You wake up. You swing your feet out of bed. You take your first step. And there it is, that sharp, almost electric pain right through the heel and into the arch, like you're walking on broken glass. You know it's going to ease up eventually, but for the next ten or fifteen minutes, every step reminds you it's there. If that sounds familiar, you've met plantar fasciitis. It's one of the most common things I see in the clinic, and it's also something I dealt with myself for a long time. I know exactly what that first step feels like. This week I want to walk through what the current research actually says about treating it, and I want to be upfront about something frustrating first.
ARTICLE BELOW:
A Quick, Honest Detour
One of the newest and most relevant studies on this topic, a network meta-analysis published just last month looking at which treatments work best when combined with a home exercise program, is sitting behind a paywall. I can't access the full thing. I have the abstract, the methods, and the headline results, but not the complete picture.
This is one of the real frustrations of trying to practice evidence-based medicine. Sometimes the best, freshest research exists, and you simply can't get to all of it. So some of what follows is going to be me being honest about working from partial information, combined with what I've seen treat hundreds of cases of this in the clinic and in my own foot. I'd rather tell you that directly than pretend I have the complete picture when I don't.
The Research
The primary source this week is the 2023 clinical practice guideline on heel pain and plantar fasciitis from the Journal of Orthopaedic and Sports Physical Therapy, JOSPT for short. This is a formally graded synthesis of the evidence, every recommendation rated from A, strong evidence, down to F, expert opinion only, and it's a major update from the 2014 version.
I want to be upfront about what this study is and is not. This is purely observational. There was no intervention, no controlled variable, no if-then conclusion to draw. The researchers collected data and described what happened. That makes this an educational piece, not a prescriptive one. We can learn from the patterns without treating them as proof of what works best.
What They Found
The research suggests these are the key takeaways
🟢 Strong evidence on this one. The JOSPT guideline is one of the more rigorous, transparently graded review processes out there. A couple of individual pieces carry more moderate confidence, and I'll flag those as we go.
Here's something I want to get out of the way first, because it would be easy to read this issue and think the only things that matter are the strength training and dry needling findings, since those are the ones with the dramatic "before and after" story. They're not the only things that matter.
Stretching, manual therapy, taping, and night splints all carry Grade A, the strongest evidence rating in the whole guideline. Plantar fascia stretching. Calf and soleus stretching. Manual therapy aimed at improving ankle mobility and working out trigger points in the calf and the fascia itself. Taping, used short term alongside other treatments. Night splints, especially if you're someone whose pain is worst in that first minute out of bed. All of it Grade A. None of it new or flashy, but all of it well supported.
What did change since the last version of this guideline in 2014 is resistance training and dry needling. Strength training went from basically a shrug, no real evidence either way, to a real recommendation backed by an actual trial. People doing heavy strength work improved more and hurt less at three months than people who just stretched, and that gap was still there a year later. Dry needling went from "we can't recommend this" to a real Grade B, with a meta-analysis of six trials showing it helped with pain both short term and out to six months.
Orthotics land lower, Grade C, weaker evidence, and the guideline is specific that they should never be your only tool, they work best stacked on top of other things, and mostly for people whose feet roll inward more than they should. If your pattern is the opposite, not enough shock absorption, a simple heel cushion actually carries Grade A support, which I did not expect.
Here's the part that actually surprised me most. A separate analysis looking at over 2,400 people found that exercise by itself, no other treatment added, only showed benefit in the long run. Not short term. Not medium term. Long term only. The things that worked fastest in that same analysis were a cortisone shot and shockwave therapy, neither of which is something I do as a PT.
I am not telling you that to talk you out of doing the exercises. I'm telling you because it matches exactly what I see in the clinic and what I went through myself: doing the strength work alone and expecting quick relief sets you up to feel like it's not working, when really it just needed more time, or it needed a partner, stretching with it, manual therapy with it, the right modality stacked alongside it.
That's really the whole story here. Nothing on this list wins alone. The research keeps landing in the same place my own experience does, combine a few of these, give it real time, and stop looking for the one thing that fixes it by itself. There isn't one.
What This Means For You
Here's the pattern I see constantly in the clinic, and it lines up closely with what the research is pointing at.
