Click here to see what we discussed in Part 1.
The science backing plantar fascial stretching (PFS) is not convincing to say the least. So, how about a little common sense if you’re not convinced yet. Let’s make the isolated gastrocnemius contracture and calf stretching sexy, what do you say?
First, let’s examine the act of PFS. It is not easy to do and requires one to be barefoot and sitting. Awkward! Yet calf stretching is so easy to do: anywhere, anytime, and done with your shoes on.
Pure collagenous structures like the plantar fascia and the Achilles tendon really don’t stretch much, if any. Let me be even more clear, they don’t stretch unless we use a knife. Certainly they do not “move” compared to muscle and it’s surrounding weaker, less substantial connective/collagenous tissue. Spending ones time stretching the plantar fascia is like moving a mountain. But I digress. The plantar fascia is not even the problem, so even if one could stretch it, why do it?
Here are two repeatable and simple daily occurrences that show the plantar fascia being tight is not the problem, thus PFS is misguided.
“So much of what we do everyday is habit based on what we saw someone do or what we were told to do in the past.”
- Why does wearing higher heels (yes, I said higher, not high) like Dansko’s or mild wedges, so often give temporary relief?
Go ahead, be honest, release your guilt and admit that these type shoes feel better. I know that you have been categorically told to never wear those shoes and wear flats/supportive shoes, but that does not make it right. So much of what we do everyday is habit based on what we saw someone do or what we were told to do. But could this ‘any heel is bad’ concept be wrong? Damn right it could be. Go ahead and wear those higher heels if you want, they just might make you feel better. One would think that the windlass effect in the foot would place the plantar fascia under an acute, increased tensile strain and incite immediate pain, not relief, with the use of any heel. 
This would happen because the toes are dorsiflexed (raised up), which places more tension on the plantar fascia. Look it up! What higher heels actually do is immediately relax the gastrocnemius a bit, which in turn reduces the linked tension on the plantar fascia. If someone has a better explanation, bring it.
2. Have you ever noticed the diagrams of the foot and the tearing and the inflammatory “fire” representing plantar fasciitis. They always show the heel up in the air near toe-off when the toes are dorsiflexed and the plantar fascia is under maximal strain or tension. OUCH! See! It’s so obvious, yet so utterly wrong.
This is where misperception and urban myth run amuck. The plantar fasciitis pain experienced during walking gait is not when your heel strikes the ground and it is definitely not after the heel raises and the toes roll up as you toe-off. The pain is always experienced at a precise time in the gait cycle giving the characteristic shortened gait of plantar fasciitis, as well as many other problems that result from an isolated gastrocnemius contracture. It is the brief time just before the heel raises, not after. This is because the gastrocnemius reaches its length limit and runs out of room and the stride is shortened to subconsciously avoid the pain produced as the plantar fascia comes under intense tension over a very short time. This is also why going downstairs and walking uphill is routinely more difficult: it requires more dorsiflexion.
The evidence abounds and is growing everyday as to the association between the isolated gastrocnemius contracture and plantar fasciitis as well as many other foot and ankle problems. Why do we (doctors, patients, physical therapists. trainers, etc.) categorically deny what is right there in front of us? The literature is finally catching up to this fact. Just sit back and watch over the next 5 years as the powerful, damaging effects that the isolated gastrocnemius contracture exerts upon the human foot and ankle becomes common knowledge. Who knows, calf stretching might even rise to sexy status.
Stay healthy, my friends.
-AO
Dear Angry,
As a podiatrist with an MSc in applied biomechanics and practising in that field for over 15 years i have always worked in the principles you describe with a very high success rate in terms of resolved pain.
Plantar Fasciitis and in fact any mechanical tissue trauma is solely attribited to excessive internal stress, where stress = force applied / cross sectional area of the tissue of interest.therefore identifying the cause of the excessive stress and designing an appropriate intervention is key to succesful outcome.
Hi Dr. Smith,
Great comments and I do not doubt you are seeing high success rates with PFS. I should have said I use it also, which I do. However, I use it only in conjunction with calf stretching. In other words, calf stretching first line and PFS if they want to add on another. My real point here is more to promote calf stretching and not so much put down PFS, but it appears I did not do so well.
