It often creeps in quietly- a seemingly innocent dull ache under your foot when you walk or stand for too long. But then it gets worse. That occasional pain transforms into a sharp, stabbing pain that renders every step into an annoying chore. Plantar Fasciitis affects 4-7% of us, and it’s the most common foot injury, accounting for about 15% of all foot injuries in the general population.
However, the good news is that it’s highly treatable, with estimates showing up to 90% success rate with conservative treatment methods. Stretches and a variety of corrective exercise routines have been shown to improve pain and functional biomechanics in the affected foot and leg as a whole.
This article will explore some of the best exercises you can use to get started on your journey to a pain-free and fulfilling life. We’ll lay the foundation with a quick recap of what Plantar Fasciitis is all about, then delve deep into the key moves you need to get back in business.
Plantar Fasciitis: A Quick Recap on its nature, Causes, Signs and symptoms, Treatment
Plantar Fasciitis is a painful condition marked by irritation and degeneration of a thick pad of connective tissue at the bottom of the foot, known as Plantar Fascia.
The Plantar Fascia: What it Looks Like
This tissue originates from the heel bone a.k.a Calcaneus. It thickens up in the mid portion of the foot before dividing into 5 strips which insert into tiny ligaments connected to the toes.
Function
The Plantar Fascia promotes proper mechanics when walking, running and other forms of weight bearing activity. It acts as a shock absorbeing struture for the foot on impact. In fact, studies show that it’s capable of absorbing forces equivalent to 110% of your body weight when walking. This means efficient transmission of forces into the ground, which facilitates better movement and prevents foot injuries. Additionally, it helps to maintain the normal arch of the foot, which in itself also helps with shock absorption by acting as a spring.
Key Causes of Plantar Fasciitis
Repetitive Strain
This is the commonest cause of Plantar Fasciitis. The Plantar Facia is quite tough and resilient, but it has its limits. Repetitive strain during various forms of physical activity that load the foot can cause tiny tears within its structure, causing pain. In the long run, these injuries may fail to heal properly, setting the stage for degenerative processes which create cycles of pain and discomfort. Plantar Fasciitis is one of the “repetitive Strain” injuries, which affect weight-bearing soft tissues in the human body.
Trauma
Abrupt tears caused by sudden high impact trauma i.e running, landing on a blunt object. Just like overuse injuries, these tears may not heal effectively, creating a chronic cycle of pain and inflammation.
Other causes and related factors
A number of structural issues may render the shape of the foot less ideal for efficient shock absorption. These include:
- Pes Cavus, aka High Arch foot: Increases strain on the Plantar Fascia as the foot does not effectively change its arch to absorb shock/force.
- Pes Planus aka Flat foot: The foot lacks the longitudinal curvature that’s needed for the spring effect which allows it to absorb impact. This increases stress on the Plantar Fascia, thereby exposing it to injury and Plantar Fasciitis in the long run.
- Muscle tightness: Tight calves and intrinsic muscles of the foot limit your ankle joint’s ability to move, especially dorsiflexion(bending the foot upwards). This causes the foot to compensate by stretching the Plantar Fascia, which increases tension and risk of injury within the tissue.
- Overweight/obesity: Excessive weight is associated with higher magnitude of forces/shock through the Plantar Fascia and the foot as a whole, which increase the risk of injuries and pain.
- Heel Spurs: Spiky heel-bone protrusions increase pressure at the origin of the Plantar Fascia, causing irritation and pain.
Treatment overview
Conservative/non-invasive therapies are first-line treatments for Plantar Fasciitis. When these fail, more invasive techniques like steroid injections and surgery may be used.
Physiotherapy
Physiotherapy combines active and passive treatments to promote healing, reduce symptoms, and improve general physical function. Key treatment methods include:
- Manual Therapy: Involves hands-on Plantar Fascia manipulation techniques, joint manipulations and massage in associated muscles and other soft tissue structures.
- Exercise Therapy: Combines stretches and strength training programs to address faulty biomechanics.
- Dry Needling: Involves insertion of special needles to aid with pain relief.
- Orthoses: Recommending appropriate footwear to correct biomechanical deficiencies.
Exercise and Plantar Fasciitis: How it works
Exercise has long been linked to reduced pain and improved physical function in individuals with Plantar Fasciitis by the scientific research community. Key mechanisms include:
- Reduced pain sensitivity: Exercises like Plantar Fascia stretches trigger mechanical stimuli, which inhibit transmission of pain signals in the central nervous system.
- Reducing tightness and stiffness: Stretching the Plantar Fascia and related muscles (i.e Calves) restores normal tissue length and flexibility. This improves joint range of motion, which is critical to the foot’s ability to adapt its shape to varying terrain. Additionally, normal tissue length means increased capacity to handle loads, which means less irritation to the Plantar Fascia.
- Improved dynamic strength and agility: Muscle strengthening exercises improve muscle performance in key movers of the foot i.e Calves, intrinsic foot muscles.
This isn’t mere hearsay. At Healthy Movements Physiotherapy, we’ve seen the wonders that exercise can do for Plantar Fasciitis first hand. In fact, our experience agrees with what the research says on conservative treatment of Plantar Fasciitis. Over 90% of all patients we’ve treated for Plantar Fasciitis get back to what they love to do without/with minimal pain or discomfort after treatment.
Casey’s case offers a great example:
A few weeks ago, she walked into our treatment room with a limp. She complained of a sharp, unrelenting heel pain that worsened with any activity that involved putting weight in her right foot. It just showed up from nowhere with no obvious cause and got worse over a few weeks. At this point, she had to use over-the-counter pain killers to get through her day.
