How to Heal Acute and Chronic Plantar Fasciitis...For GOOD!
If you’ve ever experienced plantar fasciitis, then you know just how excruciating and debilitating it can be. In 2014 I had just moved to Portland and shortly after, at the mere age of 26, I experienced my first bout of plantar fasciitis. I was working on transferring my massage therapy license from Colorado over to Oregon, so I was working as a front desk sales associate at a local spa, which meant that I was on my feet for 10 plus hours a day. By the end of the day, my feet were swollen. It hurt so much to put weight on them that by the time I got home I could barely take my dog for a walk around the block, and I felt like crawling. After the “walk,” I would immediately hop in the shower with the shower head pointed at my feet, the coldest setting possible, and I would just sit down in the shower for at least 10 minutes. I would finish my shower and the commence the icing. It was awful - I felt like I was dying.
I went to the doctor and they told me that there wasn’t really anything that they could do about it, unless I wanted to get cortisone shots. And since I had just barely been taken off of my dad’s insurance plan, I wasn’t about to pay for those out of pocket just a few months after graduating from college. After doing some self-care, stretching and a few massages (I couldn’t afford to get a massage every 2-3 days, which is what I needed in the acute stage), things got a little better, but I still felt that constant inflammation and couldn’t jog or just, you know, be a 26 year old. Wearing heels was completely out of the question, and almost overnight, my feet changed. I could no longer wear any shoes that had any sort of constriction because it made me severely uncomfortable - Berkenstocks were my new friend.
I tried everything - massage, stretching, icing, R.I.C.E, toe separator socks (which are insanely comfortable, by the way), a boot that is meant to stretch out your calves (aka gastrocs) while you sleep (often the main culprit in plantar fasciitis) - everything except cortisone shots. I went to a podiatrist and he couldn’t believe that a 26 year old was experiencing plantar fasciitis. I told him that I was a massage therapist and that it’s just biology - anyone with a body can experience that; age isn’t the main determinant, although it is commonly a condition that affects the seasoned population.
To help my body out, I decided to get out of massage therapy and got a desk job instead, thinking that being off my feet would give my gastrocs the rest that they needed. However, months after working the desk job, I was still having issues walking more than a couple of miles. I switched shoes - I found shoes with wider toe boxes to support my wide feet - and stopped wearing any shoes that made my feet feel constricted. I started adding more turmeric to my diet to help with inflammation and really honed in on my diet to help with any residual effects of inflammation. I did a couple of juice fasts and tried to lose weight - as much as you can without actually being able to workout that much. It was miserable, and I swear people thought I was just making excuses.
It’s been 3 years this July since I first started to experience the initial plantar fasciitis symptoms, and only until the last few weeks have I even noticed that I haven’t really had any symptoms. So, what’s changed? I started working out at a new gym, BFit Edge, doing their barefoot classes roughly 6 times per week, including yoga, bootcamp, kettlebell classes, Pilates and barre.
In fact, it wasn’t even until last week when I realized that my foot (it was mostly my right foot that was affected), wasn’t having any symptoms, even though I have been doing HIIT running, the elliptical, hiking, walking, fitness classes, AND up to 30 hours per week of massage. Even more of a surprise, I haven’t even been stretching my gastrocs out all that much, maybe just 3 times per week, holding the stretch for 30 seconds, but I do get stretching in the yoga and some of the strength training classes as well. Downward dog is amazing for stretching out the gastrocs! I also haven’t even been massaging my feet a lot either, which is something that really surprised me.
The main theory behind plantar fasciitis is that it’s caused by fascial constriction in the gastrocs AS WELL AS the plantar surface (or bottom) of the foot - or vice versa. Once that fascia gets tight in one area or another, it pulls throughout the muscular attachments, into the other areas of the body that those muscles attach to. The gastrocs, aka the calves, have insertion points on the posterior (or backside) of the femur (the thigh bone), and travel down the lower leg, attaching onto the Achilles tendon. You also have muscles on the sides and front of your legs that attach all the way down to the bottoms of your toes - that’s why you can move your toes! If the fascia and the muscles get tight in one area, it can affect your body in a completely different area. This is why stretching and massage are so effective in the treatment of plantar fasciitis because it helps to loosen the fascia and muscles.
However, what I’ve found from personal experience is that plantar fasciitis isn’t only caused by fascial constriction and muscular tension, but also muscle weakness. Think about it, if your peroneals (the muscles that run down the outside of your legs, sometimes called the fibularis), aren’t strong enough to do their job, plantar flexion and eversion of the ankle joint, then the other muscles, such as the gastrocs, have to pick up the slack. This inability of the peroneals to do their job could be caused by a variety of things - posture, footwear, deformities - but nonetheless, it can cause some serious issues and lead to plantar fasciitis.
So, now that you’ve read some of my life story here, try implementing some of the above to see if it helps. Each person is going to be different, and if you’re in the acute stage versus the chronic, your treatment plan is going to be quite different. You probably won’t be able to workout or stand for very long, and that’s okay. Get through the acute phase so you can start working on ankle strengthening exercises.
