Plantar fasciitis is one of the most nagging and limiting orthopedic pathologies in the foot. It’s estimated that nearly 2 million Americans experience plantar fasciitis each year and it is the most common condition of the foot in runners. Plantar fasciitis can be defined as inflammation of the plantar fascia and surrounding fascial tissues due to repetitive microtrauma from excessive traction and/or loading forces. However, that nagging heel pain that drives people to want to fix plantar fasciitis is typically not just an acute inflammatory condition but rather a chronic issue that is now revealing itself. In this article, we are going to discuss the common causes and risk factors for this heel pain and show you some of the best plantar fasciitis exercises. 

 

What Is Plantar Fasciitis?

The plantar aponeurosis, better known as the plantar fascia, is one of the many passive structures within the foot that provides support to the medial longitudinal arch. It is comprised of three separate bands, a medial, central, and lateral band. The most common site of patient-reported pain is usually at the medial tubercle on the plantar aspect of the heel, or calcaneus, which is the origin of the central band of the plantar fascia.

The specific cause of plantar fasciitis is poorly understood; however, there are many risk factors and impairments that have been strongly associated with plantar fasciitis. Most commonly, individuals report plantar fasciitis pain after a period of increased or unaccustomed activity, especially after a period of inactivity. This could be after partaking in more vigorous activity, increasing your running/walking mileage, or simply increasing the time spent on your feet every day at work. Additional risk factors include a body mass index between 25-30kg/m2, limited dorsiflexion range of motion, and running. A term the medical world is turning to is plantar fasciopathy because chronic plantar fasciitis can be looked at as being parallel to conditions like chronic tennis elbow or any chronic tendinitis issue, where it is more a chronic degenerative issue versus an acute inflammatory issue.

 

Dealing With Nagging Plantar Fascia Pain? Fix It Now!

The Foot & Ankle Rehab Program is a physical therapist-developed, step-by-step program that teaches you how to optimize your foot & ankle health. This program will expose you to various foot & ankle strengthening and stabilization exercises supported by science. This program will bulletproof this region, and help combat movement impairments that oftentimes can be contributing to your plantar fasciitis. Learn more HERE!

 

Common Plantar Fasciitis Findings

• Plantar medial heel pain: most noted with initial steps in the morning or after a period of inactivity as well as prolonged weight-bearing.

 

• Symptoms may appear after an increase in weight-bearing activity (running, walking).

 

• Bone spur on the heel (due to excessive tension from the plantar fascia causing periosteal lifting of the bone).

 

• An antalgic (painful) gait pattern due to pain originating from the plantar fascia

 

There are many risk factors that are attributed to developing plantar fasciitis including stiffness in the gastroc-soleus complex, high BMI, poor ankle joint dorsiflexion, running, and an inefficient windlass mechanism, which will be defined later in this article.

 

Overpronation Versus Underpronation

Pronation is a normal movement that occurs at the foot whenever walking or running. As you take a step, your heel strikes the ground first. From that position, your foot will naturally ‘roll over’ from the outside portion of your foot to the inside portion of your foot. 

In regards to foot pronation, there may be instances where someone will either overpronate or underpronate, which can be due to a lack of control at the foot and ankle complex, pain, or a combination of these factors. There is a misconception that only people who overpronate are at risk for plantar fasciitis, however people who underpronate can also develop fasciitis. It is the duration of how long you remain in pronation, rather than pronation itself, that is problematic. 

• Overpronation: This leads to a flattening of the medial longitudinal arch (MLA) causing the plantar fascia to elongate and have increased tensile forces causing microtears. This type of foot has too much mobility. 

 

• Underpronation: Limits shock absorption and unable to dissipate forces so the fascia takes the brunt of the load. This type of foot has too much rigidity. A stiff GSC will encourage a person with a very mobile (planus) foot to unlock the midfoot and pronate excessively as compensation, placing stress on the fascia. A stiff GSC in a person with a stiff (cavus) foot will also apply more tension to the fascia due to the inability to absorb shock and dissipate forces.

 

Plantar Fasciitis Quick Tips

 

How To Fix Plantar Fasciitis? Exercise!