A visit to the general practitioner revealed it was more than just one of those “pains” that go away with time. A diagnosis of Plantar Fasciitis was made. Pain medication was prescribed and she was referred to our clinic for physiotherapy management.
Our physical assessment identified a few key factors behind her diagnosis:
- Decreased right foot arch.
- Tight Plantar Fascia and Calf Muscles.
- Faulty mechanics in her right leg: It was more than just a foot problem. There were muscle and postural imbalances in her right leg and pelvis which increased tension and stress on the foot.
Our treatment approach combined manual therapy, corrective exercise, and dry needling to deal with symptoms and improve mechanics. The pain was gone in 2.5 weeks of consistent physiotherapy. Stretches combined with strength and postural training played a key role in improving her foot mechanics, offering a long term solution to her problem. She’s now incorporated the stretches in her normal workout routine, and pretty much back to being the passionate and productive professional she is.
Effective Exercises for Plantar Fasciitis
Before we get deep into exercises, it’s important to note that exercise programs for Plantar Fasciitis are best developed with a qualified Physiotherapist. Much as the moves below may help, proper form and exercise selection requires professional input. This keeps you both safe and effective.
Reach out to our seasoned musculoskeletal Physiotherapists here.
1. Plantar Fascia Stretch
Aim: Reduce pain and tightness in the Plantar Fascia.
How to do it
- Sit on a desk or chair, feet at shoulder width apart.
- Assuming your left foot is affected, lift your left leg and place it on the right thigh. At this point, the outer side of your left ankle should be comfortably rested on the lower portion of your right thigh, just above the knee.
- Secure your left heel with the right hand while holding your toes with the left hand.
- Bend your toes and the whole foot to the left. You should feel a gentle stretch along the bottom surface of the foot.
- Hold for 20-30 seconds. Release.
- Repeat the stretch for 2-3 times.
When to stop
Severe(unbearable) pain along the plantar Fascia during the stretch. You may need professional help for other pain relief options.
2. Calf Stretch
Aim: Reduce/prevent tightness in the Calf muscles and Achilles Tendon.
How to do it
- Stand tall at about arms length from the wall.
- Extend your arms forward and lean on the wall for extra support.
- Take a step back with the affected foot.
- Lunge forward on your unaffected leg until you feel a gentle stretch along your calf muscles.
- Hold the stretch for 20-30 seconds, 2-3 times.
Note
Keep your knee extended to ensure optimal stretch intensity.
3. Heel Raises
Aim: Improve/maintain Calf muscle strength.
How to do it
- Stand tall, feet placed at shoulder width apart.
- Lift your heels, shifting your bodyweight into the forefoot.
- With control, return to the starting position.
- Repeat the movement for 10-15 times. Aim for 4-5 sets.
Note: Pay attention to your body’s response. Too much pain means you’re not yet ready for the exercise. You can start by holding onto a stable object (i.e chair) or leaning on a wall and gradually work your way up to the free bodyweight version.
4. Towel Scrunches
Aim
- Promote foot joint flexibility.
- Preserving baseline strength in toe flexors.
How to do it
- Stand tall, with a towel placed underneath the affected foot.
- Curl your toes as hard as you can to draw the towel backwards.
- Repeat for 10-15 times, 3-4 sets.
5. Foot Eversion and inversion
Aim: To improve/preserve foot and ankle joint flexibility.
How to do it
- Sit down on a chair or bench.
- Cross the affected side’s knee over the the unaffected side.
- Twist the affected foot in and out simultaneously, 10-25 times each side, 3-4 sets.
Again, these are great exercises to get started with. However, you’ll most likely need professional input to keep things safe and effective depending on your condition.
Get in Touch With Us
Is Pain or discomfort from Plantar Fasciitis holding you back? Our Physiotherapists specialize in evidence-based treatment of various forms of orthopedic problems, including Plantar Fasciitis. We blend years of experience and expertise to ensure you get the treatment you need to reclaim a productive life. Book an appointment today through the button on the top left to get started. We’re looking forward to being part of your incredible journey towards a pain free life.
Frequently Asked Questions
Plantar Fasciitis is caused by irritation and degeneration of the Plantar Fascia: a strong tissue connecting the heel bone to the forefoot. The key culprit here is repetitive strain caused by a variety of factors including consistent high-impact physical activity. Other key factors include structural deviations like flat feet, high-arched feet, and mal-positioned heel bones. Tight muscles and faulty biomechanics in other areas like the calves and other leg muscles can place undue strain on the Plantar Fascia, predisposing to development of Plantar Fasciitis.
Conservative treatment approaches are key to successful treatment of Plantar Fasciitis. A combination of Physiotherapy treatments like manual manipulation, stretches, corrective exercise, and strength training has a high success rate. When conservative methods prove futile, injections or surgical techniques can be used to improve treatment outcomes.
Over 90% of people with Plantar Fasciitis return to normal activity after conservative treatment. Unlike most chronic degenerative/inflammatory conditions, the prognosis is exceptionally good after a few weeks of treatment.
There really no definititve time frame for everyone. Just like most soft tissue conditions related to repititive strain, a wide range of factors affect the speed of recovery. For some, physiotherapy interventions may cut the recovery period to a few weeks, while for others, it could be a longer battle last for a few months.
Walking is safe for Plantar Fasciitis if you follow a few precautions relating to foot wear and load management. Appropriate foot wear will be recommended by a Physiotherapist depending on the key factors behind the condition. Additionally, issues like walking distance, time, and pattern will be looked into to inform the recommendations.