For the acute stage:
1. R.I.C.E. - Rest, Ice, Compression, Elevation.
Your body needs rest during this stage. Overdoing it is only going to slow the healing process and make it harder for you to get over this. You may also end up doing more damage. Ice helps with inflammation and swelling, very common with this ailment, and compression and elevation help to bring the blood flow and lymphatic fluids back to the heart.
2. Get Targeted Massage Therapy.
I recommend getting a therapeutic massage from a professional at least once per week, but two to three times per week is optimal if you can afford it. You can get a very specifically tailored treatment at many places, although chiropractic offices would be my best suggestion, unless you find a therapist with specific training and knowledge of plantar fasciitis. The massage therapists at the chiropractic office may also prescribe you some light strengthening exercises to do, based on the personal mechanics of your foot. Wherever you go, make sure you get at least a 30 minute session, with more time spent on whichever foot/lower limb that is bothering you most.
3. Light stretching.
Although stretching too much can also aggravate the symptoms, you should still stretch, as often times plantar fasciitis is caused by fascial constriction as well as muscle weakness. It’s best to just work on both.
4. Try adding in some (natural) anti-inflammatories to your regimen.
I always recommend trying natural anti-inflammatories first such as turmeric, but if you need instant relief, NSAIDS can work too, so long as your doctor has given you the OK to take them. I would avoid using cortisone injections because in the long run they can cause more harm than good, but ultimately that's up to you and your doctor. You also don’t want to get too reliant on using medical-grade anti-inflammatories, such as cortisone, because you miss out on your bodies’ natural pain responses. Your body is meant to feel pain to warn you not to over exert yourself. If you mask those natural pain responses by using cortisone injections, you could really hurt yourself.
5. Eat Healthy!
Clean up your diet in general to include fresh fruits and veggies - they do wonders for healing. Eating a proper diet to include fruits, vegetables, and lean and organic meats (if you eat it), is crucial to proper healing. Avoid sugars, dairy, refined carbohydrates, caffeine, and alcohol, as they inhibit your body’s natural immune system response. All of those release cortisol, a stress hormone, into your bloodstream, which decreases the body’s immune system response, therefore slowing down healing time.
6. Wait. Be patient, give it time, and your body will heal itself.
Make sure you’re getting enough rest too. That’s when our bodies’ natural healing really goes to work!
If you’re in the chronic stage:
1. Start adding in strengthening exercises.
Doing barefoot classes such as yoga are great to help your body learn how to balance on its own, without footwear. Because we wear shoes on a daily basis, our feet and lower leg muscles have “forgotten” how to balance the body. Just try taking a Vinyasa or Yin yoga class and you’ll be amazed with how challenging it is to balance in some of those poses! One of the great things about yoga is that it brings an awareness to our bodies that we never had before. Pay attention to where you feel the strain in your feet and lower legs, as those may be the areas that you need to strengthen a little more.
You can also try simple balancing exercises at home. Start barefoot standing on both feet. Lift your right foot up (you can put your hands on your hips or have them out to the sides if that’s more comfortable). Then once you feel comfortable there, close your eyes. It’ll surprise you with how hard that is to hold! Anytime that you start to feel yourself losing balance, slightly tap your right toes down to catch yourself, but try to bring them back up as quickly as possible. Repeat on the other side. Do that at least once per day for a minute on each side, or two to three reps, a minute each, three times per week.
2. Get Massage!
Even in the chronic stage, massage therapy dramatically reduces pain from plantar fasciitis. It also helps to return lymphatic fluids and stagnated blood back into circulation, which will help with any lingering inflammation and swelling. Depending on the severity of your symptoms, I recommend getting a targeted plantar fasciitis treatment at least once per month, but up to once per week. Once again, you can choose to do shorter, more focused sessions for 30 minutes, or you can do longer sessions, which will also allow you more time for other areas that may need work.
3. R.I.C.E. when needed.
If you start to experience more pain and swelling due to increased activities, as always, listen to your body - Rest, Ice, Compression, and Elevation. You can also add in a drop or two of peppermint essential oil to your foot lotion to give your feet a cooling sensation and to help with any inflammation.
4. Continue eating a proper diet.
No matter what stage of the healing process you’re in, hitting up late night McDonald's and Taco Bell after a heavy night of drinking is no bueno for your bod. If you’re serious about healing your plantar fasciitis holistically (and any other ailments), then you have to treat the entire body and do the work. Plus, you’ll feel so much better without all those added chemicals!
Continue stretching out your gastrocs, feet, and hamstrings at least 3 times per week and holding the stretches for at least 30 seconds. We’re talking about less than 5 minutes per week - although it would be best to stretch every day. You can do it!
Some other tried and true remedies for plantar fasciitis include self-massage tools to help release the fascia on the bottom surface of the foot, as well as filling a Gatorade bottle with water, freezing it, and massaging your feet with it daily. Whatever you do, always work within your pain tolerance - less can definitely be more. It’s always better to start with less and gradually work your way up to more to prevent any injury, as the fascia is a very delicate connective tissue.
I wish you the very best in healing your plantar fasciitis! If you have any questions, please contact me at firstname.lastname@example.org.
Cheers to Your Health!