasting 20 minutes.

The Globus sport muscle stimulators (Runner Pro, Cycling Pro, Triathlon Pro) or the Genesy 300 Pro all provide the necessary programs.

Use low-level laser therapy!

Low-level laser therapy has an anti-inflammatory effect similar to microcurrent. It can be applied even more easily than electrical treatment.

You should hold the device on the painful spot and keep it there until the therapeutic energy dose is delivered by the laser beam. The required treatment time is indicated in the user manuals, but Achilles treatments generally take 5–10 minutes. A higher-power low-level laser delivers the necessary energy in a shorter time.

For example, the Personal Laser L400 or the Energy-Laser L500 Pro are suitable for this purpose. You can find low-level laser devices here.

If these practices do not help, clinical physiotherapy treatments (shockwave therapy, irradiation) may be considered.