Recreational running and jogging, as well as marathon and ultra-marathon participation are at an all-time high. According to statistics released last summer by Running USA, about 20 million Americans run or jog at least 100 days a year. With the increase in running, however, comes the increase of a nagging, sometimes debilitating foot injury: plantar fasciitis.

Other people besides runners develop plantar fasciitis, such as workers who stand for prolonged periods of time, which is why most supermarkets supply thick, cushioned mats for cashiers. But runners seem to be taking the brunt of plantar fasciitis injuries.

It’s estimated that up to 10 percent of all running injuries are caused by plantar fasciitis.

What is plantar fasciitis?
Fascia refers to the connective fibrous tissue that supports muscles, tendons, ligaments and organs in our body. In the foot, the connective tissue runs from the bottom of the heel to the toes creating the arch. When the fascia of the foot becomes irritated from overuse, it can lead to inflammation, which can be painful.

If you think of the main arch of your foot as a bow, the fascia under the foot is the arrow. If the string is pulled back too tightly, the arrow is going to misfire. To further the analogy, you can think of the plantar fascia as a guitar string. Wound too tightly, the guitar will emit a cacophonous sound, perhaps equivalent to the wail of a runner experiencing a painful bout of plantar fasciitis.

What causes plantar fasciitis?
Most literature on plantar fasciitis blames inflammation caused by stress,  perhaps by suddenly jogging 12 extra miles instead of gradually increasing your distance over time. Obesity, excessively flat feet or unusually-high arches are also blamed. Perhaps one overlooked cause is the deterioration of collagen, a protein-rich fibrous connective tissue. As we age, collagen becomes weaker. Worn-out shoes are also thought to be a cause of plantar fasciitis. Some runners believe wearing shoes, in general, while running, can cause the problem. 

Prevention of plantar fasciitis
While it’s probably not prudent to run without shoes on asphalt or pavement if you don’t want shards of glass embedded in your feet, running barefoot on natural surfaces (dirt, grass, sand) strengthens the small muscles and connective tissue of the feet as nature intended, mimicking the primordial biomechanics of early mankind — say barefoot running advocates. 

Passive, gentle stretching of the Achilles tendon and calf muscles may help prevent plantar fasciitis. And ladies, here's something you should know: wearing high heels shortens the calve muscles and tightens the connective tissue adjacent to the heel.

Treatment of plantar fasciitis
Most treatments of plantar fasciitis will work for almost every sufferer, albeit temporarily. Suggestions include resting, an obvious treatment, though avid runners may find that suggestion as painful as the condition. Icing and over-the-counter anti-inflammatories may also provide relief. Don’t use heat treatments for the first 48 hours after pain develops. Night casts, which provide a gentle stretch for the fascia, keep the toes pointed up at night while you sleep. The cast keeps the toes at a 90-degree angle to the ankle joint.

One study in the Clinical Journal of Sports Medicine concluded that a treatment comprised of a heel pad, stretching program, anti-inflammatory drugs and a tension night splint provides treatment of plantar fasciitis.

For longer-term treatment, also consider strengthening the muscles that support the arch, namely those of the toes. Most runners stretch the calf muscles and Achilles but neglect exercises like toe pulls and walking on the toes.

Exercises to prevent and treat

  • Walking on the toes: One of the easiest ways to strengthen the plantar fascia is to make sure the minuscule muscles, tendons and ligaments of the toes are strong enough to support the medial arch. Simply walking down the length of a room and back on your toes can prevent plantar fasciitis, or possibly reverse the mild pain associated with it. 
  • Walking on the beach: If you live anywhere near sand, go take a walk barefoot. This will strengthen the supporting structural joints and connective tissue of the foot. Wearing shoes does not allow the proper activation of these smaller but critical muscles. 
  • Calf raises: Unless your calf muscles are extraordinarily tight, try to hang your feet off a stair. Hold a rail for balance and lower your heels towards the floor. You will feel a stretch down to your Achilles' heel, which is where the plantar fascia is connected to. 
  • Tennis ball roll: Not so much an exercise as a therapeutic remedy, stepping your bare feet on a tennis ball from a standing position will provide you with a massage of the plantar fascia — without having to pay a hefty spa fee. This will soften the fascia of your medial arch and may help alleviate plantar fasciitis symptoms. 
Do you suffer from plantar fasciitis? What do you do to treat it? Let us know in the comments below.

Judd Handler is author of "Living Healthy: 10 Steps to Looking Younger, Losing Weight and Feeling Great" and can be reached at

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