Less Common Strategies to Address Plantar Fasciitis Pain

I suspect you have found your way to this blog because you are dealing with some type of foot pain. If your pain is primarily located on the bottom of your heel (the part that touches the ground when standing), and seems to be worse after sitting for long periods of time or when you first get out of bed in the morning, it is possible plantar fasciitis is the cause.

Plantar fasciitis is a very common condition. The more current and correct term is plantar fasciopathy, as it is not actually a primary inflammatory condition, but more of a degradation of the fascia.

As a physical therapist who has personally dealt with plantar fasciitis, I have first-hand experience and have conducted extensive research on the condition.That being said, I want to talk about some of the less common treatment strategies. I am sure you have already read through 10 different website articles that tell you to rest, ice, lose weight, wear orthotics, stretch your calves and your plantar fascia frequently, and try to figure out how to sleep in night splints. While these treatments can be beneficial for some, it's sometimes necessary to explore more unconventional methods or delve deeper into your movements to uncover the true underlying cause. Consulting with a physical therapist familiar with plantar fasciitis can help determine the right treatments for you

Below are some other suggestions for treating plantar fasciitis that are less commonly discussed. 

• Dry Needling: Targeting muscles including the gastrocnemius, soleus, and plantar foot muscles (like quadrates plantae). Research into this has shown both short and long term benefits from including dry needling in treatment of plantar fasciitis, typically along with stretching and other manual therapy techniques.

  
  

  

  Dry needling with electric stimulation

  
  
  
  

• Foot strengthening: Muscles like your posterior tibialis and deep, intrinsic muscles in the foot including your toe flexors can help to take stress off of the plantar fascia. When people are always in supportive, cushioned shoes, these muscles do not have to work very hard and end up becoming weaker. By strengthening these muscles, we can help to provide a more active support to the foot. Sometimes it makes sense to think of an orthotic in your shoe as a bandaid, and the strengthening exercises for the foot will be a better long term solution.

  
  

• Consider the spine: Especially if your plantar fascia pain is bilateral, it is possible that the pain you are feeling is actually being referred from the spine. The S1 nerve root has a referral point into the bottom of the feet, and should not be overlooked in cases that are not responding to traditional treatments!

  
  

• Check for leg length discrepancy: The longer leg tends to be in more pronation in order to shorten the leg, which can place increased load on the plantar fascia. Tread carefully with this, as there is a difference between a true, structural leg length discrepancy, and a functional leg length discrepancy that results from tightness in joints or muscles. Again, this is where a professional well versed in this area can help you assess and decide whether or not a lift would be beneficial to help even things out.

  
  

• Most importantly: Meet with someone who can do a thorough gait assessment. We need to figure out WHY the plantar fascia is being loaded more than it can tolerate. Your foot needs to be able to move through both pronation and supination during gait. Some things that can stress the plantar fascia are prolonged time in pronation, or the inability to get into pronation meaning the foot remains rigid in supination. Other things like weakness in the hip which may limit control of leg internal rotation, and secondarily cause increased stress on the plantar fascia, may also be contributing. Mobility drills, manual therapy, and targeted exercises focused on building neuromotor control and strength can all assist in addressing issues like this. 

  
  

  

  Dr. Annie Leavitt performing a gait assessment

  
  

All of the above options are meant to provide encouragement to think a little outside of the more traditional box when trying to treat persistent plantar fasciitis. I encourage you to consult with us at The Climb Clinic or meet with a physical therapist in your area skilled in the diagnosis and treatment of foot conditions to help guide you through this process!

Koc TA, Bise CG, Neville C, et al. Heel pain - plantar fasciitis: revision 2023. J OrthopSports Phys Ther. 2023; 53(12):CPG1-CPG39. 

Bolgla LA, Malone TR. Plantar fasciitis and the windlass mechanism: a biomechanics link to clinical practice. J Athl Train. 2004; 39(1): 77-82.