How to Recover from Plantar Fasciitis

I’ve dealt with plantar fasciitis and I get asked pretty frequently what I did for it. Below is my own personal recovery regimen. It’s not medical advice and shouldn’t be taken as such. If you have symptoms (mainly, a painful or burning sensation in the heel, particularly in the first steps upon waking or standing), begin an active, not passive recovery process as soon as possible. I shut down my training within three runs of my first symptoms and still dealt with the injury for more than half a year.

I will reiterate that this was my own course of treatment. I’m sure that many others will offer their own paths to recovery in the comments. In fact, I encourage it. However, these, too, should be taken as personal paths to PF recovery. With that out of the way, here are a couple quick thoughts on PF.

First, recovery is a long, long process that you need to stick with even after symptoms abate!

In the short term:

  • Try wearing supportive shoes. I like light, flexible shoes, but ran in the Salomon XT Wings 2 with an aftermarket insole for 4-6 months. Cut out or limit uphill running for a while. Same goes for speed work. If you’re engaging your calves, you’re tightening the PF.
  • Wear a night brace. I couldn’t get used to fabric ones that really bent my toes up. A hard boot is so worth it.
  • ALWAYS wear a supportive shoe until you’re 100% healthy. That means in the house, in the shower, and for your very first and very last steps of the day. First thing in the morning is key. If you’ve got PF, you’ll have noticed pain or at least severe tightness in your arch when you take your first steps.
  • Stretch your calves. Stand on some stairs with the edge of your toes at the ball of you feet. Transfer 60-70% of your weight to one calf. Hold for 90 seconds… or, as I prefer, 3×30 seconds with a 2-3 second release between stretches. Repeat with your other foot, even if it’s uninjured. Repeat this 3 times a day.
  • Ice the affected area 1-3 times a day for 10-15 minutes each time.
  • I took ibuprofen per directions for a couple months. I’m not sure I would do this if I had a recurrence.
  • Roll a tennis ball under your arch for a few minutes 2-3 times a day. Over time you’ll feel you need to increase the pressure to get any result. Eventually, you can move on to a golf ball. Do this on a light to medium weight carpet. It does not work well on hard floors as the ball tends to scoot away.
  • I used KT Tape with good success.

As part of both the short and long term:

  • I was told that I needed to learn how to reengage and strengthen your glutes. For a while, I did sidelying hip abductor exercises. Once you start doing the sidelying hip abduction exercise, you’ll be able to feel your glutes when running… practice engaging them. I found it was easiest to do so on slight inclines.
  • Work on your core strength. I did plank circuits.
  • It was also recommended that I work on ankle mobility.

Long Term:

  • GRADUALLY work back to normal support in shoes and amount of shoeless walking.
  • Graduate to more intense core and glute exercises.
  • Eventually, I switched to eccentric calf strengthening. Basically, it’s the same as the stretching, except I started out with two feet together. I’d get on my toes, slowly drop down (2 count), and then raise back up. I started with 3 set of 20 with the sets spaced at least 15 minutes apart if not much longer. You can build up the number in a set to 40 or 50… and then move on to doing single leg raises and drops.

Call for Comments
Have you dealt with plantar fasciitis? If so, how did you approach treatment? How long was your path to recovery?

There are 97 comments

  1. patrick

    i agree entirely with your suggestions. personally, i'd emphasize frequent stretching (once or even twice a day is not sufficient) and strength training for your glutes, hamstrings.

    unbeknownst to me, the PF problem often originates way up the back of your legs and lower back…so i had to figure out some way to get those muscles to loosen up after a workout. through a combination of massage, static and "active" stretching and cold/heat treatment, i was successful. that was, perhaps, the biggest help. just because i used to stretch a bit after a run does not mean you actually got those muscles to relax again.

    i also noticed that i sleep with my feet pointing "down," allowing my PF and calves to tighten up during the night. i made a conscious effort to keep my toes pointed up as i waited for sleep. haha, i swear it helped!

  2. Sascha

    Thanks for posting this information. You mention that you stopped training when you began having symptoms. When were you able to start running again, and how did you go about working back to your old routine?

    1. Bryon Powell

      I should have said I stopped "training." I ran 25-35 miles per week most of the 6 months I battled PF symptoms. Outside of the first month, the symptoms were generally quite mild, but I was never felt 100% healed. I even got up near 50 miles per week. It's more that I greatly reduced my mileage, didn't run fast, and avoided every hill I could for a couple months. I gradually worked hills back in.

  3. footfeathers

    Just a couple of suggestions (I had PF bad in '05, never since).

    1. attack it the instant there's the slightest twinge in the heel. Just like IT pain, the faster you get after it with massage, wearing arched shoes all the time, and rolling something under foot (I keep a baseball at work), the less likely it'll extend beyond a day or two. Once it takes hold, PF has a shelf life of 1 – 1.5 years and there's not much you can do about it other than letting ride its course.

    2. if you do have it, every day before getting out of bed reach down like you're stretching your hammys, drape one hand over the toes and gently pull the the foot into a dorsaflex (pull toes/foot back towards you) and with the other hand massage the fascia from the ball of the foot to the heal.

    Like Bryon points out, NEVER walk barefoot when you have PF; takes you right back to square one.