The good news is that over 90% of those diagnosed with plantar fasciitis will recover in 6-12 months with conservative treatment. There are a host of conservative treatment options available that are strongly supported in the literature for treating plantar fasciitis including rehab. If you can’t see a local physical therapist, there are still plenty of things you can do at home to treat your plantar fasciitis. The first, and easiest thing to do at home, is to stretch your calf and plantar fascia. Plantar fascia-specific self-stretches and calf stretches are easy to implement and have been shown to provide short-term pain relief. Calf stretching is important because not only do tight calves limit dorsiflexion range of motion (which is a risk factor for the development of plantar fasciitis itself), but there is also a soft tissue connection between the Achilles tendon and the plantar fascia.

Thus, calf and Achilles tendon tightness can translate into plantar fascia tightness as well.

Stretching should be implemented at least two to three times per day. Calf and plantar fascia stretches can either be held for sustained or intermittent stretching times as neither dosage demonstrates a better effect in the literature. Here are some stretches you can work on!

Calf Stretch – Off Step

Sample Foot & Ankle Rehab Program Exercise Video

• HOW: Place an elevated surface next to a wall. Stand on the surface and use the wall for support. Straighten one leg as you keep your toes on the surface and let your heel drop to the ground creating a stretch in that calf. Hold that stretch for as long as prescribed. 

 

• FEEL: You should feel a stretch in your calf. 

 

• COMPENSATION: Keep your knee straight as you stretch. Keep your toes on the surface to create the best stretch.

 

Wall Calf Stretch – Knee Bent

Sample Foot & Ankle Rehab Program Exercise Video

Having the knee bent will bias your soleus muscle, which is one of your two calf muscles. It is important to stretch both of your calf muscles for optimal mobility!

 

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Joint Mobilizations For Ankle Dorsiflexion

Physical therapists might perform soft tissue mobilizations to your calf to improve dorsiflexion range of motion, or joint mobilizations to your foot and ankle to ensure that there is adequate joint motion. Inadequate joint motion means that other structures in your foot must compensate for the increased demand, and many times that structure is the plantar fascia. Specifically, limited ankle dorsiflexion has been shown to be a low to moderate risk factor for the development of plantar fasciitis. Here are some ways you can enhance your dorsiflexion mobility!

Ankle Dorsiflexion Mobilization – Static

LISTEN: WHY ANKLE DORSIFLEXION MOBILITY HELPS HEEL PAIN

 

Big Toe Mobility

Limited great toe mobility can also be a risk factor for developing plantar fasciitis. If you do not have big toe extension and plantar fascial mobility, you will not be able to roll through your foot and your toe as you walk!

Quadruped Rock Back – Big Toe Extension Bias

 

The Windlass Mechanism

The orientation of the plantar fascia helps maintain the arch of the foot when walking and maintains the appropriate timing of pronation and supination. Originating from the calcaneus (heel) to the phalanges (toes), the plantar fascia helps to maintain the medial longitudinal arch via the windlass mechanism. The windlass mechanism occurs with dorsiflexion of the big toe (toe pointed upwards) and plantarflexion of the metatarsal, allowing for a rigid foot needed for efficient propulsion and push-off during the gait cycle. If this mechanism is altered there may be over-flattening of the arch causing excessive tensile stress to the fascia. If you are an overpronator,  you will benefit greatly by improving your windlass mechanism, minimizing tissue stress and thus pain.

Windlass Mechanism Plantar Fasciitis Exercise

• Step 1: Sit in a chair with both feet placed flat on the floor

 

• Step 2: Raise the arch of your foot by sliding your big toe toward your heel without curling your toes or lifting your heel. 

 

• Step 3: Hold the position for 2 seconds then relax. Once you feel comfortable performing the short foot movement you can gradually progress to performing the exercise while standing and then eventually from a single-leg standing position.

 

Therapeutic Modalities and Taping Techniques For Plantar Fasciitis

A physical therapist can also deliver medications directly to your areas of pain, such as dexamethasone or acetic acid via iontophoresis, to provide short-term pain relief. Additionally, a physical therapist can utilize taping techniques or design custom orthotics to complement their manual interventions to treat your plantar fasciitis. The goal of taping techniques and orthotics is to decrease abnormal foot pronation, which is thought to increase the stress placed on the medial longitudinal arch.

While direct evidence to establish an association between plantar fasciitis and abnormal foot motion is inconclusive, there is strong clinical support for the use of taping and foot orthotics for the short-term reduction in pain as well as improvement in function. In addition, there is strong evidence for the use of night splints in the short term to reduce plantar foot pain.

