Plantar fasciitis (PF) is a heel pain that can come on gradually or quite quickly and is most commonly felt as sharp pain in the arch of the foot or more towards the heel when walking or applying load through the foot, e.g cycling. It is extremely common, affecting more than 1 in 10 adults in their lifetime.
What causes Plantar fasciitis?
The plantar fascia is a layer of connective tissue that spreads from the achilles tendon to the base of the toes on the underside of the foot.
The development of this plantar fascia pain usually follows a period of change, either on of off the bike (e.g. increased training loads, new shoes, different bike, standing more at work, taken up running)
These changes alongside other risk factors can over time lead to thickening and degenerative changes in the fascia resulting in pain.
Higher body weight
Genetic predisposition for tendon-related pain
Previous bony injury to the foot
Nerve injury affecting the foot/ankle
Calf tightness / restricted ankle movement
Footwear (cycling shoe, insole, cleat set up)
Off bike sports (e.g. running)
Occupation (jobs that require prolonged standing)
Inadequate bike fit
What are the symptoms?
The most commonly reported symptom for PF is start-up pain, or pain on first steps in the morning or after a period of sitting. This will often be a sharp pain located under the heel or in the middle of the arch of the foot.
Local palpation - pressing at the connecting point between the foot arch and the heel bone will reproduce the symptoms described.
How can I manage Plantar fasciitis?
It is said to be a largely self-limiting condition with up to 90% of cases resolving over the course of 12 months. However, during this time it can be extremely debilitating and have a marked impact on your cycling and daily function. It is important not to ignore the early symptoms of PF as the more chronic it becomes the more it will affect your performance and training capacity.
Wearing soft soled shoes or trainers with a slight heel to toe drop will reduce contact pressure and tension on the foot arch.
Cycling shoes with a less stiff outsole can also be more comfortable - e.g carbon-nylon rather than 100% carbon fibre.
Shoe width and shape is also important, a narrow shoe can cause bunching of the foot and lead to pressure points
Insoles that help to support the foot and distribute forces more evenly within the cycling shoe can make a huge difference. For best outcomes these should be assessed and fitted individually though they do not necessarily need to be 'full-custom' insoles.
Physiotherapy / Exercise
Ice massage - fill a water bottle 3/4 of the way and freeze it, then use this bottle as a combined ice/roller to gently massage the area.
Simple calf stretching can be helpful if your ankle mobility is limited.
Structured loading programmes guided by a physiotherapist show good outcomes
If simple measures are not helping then it is best to have it fully assessed by a specialist clinician experienced with these issues in cyclists.
Cleat set up and positioning can make a big difference to how pedaling forces are felt by the foot so getting this correctly set up can be an important step.
Cycling specific insoles form a central role in helping to support the foot and can be combined into a bike fitting session to address these problems.
Leg length discrepancies can cause one foot to over work and place strain on it which can lead to this pain.
Shockwave therapy has demonstrated positive treatment outcomes but this must be combined with a comprehensive management strategy for best effect.
What else could it be?
Tarsal Tunnel Syndrome
Plantar heel pad contusion
Stress fracture of calcaneus (heel bone)
Referred pain (spinal)
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