    1. Brett

      Good points Tim. I wonder if you are the person that gave me advice a couple years ago. The advice was:

      1) Stop incline/speed work

      2) Reduce mileage dramatically

      3) Get arch supports, foot log/golf ball/etc

      If you do all these fast and attack the injury, it can go away and be gone forever.

      Sure enough, I have never had even a twinge of it since. The only real life changes I have made is that I wear arch supports in my cushioned shoes and thats it.

  4. Rob

    The path to recovery from PF must be highly personal because I pretty much did the exact opposite of most of what you suggest.

    For me, I believed my issues with PF stemmed from using too restrictive and supportive running shoes for many, many years. In that time my PF would flare up from time to time and I could never get it to go away for long despite following quite a bit of what you've suggested. Those remedies seemed treat my symptoms but not the overall problem. So I decided to try a totally different tact and I abandoned my typical, supportive, beefy running shoes for more low profile, minimal drop running shoes. I gradually eased into this new way of running for me and it took a lot of time and my feet hurt quite a bit, but a good kind of hurt like for the first time I was activating those dormant muscles.

    So eventually I even weened myself from all orthodics and now I'm running all my mileage in minimalist, no support, light weight road/trail shoes. It was a long process, took truthfully 2-3 years before I felt fully transitioned. I knew I'd "arrived" when I tried running in my old favorite trail shoes and couldn't stand them! The key for me was activating the muscles in my feet and lower legs (and I guess by those activating, it activated everything else).

    I feel much stronger now, I'm running faster and my running form has gone from being a heel striker to more midfoot and I've been free of PF for years now! I've also been working in more barefoot or pseudo-barefoot running (Vibram Five Fingers) since this past June and I think that has gone even further to help strengthen my arches, feet and lower leg muscles.

    I like to use the following analogy: Your feet/arches are like a bridge. If that bridge is weak and threatens to collapse then sure bracing it with supports (othodics) probably does relieve a lot of the stress (pain) and helps in the short term, but long term isn't it best to strengthen that bridge (your feet, arches)? So the boots, orthodics, stretch socks probably certainly do help in the short run, just like wearing a cast helps mend a broken bone, but at some point you've got to strengthen those muscles.

    But like you said, that was my recovery process and it's worked for me and numerous others I know who where in similar situations. Find what works for you!

    1. Bryon Powell

      Rob, sounds like you had a long path to PF recovery. I'd think that if done VERY slowly and with a gradual transition, the change to minimalist shoes would be equivalent to doing the strengthening and stretching, and quite possibly even the running form readjustment I went through, except I did most of my work away from my runs.

      I'm glad you mention that you made the change slowly… as I'd strongly advise against a sudden 100% change from normal running shoes to barefoot running to treat PF despite some occasional anecdotal support. There have been far too many cases pointing in the opposite direction of a sudden change to minimalism triggering PF.

      1. Trail Clown

        I waged war with PF from 2005-2008. Yes, 3 years. It set in at age 35, and lasted till 38. I decided that after 3 years of beefy supportive shoes, $500 orthotics, stretching, night splints, NSAIDS, no hills, no barefoot inside, etc., that I would go minimalist. I did not go slowly enough (ran Bull Run 50 in Five Fingers, suffered a neuroma), but there is no turning back for this old Clown. I'm turning 41 this year, and have been symptom free for 3 years. Now I have just reconciled myself to slower running, especially on hills. I think it hits alot of runners in their mid-30's who try to maintain the same speed as in their 20's. And I agree that the whole body must be addressed when preventing it. I'm looking forward to the new batch of zero drop shoes coming out this year (Altra for ex.), as even small-drop shoes (NB 101's for example) can cause minor PF tweaks.

      2. Rob

        Totally agree. My point is that our bodies don't (or shouldn't) require all these crutches: orthodics, supportive shoes, etc… I completely agree that they can do wonders to treat the immediate pain and discomfort associated with PF (and possibly other ailments). But none of this technology is treating the underlying problem. By slowly weening yourself from these devices you force your feet/lower legs to strengthen and work how they're intended to work. Let's not forget that most of us have been wearing beefy, non-zero drop shoes for most of our lives so it's not surprising that it takes a long time, perhaps several years, to adjust to going w/o any support. It's this very reason why people suddenly going minimalist or barefoot are hurting themselves. Duh! The idea is to not throw the crutches away, but to gradually work in some training w/o the crutches until you get more comfortable and after a while you not only won't need the crutches, but you'll feel uncomfortable in them (where they used to be very comfortable!).

  5. ScottTomKretz

    Maybe some can help me here. I'm currently suffering with what I've been told by several is probably an achilles thing, but I've heard so much that seems to cross-over between PF and achilles troubles. It's been going on since late December, I've tried running all of 3 times since and each time it's gone to crap after about 20 minutes, even after having taken a month off and doing a hefty regimen of balance work, calf raises and resistance band ankel strengthening. Anyone know what the best way to tell the difference between PF and achilles troubles is?

    The main that's killing me here is that nothing seems to make much of a diffeerence. I felt that I'd at least have a little less trouble after a month of nothing but XT and rehab when I tried running again 3 days ago…Fortunately, I found out just the other day that Simon Gutierrez works for the ortho/sports medicine & rehab wing of the local hospital here in Alamosa, so I'll likely be making an appointment ASAP.