It is my opinion and the growing opinion of others and the subject of much emerging research that the isolated gastrocnemius contracture is the primary cause of the majority of non-traumatic adult acquired foot and ankle problems. And as a result, most are accurately treatable addressing the calf contracture, but more importantly preventable with daily calf stretching. Next time you are seeing a patient with posterior tibialis tendon dysfunction, non-traumatic midfoot arthritis, insertional Achilles tendinosis ask them if they have had plantar fasciitis in the past. My data says 65%. This is not a coincidence, but is linked by a common unresolved pathway, the isolated gastrocnemius contracture. PFS, no doubt, does help today, but does it address the true underlying condition? Against most odds I believe it does not and, agree or not, that is my point.
BTW, I trained as a Sr. Registrar in for 6 months in London in the mid 80’s. I loved everything about England.
Thanks,
AO
Dear AO,
First off, thanks! You humor and anger was just what i needed to read. After an appointment with a podiatrist, speaking to multiple PT friends and researching my A** off, I was more confused than ever. My background is also in biomechanics but no matter what I do the pain has progressively gotten worse over 4 months and ive gained 8 …no running = angry me stuffing my face in sadness. FYI im a 40 ry old female at 140 lbs with only one past foot issue (foot drop about 6 years ago brought on by running)
So I started your stretching 9 min prog yesterday and am praying for a miracle. Question to make you angry as you’ve likely already answered this but to make sure …..I currently have all lower drop running and athletic shoes. 4mm and under. The higher shoes do feel better…so should I just shove my misguided pride you know where and go buy some comfy high drop shoes with a boatload of cushion and arch support? I have very high arches, Dr told me “hypermobile” ankle joints and that is why I am having this issue. Did laser and now he is starting custom orthotics. I’m fine as a short term help me heal type protocol, but i dont think i have crazy messed up feet.
Also, will things like icing, elevating, epsom salt help at all or are there any other little tips ? I have more than enough time on my hands to do whatever I need. Hopefully you are having a good day after this long rant. I appreciate your site!! Good day ~Cori
Yo Cori,
I love your attitude. You are angry…good! Is the drop foot the same foot now with plantar fasciitis? My suspicion is the answer is yes. It has been a bit since your comment, and I would say you must already be better and realizing the magic of calf stretching.
Why are you not running? There are only two answers, and unfortunately, the first is far and away the most common. 1) You think you should not run. This stems from your advice from your doc, PT, reading, etc. This is the standard, overly cautious, unfounded garbage that is almost universally promoted. Sissys! Rest without calf stretching only makes the situation worse. Do you feel me? 2) You try to run and it actually is indeed too painful. This is about 15% of runners with plantar fasciitis. I am ok for runners to run as long as they are not incrementally and progressively getting worse. An up and down cycle of acceptable pain associated with running that does not increase over time is fine.
To be blunt because it makes me angry, all the shoes, orthotics, cushioning, heel height just drives me crazy. These things can make one feel better in a hit and miss fashion, but there is no substitute for addressing the root cause, equinus. As far as other palliative measures, there is no one that is better than the next and each is hit and miss and depends on the individual. Thus it is clearly trial and error. The hypermobile thing and any association with plantar fasciitis is quite simply incorrect. I had a more choice phrase selected fo this one, but I decided to keep it PG-13.
I would agree with your “no crazy messed up feet”. If you have been an injury-free runner basically for years then you are right. And by the way, I am not buying that running caused a foot drop unless it involved piriformis syndrome. This would have more to do with post-childbirth changes in the SI joint and less to do with running.
With all that, you are now finally doing the right thing and your attitude makes you a winner, and it does not even make me angry.
Stay healthy my friends,
AO
Great blog, plain and simple. I can say that consistent calf stretching is what works.
Thank you for the note. Glad to see you have been helped.
