Plantar fasciitis is an annoyingly common problem in runners. “In the general population, it can be as high as 10 percent of people [who] deal with it over the course of their life,” says Dr Todd McGrath, primary sports medicine physician at Hospital for Special Surgery in New York City. But in runners, specifically, that number climbs to about 25 percent, he says, adding that there are some reports that middle-distance runners are more inclined than others to experience plantar fasciitis, but it’s unclear why that is.

The good news is that most cases of plantar fasciitis get better, says McGrath. More specifically, he says that 80 percent of patients with plantar fasciitis will be better within a year. And, you can prevent plantar fasciitis with pretty much the same exercises you would do to treat it. So even if you’re perfectly healthy right now, it wouldn’t hurt to keep reading and add some of these strategies to your repertoire.

Before we get into it, it’s worth noting that the term plantar fasciitis may be something of a misnomer. “The word ‘itis’ is associated with an acute inflammatory response, so typically it only lasts a week or two,” says James Chung, a Kinstretch instructor and physical therapist at MOTIVNY. “But some people have this for [much longer], so it’s more appropriate to call it fasciopathy, and there’s little or no signs of actual inflammation in the tissue itself.” But because the terms are often conflated, we’ll use them interchangeably for the sake of this article.

Symptoms of Plantar Fasciitis
Before you start with treatments for plantar fasciitis, it’s important to make sure that’s what you’re actually dealing with, as both experts note that there are some similar conditions that masquerade as plantar fasciitis — and might require a different treatment approach.

“The classic hallmark sign is waking up in the morning and having pain on that first step,” says Chung. He suggests ranking your morning foot pain on a scale of 1 to 10 and using that as a marker of progress. Also, the pain tends to be very close to the heel and more towards the inside of the foot, though some people may feel irritation right in the centre of their arch, Chung notes.

Causes of Plantar Fasciitis
“Sometimes the cause is just bad luck,” says McGrath. However, increasing training load and doing too much too quickly can lead to it, as can poor running shoe choices (or a combo of the two). “If the shoe is particularly broken down and you’re a runner who needs a little bit of medial support (i.e. if you’re an overpronator) in the shoe, then that can lead to [plantar fasciitis],” he says.

How many years and kilometres you’ve run over your lifetime has also been correlated with plantar fasciitis. “We do know that long-term runners get this a little bit more than somebody who’s just taken up running, and that’s probably related to some chronic changes from running,” McGrath says.

It also may be linked to the years you’ve been around. “We know that [people] between [the ages of] 40 and 60 or so tend to be much more [likely to have] plantar fasciitis than teenage runners up into runners in their early 30s,” McGrath adds.

When to See an Expert
“If it’s not getting better or if it’s getting worse, if you’re limping around day in and day out, we should probably take a look,” says Chung.

As mentioned, people often assume any foot or heel pain is plantar fasciitis but a stress fracture or nerve condition could also be to blame — and would require a different approach to treatment.

If you feel pain when squeezing both sides of the heel bone, or if you experience numbness and/or tingling in the foot, those are definitely signs to see a pro.

Even if it is plantar fasciitis, it’s with considering working with a physical therapist who can do manual therapy on the area and recommend a customised treatment plan. A professional will be able to pinpoint the contributing factors and figure out the best ways to address them.

How to Treat Plantar Fasciitis

Here’s a list of treatments for plantar fasciitis, ranked in order of how you might see them prescribed by physical therapists and doctors.

1. Foot Exercises and Stretches
McGrath recommends his patients begin with a good stretching and strengthening game plan, and sometimes he refers them out to a physical therapist, while other times he gives them some at-home exercises to complete.

“A lot of people don’t do isolated foot exercises, so I’ll make sure to emphasize training the arch of the foot because while the plantar fascia is not a muscle (it’s a thick fibrous tissue), you have a lot of muscles around it,” says Chung. (You can see some great exercises for plantar fasciitis here. And McGrath specifically recommends a “foot shortening” exercise, which involves moving your big toe away from and back toward your midline.)

The key to results when stretching the arch of the foot (a go-to plantar fasciitis exercise) is doing at least three rounds of 15 seconds each, performed twice a day for at least four weeks — doing it consistently is what matters.

2. Ankle Dorsiflexion Work
“There are theories that say the plantar fascia is somewhat of a continuation of the Achilles tendon, [so] a lot of plantar fascia rehab will look like Achilles rehab,” says Chung, adding that this is why building ankle dorsiflexion and flexibility through the calf muscles is a key component for treating both conditions.

Chung suggests trying one to three sets of 90- to 120-second holds of this wall-supported ankle dorsiflexion stretch and doing one to three sets of 45- to 60-second holds of an isometric version, which means pushing your foot down toward the floor (and lifting the opposite leg) to activate the lower leg and load the ankle joint.