  6. Jim Blanchard

    I recently recovered from my 2nd bout of heel bursitis with pain radiating into the Plantar fascia so I consider the problem and treatment to be almost identical to PF. Thanks for your complete post and I did about everything you mentioned. For me Ibuprofen had almost no affect on the foot, perhaps a circulation issue. Although I kept wearing a more flexible shoe [no minimalist shoes until I recovered] I did start using a wonderful soft custom trail running specific orthotic. After my experience in the past with hard orthotics that caused more problems then they fixed, this was a real find. Custom made by a fellow in WI. One last thing, I found great relief from soaking my foot in Epsom salts twice a day. Besides pain relief it is supposed to improve circulation and hasten healing. An old school remedy that we seem to have overlooked.

  7. Jake

    I came down with PF after hiking the John Muir Trail last summer. It bothered me quite a bit in August/September… I kept running (an hour a day or so), but didn't really hike for a while. By October it had cleared up for the most part, and by November I was back running 100+ mile weeks. To this day, its still not 100%, but I can run 100-140 mpw by managing it. Some keys for me are:

    1) Wearing very supportive slippers around the house and supportive / well-cushioned shoes at work

    2) Wearing a lightweight ace bandage brace. I don't know why, but it seems to help!

    3) Backcountry skiing! I spend 8-15 hrs on the weekends in my ski boots while touring. Its a great aerobic workout, and the boots don't really allow my foot to move much, but since my legs are working so hard, there is a lot of blood flow. Its the IDEAL cross training for runners, in my opinion! (especially if you love skiing!)

  8. Hone

    I have dealt with severe PF for over 2 years until about 2 months ago. The things I learned (for my body)

    1. Don't take time off off running because it doesn't help. I could take a month off and when I started up again it just came right back.

    2. Reducing mileage doesn't help it either.

    3. Stretching is a waste of time. (I dont believe there are any benefits to stretching anyways)

    The thing that helped me was that I finally broke down and went to a physical therapist. I told him that I was running high mileage and in so much pain I was over-dosing on Celebrex. He gave me ASTYM treatment for 3 weeks (while I continued running at least 15 miles a day) and then it was better. I was so pissed that I ran with the pain for 2 years and he was able to clear it right up without anytime off.

    PF sucks and it is a horrible injury. I am glad it is gone.

    I also now wear this at all times on my right arch when running so hopefully it never comes back. http://www.roadrunnersports.com/rrs/products/PRO0

  9. Tina

    Interesting that no one has mentioned using ice as part of the treatment plan. Besides doing the exercises, custom orthotics, decreasing running miles, and other recovery options already mentioned, I've been applying ice after my run (and an additional 1 – 3 times daily). I also find it helpful to use moist heat before massaging my foot or exercising it. I also use ginger oil and arnica gel at least 2 times daily – gently massaged into the painful area. I've implemented these treatments for a little over a week now, and it seems to be accelerating the healing process.

  10. Fitz

    I think it's important to note that once you've beaten PF, you're not guaranteed to never get it again – which is why you need to keep up with the maintenance. Using a tennis/golf ball for self massage, strengthening with foot exercises, and being mindful of your training volume/intensity are all helpful to keep it at bay.

    1. Bryon Powell

      Right on! Nine months after going symptom free, I still have a golf ball sitting on my desk and a length of 4×4 for stretching stashed just a couple feet away. I've still not given up on strengthening… though I'm better about it when it's (a) warmer or (b) I'm running more.

  11. Jim

    Great post! KT Tape chiropractor Dr Kuykendall posted an article about the best treatment options for plantar fasciitis yesterday. He mentioned:

    "Manual therapy, KT Taping, arch supports, and gait training are all effective ways of managing this condition. Self management includes ice therapy after activity, stretching, and myofascial release tools like foam rollers, lacrosse balls, and sticks. Experienced athletes, especially runners, can always benefit from working on their overall mobility between races with strength and flexibility training. The same goes for the less conditioned patient with a higher percentage of time being spent on weight management, establishing proper mechanics, and core stability."

    http://www.kttape.com/the-truth-about-plantar-fas….

    Enjoy! Jim- KT Tape support team

  12. Sarah Lavender Smith

    I read this post and all the comments because I fear PF and feel fortunate to have dodged the bullet so far. But other than this comment from Fitz above, "Using a tennis/golf ball for self massage, strengthening with foot exercises, and being mindful of your training volume/intensity are all helpful to keep it at bay"

    along with your tips on core work & other pointers for proper biomechanics, I didn't see advice on prevention and what causes it. Do you have any add'l tips for prevention, and why do you think you developed it in the first place?

    thanks for the info!

    1. Clara

      Reading the comments, advice, etc, I should have thought it obvious that cause is weakness in the muscles required for running (glutes, tums, calf, arches, etc) and prevention is to get these strengthened by doing the exercises suggested.

      1. darrin

        I would disagree that weakness is the sole/main culprit. Tightness/lack of flexibility was one of the main causes for my development of PF.

        1. IveRunAMuck

          I agree with tightness/lack of flexibility… that was my issue, and I wound up with PF. Finally better and increasing my mileage/speed. Foot feels better than it has in over a year.