Interesting blog. I began to experience pain in my arch area (not heel) early this year. It started as annoying and moved to excruciating. Not that age is important, but I am 50, eat well, and not significantly overweight (up or down 10 lbs.) I didn’t realize what it was, but pretty sure it was a result of increasing the walk on the treadmill to a run. I went to the podiatrist she looked at my foot and said it was plantar fasciitis. She confirmed my new Birkenstocks were great, the good feet inserts in my new balance were fine, and my night splints could help. She sent me on my way with a boot and suggested I buy custom orthotics. I went to a physical therapist who wasn’t very helpful except to say I should stretch my toes and calves. And I read so much on the internet/Web MD (too much) about stretching plantar, calves, contrast baths, roll your foot on a iced bottle of water, deep tissue massage with a tennis ball, Strasburg sock, night splints, tape, Birkenstocks. It has been a few weeks. and I am trying all of these things and nothing seems to be working. I am considering low light therapy and scared to death about cortisone shots because it could cause more damage from what I hear. Wondering if I was even diagnosed properly? Should I seek another opinion? Request an MRI? Thoughts?
Hi Debbie,
Whoa there on all the treatments. You are the poster child for everyone searching for the cure in so many places, all the wrong places I might add. And just like so many you are not looking to the one and only thing that addresses the cause and actually fixes the problem, your calf. Just try stretching your calves…it will blow you away. Please be consistent and patience. Good things don’t come easy or fast!
Stay healthy my friends,
AO
Debbie, If you’re trying all of those treatments how will you know which one works?
Does this stretching also work for terrible calf and foot cramping every night. I am awake every night with cramping. My calf muscles ache and twitch as soon as I am not standing on them. Thanks
Hi Jennifer,
Great question, so good it did not anger me one bit, which actually angers me in and of itself.
The odds are fantastic, 90% plus, that your cramps and twitching will resolve with daily calf stretching. While there is no definitive published evidence to my knowledge, my clinical practice experienced showed me the value of calf stretching for both issues. About 15 years ago I noticed a serendipitous trend from my patients. I would send them out with calf stretching marching orders for their presenting problems such as plantar fasciitis, or second MTP synovitis or midfoot arthritis not aware they also had night cramps. They would return with stories of the unintended consequence or resolution of their night cramps/Charley horses and restless leg syndrome (twitching). Yes, I actually listened to my patients and I learned a lot from them along the way. While restless leg syndrome was more or less a hit or miss, night cramps was a resounding hit. My experience went from listening to actively treating night calf cramps. These were people who had limited success with the usual treatment dog and pony show: hydration, magnesium, potassium (bananas), random stretching, the list goes on. I found that my patients nightly calf cramps resolved with daily calf stretching when all else failed. So this is the definitive treatment for what is likely the source, to begin with: equinus.
The difference between my recommendation and others regarding stretching is to do it every day to restore the normal calf length as definitive treatment. Others recommend stretching basically generically and to be done randomly when needed.
It also seems to be a great help with calf cramps experienced in late pregnancy. BTW plantar fasciitis is incredibly common postpartum. So, are we beginning to see a pattern here?
Stay healthy my friends,
AO
Hello, I’ve been struggling with PF in both feet for at least 6 years , have done foot and calf massages, cortisone, tennis balls , laser, tens unit and have a Chiro running a vibrating ball over the bottom of my feet right now. I’m so tired of not being able to walk long walks. So I’ve also found a website King brand BFST that swears they have a cold compress item to take the swelling down and then they have a hot wrap to apply heat to the PF. They have all good reviews and relief from people that have tried this . They don’t recommend stretching . In fact, they have posted 10 PF “myths”. I’m so confused . What do you think of the cold/hot method ? You can find their website if you google King brand bfst . Thank you for your advice , wanda
Ugh.. I have been dealing with planter fasciitis now for around six months since October. I have had two months of physical therapy I have tried needling/acupuncture. Some days are better than others. Bad days are really bad. I have put on weight because I cannot exercise. I seen your article because I keyed in “stretching kills plantar fasciitis “ And this is what came up. I seen in a previous post where someone said she started doing your stretches I Praise they work. which stretches are those? I’ve been trying to do heel raises to strengthen my calves but even that hurts…
Hi there Nikki,
The good news is you are not alone, sister. The bad news, you are are not alone. Unfortunately, you have been “running” with the rest of the herd (95%*) that treat at the wrong culprit, the plantar fascia. Sure, the plantar fascia is what hurts, and thus it is logical to treat it, but does that make it right? You mention, as do so many, the sexy quick fixes endorsed vehemently by the herd. These misaimed treatments might help the symptoms, but they don’t address the true underlying problem, equinus.
