Plantar Fasciitis — A Whole-Chain Approach to Heel and Arch Pain

Plantar fasciitis is one of the most common causes of heel pain. It often shows up as a sharp, stabbing pain with your first steps in the morning or when you stand up after sitting. The American Academy of Orthopaedic Surgeons (OrthoInfo) calls it "one of the most common causes of pain on the bottom of the foot at the heel," and says about 2 million patients are treated for it every year. At The Bluff Technique Healing Center in Westwood, we treat plantar fasciitis as a foot problem and also as a problem of the whole chain behind it: the calf, the Achilles tendon and the back of the leg.

The plantar fascia is a thick band of connective tissue on the bottom of the foot. MedlinePlus (U.S. National Library of Medicine) explains that it "connects the heel bone to the toes and creates the arch of the foot." When this tissue becomes swollen or inflamed, the condition is called plantar fasciitis. MedlinePlus also explains that the band acts like a rubber band to create tension that maintains the arch.

Every step loads this tissue. Small amounts of damage can build up when the load is more than the tissue can comfortably handle, for example after a sudden jump in running mileage, long shifts on hard floors, or worn-out shoes. The result is pain near the heel that is usually worst in the morning and after rest, not during activity.

According to AAOS OrthoInfo, the most common symptoms include:

• Pain on the bottom of the foot near the heel
• Pain with the first few steps after getting out of bed, or after a long rest such as a long car ride
• More pain after exercise than during it

See a physician if you have numbness, tingling, swelling, pain after a fall, or heel pain that doesn't follow this pattern. Stress fractures, nerve entrapment and Achilles problems can feel similar.

Plantar fasciitis rarely starts and stops at the heel. Medical sources consistently list tight calves and Achilles tendons as risk factors. AAOS OrthoInfo names "tight calf muscles" as a risk factor and notes that "plantar fasciitis is aggravated by tight muscles in your feet and calves." MedlinePlus lists "a tight Achilles tendon (the tendon connecting the calf muscles to the heel)" as a risk factor, along with running long distances, downhill or on uneven surfaces.

Anatomy helps explain why. The Achilles tendon and the plantar fascia both attach to the heel bone (calcaneus), and researchers have studied how closely the two are linked. A 2021 cadaveric study published in Scientific Reports and archived in PubMed Central found a close structural relationship but could not confirm that the fibers run continuously from one to the other. The authors note that a direct link is still "an area of debate."

Our view is practical. Whether the fibers connect directly or the two pull on each other through the heel bone, tension in the calf and Achilles plausibly changes the load on the plantar fascia. Tension higher up the back of the leg may also play a part. Some clinical reviews list tightness in the hamstrings, calf muscles (gastrocnemius and soleus) and Achilles tendon as functional risk factors. That is why a Bluff Technique session for plantar fasciitis rarely focuses on the foot alone.

AAOS OrthoInfo notes that heel pain is often seen in athletes from overuse and in people who stand for long periods, and that plantar fasciitis is most common between ages 40 and 60. Our Los Angeles clients fit those patterns:

• Beach-path runners: LA County Beaches & Harbors describes the Marvin Braude Bike Trail as a 22-mile paved path from Will Rogers State Beach to Torrance Beach. Runners from Santa Monica, Venice and the Palisades log long, repetitive miles on it, often in worn shoes. See our Santa Monica and Pacific Palisades pages.
• Rose Bowl loop runners and walkers: The City of Pasadena describes the Rose Bowl Loop as 3.10 miles around the stadium and Brookside Golf Club. Many people run it several times a week, which means a lot of repeated impact on pavement. See Pasadena.
• Brentwood San Vicente runners: The grassy, coral-tree-lined median of San Vicente Boulevard is a favorite running route in Brentwood. Mileage often climbs quickly before race season.
• Standing professionals: AAOS specifically names healthcare workers, factory workers and teachers. In Los Angeles we also see chefs, retail staff, film crew, and surgeons and nurses from nearby medical centers. All of them spend long hours on hard floors.

Our protocol is designed to work alongside the care your physician, podiatrist or physical therapist recommends, not to replace it.

1. Assessment: We look at foot posture, ankle dorsiflexion (how far your shin can move forward over your foot), calf and hamstring tension, pelvic alignment and gait. AAOS notes that physicians also check for limited ankle dorsiflexion during the exam.
2. Plantar fascia and foot: Sustained, no-force engagement on the sole of the foot and the tissue around the heel, adjusted for comfort so a sensitive area isn't irritated.
3. Calf and Achilles: Layer-by-layer work through the gastrocnemius, the soleus and the tissue around the Achilles.
4. Hamstrings, hips and beyond: Whole-body sequencing up the back of the leg, because restrictions higher up can change how load reaches the foot.
5. Self-care guidance: Simple suggestions that go with the calf and plantar fascia stretches medical sources recommend, plus sensible mileage management for runners.

What the evidence says: Research on myofascial release for heel pain is limited. A 2018 systematic review indexed in PubMed included one randomized trial on heel pain (65 participants). The authors concluded that the overall evidence for myofascial release in chronic musculoskeletal pain was "not sufficient to warrant this treatment." Research is ongoing: ClinicalTrials.gov lists a registered trial comparing 15- and 30-minute myofascial release sessions for plantar fasciitis. Many of our clients report less morning pain and easier movement, but we don't promise outcomes and never claim to cure plantar fasciitis.

The outlook with conservative care is good. According to AAOS OrthoInfo, "more than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods." Myofascial work may make that process more comfortable.

• Myofascial Release Therapy
• Sports Recovery Bodywork
• Fascia Release Therapy
• Posture Realignment
• Chronic Pain Relief
• Related conditions: Back Pain, Sciatica
• Browse all conditions and services