  13. Jeff

    I've had PF for over a year now. I've tried most all the standard treatments. After reducing mileage for 6-7 months I started ramping up for some spring races. PF flared up worse than ever. Finally decided to completely quit running for awhile. Hopefully this works cause I'm starting to think I'll never be able to run again. I think my problems all stem from experimenting with the NB100's.

    1. Zoe

      Oh man. Don't start thinking you'll never run again… I have that same fear, and it's taken me a year and a half to find a treatment that works- but I've been seeing a physical therapist for ASTYM treatments and it's amazing. It's excruciatingly painful but it's the only thing that's really helped me. I've had seven treatments so far and he says most people can start running again after 6-12 treatments. If that doesn't work, look up ART therapy. It stands for Active Release Technique (/Therapy?). I've never had it but I've heard people say that it's the only thing that worked for them. And night splints, stretching, icing, heat therapy, and eventually strengthening. I also put my feet over the jets in a hot tub every day and it reeeeally helps. Good luck! Don't lose hope! Be aggressive or it will NOT go away!

  14. Bradley

    This thread is of immense interest to me as I may be experiencing the beginning of PF. Thanks Byron!

    Last October, while running an uphill portion of a trail in the Puget Sound area, I felt a slight pull and tear on the bottom of my left foot, right about the middle of my arch. It wasn’t painful, but it was an uncomfortable and odd sensation that I had never felt before. I actually thought I had something in my shoe, perhaps a tiny twig, and continued my run, but the sensation came back throughout the rest of the run and I realized that I had done something to my arch. Of course, I had heard of plantar fasciitis, but I was convinced that this could not be the beginnings of that condition for me. “Doesn’t the discomfort originate at the heel, not the arch?” I thought. Since October, I’ve experienced this tearing sensation off and on, but mostly when I’m on softer surfaces barefoot or with thin shoes. One place where it occurs with regularity is the rock climbing gym, while wearing my climbing shoes on the soft mats.

    I’ve actually taken some precautionary measures to prevent a full blown PT occurrence, such as stretching, massaging, icing, and wearing more supportive everyday shoes. I am a little curious, however, to know if anyone else had their PT originate in a tear in the arch. I assume if the plantar in the arch area is weakened it can lead to PT if one is not careful. At this, point, however, I still have absolutely no pain in the heel. I intend to keep it this way!

    Thanks again, Bryon.

    1. Lianne

      I realise this thread is years old but Ive found it very helpful. I also experienced a strange popping sensation in my arch during a game of netball. No immediate pain, it just felt uncomfortable. The pain came later that night and I eventually couldn’t place any weight on my foot but there was never any swelling or bruising…its been 1 week now and Ive been icing, massaging amd stretching every day. I thought my foot was ok so decided to play netball again tonight. Big mistake! A few minutes into the game I jumped for the ball and felt my arch over stretch. Now im worried ill have to give up my fav sport :

    2. Mathew

      I had exactly the same start of my PF.
      After a two day trail run of 60km i rested for a week. Then i started training again and on the first run i felt the same sensation you described in my right foot at km 5 .. i ran for another 5km to get back home.
      Since then i had this pain in the heel and decided to go back running once this pain is gone… now 4 months later i still suffer from it. It has been bad 3 months ago. With custome made orthotics it feels bit better. I ice at least twice a day, stretch the feet in the morning and during the day. Rolling a ball under the feet. It is a slow process i guess.
      In the beginning i couldn’t walk for 100 meters whitout crunching of pain. Now i can walk some kilometers but then the pain comes back.. running seems impossible now.
      PF is the worst that happened to me till now.. it also swells the fat pad on the heel and feels tender. The typical sharp pain in the morning that is typical for PF isnt present but a deep dull pain is present.
      MRI shows a chronic PF on the insert of the fascia..
      Im harvesting all tips here determined to beat it to never have it back later.
      I just loved running so much…

  15. Jenny Handy

    I am in my 2nd flare up right now. It sucks. I have basically stopped running in hopes the time off would work. No such luck. But, I live in the mountains so flat routes for running are hard to come by. I am currently trying the massaging while at home and work. Hopefully the symptoms subside soon. Thanks for posting this!

    1. Anonymous

      I had a bad case about 3 years ago. I have beenrunning about 100 miles/month for 6-7 years now. I tried the foot straps, massage, stretching tennis ball, etc. Finally, I started taping my arch when I run. After about a month of doing that my sympyoms abated.

  16. Steve

    This is the fix that worked for me — TOOLING.

    I went to my physical therapist and after the evaluation stuff and stretches/exercisses he broke out with the nylon tools and the skin lube. He then proceeded to make me cry like a 6 year old girl by scraping the attachment points of the PF and all along the arch with the tools. It breaks up scar tissue and promotes blood flow to the area for healing.

    I have gone in for whole leg tooling 1-2 weeks before a 100 mile race – seems to loosen things up, promote quick recovery and 100 mile PR's. I went in for tooling after a knee surgery. There is a technical name for it and the PT has to be licensed in the technique – something like ASTYM or AYTM or ….

    Try it – you like it – it works. Now I expect my PT to inflict pain – no pain no gain!

