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“Grounding”, also known as “Earthing”, refers to the direct connection with the Earth through bare hands or skin. It has long been used by many cultures with the thought and subjective report that walking barefoot on the Earth can enhance one's overall health and well-being (1). For many, the thought of walking barefoot on the beach might sound therapeutic, while for others, walking barefoot on any surface may cause them to wince at the thought of the associated pain. What pain are we referring to? We’re talking about plantar fasciitis.
Plantar fasciitis can affect many different individuals spanning several age ranges and activity levels. In the United States alone, plantar fasciitis can account for over one million doctors visits per year (4). Affecting many different ages and activity levels, plantar fasciitis can be equally as debilitating to the recreational road racer hoping to train for their first marathon and the experienced hiker hoping to check some hikes off their “to-do” list.
Let’s spend the next several minutes discussing the role of the plantar fascia in the foot, what plantar fasciitis is, and some appropriate strength exercises for plantar fasciitis to help you get more grounded.
Plantar fascia? What’s that?
The plantar fascia, or plantar aponeurosis, is a sheath of connective tissue designed to support the muscles and bones of the medial longitudinal arch of the foot. The plantar fascia runs from the inside of the heel bone to the toes. This support system acts like a pulley when the big toe is dorsiflexed, narrowing the space between the big toe and the heel and lifting the arch (2).
Functionally, this positioning of the foot happens frequently, so frequently you may not even recognize when it’s happening. Running, walking, dancing, and even going up and down stairs all place the foot in this mechanical position. How many times do we partake in any of these activities on any given day of the week? I think the fair answer is A LOT. So what are we to do when this valuable pulley system starts to give us pain? Keep reading to find out!
What is plantar fasciitis and how should it be managed?
Plantar fasciitis refers to irritation of the connective tissue due to a lack of strength and durability to increased load, for example, weight bearing. Oftentimes it presents as pain that runs from the inside of the heel into the arch and is worse after periods of prolonged rest. Think about those first few steps out of bed in the morning, or standing up after sitting for that two hour work meeting. Ouch!
READ:PLANTAR FASCIITIS EXERCISES
While mobility of the ankle (psst - dive into the blog below), calf, and big toe should not be overlooked, the management of plantar fasciitis should absolutely include strengthening exercises for muscles of both the foot and ankle. In a study that analyzed the benefits of stretching versus strengthening in the management of plantar fasciitis, it was reported that a progressive strength program led to greater self reported improvements than stretching alone (3). Read that sentence again.
A larger more recent study concluded that those with established plantar fasciitis demonstrated weakness in the intrinsic muscles of the feet and toes, and the muscles of ankle dorsiflexion, inversion, and eversion (4). This seems like a no brainer, right? If individuals with reported plantar fasciitis are demonstrating weakness in the muscles that assist in supporting the plantar fascia and medial longitudinal arch, start by strengthening those muscles! And in true PT fashion, this strength and stability should then be transferred into functional exercises that challenge these muscle groups to work together. Make sense? Let’s dive into some strength exercises below!
What strength exercises should be performed to assist with plantar fasciitis?
We recognize that there are dozens of strengthening exercises that can be performed to tackle your plantar fasciitis, below are just a few of our favorites! Read on to learn why!
Exercise 01 of 04
Exercise demonstration
Seated Big Toe Flexion - Band
View exercise instructions
- HOW: In a chair, cross one leg over the other and place a resistance band around your big toe. Try to keep your ankle and foot up as you only use your toe to push the band down and up.
- FEEL: You should feel the muscles in the bottom of your foot working.
- COMPENSATION: Don’t let your ankle move up and down, only allow motion at the big toe
Working on strengthening the muscles that assist with big toe flexion with the above exercise is crucial for strengthening this tissue that helps to support the role of the plantar fascia. The plantar fascia has an attachment point on the calcaneous, or heel bone, as well as up through the toes so we want to make sure this supporting musculature is strong!
Exercise 02 of 04
Exercise demonstration
Heel Raise – Ball Squeeze
View exercise instructions
- HOW: Place a tennis ball, lacrosse ball, or any other small circular like object in between your heels. Squeeze the ball with your heelas and keep that constant tension during the whole exercise. Then, push up with your toes raising your heels. Make sure to push straight up with all of your toes working simultaneously. The goal is to keep the ball between your heel the entire time.
- FEEL: You should feel your calf muscles working.
- COMPENSATION: Don’t let go of the ball as you raise your heels. Control the motion and do not go too fast.
Exercise 03 of 04
Exercise demonstration
Single Leg Short Foot Hold - Band
View exercise instructions
- HOW: Get set up standing with a theraband under the knuckle of your big toe on one side. Begin the exercise by lifting your arch and assuming optimal foot/ankle position, then balance on that leg for that time prescribed.
- FEEL: You should feel all the muscles in your foot, your arch, and your calf working with this exercise. After some time passes, you may also feel your hip on the same side you're balancing on working as well.
