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Heel pain: the tip of the plantar fasciitis iceberg

The plantar fascia is a thick band of connective tissue that connects the heel bone to the toes. When it gets inflamed, it typically causes heel pain, the classic symptom of plantar fasciitis (PF).

Anybody can get it, but runners are particularly susceptible. The fascia is stretched tight across the bottom of the foot and the repetitive stress of running can cause small tears. Over time, those tears can lead to long-term inflammation and heel pain. 

Planter Fasciitis

PF pain usually builds over time – it doesn’t typically appear out of nowhere. Most people describe it as a stabbing pain in the heel that often shows up first thing in the morning and after working out.

Getting at the root cause

Like many problems that bring people to the chiropractor, the heel pain PF causes often has its origins farther up the chain. It’s a recurring theme; the site of the pain is typically not the problem. PF can have many causes, but the setup in runners usually starts with poor biomechanics in the lower leg. That can result from the runner’s particular gait and physiology or can stem from running on worn or ill-fitting shoes. 

Foot Pressure

Over time, the feet become pronated – rolling too far to the inside. That puts a lot of stress on the lower leg and makes the plantar fascia work harder than it’s designed to – causing stress injuries and inflammation. 

PF can take years to cause trouble, a cumulative effect of repetitive stress. Of course, other problems can cause heel pain, including tendonitis, so we are careful to rule out those before targeting the PF.

Your chiropractor can help

PF is among the more challenging problems medical practitioners face. With most issues, we can predict very accurately how many treatments will make a difference and how long it will take before you start feeling better.

Dr. Craig ART treatment runner

Not so with PF – it’s a real oddball, a bit of a roller coaster. I have treated people successfully in two visits – others need a dozen before we start seeing results. Even then, it can be a case of two steps forward, one step back. It’s not unusual for patients to report a few good days followed by some challenging ones.

It’s a challenge for other practitioners, too. Traditional treatments are largely ineffective or temporary. It doesn’t respond well to surgery. Immobilization by boot is a temporary fix. Massage can make things feel better but doesn’t get at the root cause – as do cortisone injections. Think of a bridge. If the piers are crumbling – it doesn’t matter how much you fix the road deck – the bridge is going to come down. You’ve got to get to the root cause.

That’s where chiropractic can make a real difference. Chiropractors – especially those trained in Advanced Release Techniques (ART) – target the entire chain. We’ll work the lower leg, the shin, ankle and hamstring and the plantar fascia itself. Don’t be surprised if we pay some attention to the hip and quads, too. Remember, PF is a symptom of whole leg function.

Trouble in the real world

PF is made more challenging by the fact that the plantar is a difficult part of the body to rest. Nobody wants to sit immobile for an extended period. That’s especially true of the average runner. Runners want to run and asking them to stay off their feet is a fool’s errand. 


Carrying excess body weight can put strain on the plantars. And shoes are a big contributor. If you’re a high-mileage runner, you’re unlikely to get more than six months out of a pair of running shoes. But few runners replace them that frequently. That’s understandable. You can’t really feel when they’re worn out and they can be very pricey.

We also see PF in kids – especially sports that require cleats. Sports cleats are among the most problematic shoes made. They’re designed to be lightweight, sacrificing support. They are almost all too narrow, too thin and too stiff to provide much protection to the feet and legs. 

PF can also be the bane of women who wear high-heeled shoes every day. The have similar issues as sports cleats – too narrow, with insufficient support – made worse by the steep angle they force your feet into.

Preventing a relapse

When we do meet success in treatment – if the patient goes right back to the status quo, the PF is likely to return. Good shoes are the keystone of heading off a relapse. We recommend runners get fitted by a professional – don’t just buy running shoes off the shelf. For kids in cleats, we work with coaches to allow limiting cleats to game days and allowing better shoes in practice. You may like the look of high heels or think your workplace demands it – but it’s a good idea to wear them only when you have to. Don’t make them your daily drivers. Cheap flip-flops can also be problematic.

We can also work on biomechanics – correcting deficiencies or imbalances that can contribute. And chiropractic work to keep the entire leg limber and healthy can go a long way.

With patience and persistence, we can almost always make progress. Even if the pain doesn’t go away and stay away, we’ll see more pain-free days and pain that’s more manageable and doesn’t interfere with activity.

I advise all my plantar fasciitis patients to persevere. Look at progress week to week, not day by day. In most cases, things will gradually get better over time – if you follow your doctor’s orders.