    1. Hone

      I wrote about that up above. It is all about ASTYM because it breaks down the scare tissue and the Physical Therapist actually wants you to run as much as possible while going through the process. When I first went in I had a massive lump of scar tissue on my arch because I had been dealing with the PF for so long. The only way to heal scare tissue it to physically break it up. That is why taking time off doesn't really help it.

      You are right about scraping part. That was very painful. I seriously almost popped the PT dude during a few sessions but now have been running well over 100 miles a week the last couple months with no problems after 2 years of pain.

      I tried all of the other stuff that people have mentioned and none if it worked. ASTYM cleared it up right away.

  17. anonymous

    Rob- Thanks for mentioning the different methods of fixing PF. I think that all the orthotics, stiff shoes etc make it worse…hence a year and a half recovery. Nothing more than a crutch. But it sounds like I might be the vocal minority (which is ok).

    Love the stem, deep massage, ice, and slow rebuilding of the plantar. (support doesn't rebuild…it weakens!!) Everyone is different but ever since I took the time to really strengthen my feet through balance exercises, toe curls, minimalist running, and a focus on good running form…my feet never hurt.

    Use it or lose it…I prefer to use it.

  18. Niall

    I am just on my way back to running after 12 very very long months of no running due to PF. During the recovery period I tried most of the suggestions below. I believe different things work for different people which is what makes PF different to other injuries. For me I found calf stretching and strengthening the most benficial followed by core and glute work.

    The most beneficial treatment of all for me was acupuncture. Being a natural sceptic it took me until month 10 of PF to try it. After two sessions there was a marked improvement and after four I am now back running. My physio used acupuncture on my calves also. The link between calves and PF seems to me at least to be very strong.

    Now that I am back running I am working on becoming a mid or fore foot striker which feels a bit odd bit I am determined to stick with it. From what research I have done it seems my rear foot striking (along with running on roads) is most likely the source of my problems.

  19. Fitz

    Does anybody know the difference between ASTYM and Graston Technique? Both seem to be very similar in using tools to break up scar tissue. I've received Graston for ITB pain and the rumors are true – painful, usually causes bruising, but quite effective.

  20. Antirabbit

    Im fairly sure there are several different root causes of PF:

    1. Weakening/stress of the arch its self

    2. Lower leg issues/Achilles issues

    3. Upper leg issues.

    I have the 2nd. With that said, I find the arch support to do very little. I find calf stretches/massage very effective. Ususally a few miles into a run I cant even tell I have a problem.

    After the run is where the pain and issues begin. Calf sleeves go a long way to helping minimize this. As stated above, time off doesnt really help. Engaging my glutes helps a ton, wearing minimal shoes helps as well, however, if I over rely on the calf muscles-Im in trouble.

    Ive seen my Orthopod about this, and there are a number of stretching exercises that can and do help, my issue is I cant do them due to an ankle joint issue (hence the orthopod). Once I have my surgery, this will hopefully clear up.

    I can only say that IT band issues are the only rival I have experienced that suck as bad as PF.

    1. Zoe

      Icing? Running on softer surfaces? Stretching the top of your foot?- if you can have someone push down on the tops of your feet when you have your legs sticking out straight- that helped me.

  21. Kevin

    While it is important to find what works for you and do it, I think there is merit in looking at why plantar issues occur. An article by Dr. Ray McClanahan of NW Foot and Ankle (link below) was of great use when I was battling plantar issues.

    http://quoindesign.com/nwfootankle/FasciosisTreat

    After trying a lot of the support approaches, I went to Dr. McClanahan and used a mix of taping and stretching to help improve the injury. I also switched all shoes (walking and running) to ones with full flexibility and wide toe boxes for natural foot function. The transition of this type does take some time and a lot of stretching (incorporated Yoga for Runners by Ann Richmond also), it seems to address the root cause of why plantar issues may occur and help to strengthen and put the foot back into its natural position to prevent future injuries.

    1. Tina

      Thanks for the link… interesting information. Their discussion on modifying the shoe reminded me of what "Tony" Anton Krupicka does to tweak his trail running shoes.

  22. Tom Caughlan

    I struggled with this injury all through college from wearing trainers with big heel drops and then wearing spikes all the time for workouts and races.

    The Strausberg Sock is great to wear in bed to make that first step in the morning not so painful.

    Besides the stair stretch, I felt that deep tissue message on my calves and hamstrings really helped the whole kinesthetic chain. Rolfing if you can afford the sessions.

    Great write-up Byron. Worst injury to get through!

    1. Andy

      A helluva lot of of interest in this topic, and rightfully so. Have battled PF for the past 5 months, brought on by a too quick transition to a lighter shoe — minimalist wannabes, beware! Took 2 weeks off but that did nothing. Then ran thru the pain for a few months, which was tolerable until about 3 hrs into long runs, and afterwards was really bad. Finally started with ART and have laid off running for a bit, the combo of which seems to be helping slightly. Unfortunately, all the conventional things people recommend — ice, massage, night splint, stretching, orthotics, etc. etc. have been of little or no value.

      I appreciate all the info packed into this blog — Those of us who are suffering but are already registered for some spring ultras and are desparate to get in some training miles are looking for the quick fix to this treatment resistant problem. Thanks Bryon.

