athletic man wrapping his foot due to plantar fasciitis

Surprising Reasons Why Your Plantar Fasciitis Isn’t Getting Better

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Plantar fasciitis affects approximately 2 million people per year and has long been known as a painful and tricky injury to treat. 

There’s a laundry list of first-line treatment tactics, but what happens when plantar fasciitis won’t go away?

To stop this annoying heel pain in its tracks, you need to look beyond the foot. 

Today you’ll learn the not-so-obvious causes of plantar fasciitis for a comprehensive approach to beat the pain and get back to life!

Disclaimer: This content is for educational purposes and is not medical advice. Read the full disclaimer.

WHAT IS PLANTAR FASCIITIS? 

To answer that question, we have to start with what is the plantar fascia?

The plantar fascia is a thick band of connective tissue that runs along the arch of the foot to the heel bone. It functions to support the arch and transfer force through the foot and lower leg during movement.

When the plantar fascia ligament is asked to pull more than its fair share, it’ll let you know, in the form of stabbing pain with every step. 

Plantar fasciitis is an inflammation of the fascia at its insertion point on the heel. If the pain becomes chronic, for example, months to years, the condition may be called plantar fasciosis.

There’s also some newer evidence that chronic plantar fasciitis is related to decreased blood flow, which affects the body’s ability to get fresh blood carrying oxygen and other reparative cells to the area to initiate tissue healing.

This finding argues that chronic cases are less about inflammation and more about tissue degeneration, making the condition more multifactorial than originally thought.

cartoon image of the foot showing plantar fasciitis for education in an article about plantar fasciitis relief
image source: depositphotos.com

PLANTAR FASCIITIS SYMPTOMS

A hallmark sign of plantar fasciitis is heel pain/arch pain first thing in the morning. The pain may improve as the tissues warm up and may worsen with prolonged walking/standing.

During normal activities, the tissues are warm and move through their full range of motion (ROM). 

After sleeping for several hours with your feet in a more relaxed position, those first few steps may cause severe pain as the inflamed tissues attempt to warm up and move through their full range of motion again.

Plantar fascia pain can also feel worse after prolonged standing and walking activities.

WHAT CAUSES PLANTAR FASCIITIS?

Though it may seem like plantar fasciitis creeps up overnight, several background issues can contribute over time, sometimes for weeks or months. 

  • Anatomy/structure of the foot
  • Poor footwear choices
  • Altered movement mechanics (due to other injuries, tightness, or weakness) that change the way we walk
  • Ramping up fitness activities too quickly, especially running
  • Spending a lot of time standing/walking
  • Wearing high heels
  • Obesity

Read 11 Signs You’re Not Wearing the Best Shoes for Your Feet

WHAT’S THE DIFFERENCE BETWEEN PLANTAR FASCIITIS AND HEEL SPURS?

These two often become confused. It’s a common misconception that heel spurs cause plantar fasciitis, the truth is, it’s likely to be the other way around. 

A heel spur (sometimes called a bone spur) is a bone or calcium deposit that grows in the heel (calcaneus) where the plantar fascia inserts, in response to repetitive stress. Heel spurs can develop in response to chronic plantar fasciitis, but the heel spur itself doesn’t often cause pain. 

HOW LONG DOES IT TAKE FOR PLANTAR FASCIITIS TO HEAL?

Unfortunately, plantar fasciitis improvement is often slow, especially if you ignore the pain for a few months and allow the condition to become chronic.

With the right treatment, plantar fasciitis can heal in 6-12 months.

The earlier you address symptoms, the faster you can see results.

COMMON PLANTAR FASCIITIS TREATMENTS

Here are some common first-line treatments often used to decrease plantar fasciitis pain.

These treatments can be a helpful starting point and offer some short-term pain relief, but what happens when the pain doesn’t go away? 

There may be more to the puzzle. 

image source: depositphotos.com

PLANTAR FASCIITIS NOT IMPROVING? {WHY FOCUSING ONLY ON THE FOOT DOESN’T WORK}

Chronic heel pain can be very frustrating. It’s easy to think, I have foot pain, so I’ll treat my foot. 

It seems logical, right? Except, it’s not. 

Successful treatment for plantar fasciitis pain is often a multi-pronged approach. 

Yes, it’s important to decrease inflammation locally and improve foot/ankle range of motion. That’s where many of those first-line treatments come in handy. 

But it turns out; the foot is connected to the rest of your body. When plantar fasciitis won’t go away, it’s time to look elsewhere.

Many other factors further up the kinetic chain can manifest as plantar fasciitis. If you don’t look beyond the foot, you’ll never find other contributors to the issue, perpetuating the chronic pain cycle. 

Treat the actual problems instead of just the symptoms. 

All the ice and foot massages in the world won’t fix the issue if there are other contributors, for example, the hip. It’s a delicate dance of decreasing local inflammation while restoring healthy movement. 

The best way to get rid of plantar fasciitis is to also look beyond the foot.