“It’s not about trying to lengthen the plantar fascia,” Chung says, explaining that it takes upward of more than 450 kilograms to stretch it less than one percent. “It’s a very strong tissue and you are not going to decompress it or create any change in the tissue itself with a ball, what you will do is affect your sensitivity to that pressure, which is enough to reduce symptoms in that area.”

On the flipside, Chung does not recommend using a massage gun unless you’re doing it “very gently.”

4. Strategic Purchases
Sometimes McGrath recommends night splints, gel heel cups, or over-the-counter orthotics for running shoes, but these tools are not always necessary. Same goes for taping the area to help take the load off the plantar fascia. “Those are all little things that’ll take the edge off and you can do in conjunction with a good stretching and strengthening program,” he emphasizes.

Another pro tip: McGrath will often recommend patients wear slippers or shoes around the house, rather than going barefoot, to help support the foot when pain is present.

(Just note that to help prevent plantar fasciitis, going barefoot for activities like walking can help strengthen the feet.)

5. Lifestyle Tweaks
“You don’t get better when you’re tired and your body’s significantly stressed,” says McGrath. “Lowering that overall stress level, both running-wise as well as life in general, will certainly help.”

Chung agrees, adding that pain can be influenced by everything from how well you’re sleeping to your mood and stress levels. “Those are all things that contribute to how pain presents systematically throughout the body,” he says.

6. Shockwave Therapy
In some cases, McGrath is an advocate of shockwave therapy, which creates a very high frequency impulse that’s meant to essentially cause a little bit of tissue damage, he says.

The device used looks like a massage gun, but the two function differently. “Massage guns use percussion therapy (direct impact) and shockwave uses sound waves to generate impulses,” he explains, adding that there are two forms of shockwave used: radial and focused, and oftentimes patients will receive a combo of the two. “Radial sounds similar to a massage gun when being used, and tends to work well at or near the skin surface,” he says. Focused shockwave therapy, on the other hand, is used for deeper tissue, calcification in tissue, and tissue near the bone.

Getting shockwave therapy typically involves three to five 10- to 15-minute sessions. It might be somewhat uncomfortable but McGrath says that it’s generally not very painful.

Another pro for shockwave therapy is that there’s no downtime so patients can continue to train through it and may even start seeing results after just one session. “The treatment does stimulate an anesthetic effect afterwards,” McGrath adds, meaning the area may feel a little numb for an hour or two after the procedure.

“We don’t fully understand the pathophysiology of what’s happening, [but] there’s some debate about [whether] it causes a localised acute reaction causing some inflammation in the area and leading to tissue healing or [whether] it disrupts the nerve fibers a little bit, and it may be a combination of all of that.”

Because this treatment is more aggressive than the others above, McGrath typically will hold off on recommending it until a patient has gone six weeks without success first. (Insurance also doesn’t always pay for it.) Even then, he might just recommend another six weeks of stretching, strengthening, and the adjunct treatments if he sees signs that it’s beginning to work.

7. Cortisone Injections
This is probably the most common invasive — because it involves a needle — option, according to McGrath, who adds that in his practice they don’t use cortisone injections as often as they used to. They aren’t the best long-term solution.

“They’re essentially putting a very strong anti-inflammatory medication right at the source of the problem, and there’s some debate about whether that’s good or bad,” he says. “There is some evidence that there’s a slight increased risk in potential rupture of the plantar fascia when you do a cortisone injection and there are some reports of a risk of fat pad atrophy (and you want a little bit of cushioning between the bone and the ground).”

That said, McGrath says that he tends to reserve these shots for people who are in “profound” pain day in and day out — and they would likely be given in conjunction with another treatment, such as the stretching and strengthening routine.

In two-thirds of patients, cortisone shots start to work within three days and most patients have improvement within a week. Repeat injections can up those aforementioned risks so McGrath doesn’t always recommend them, but if he does, they should be spaced out by at least three months.

Other Potential Treatments for Plantar Fasciitis
One additional option is platelet-rich plasma (PRP) injections, but there’s mixed evidence, both in support and against their use, says McGrath. “It doesn’t really seem to have a huge downside other than the discomfort and a little bit of time off [after] the procedure,” he notes.

“There’s some early evidence on the use of Botox for [plantar fasciitis],” he says, including a couple of small case studies that have shown that it’s somewhat beneficial and others that have shown that it may not be.

It’s important to stress that both PRP and Botox are experimental at this time, he says. They still lack solid, positive evidence.

“Beyond those, you get into things like surgery as far as invasive procedures, but I honestly don’t remember the last time I sent anybody for surgery for plantar fasciitis,” he says. “When we start thinking about surgery, I step back and say, ‘what else haven’t we tried yet?’”

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