How I Treated Plantar Fasciitis

Few years ago, I have suffered from a condition called plantar fasciitis and was not able to play soccer and even had a challenge walking.  Plantar fasciitis is a common condition characterized by inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot connecting the heel bone to the toes. It often causes sharp heel pain, especially with the first steps in the morning or after periods of rest.

Because of my own curiosity and frustration, I started studying about the foot and came up with process that not just to treat the issue but to strengthen the feet to improve overall performance.  Before going in detail, let’s go through the basic anatomy of the foot.

Foot Anatomy

The human foot is a complex structure composed of bones, muscles, ligaments, and tendons that work together to provide support, balance, and mobility.

Bones of the Foot

The foot contains 26 bones, which are categorized into three main groups: the tarsal bones, the metatarsal bones, and the phalanges. The tarsal bones, located in the rearfoot, include the calcaneus (heel bone), talus, navicular, cuboid, and three cuneiform bones. The metatarsal bones form the midfoot and connect the tarsals to the phalanges, which are the bones of the toes.

Joints and Ligaments

Numerous joints, such as the ankle joint and subtalar joint, allow for movement and flexibility. Ligaments, which are strong bands of connective tissue, stabilize these joints and help maintain the arch of the foot. The plantar fascia is a prominent ligament that supports the longitudinal arch and absorbs shock during movement.

Muscles and Tendons

Muscles in the foot are divided into intrinsic and extrinsic groups. Intrinsic muscles are located within the foot and control fine movements, while extrinsic muscles originate in the leg and are responsible for larger movements like dorsiflexion and plantarflexion. Tendons, such as the Achilles tendon, connect muscles to bones and enable movement.

Arches of the Foot

The foot features three main arches: the medial longitudinal arch, lateral longitudinal arch, and transverse arch. These arches distribute body weight, provide stability, and act as shock absorbers. Proper arch function is essential for healthy gait and posture.

Blood Supply and Nerves

The foot receives blood primarily from the posterior tibial, anterior tibial, and peroneal arteries. Nerves, including the tibial and peroneal nerves, supply sensation and control movement. Proper circulation and nerve function are crucial for maintaining foot health.

Understanding the anatomy of the foot is important for diagnosing and treating injuries, conditions, and diseases that affect mobility and quality of life. Maintaining foot health through appropriate footwear, exercise, and medical care can help prevent common issues such as plantar fasciitis, bunions, and fractures.

How Did It Happen?

Biggest reason for me (having plantar fasciitis) was neglecting to train feet and ankle and amount of load through lifting weight and sprint work during training and soccer became too much for the foot.  I also did not treat the first sign of plantar fasciitis which for me was tightness around the ankle and I only thought it was just tightness or soreness from training.  The condition just keeps on getting worse to the point where I could not run. 

After few weeks of avoiding running and jumping, the pain subsided so I participated in the soccer game.  During the soccer game, I felt tightness around my right ankle but was able to move so kept playing. Then all a sudden I experienced the excruciating pain in ankle and my foot and had to be carried off the field.  After 10-15 minutes pain was still there but I was able to walk.

So, what happened?  I knew it wasn’t a tear or a fracture.  After doing some assessment and research, I’ve concluded that it is a plantar fasciitis.  But more than the name of condition, I realize that my foot was over worked with both training and soccer.

More I studied about the condition and the foot I’ve learned that even just walking, the heel experience about 4 times the body weight upon heel strike and 8 times the body weight as you push off.  While sprinting amount of force place on each step is about 3-5 times the body weight. For track athletes this contact force may only be .1 second over the period of 10 seconds but for team sports athletes there will be constant stop and go movement where add more stress. Clearly, my feet were not trained properly to handle all the load that I have placed during both my own training and soccer.

Recovery Process

While learning the anatomy and biomechanics of the feet, I started planning my recovery process. Instead of going to see doctor I wanted to find a way to fix the problem that I created.  My plan was in two phases. 1.) Restoring the foot function and 2.) retraining the foot.

Restoring

Restoring the function consists of restoring joint mobility and elasticity of the muscles in feet and ankles. It was so stiff and the toes were squished together.  Foot and ankle muscles were also tight especially flexor hallucis, soleus, and anterior tibialis.  There are other muscles that were tight/weak but these three for me were giving me a problem.  I focused mainly on improving blood circulation by using golf ball, massage gun, foam roller, and warm water. 

Because I wanted to improve blood flow I spent time with warm foot bath.  While my feet were in warm water I felt tingling sensation at the bottom of my feet. Initially, I was debating if this is a good sign or not, however, after 10 minutes of foot bath, I had a temporary pain relief. So this became my routine especially towards the end of the day. 

Rolling out using golf ball and foam roller at the bottom of the feet and soleus (ankle area) was part of my warmup routine to restore elasticity of the muscles in that area.  This process was uncomfortable but helped improve squats, lunges, and step up movement.

Toe Spacers help realign the toes and help get the toes moving

Although I usually walk barefoot at home, I also start utilizing toe spacers to brace my toes for realignment.  Initially, it was difficult to get it on since the toes will not open and every time, I force it to open either bottom of foot or calf area get cramped. Started with wearing the toe spacer for 5 minutes and working up to be able to wear it for more than an hour in about a month. 

Retraining

While working on restoring the function of my feet, I also worked on retraining my feet and ankle.  My personal workout consists of 2 lower body days and 2 upper body days.  To avoid overdoing training, I kept my feet and ankle rehab exercises only on leg days.  There are 4 exercises that I focused on.  Those are toe raises, calf raises, soleus raises, and step downs.

Toe raises are designed to train the muscles in the shin area called anterior tibialis.  Initially, I lean against the wall or pillar, maintaining knees to be straight and lifting toes up and down for 20-30 reps. 

Calf raises are working on muscles right below the knee called gastrocnemius.  While training calf muscles are primary focus of this exercise, however, my focus was more on “can I use my calf muscles with properly utilizing my toes?”.  This was more of a challenge in the beginning.  Initial tendency was my big toes didn’t want to cooperate.  Hence, the foot turned out as heel was raised for the exercise. It did require consistent focus on proper foot usage before I was able to use all 10 toes to participate in the movement.

Soleus raise or knee bend calf raises, are designed to train soleus or muscle that primarily support Achilles tendon.  Compared to gastrocnemius, soleus is smaller in muscle size but more I train, the more I realize the importance of this muscle is in ankle stability, especially when the toes are properly engaged.

Step down is focusing on improving the knee function by controlling the descending portion of the step ups.  Although knee is the major focus in this exercise, however, without proper ankle and toe mobility, this exercise cannot be done right.  There’s two ways of doing this exercise.  One is keeping foot flat.  This way you get to work on ankle mobility in relation to knee flexion and extension. Second is to keep the heel lifted and load through the toes.  This will create challenge with ankle stability and toe function as the knee goes through flexion and extension.  Both mechanics are important in walking, running, sprinting and going up and down the stairs.

These four exercises have been my non-negotiables since and performing at least twice a week, thinking that the foot and ankle need to be trained on regular basis and applying these to my clients as well to make sure they have strong feet and ankles.  Analogy I often use is even if you have 500 horsepower cars but if the tire is flat then the car cannot perform, at all. 

Summary

After about 6 months of restoring and retraining, my overall sports performance is better than prior to the plantar fasciitis.  I’m not certain that the condition is completely gone but even by playing soccer, I haven’t had any issues.  However, I will need to keep on managing my feet and ankles, so it won't happen again.