NOT-SO-OBVIOUS CAUSES OF PLANTAR FASCIITIS

Any area of the body can change how we move and walk. When movements are altered in a dysfunctional way, it can lead to overuse issues. 

Here are some examples of how other structures can overuse the foot and ankle. Evaluating these areas can provide a key puzzle piece in plantar fasciitis relief.

LACK OF EXTENSION AT THE BIG TOE

I know, I just said you need to look outside of the foot. We’ll get there.

Extension at the big toe is a requirement for fluid walking and running and is often overlooked as a source of dysfunctional movement. If the range of motion is lacking, your body needs to engage other muscles and tissues earlier in the gait cycle, which can contribute to overuse.

Lack of extension range of motion here can contribute to a host of overuse injuries at the foot/ankle and beyond.

CALF MUSCLE TIGHTNESS

Calf muscle tightness or the perception of a tight Achilles tendon is a common contributor to plantar fasciitis. 

Tightness in the calf muscles (gastrocnemius and soleus) can restrict ROM of the ankle into dorsiflexion (pulling the foot toward you). Issues with the Achilles tendon (that attaches to the calf muscles) can also restrict dorsiflexion.

Limited dorsiflexion can affect your stride length (how long of a step you can take) and flexibility with activities like going downstairs or even squatting.  This can place additional strain on the plantar fascia. 

To learn different methods to stretch the calf muscles, check out the ankle/foot flexibility library. 

BEST TOOLS FOR TIGHT CALF MUSCLES

Here’s an awesome adjustable calf stretch incline board. This tool is an easy way to get a great stretch and allows you to change the angle as your flexibility improves – a crowd favorite in physical therapy clinics.

Muscle scraping is also a great way to address problem areas at home. Muscle scraping tools offer a different type of soft tissue mobilization that can’t be accomplished by hand. My Sidekick tools were tremendously helpful during the pandemic when getting a massage was not an option.

Muscle scraping tools are used for soft tissue such as muscle and fascia to break up scar tissue and improve soft tissue mobility. These tools come in a variety of shapes to contour various body parts. 

Scraping is an excellent adjunct to your regular foam rolling routine, along with stretching and mobility exercises for best results. Using a scraping tool for the calves and feet can help with soft tissue mobility and provide some relief.

The brand that I use is Sidekick. The Eclipse tool is perfectly shaped for calves and feet. The Swerve also works for these areas, in addition to being a great all around tool.

Click here to read my full review of Sidekick plus learn more about muscle scraping. You can also check out this article specifically about scraping therapy and plantar fasciitis – does it speed up recovery?

woman demonstrating a standing calf muscle stretch
Copyright Maura Blackstone

HIP/CORE MUSCLE WEAKNESS

It seems like core strengthening is some magical fix for everything doesn’t it? Let me explain.

The glute max is the most powerful hip extender in the body, and also a common muscle group to find weakness, especially with prolonged sitting. 

Glute max helps propel you forward while walking. Weakness in the glutes can contribute to a host of issues, including plantar fasciitis. 

But the hip is so far away from the foot! 

Sounds crazy, right? 

It’s not that far-fetched from a movement perspective. Remember, it’s all connected. Strengthening the glutes can contribute to plantar fasciitis relief.

The body will keep moving down the line (or up the line), looking for other tissues to pick up the slack. After a while, these tissues become overworked and inflamed. 

These loop resistance bands are an awesome way to build hip and glute strength – lateral walks and clamshells are two of my favorite exercises!

Glute bands are also heavy-duty fabric resistance bands designed to work these strong muscles without heavy equipment.

woman doing warrior 1 pose to stretch hips. Decorative image to demonstrate exercises for the best ways to get rid of plantar fasciitis.
image source: depositphotos.com

HIP FLEXOR TIGHTNESS

The hip flexors function to propel your leg forward while walking and to bring the knee toward your chest. Psoas, the major hip flexor, also plays a role in core stability. 

Tightness and weakness are usual suspects in those with sedentary jobs, spending extended hours sitting. 

Lack of full ROM of the hip flexors can limit how far your hip extends (the opposite direction of flexion). Hip extension is essential for walking. If it’s limited, that can create extra work for the calf and foot. 

Spoiler alert, it may even be on the opposite side of the body!

For ideas on how to stretch the hip flexors, check out the hip flexibility library. 

Related Read: How Do You Fix Tight Hip Flexors?

LIMITED ROTATIONAL MOBILITY OF THE SPINE

Have you ever wondered why we swing our arms when we walk? That reciprocal movement helps us walk easier and with more fluidity. 

Now try taking a few steps holding your arms at your sides, keeping your upper body still. 

Awkward right?

You may have noticed you didn’t move as fluidly, and you had to work a little harder to get going, which was more work for the feet and ankles. 

Check out the spine flexibility library.

WHAT’S THE BEST EXERCISE FOR PLANTAR FASCIITIS?

It depends on what’s causing your plantar fasciitis.

