Thoughts on Plantar Fasciitis

Last week, Gina Kolata had an interesting piece on orthotics in the New York Times. After I tweeted on my own experience moving away from orthotics, I had a number of enquiries from students and friends who’ve suffered from plantar fasciitis (PF) asking my thoughts on them. Now, remember: I’m a doctor of philosophy (worse still, in English literature), not a medical doctor, and what worked for me may not work for you.

I’ve had bouts of PF over the years, usually related to my tight calves. This tightness came not only from running, but from a more unlikely source: the balance ball I’d taken to using as a desk chair. I was always bracing myself with my feet, holding my calves in an engaged position. Deep in my lower legs, my posterior tibialis, which attaches to the arch of the foot, was way too tight. It’s tough to get at this muscle with massage or self-massage.

Enter orthotics, both over-the-counter and custom. Supporting the arch from underneath helps prevent its collapse in the load portion of the running stride, reducing strain on the connective tissue that runs the length of the feet. This is palliative care, reducing the inflammation that leads to pain. But in my line of work, going barefoot is normal. Without my orthotics, my feet would feel pretty beaten up at the end of a long weekend teaching yoga.

The solution: strengthening the lower legs and feet slowly, and moving away from the orthotics gradually. I’ve been paying much more attention to standing balance poses than I used to—in fact, to standing poses in general—and up at the other end of the leg, working to strengthen my glutes. The side-kicks series from Pilates is very useful here, and you can find it beautifully illustrated in Alycea Ungaro’s book Pilates: Body in Motion. When my athletes complain of PF, I have them do some basic foot-strengthening stuff, like writing the alphabet with their toes, before moving on to standing work. Stretch the feet and calves frequently (there are some ideas in The Athlete’s Guide to Yoga). In time, we can build up mileage without orthotics in.

If you’re having problems with pain in your heels or arches, the first step is to check your biomechanics, ideally with a well trained coach or PT used to working with runners. They’ll help you devise a plan of treatment that might involve some of these things that have worked for me. Expect no miracles; these things take time and work, much of it dull.

Look at your footwear (is it fresh and right for you?) and your training plan, too. Maybe you aren’t allowing adequate recovery between workouts. This will be covered in detail in my new book, The Athlete’s Guide to Recovery, out in April. For that matter, if you are a cyclist, check your bike fit. (In the Triangle, I recommend Victor Jimenez of the Bicycle Lab.)

And please let me know what has worked for you in the comments.

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