  23. dbconlin

    I am currently dealing with PF, about 3 months in. There is a lot of great advice in this thread, but it is also apparent how much conflicting info there is too. For example, some argue to only wear supportive shoes w/ arch supports, never walk barefoot, etc. while others claim that these very devices are too blame and recommend getting back to basics (i.e. minimalism) immediately.

    This makes it hard to choose a course of action. I personally am threading the middle ground, and would therefore concur with much of the advice posted. I however don't think "never walking barefoot" for example is a requirement. Maybe at first, but as one improves, it seems logical that one should begin to explore taking away the supportive devices that have been installed for the pure sake of recovery and possibly explore a path toward minimalism to prevent recurrence. This of course should be combined with an appropriate strengthening program and should be incorporated gradually.

    Speaking of strengthening, I recommend seeing a Physical Therapist. An appropriate program would include a gradual build-up of one legged balance excercises (which strengthen the foot), calf strengthing, adductors, hamstrings, core, etc. Also flexibility of the hind foot/leg should be addressed.

    Someone inquired about shin splints. I have dealt with this too and, interestingly, my form makeover and PF-oriented strengthening program have essentially solved this issue as well. Shin splints may actually refer to a variety of issues, but if you have pain medial to the tibia, it is likely related to calf (particularly soleus) weakness. The eccentric calf strengthening excercises Bryon has described are appropriate here. Try also doing the same but with the weighted leg bent to emphasize the soleus muscle.

  24. Rich

    Like Rob and a few others I also went with the less-is-more route to deal with PF during 2009-10, which I can only guess was brought on in part by a slight increase in intensity, but not mileage. Somewhat unusually my PF started out at the insertion point on the fifth metatarsal, with an assumption originally of a stress fracture but finally after four months later it was shown to be PF after seeing a tendon specialist. I was unable to run at all for four months – switched totally to cycling and continued strength training as well as doing eccentric stretching of my calves just as is done for Achilles tendinopathy, as well as rolling first a tennis ball and then a larger size superball under my foot (I found a golf ball too small, and the tennis ball too soft). Although not my subject area directly, working at a university I had access to all of the recent research articles on PF and read many of the studies published over the past decade, and the pathologies and treatments in the literature are very diverse and totally inconclusive on the correct approach to take. So the variable experiences reported here I think reflect the different possible causes to PF, and thus different needs to rehabilitate it.

    After four months I tried running once a week over a month, then twice a week and then switched back to my Inov8 f-lite 230’s with the notion that it was my foot that needed strengthening. An article in Running Times (Is the Key to Curing Plantar Fasciitis in Your Toes?) came out in April 2010 after I had already decided to go back 100% to my Inov8s. The article took up a 2003 study that found the scar tissue problem mentioned in several replies posted here, and brought up the need to strengthen the feet (and toes). At home I switched to going barefoot all of the time– and still do, and once our long winter ended and the snow finally melted (which isn’t until early May), I made an effort to go barefoot outside as much as possible. After 10 months I could resume racing. However, as pointed out by others here, hill training and speedwork can be problematic and I still can only do these judiciously – only one of these in a week even now after 19 months. The first race I ran last June (8 km x-c race) brought back the PF, but then as classic PF closer towards the heel. After 9 months, I was able back up to the same volume of running I had pre-PF, about 7-8 hours week, and over the past few months even up increase up to an average of about 9 hours/week (100-120 km/week) in preparation for this year’s racing goals. With continued strength training (done either in Five Fingers or nowadays just barefoot), stretching and especially eccentric stretching of my calves (minimum of twice per day with an extra 15 kg in a pack) I have managed to keep the PF under control, but it is still always there – so ‘manage’ really is the right word.

  25. Andy

    2 follow-up questions: (1) if scar tissue is to blame (as some have claimed), why do non-aggressive treatments (including rest) work for some people? (2) What's the buzz on shock wave therapy? (no pun intended) I've heard/read that it — like others have said about ART or ASTYM — is the only thing that really worked for them. Anyone out there with experience with this?

  26. Will

    The only time I struggled with PF I was lucky enough to live with a ice-cold creek 3 feet from my front door so I iced a great deal and the PF disappeared without too much trouble. I was lucky that the pain didn't last long. I've got some friends who fought PF for over a year and tried all the traditional podiatry fixes – supportive shoes, orthotics, stretching, massage, cortisone shots, etc – with little to no success. Eventually they said "f- this" and went unshod (or minimally shod) when running for a few weeks, and voila! the PF was gone. Obviously these are just anecdotes, but I have little trust in traditional podiatry fixes for everything. My wife's a college biology professor (and Vibram Five Finger runner) who had one of her students enter podiatry school a few years back. He comes back to her every year and tells her that there is no future for traditional podiatry in sports medicine as it's all a sham designed to sell orthotics. I know orthotics work for some people, but when I worked in a specialty running store and had people buy them to fix knee pain or shin pain or PF I cringed as they don't address the underlying muscular problems that often are at the root of running pain.

  27. Jeff

    I quit running about three weeks ago in an effort to get rid of my PF but some people are saying it does not help PF to stop running. Should I continue training while trying various methods to get rid of my PF? I would like to be ready for a 50 miler the end of May without causing any permanent damage.

