Functional Medicine Approach to Plantar Fasciitis Beyond Stretching
"Plantar fasciitis is like a pebble in your shoe—small but relentless. Treat it early before it becomes a boulder."
--Dr. Alan Kay
Recently, my dad developed plantar fasciitis after a round of golf. Seeking relief, he turned to friends, family, and the internet for advice. All he heard was the same generic tips: stretch on steps, roll a golf ball under the foot, and apply ice. What no one mentioned was addressing the real root cause—weakness and tightness in the posterior tibialis muscle.
Plantar fasciitis is a sneaky, stubborn condition that seems to strike at the worst times, like when my dad had just finished an easy game of golf. While the typical advice focuses on temporary fixes, few people understand that the pain often originates in the posterior tibialis. This muscle, crucial for supporting the arch of the foot, can trigger heel pain when it's tight or weak. Unfortunately, many spend months—even years—dealing with lingering symptoms that could be resolved much faster with the right approach.
Let's break down what plantar fasciitis really is, how to prevent it, and some functional strategies to manage and fix it if you're already feeling that sharp pain.
What is Plantar Fasciitis?
Plantar fasciitis is a painful condition that develops when the plantar fascia, a thick band of tissue running from your heel to your toes, becomes inflamed or develops microtears. Most people experience sharp heel pain, especially during the first few steps in the morning or after long periods of standing. While the pain originates in the plantar fascia, the underlying issue often lies in the posterior tibialis muscle.
This muscle helps support the arch of your foot, and when it becomes tight or develops adhesions, it alters your foot mechanics, placing excessive strain on the plantar fascia. Over time, this can lead to chronic pain and dysfunction. Treating plantar fasciitis effectively means going beyond just symptom relief—it requires addressing the muscle imbalances and tissue restrictions that caused the issue in the first place.
Strategies to Prevent Plantar Fasciitis
Here are strategies to prevent plantar fasciitis in the first place and to stay symptom-free.
Ditch the Cushioned Shoes: One sign of foot health is the ability to walk barefoot and/or wear minimalist shoes comfortably. When you can’t do this, your feet are weak and overly reliant on the support of those cushiony shoes. See this article for more on better shoes and barefoot transitioning.
Strengthen the Feet: Incorporate exercises into your daily routine. Place a towel on the ground and scrunch it toward you with your toes, pick up objects like marbles, and place them into a cup, heel raises, and single leg standing (while you're brushing your teeth for a good routine).
Progressive Overload in Training: Avoid jumping straight into intense activity. Gradually increase your workload using progressive overload. For example, instead of running five miles right away, mix in walking or shorter running intervals. Schedule rest days to prevent overuse.
Manage Your Weight: Your feet take on 1–2x your body weight when walking, 2–4x when running, and up to 7x when sprinting. If you're overweight, losing even a few pounds can significantly reduce the strain on your feet, lowering your risk of developing plantar fasciitis. Here are some tips to do that.
Strategies to Fix and Manage Plantar Fasciitis
Target Trigger Points: Often, plantar fasciitis involves trigger points in the posterior tibialis. To identify the trigger points, start by palpating along the inner side of your calf, from just above the ankle to about midway up the leg, pressing firmly to locate any tender or tight spots. These areas may feel sore, tender, or radiate pain when pressure is applied. There may be multiple ones but you’ll know it when you’ve found it. Once you find it, use these three techniques to get rid of it:
Massage: Trigger point massage helps break down adhesions and improve blood flow to the area. Keep the foot still and massage.
Pressure and Movement: Apply and sustain deep pressure to the trigger point while moving the ankle in different directions.
Scraping (a.k.a. IASTM or Instrument-Assisted Soft Tissue Mobilization) is an effective method to reduce scar tissue and increase mobility. You can use a simple tool like a spoon or a specialized scraping tool, applying light pressure with some coconut oil as an emolient to help the tissue move. Many occupational therapists or physical therapists are trained on how to use IASTM so consider getting treatment if you are unsure of how to use this technique.
These three steps may seem basic, but they directly addressed the muscle that was pulling on the plantar fascia, resolving the root cause of the pain.
Stretching and Mobility: Stretching often takes the spotlight in the plantar fasciitis recovery world. While it’s a part of the solution, it shouldn’t be your only solution as it won’t resolve the underlying muscle imbalance. Focus on the above but incorporate these stretches as well:
Start with calf stretches, which target both the gastrocnemius and soleus muscles. Stand facing a wall, place one foot behind the other, and keep the back heel on the ground. Lean forward to stretch the calf, holding for 20-30 seconds. Bend the back knee slightly to shift the stretch to the deeper soleus muscle.
Plantar fascia-specific stretches are equally important. Sit with your legs extended and use a towel or resistance band looped around the ball of your foot. Gently pull the foot back toward you to stretch the fascia. Hold for 20-30 seconds and repeat a few times.
Orthotics: Orthotics are usually the number two recommendation for plantar fasciitis. If you need them to get through the day, then use them, but be quick to ditch them. They can offer temporary relief by providing extra support and cushioning to your arches, but they don’t address the root cause of the issue. Relying on orthotics for too long can weaken the muscles in your feet and legs, leading to further imbalances. The goal should be to strengthen the foot muscles, improve mobility, and eventually phase out orthotics as your feet regain their natural function and stability and transition to as minimalist-as-possible shoe.
Reduce Stress: High stress levels and adrenal dysfunction can worsen plantar fasciitis. Manage stress through mindfulness, yoga, or whatever relaxes you, and avoid aggressive activity during times of high stress.
More: If you want to get into the nitty gritty of injury recovery then check out this article for a much deeper dive.
Final Thoughts
Plantar fasciitis is often treated with simple stretches and temporary fixes, but to truly solve the problem, we need to look beyond the foot and address deeper muscle imbalances and stress factors. Start by identifying the root cause, like the posterior tibialis, and focus on strengthening your foot and calf muscles. Stretching is helpful, but strengthening, massaging, and gradually increasing activity will ultimately lead to long-term relief.
Whether you're dealing with plantar fasciitis now or want to prevent it in the future, understanding the broader picture is essential. Don’t just treat the symptom—fix the cause.
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