I am glad you found me, and I am sure you will be over this soon if you do the stretching. Stay the course and be patient. Here are a few caveats for you:
* Starting out modify the stretching intensity, which means how hard you stretch your calf. This equates you how much your foot is off the step. Tennis shoes and carpeted steps are the kindest to your foot, especially in the beginning.
* Starting out modify the time you stretch. While many can start right at 3 minutes, some cannot. Baby steps! And build as you can. Again, patience, please.
* Beware of 6 months! According to my colleagues, you are now in the chronic state of plantar fasciitis. This means there is just one more treatment left, surgery. Consider this, at least in my not so humble opinion; you have never treated your problem, equinus. Thus, you have never treated your plantar fasciitis. Sure, you probably stretched a bit in PT, but did you stretch? I would say you stretched almost none. Calf stretching done the right way almost always works, but it won’t work if not done.
Now for the AO tirade, and I am mad, but not at you. All too often, I ask myself, “When will someone, some journalist, anyone, finally wake up and get this story straight?”. In fact, it keeps me up at night. No one seems to want to believe in calf stretching, let alone discuss the real root cause, equinus. As the Angryorthopod and as myself (there is a real me), I have been pushing this concept for a couple of decades, and just the mention of equinus is tantamount to kryptonite. Mention it on one of the wacky plantar fasciitis Instagram sites (see below), and you are told to get off. Mention it to a journalist, who has little knowledge on the subject, and the lines of communication are shut down…no article, no interview.
Maybe I am wrong, even thought the scientific evidence (much I wrote) supports me. I will let the AO Nation judge for themselves. I will leave with a couple of links to articles that are parallel to where I have been in my quest for 25 plus years.
* https://www.theguardian.com/society/2016/apr/07/the-sugar-conspiracy-robert-lustig-john-yudkin
* https://www.bmj.com/content/bmj/351/bmj.h4962.full.pdf
Also, here are a few social media sites to check in on the herd activity.
* https://www.instagram.com/explore/tags/plantarfasciitis/
* https://www.facebook.com/search/top/?q=plantar%20fasciitis%20support&epa=SEARCH_BOX
Nikki, when the calf stretching works, please reach out and let us know, but more importantly, let the herd know.
Stay healthy my friends,
AO
*The 95% is an estimate based on 30 years of clinical experience and reading basically everything available; scientific papers, journalistic reports, and social media.
I’ve had PF for over a year. I’ve waited 4 months to post this until I was sure of my results. I developed PF for the first time in my life a year ago by walking barefoot all the time everyday for weeks, both indoors and outdoors (something I’d never done before). The pain was like a knife in my heel. I tried 4 kinds of night braces, 4 kinds of stretching regimens (including this one for 3 weeks which made the pain worse), wraps, apple cider vinegar and various supplements and creams with no improvement. Only ice massage alleviated the pain for a few hours. I tried 5 kinds of “PF-specific” shoes, all of which did nothing or made the pain worse, except for 1 pair that at least made walking short distances bearable.
4 months ago I started intensive daily treatments with a 1 watt infra-red LLL (low-level or “cold” laser) on 4 spots on my foot for 3 minutes each. I also used a wearable Pulsed Electro-Magnetic Field device directly on the heel for 2-4 hours/day. I don’t know whether it was the laser or PEMF (probably both, based on my research) but within a week I started to feel a difference in pain level. Now, 4 months later, it is 95-100% cured and I have resumed running and hiking for the first time in a year. I say 95% because after doing 3 consecutive days of high intensity running and long distance hiking I can feel something in the heel but the pain is less than 1 on a 1-10 scale. I continue to run every day and still treat with laser and PEMF daily.
Hi David,
I am glad you are on the other side of your plantar fasciitis. But, are you on the other side? It seems these treatments”worked”, but only symptomatically in my opinion. You never mentioned stretching and if that has not been done then the underlying root cause remains. My advice is when you have recurrent plantar fasciitis or any of the other equinus caused issues please start stretching ASAP and keep doing it. Finally, stretching is free while laser and PEMF- are not. Best of luck to you.
Stay healthy my friends,
AO