What is Plantar Fasciitis?
Plantar fasciitis is heel pain that is worse with the first steps in the morning, walking after sitting, or prolonged standing and walking, that is diagnosed by a clinical exam. The pain is located on the bottom of the heel and can extend into the arch of the foot or toward the back of the ankle.
Pain from plantar fasciitis normally begins after an increase in standing, walking, or exercising. However, it can develop without a change in activity level. It is believed to be largely caused by thickening of the plantar fascia. The plantar fascia is a band of connective tissue that runs along the arch of your foot, beginning at the heel. Changes to the plantar fascia are thought to be caused by tightness in the ankle and leg, foot shape, and decreases in foot and ankle strength.
Many people seek plantar fasciitis physical therapy treatments to ease the pain with everyday activities. Commonly, the best treatment for plantar fasciitis includes stretching and strengthening of the foot, ankle, and leg. One study demonstrated from the Health Sciences Institute in brazil found that specific plantar fasciitis stretching alone and stretching in combination with strengthening both improved symptoms and helped in reducing pain.
Plantar Fasciitis Stretching
Achilles tendon and plantar fasciitis stretching have been shown to reduce pain from plantar fasciitis. Also, stretching of the hamstrings has been included in a stretching routine for this condition. Here is an example stretch progression plan you could follow at home:
- Standing Calf Stretch:Standing with one foot behind the other, lean forward until you feel a stretch in your back leg. Make sure to keep your heel on the ground. You can alternate between bending and straightening your back leg to feel the stretch higher or lower in your calf.
- Plantar Fascia Stretch: Remove your shoes and sock. Place your painful foot over your opposite knee. Grab your big toe and pull it toward your shin. Place your other hand at the base of your arch. You should feel a taut band at your arch and feel a stretch along the bottom of your foot.
- Stair Stretch:Place your toes and the ball of your foot on a step. Allow your heels to drop below the step. You should feel a stretch along your calf, heel, and maybe your arch.
- Plantar Fascia Rolling: You can use multiple objects for this activity, including a tennis ball or a frozen water bottle. Place the ball under the arch of your foot and roll it back and forth along the arch of your foot. You can adjust the intensity by how much weight you put into your leg.
- Hamstring Stretch with Strap: Grab a stretching strap or a long towel if you do not have a strap. Lay on your back and place the strap around your foot while holding it with both hands. Pull the strap towards your chest until you feel a stretch in the back of your thigh.
- Standing Calf and Plantar Fascia Stretch: Similar to the standing calf stretch, stand with painful foot behind your other foot. Roll up a small towel and place it under the ball of your painful foot. Then lean forward until you feel a stretch in your arch or calf.
Best treatment for Plantar Fasciitis – Exercises
Plantar Fasciitis has been linked to weak muscles in the feet. Therefore, if we strengthen the foot and related muscles then we can reduce symptoms of plantar fasciitis. It has also been found that strengthening the hip together with the foot reduced heel pain from plantar fasciitis. It is believed that hip strengthening provides stability for the entire lower extremity. Here is an example of an exercise progression plan you could follow at home:
- Towel Scrunches: While sitting down, place a towel under your foot. Keep your heel on the ground then scrunch the towel with your toes. You should be able to scrunch the whole towel backward piece by piece.
- Heel Raises: Standing on the ground with your feet flat, raise your heels off the ground and lower them back down. You may hold onto something if you need balance support but try not to use your arms to push yourself up.
- Clam Shells: Laying on your side with your knees bent, slowly raise your top knee toward the ceiling. Keep your heels together and your hips still. You should feel this exercise on the outside of your top hip.
- Toe Yoga: Place your foot flat on the ground without shoes or socks. Raise your big toe up while keeping your little toes on the ground. Then switch and raise your little toes without your big toe.
- Single Leg Stance: Practice standing on one foot without allowing your arch to collapse. This can be done with or without shoes depending on how painful it is for you to stand without shoes. Try to maintain your balance as long as you can. You will notice your arch and ankle muscle begin to get tired.
- Eccentric Heel Raises: Standing on the edge of a step, go onto your tippie toes. Then, lift your non painful leg off of the step and lower yourself down with just the painful side. Place both toes back on the step and raise up again. Think “up with 2, down with 1.” The key here is to go slow.
- Resisted Side Stepping: Place a resistance band around both feet then stand up. Keeping your toes, knees and hips all facing forward step to the side repeatedly then step back to the other side until you reach your starting point. You should feel your hip muscles fatigue.
- Doming: With your foot flat on the ground, place a penny partially under the ball of your foot where you can still see it. Also, place a pen under the arch of your foot. Maintain contact with the penny and your heel on the ground, then lift the arch of your foot off the pen. This is not a big movement. Just try to lift your arch enough to clear the pen. Try this exercise first in sitting, then if it is easy progress to standing.
- Single Leg Deadlift: Standing on one leg, lean your body forward and kick your opposite leg backward to make a “T” with your body. Return to standing and repeat. Sometimes it is helpful to think of this exercise as a “teeter totter”. Your chest goes down and forward as your leg goes up and backward. Avoid twisting your hips.
- Side Plank with Hip Abduction: Lay on your side with your elbow directly under your shoulder and your feet stacked on top of each other. Lift your hips up so only your elbow and feet are in contact with the floor. Maintain that position then lift your top leg straight up. Keep your toes pointing forward and your hips still.
Submitted by Kellie Stickler Edited by Alex Franz Reviewed by James Caginalp PT, DPT, CSCS, CES, PES
- Engkananuwat, P., Kanlayanaphotporn, R. & Purepong, N. (2018). Effectiveness of the simultaneous stretching of the Achilles tendon and plantar fascia in individuals with plantar fasciitis. Foot & Ankle International, 39(1):75-82. doi: 10.1177/1071100717732762.
- Kamonseki, D.H., Goncalves, G.A., Yi, L.C. & Junior, I.L. (2016). Effect of stretching with and without muscle strengthening exercises for the foot and hip in patients with plantar fasciitis: A randomized control trial. Manual Therapy, 23:76-82. DOI: 10.1016/j.math.2015.10.006.
- Huffer, D., Hing, W., Newton, R. & Clair, M. (2017). Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Physical Therapy in Sport, 24: 44-52.DOI: 10.1016/j.ptsp.2016.08.008.