    1. darrin

      Both my podiatrist and PT had me back running fairly quickly. A short break to allow the inflamation to settle, then new shoes, orthodics, ice, exercies, etc.

    2. Bryon Powell

      This isn't medical advice, but if the injury is quite acute (pain most of the time), I'd personally rest a couple days. However, if the pain is of the morning pain or just-stood-up pain or just-started-running pain variety, I'd definitely keep logging some miles. I wouldn't go full bore and would cut back on speedwork/hills to some degree, but, personally, I feel that outside of severe pain, just resting it won't help.

      1. Andy

        Agree with Bryon: I took off an entire month (thank goodness for our hellacious New England winter where spinning didn't seem quite so aversive), and the PF really didn't get much better, despite PT (including ART), icing, stretching, etc. Have resumed runing, but with Bryon's approach of moderating the distance, effort, and frequency, and taking a "chronic management" approach with continued icing, stretching, PT, etc. Still in pain, but we'll see. I too am registered for a 50k in mid-April and a 50m in early May, and may have to re-think short-term goals. If it helps, go to Anton's blog for some perspective on sacrificing races in favor of just getting and staying healty so you can do what you love — run!

        1. Jeff

          Thanks for the info everyone. I'm going to get aggressive about treating this with some stretches and exercises I got from my doc and start doing some easy runs again. Also will be wearing a night splint every night. I bought a ball called a foot rubz to massage and loosen up the tissues. The strange thing is when I use it I'm not all that tender right where you would think for plantar fasciitis. I'm more tender on the inside of the heel. Thanks again for the info.

          1. Andy

            Jeff – The inside of the heel is *exactly* where you usually feel PF, where the fascia loops around and connects to the calcaneus. I've also got the Rubz ball, the night splint/sock, etc. etc. Let's hope that patience and perseverance will prevail. They say that for as long as you've had PF, it will take at least that long to get rid of it. Talk about being in it for the "long run" …

            1. Hone

              "They say that for as long as you’ve had PF, it will take at least that long to get rid of it. Talk about being in it for the “long run”

              Who says that? I had a terrible case for 2 whole years (while stretching, icing, and all of the other crap) and was finally able to clear it up in about 3 weeks while running 100+ mile weeks. I really hope that everyone with this problem will get a note from their doctor to go see an ASTYM specialist. All of the sitting around waiting for it is to heal up is a massive waste of time.

              I am not even close to being elite but I have had enough success in this sport to have a little bit of credibility. Laying off the running will just make you fat and depressed. Trust me.

              -Evan

            2. Andy

              Lucky you – the closest ASTYM/Graston provider is about a 100 miles from me. Agree that ice, stretch, etc. appears to be a bunch of crap. Thanks to your advice, I may be commuting 2 hours for PT very soon.

  28. Susan

    I've been suffering from PF for almost a year now. The pain flared up last spring when I began training for a half after an inconsistent winter. I've tried PT (4 mos with no success) now undergoing accupuncture…no real success there either. Reading about people actually getting over this is inspiring. Right now I can't even get on an eliptical without pain. I am at a loss at what to try. Not sure I believe in orthodics. Want to hear more from people who've had success with minimalist shoes and alternative medicine.

  29. Amanda

    I am fairly new to running, got some new Asics running shoes last week, they did great on my 2 mile run, so ran 4.3 miles last night with them and experienced the worst arch pain in my life! I couldn't walk. I remembered a friend mentioning PF, so I googled it and am pretty sure that's it. I iced it, put some Melaleuca cream on it, and prayed over it! I'm 100% pain free this morn, but will take it easy and definitely get some inserts for my new shoes. Thanks for the great info!

  30. David

    ASTYM didn't do much for me. What did was minimalism. So add another to the list of anecdotal evidence…

    At some point, I just got frustrated with nothing working and finally took out my Superfeet insoles. I had been working on my gait (midfoot strike) and was wearing a lower drop shoe, but with Superfeet in them. One day I got home from work, was like "What the hell am I going to do, my foot hurts?" and decided to go for my run without the insoles. I ran very gingerly/slowly and for a very short distance and it was obvious my foot was working way harder than it had been. But if felt ok and then again a few days later even better. From there forward, it generally improved. After a couple of weeks, I went on a month-long trip, didn't run at all, but only wore minimalist shoes with no support/insoles. My foot continued to get better. When I came home, I started running again and was able to start upping the miles while continuing to improve. Now, about 1 year later, I am doing the same thing and, while I occassionally have some soreness/fatigue, my PF has not limited me for the past 9 months.

  31. tracey cavanaugh

    That is so interesting that you mention the Superfeet. I had never had a problem with my feet before (running 40 miles/week) until I put the Superfeet in my shoes. My intent was to overcome a gait problem I was having. I started having pain about 10 miles into my 18 mile run. It's now been a week and a half of hobbling and icing and only biking in an attempt to recover. I returned the Superfeet. They offer a 90 day full refund. Still totally bummed to not be able to run for so long !!

  32. Jason Trew

    You list a lot of suggestions. Can you explain how you organized them into a routine? Was there any logic to what exercises/stretches were performed in relation to each other? For example, it seems to me that some warm-up exercises should precede stretches and then ice as the last item…? Could I combine some ideas – like soak my feet in a ice bath, with epsom salt, and rolling my foot over a tennis ball? I'm just trying to figure out the best way to arrange these ideas for effectiveness and efficiency.