- COMPENSATION: Do not lose optimal foot/ankle position, don't let your arch fall, don't let the knuckle of your big toe lift off the ground. Maintain single leg balance with optimal pelvis and trunk control/position.
We aren't gonna lie, the above two are some of our favorites. The Heel Raise - Ball Squeeze helps to target a muscle in our foot called the Posterior Tibialis. This muscle helps to support our arch eccentrically with daily movements such as running, walking, even standing! Making sure that it is strong goes a long way in providing your plantar fascia with the heavy lifting power it needs.
Short Foot Holds as demonstrated are also a great exercise to help to target the smaller muscles of our foot and teach them how to work appropriately in a standing position. This one is tough, not because you're moving heavy weight but because you are going to be working hard to send signals down to the smaller muscles of your feet! Stay consistent with this exercise, practice does pay off!
Exercise 04 of 04
Exercise demonstration
Lateral Lunge - Alternating
View exercise instructions
- HOW: Take a step out to the right into a lateral lunge position. Then, pull the rest of your body over your right leg through using the muscles on the inside of your thigh. Next, take a step out to the left and repeat that direction.
- FEEL: You should feel all the muscles in your legs working, but especially the inner part of your thighs working to pull yourself over.
- COMPENSATION: Make sure you pull yourself over. Do not lean over your foot and stand up doing a single leg squat.
Don't underestimate the role that the foot has to play in various planes of motion. That's right, not only does our body moving in a forward direction throughout the day, it also moves to the side, and back and sometimes even in circles if you're chasing a toddler around! Let's be sure that we are training our body in these various planes with exercises such as a Lateral Lunge
Closing Thoughts
Plantar fasciitis affects many individuals every year, spanning across many different ages and preferred activities. Creating pain with weightbearing that often runs from the heel along the inside of the arch, plantar fasciitis is not only uncomfortable and frustrating, but can also be confusing when it comes to management. While mobility of the ankle, calf, and big toe are important to allow for proper mechanics, strengthening of the muscles surrounding the foot and ankle are crucial to overcoming plantar pain. Give the mentioned exercises a try! Or send along to someone that might benefit from some foot and ankle strengthening.
LEARN MORE ABOUT OUR PLANTAR FASCIITIS REHAB PROGRAM
Our feet connect us to the world in so many ways. The first steps out of bed in the morning, the sand between your toes, the warming of chilly feet next to a fire, or the experience of grounding that has been practiced by many cultures for years and years. Plantar fasciitis should not be hindering any preferred activity or experience. And chances are with a couple of strengthening exercises, our reconnection to our feet and the Earth might be closer than we think.
Resources
- Oschman JL, Chevalier G, Brown R. The effects of grounding (earthing) on inflammation, the immune response, wound healing, and prevention and treatment of chronic inflammatory and autoimmune diseases. J Inflamm Res. 2015 Mar 24;8:83-96. doi: 10.2147/JIR.S69656. PMID: 25848315; PMCID: PMC4378297.
- Huffer D, Hing W, Newton R, Clair M. Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Phys Ther Sport. 2017 Mar;24:44-52. doi: 10.1016/j.ptsp.2016.08.008. Epub 2016 Aug 18. PMID: 27692740.
- Rathleff MS, Mølgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015 Jun;25(3):e292-300. doi: 10.1111/sms.12313. Epub 2014 Aug 21. PMID: 25145882.
- Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life (Basel). 2021 Nov 24;11(12):1287. doi: 10.3390/life11121287. PMID: 34947818; PMCID: PMC8705263.
About The Author
Lyndsay Provencio, PT, DPT
[P]rehab Writer & Content Creator
Dr. Lyndsay Provencio graduated from Colorado State University with a BS in Health and Exercise Science and a concentration in Sports Medicine. After multiple personal sports-related injuries and discovering a passion for healing through movement, Lyndsay attended Creighton University to receive her Doctorate of Physical Therapy. An avid runner herself, she has a particular interest in working with high school, recreational, and elite endurance athletes and has undergone specialty training in pelvic floor rehabilitation, postpartum care, and management of the female athlete to better serve her clientele. Through this specialty training, she has acquired a Certificate of Achievement in Pelvic Health Physical Therapy through the American Physical Therapy Association. Lyndsay now owns her own practice StrongHER in Park City, UT where she specializes in female athletics and care of pregnant and postpartum individuals. Additionally, Lyndsay is BSPTS C2 certified in scoliosis specific exercises and has found a niche working with adolescents with scoliosis to improve overall spinal health. No, you’re not seeing double! Lyndsay is an identical twin to Lauren Lynass, one of our [P]rehab rockstars. A native of Colorado, Lyndsay is an adventure seeker who loves to hike, camp, and race her twin sister on the mountain trails. When she isn't exploring Park City's outdoor playground, you can find her curled up with a cup of tea and a good book. Follow along @strongher_dpt on Instagram!