People with plantar fasciitis almost always show up with the same cluster of limitations. They fail the knee to wall test, meaning limited ankle mobility. They fail the heel raise test, meaning limited calf capacity, often worse on the painful side. And they struggle with single leg balance, especially eyes closed, on that same side.
What's actually happening is a vicious cycle. Pain leads to less use of the foot and calf. Less use leads to more tightness and more weakness. More tightness and weakness leads to more pain. Around and around it goes.
The goal isn't to eliminate load entirely. It's to find just enough load to start tipping that cycle the other direction, a little more mobility, a little more strength, a little less pain, which creates room for a bit more movement, which builds a little more capacity. We are looking for the goldilocks approach. Not too much load, not too little, but the just right amount. A virtuous cycle instead of a vicious one. This is the same load-capacity scale I've talked about before, just showing up in a different tissue.
And here's the honest part the research keeps confirming: there is no single fix. Not one stretch, not one exercise, not one modality solves this on its own. It's always a combination.
My Actual Approach (not research…just my perspective)
This is what I actually use, built from a mix of what the evidence supports and what I've personally seen work over years of treating this.
Plantar fascia stretch, calf stretch, and soleus stretch, done together, not just one or the other.
Calf raises and soleus raises, loaded progressively, the same heavy-slow-resistance approach I've talked about for Achilles tendinopathy. This tissue responds to load the same way.
Foot intrinsic strengthening, building capacity in the small muscles of the foot and arch that tend to get inhibited and weak.
A night splint, worn while sleeping. Most people plantar flex their foot overnight, pointing the toes, which shortens the calf and the arch all night. Then the first step in the morning forces a sudden stretch into all that tightness, and that's a big piece of where the morning pain comes from. It's not the most comfortable thing to wear, but I've seen real benefit from it, both personally and with the people I work with.
Dry needling, when accessible. I've seen genuine results from this clinically, and it's exactly what the newest research is now backing up.
Where I'm more skeptical, based on what I've personally seen: orthotics and taping. Some people do respond to them, and the research support is mixed but present, so I won't tell you to skip them entirely. They've just never been the thing that moved the needle most for the people I've worked with.
Think a dimmer switch, not a light switch (something I see in the clinic..not research)
One thing worth knowing before you start: this isn't a light switch. You don't do the right things and wake up pain-free the next day. It's a dimmer switch, slow, gradual.
And here's the part almost nobody tells you: pain usually shrinks in duration before it shrinks in intensity. Instead of fifteen or thirty minutes of sharp pain every morning, it becomes pain just for those first few steps to the bathroom, then it's gone. That shift, less time in pain, not necessarily less pain, is usually the first real sign things are moving in the right direction.
🏆 How To Apply It
Start your morning with a few minutes of mobility and a couple of heel raise holds before you ever take that first full step. Warming the tissue up before you load it tends to ease that initial flare.
Layer your approach. Stretching alone, strengthening alone, a night splint alone, none of these are likely to be enough by themselves. Combine two or three.
Be patient with the timeline. This is a longer rehab process by nature. Watch for the duration of your pain shrinking first, that's progress even before the intensity changes.
If you're stuck, dry needling combined with manual therapy now has real evidence behind it, worth a conversation with a sports PT if a home approach alone isn't moving things.
Next week we talk about what one study found on the differences between men and women! Plus an update on my hill protocol….woof.
-Keep running happy, healthy, and strong
Spencer
There's a story I heard recently that's been sitting with me.
Picture someone standing at the bottom of a mountain, trying to get to the top. Three people offer to help.
The first hands them a book. "Read this, it'll get you there." The second is already standing at the summit, yelling instructions down. "Here's what you do, here's how I did it, good luck."
The third one straps in right alongside them, one foot already on the trail, ready to climb the whole thing together, step by step.
I've spent the last few months being the first guide. I hand you the research, I hand you a program, and I send you on your way. That's most of what Stronger Stride has been so far, and I think it's been useful. But it's not the same as climbing with someone.
So I'm considering building something different. A 12-week strength program where I'm not just handing you the plan at the start, I'm walking through it with you, week by week, talking through what that week's training actually feels like, what to watch for, what I'd adjust if something's not clicking.
Before I build it, I want to know if it's actually something you'd want.
If I started a 12 week strength program that we worked through together, would you be interested?
Know a runner who’s struggling with plantar fasciitis and would love some more evidence based feedback. Share the link HERE.