Have you been to physical therapy for plantar fasciitis and been disappointed in the results? Maybe it took way too long. Or mabye it didn’t help. That’s because our understanding of what it actually is was not accurate. This can completely effect how we go about treating it, as you’ll see. Read on.

We were told it’s all about the right shoes. We were told shoes should give us more stability and have an arch. This was not based on science and has potentially led to harming our feet. Plantar fasciitis is a debilitating, knife-in-the-foot kind of pain. Instead of getting into the right shoes, maybe it’s getting out of the wrong shoes.

We were told that this is an inflammatory condition (also wrong). In 2003, Harvey Lamont analyzed the tissues of 50 of his patients that had plantar fasciitis, and found none of them had inflamed tissue, rather they had necrosis (dead tissue). This was even found in younger patients. It turns out that an adducted position of the big toe (pointed laterally towards the second toe) causes a muscle known as abductor hallucis to compress an artery in the foot; namely the lateral plantar artery near the heel. This leads to decreased blood vessel diameter and blood flow. In a study in 2019, (Jacobs et al.) found that immediately following passive adduction of the big toe, there was a 60% decrease in blood flow, which in some individuals corrected to a 22.2% decrease, suggesting some individuals may be able to adapt. This may explain why some do fine with the wrong shoes, and some do not. 

When you decrease blood flow to a tissue, over time it dies. So it appears that plantar fasciitis is more of a problem of dead tissue, not inflamed tissue. So already out of the gate, we have a problem with the diagnosis. Let’s discuss how we were told to treat this condition and break down what we’ve been doing wrong, and what we should be doing. 

As a therapist, we were taught that you ice something inflamed. Well turns out that is a bad idea. You should never ice something that is inflamed, and if you want the details on that, check out this podcast I did with Gary Reinl. Although, this is a necrotic situation, so icing would reduce blood flow and still not be a good idea. 

We were told to strengthen and stretch the area. We got the strengthening part right but the stretching part totally depends on what you are stretching. This gets more into shoeware and how it probably causes plantar fasciitis in the first place.

So a shoe that has a narrow toe box, a toe spring, and elevated heel is bad for you. It causes the extensor tendons of the big toe and the gastroc (calf) to stiffen and shorten, and places the plantar fascia in an elongated and tensed position. On top of that, we have the toe box placing the big toe into adduction, cutting off blood supply and causing some of the plantar fascia to die and weaken. One of the roles of the plantar fascia is to support and stabilize the foot. Well a half dead and elongated tissue will not do a good job of stabilizing the foot. 

On top of all that, overly rigid shoes allow the muscles of the foot (especially the intrinsics) to relax and weaken over time. These intrinsic muscles play a vital role in supporting the arch. So if we have weak muscles and a destabilized plantar fascia, we have the recipe for a painful, collapsed foot. 

This is what I look for in a shoe:

So, get out of the wrong shoes, stretch the toe extensors, don’t ice, and be barefoot. Maybe even wear flip flops. Sound like the opposite of what you’ve been told? Well if your plantar fasciitis keeps coming back and you’ve been doing the classic rolling on a frozen water bottle and stretching your plantar fascia, it’s probably not working. 

Here are some exercises I recommend:

Here is the podcast version of the blog, share it with a friend who needs to hear it:

References: 

Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7. doi: 10.7547/87507315-93-3-234. PMID: 12756315.Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7. doi: 10.7547/87507315-93-3-234. PMID: 12756315.

Jacobs JL, Ridge ST, Bruening DA, Brewerton KA, Gifford JR, Hoopes DM, Johnson AW. 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. 2019 Nov 4;12:50. doi: 10.1186/s13047-019-0361-y. PMID: 31700547; PMCID: PMC6829837.