It may be beneficial to team up with a podiatrist and physical therapist simultaneously for the best results.

If the condition is chronic, it’s likely there is more than one issue at play. 

Unless you have another injury that you can trace back to, it can be challenging to figure out the underlying cause. 

Which came first, the chicken or the egg? 

The world may never know, but if you don’t address all the causes, you’ll spend years rolling your foot on a tennis ball, wondering why the pain never goes away.

It’s essential to get evaluated by a physical therapist that will assess your movement as a whole to call out these underlying offenders and design a comprehensive program. 

The longer an injury lingers, the more difficult it becomes to resolve. Inflammation becomes chronic, tissue damage occurs, and bad movement patterns breed more bad patterns, leading your body to feel this is the new normal. 

It’s worth it to exhaust all the conservative treatment options before jumping into surgery.

Read What is Physical Therapy & How Can It Help You

CAN TOE SPREADERS HELP PLANTAR FASCIITIS?

Shoes that cramp your toes together not only affect the mechanics of your feet but can also compress nerves and blood vessels.

With new evidence that restricted blood flow may be one of the culprits in chronic cases, trying some toe spreaders may have some benefit.

These soft gel toe separators by Mind Bodhi are super comfortable.

CAN ORTHOTICS HELP PLANTAR FASCIITIS?

Custom orthotics and over-the-counter insoles can be a great option along the plantar fasciitis journey.

An orthotic supports the arch of the foot, which also has a positive effect on the alignment of other joints of the body from the ground up.

If you have particular needs, you will need to see a podiatrist for custom orthotics. The downside is they can be costly (in the neighborhood of $400-$600 per pair).  Insurance limits how many pairs you can have, if they cover them at all.

BEST OVER THE COUNTER ORTHOTICS FOR PLANTAR FASCIITIS

For over-the-counter affordable, high-quality insoles, I recommend Superfeet.

They offer different types of insoles for all activities and are cost-effective enough to have several pairs to go around in your shoe collection.

An over-the-counter heel cup may also provide some much-needed plantar fasciitis relief. Heel cups can provide extra cushioning and support to cradle a painful heel and decrease pain.

Superfeet insoles are available on Amazon, but they sometimes run sales on their website.

WHAT HAPPENS IF PLANTAR FASCIITIS DOESN’T GO AWAY?

If plantar fasciitis is left untreated, it can start to affect other areas of the body (ankles, knees, hips, or low back) as your gait and mobility change in response to painful walking.

Chronically inflamed plantar fascia can also tear or rupture, possibly requiring surgery.

It’s never a good idea to ignore pain. This can lead to further tissue damage and greater difficulty and complexity in resolving your symptoms.

PLANTAR FASCIITIS PREVENTION TIPS

Here are some easy steps you can take to decrease your chances of developing plantar fasciitis.

  • Wear shoes with good support and replace them at regular intervals 
  • Add orthotics or over the counter insoles
  • Maintain a good balance of flexibility and strength for healthy movement
  • Don’t ramp up training too quickly, for example, significant increases in running mileage
  • Maintain a healthy weight
  • Don’t let injuries linger, seek care sooner than later

WILL MY PLANTAR FASCIITIS EVER GO AWAY?

Chronic foot pain can hold you back from enjoying your life.

Human movement is extraordinarily complex and poor movement patterns further up the kinetic chain can manifest as plantar fasciitis.

The best plantar fasciitis treatment is a multi-disciplinary approach and some trial and error. 

Other than ignoring the pain, the worst thing you can do is the same failed treatment repeatedly and wonder why you’re not getting results. 

It’s definitely worth it to explore all conservative (non-surgical) options before jumping into more invasive treatments. 

Remember to look outside of the foot to ditch painful plantar fasciitis!

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References

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

Jacobs, J.L., Ridge, S.T., Bruening, D.A. et al. Passive hallux adduction decreases lateral plantar artery blood flow: a preliminary study of the potential influence of narrow toe box shoes. J Foot Ankle Res 12, 50 (2019). https://doi.org/10.1186/s13047-019-0361-y

Lewis RD, Wright P, McCarthy LH. Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis. J Okla State Med Assoc. 2015;108(12):596-598.

Miller LE, Latt DL. Chronic Plantar Fasciitis is Mediated by Local Hemodynamics: Implications for Emerging Therapies. N Am J Med Sci. 2015;7(1):1-5. doi:10.4103/1947-2714.150080

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 Sports. 2015;25(3):e292–e300.

Santos BD, Corrêa LA, Teixeira Santos L, Filho NA, Lemos T, Nogueira LA. Combination of Hip Strengthening and Manipulative Therapy for the Treatment of Plantar Fasciitis: A Case Report. J Chiropr Med. 2016;15(4):310-313. doi:10.1016/j.jcm.2016.08.001

Scherger JE, Spinoso A, Carlson W. Use of muscle strengthening to treat plantar fasciitis. ACSM Health Fitness J. 2017;21(2):37–38.

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