Furthermore, night splints should be considered for those who have had symptoms longer than 6 months. When we sleep, our feet are in a slightly plantar flexed (toes pointed down) position; thus, our calf muscles are in a shortened position. This is counterproductive to the stretching we are doing during the day! Night splints keep the foot in a neutral position, which can limit adaptive shortening of the calf muscles, as well as decrease pain that is common with the first steps in the morning.

 

What About Cortisone Injections

In regards to plantar foot pain, healthcare practitioners may discuss the option of a cortisone injection to alleviate your symptoms. Research has been conflicting in regards to cortisone injections and plantar fasciitis. In the short term, an injection may help alleviate symptoms related to inflammation and pain; however, repeated injections are generally not recommended within the literature to address heel pain.

 

Foot Intrinsic Strengthening

So, how do we perform plantar fasciitis exercises? In addition to improving your foot and ankle mobility into dorsiflexion, foot intrinsic strengthening is crucial when addressing plantar fasciitis. Studies have supported decreased foot intrinsic strength and motor control in individuals with plantar fasciitis. When first performing these exercises, they will be difficult to master. This is because the muscles in our foot are tiny, and to perform isolated contractions of these muscles, our brains must make the connections to those specific muscles! You may find that you are unable to truly isolate one muscle at a time at first, and that is ok. Do not get discouraged. The more you practice these exercises with multiple repetitions, the quicker you will master them!

READ: EXERCISES TO IMPROVE FOOT STRENGTH 

 

Single Leg Short Foot Hold – Band

Utilizing a band can help facilitate engagement of the musculature in the foot by providing tactile feedback to your muscles.

 

Eccentric Posterior Tibialis Control

As stated in previous posts, one cause of plantar fasciitis is prolonged pronation. This is often due to posterior tibialis—known commonly as the post tib—weakness. The post tib is a primary arch stabilizer as it eccentrically controls pronation. Therefore, the plantar fasciitis exercises which help to develop strength of the post tib are critical in helping reduce over-lengthening of the fascia, which can result in microtears and periosteal lifting (bone spurs).

 

Proximal Stability – Don’t Forget About The Glutes!

Regional Interdependence is defined as a seemingly unrelated impairment in a remote anatomical region contributing to the primary complaints. This concept is especially important when attempting to resolve the poor biomechanics that contributes to plantar fasciitis. Proximal muscle weakness from the gluteus medius, gluteus minimus, and quadriceps may contribute to dysfunction at the foot, causing fascia irritation. How?

These proximal muscles assist with the loading response of gait—when the heel first hits the floor—which is necessary for shock absorption. If these muscles are weak, there may be an excessive transmission of shock to the structures of the feet rather than dissipation throughout the entire limb. Furthermore, weakness of the glutes causes an increase in hip internal rotation, as opposed to external rotation. External rotation is necessary for foot supination as it creates a rigid lever needed for propulsion. Poor supination due to prolonged pronation from glute weakness may cause overstress to the plantar fascia. Let us show you some ways you can strengthen your glute musculature and incorporate these into your plantar fasciitis exercise routine!

Isometric Side Lying Clam – Band

 

How To Fix Plantar Fasciitis: Develop High Load Strength

This specific treatment strategy—known as “high-load strength training”—may stimulate an increase in collagen synthesis, encouraging normal tendon structure in addition to the fascia to tolerate load. Additionally, this exercise facilitates an increase in dorsiflexion and intrinsic foot strength. The concept of Davis’s law states that soft tissue heals according to the imposed demands by which it is mechanically stressed.

 

Take Care of Your Foot Issues Today!

The foot and ankle complex is vitally important for lower extremities and even our entire body’s health! The stronger and more resistant your foot becomes, the less work the rest of your knees, hips, and back need to do. Take control of your foot and ankle today, whether dealing with plantar fasciitis, or a different ailment in your foot, our Foot & Ankle Rehab Program is the best place to start.

 

Closing Thoughts

There are a host of non-operative treatment options available to decrease pain and improve function related to plantar fasciitis. As mentioned earlier, 90% of patients diagnosed with plantar fasciitis will recover in 6-12 months by utilizing many of the non-operative treatment methods outlined in this article. It can be challenging to remain patient when dealing with foot pain for a long period of time, but stay consistent with your exercise and you can overcome it! If your pain or function doesn’t improve, see your local physical therapist (if you haven’t already) and seek a consultation.

 

About The Author

Michael Lau, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Product Officer

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.