Why looking beyond the foot matters—especially for runners
Plantar fasciitis is one of the most common causes of heel pain, particularly among runners. Traditionally, treatment has focused on the foot itself—stretching the plantar fascia, improving ankle mobility, and addressing footwear. While these interventions can be helpful, emerging research continues to highlight an important truth:
The source of the problem isn’t always where the pain is!!!
Looking Up the Chain
A 2025 study published in BMC Sports Science, Medicine & Rehabilitation by Li D. and colleagues adds to a growing body of evidence supporting the role of proximal strength (strength closer to the trunk, such as the hips and thighs) in lower extremity injuries.
In this prospective study:
- 177 male recreational marathon runners (ages 18–30) were evaluated
- Strength was measured using hand-held dynamometry
- Participants were tracked over a 3-month period
Key Findings:
- Hip abduction asymmetry (outsides of the hips) and knee flexion asymmetry were significantly associated with the development of plantar fasciitis
- Runners with >32.5% asymmetry in hip abduction strength had a 3.6x greater risk of developing plantar fasciitis
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What Does This Mean?
Your foot doesn’t function in isolation—it’s part of a larger system. Weakness or imbalance at the hip or knee can alter how forces travel down the leg during activities like running.
For example:
- Weak hip abductors can lead to poor pelvic control
- This may cause excessive inward collapse of the knee (valgus)
- Which in turn increases strain on the foot and plantar fascia
Over time, these repeated stresses can contribute to pain and injury.
Clinical Takeaway
We cannot assume that distal pain (like plantar fasciitis) is caused only by distal issues.
Instead, effective evaluation and treatment should:
- Assess strength and symmetry at the hips and knees
- Identify movement patterns during walking or running
- Address underlying biomechanical contributors, not just symptoms
What This Means for You
If you’re dealing with plantar fasciitis—or trying to prevent it—consider incorporating:
- Hip strengthening exercises (e.g., side-lying leg raises, band walks)
- Posterior chain work (glutes and hamstrings)
- Single-leg stability training
- Movement assessments to identify asymmetries
The Bigger Picture
This study reinforces a key principle in physical therapy:
Treat the whole system, not just the site of pain.
At ProFormance Therapy & Wellness, we take a comprehensive approach to injury care—looking at how your body moves as a whole to uncover the true drivers of your symptoms.
If you’re a runner dealing with heel pain or looking to stay injury-free, we’re here to help you build strength where it matters most.
Ready to move better and run stronger?
Contact us today to schedule an evaluation.