    P.S. Has anyone hear actually broken down and paid for access to one of those sites like "PF secrets revealed?" I'm almost that desperate at this point…

  33. heather

    I have a neuroma in the left arch and just started having that ridiculous "first steps" pain.
    My instinct is to try to start minimalist running.
    what shoes would you recommend for a woman to start (going to start trails too bc of where I've moved)? And how should I segue ? I am not as experienced or good a runner as many posting here but vey athletic. I used he app C25k to start running and now I run 2.5 (30 min midfoot strike) slowly. Would starti
    ng C25k from the beginning w minimalist shoes be gentle enough? Also tightness is in muscles in front of shins as well as calves. What would you recommend for those?

  34. David

    I am 58 years old and play basketball and run several time each week. Plantar fasciitis flared up suddenly in my right foot that caused considerable pain. I heard this can be a persistant problem, but I was able to clear it up in 3-4 weeks. First, I got new orthodics that were made to fit my feet and therefore had much better arch support. Second, I adopted a high omega-3 diet to reduce inflammation. I eat salmon every week, and walnuts, and flaxseed daily. I know, I know, no one including my doctor believes diet can help. But I am totally clear of this problem . Give this a chance. David

  35. Melissa

    PF can manifest in ball of feet. I have been having ALOT of trouble. No heel pain. A pedorthist told me once that it does not necessarily have to be confined to heel.

  36. Melissa

    So how do you know if there is scar tissue? How is that diagnosed? They don't just do the scraping without seeing if it is there do they?

  37. Melissa

    Not being able to walk barefoot is a strict adherence. You will find out quickly when you think you are well enough to do this that it does not work and the pain comes right back. Seems to me that PF manifests in different ways for different people. And the treatment is individualized, but some aspects of treatment fit some people and not others. Also the treatments you do do change over time from ones you thought were helping to not helping and ones that were not helping are helping now.

  38. Melissa

    So who is the best person to go to for PF. Podiatrist, has not worked. My pedorthist is a specialist and we have been working on it for three years now. Physical therapy is iffy, chiropractors and cold laser therapy helps once or twice and then returns. Again, who do I see?

    1. 1retsel

      I went to two medical doctors, three podiatrists, one pedarthist, two physio therpist, one sports medicine specialist. I tried all kinds of orthodics both off the shelf as well as designed by professionals. Nothing worked until I went to the final physio therpast who had a specialized knowledge in the muscles of the foot and leg. The exercises she gave me finally worked. My fasiitis of more then three years went away.

  39. Joseph

    Are you still using ASTYM cause if you are then you're not 100% cured from this. I have 6 years and counting. I don't like the whole drugging thing is isn't natural.

  40. Ryan J P

    I don't know whats been wrong with me. For two years 18-20 have had plantar fasciitis I believe in both feet. Have tried ice/physical therapy exercises to no avail. I was told that by a foot doctor, been to foot doctor countless times. Never did the ball exercise, trying that now. Seemed to help a bit, hurt while doing it. Its basically where my arch is the pain, cant say its exact spot since its more on the side of my foot rather than underneath it. I've worn numerous orthodontist and shoes as well. Feel like all hope is lost, cant really afford more products either. If I settle with what I have now for shoes and orthodontics and keep doing the exercises, might it get better one day?

  41. Run

    Great information here. I had this problem after getting into 100miles/week for the first time in order to break 14min in 5k. I was limping after a workout in spikes and the PF also lead to lower back issues. I tried every trick in the book to get rid of the PF (ice, strech, acapuncture, massage and a complete rest), but it did not do anything for me.

    Then I did one thing that helped me get rid of the PF in one week (maybe it would have healed anyway because of the normal treatment mentioned above). Two times per day I was laying on my back barefood while my wife took the shaft of a hair brush and pushed it really hard and deep into the heel (where the pain was), and I tried to relax as much as I could while she did this. This was by far the most pain I have experienced in my life. By doing this and training for 60-90minutes on the elliptical every day, made the PF go away.

  42. Pipinho

    I think that if the plantar fasciitis becomes chronic which means plantar fasciosis then we should avoid ice because our aim is to concentrate blood.

  43. Karen

    Hello! I'm a high school athlete competing at a pretty high level during season. I just started experiencing symptoms of PF a week or two ago. I'm training about 35 miles a week, no speed work for another few months. Can I keep training and still have my PF gradually resolve? I have been doing the necessary things to stop it, i.e. stretches, massage, rolling, kt tape, night brace

  44. Joseph

    You way want to take a warm shower at the end of the day, then after go for a deep tissue massage on the parts that really hurt you and after that you may want to finish it off with some icing around the parts that you massage yourself with… Diffinately continue with the night brace, stretches and whatever works for you. Some people ice there feet 3 times a day if there going throught some extensive workout… Also try buying some Dr. Scholls insert.

    I been having it for 5 year now, didn't know what it was after the 3rd year I found a good doctor who diognosis me with the correct conditioned and he explained to me what I needed to do to maintain my feet. All of the above have helped me out a lot, althought I don't play sport competively anymore.

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