Top 5 Exercises for Plantar Fasciitis

Let’s talk about plantar fasciitis and discuss our top five exercises to help recover from plantar fasciitis. Of course, these exercises are based on our opinion, and clinical experience, but some also have the backing of research. Bear in mind though, with any research, one paper will be released that recommends one protocol, and then another research recommends something completely different. We always need to use our clinical judgement, and exercises are ideally prescribed bespoke to patients as individuals depending on their fitness levels, pain levels and stage of the recovery journey.

What is Plantar Fasciitis?

Plantar fasciitis is a painful foot condition that can cause significant discomfort and difficulty walking. It's believed to affect 1 in 10 people over the course of their lifetime (Trojian T, Tucker AK, 2019). Inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of your foot, is the cause. It can be brought on by a variety of factors, including overuse, excess weight, improper footwear, and a lack of stretching. Research still varies about if plantar fasciitis (like other tendon issues) is actually an inflammatory problem, but for the purposes of this article, we’ll assume it is, as there is almost always pain.

How can I treat it myself?

The first step in treating plantar fasciitis is resting the foot. Avoid activities that place stress on your feet, such as running or prolonged walking. Additionally, you should wear footwear that provides support and cushioning. Plantar fasciitis is often an over-use injury. Reduce activity. You don’t need to completely stop doing things, but just reduce if you are over-using your foot. For example, someone training for the marathon that develops plantar fasciitis is likely to have an over-use issue. Reduce the workload and distance.

Stretching can help alleviate plantar fasciitis pain. Simple stretches such as calf raises, toe stretches, and arch stretches can aid in loosening tight muscles and enhancing flexibility. You can also try massaging your feet with a foam roller or a tennis ball. These have limited research backing them up, but patients seem to report benefits and they are widely prescribed in the physiotherapy profession.

Icing your feet can reduce pain (and some say, it can also reduce inflammation). You can accomplish this by applying an ice pack to the affected area for up to ten minutes. Just always wrap a towel around the ice and don’t risk an ice burn.

One thing to mention at this point is that it’s important to lose weight if you are overweight or obese. We commonly see patients come in with heel pain who are overweight. This is fundamental that you take steps to lose weight.

What treatment can I get from a physiotherapist?

If pain does not heal, then the next steps are shockwave therapy. This does have a significant amount of research that backs up positive responses. Ultrasound can also be beneficial. When I was a child, I was a keen cross-country runner. I developed plantar fasciitis in both heels. At points I was so bad, I could barely run with the pain. My parents took me to a hospital and I had about six sessions of ultrasound on my heels and it completely eradicated the pain (bear in mind there is no reliable evidence in research supporting the use of ultrasound, but I know it helped myself). We provide both shockwave and ultrasound for plantar fasciitis at Surrey Physio.

If the pain still does not heal, then we do provide steroid injections. They are painful, and are not recommended as a first-line approach. If all else fails, and under a shared decision-making process with our patient, we can discuss the pro’s and cons of steroid injections. First, they can be very beneficial with some patients reporting great benefits. But you should be aware of the risks and potential side effects. According to this article, “The risks of cortisone injections for plantar fasciitis are: increased pain for 24-72 hours following the injection (30%), plantar fascia rupture (<1%), infection (<0.1%), and heel fat pad atrophy (<0.1%). Systemic side effects of this type of injection are extremely rare.” I’ve done many steroid injections for plantar fasciitis and to date, not had any negative side effects, but I have had considerable positive reports from patients. Steroid injections should not be used alone, and should be backed up with an exercise programme.

Let’s look at our top five exercises for plantar fasciitis:

1. Calf stretch – Heel Drop Gastroc Stretch: Stand with your toes on the edge of a step or a box. Hold onto something stable for support if required. Drop your heels downwards. You should feel a stretch just below the back of your knee, in the calf (this part of the calf is known as the gastrocnemius).

2. Ice to the Heel: Place an ice pack or pack of frozen peas under your heel while sitting to reduce inflammation and pain. Make sure you wrap the ice in a thin towel so its not too cold.

3. Plantar fascia massage with ball: Place a tennis ball, golf ball or squash ball underneath the sole of your foot. Roll the ball up and down along your foot. Pay particular attention to the skin under the arch of your foot. Do not rub the ball over the heel of your foot. This will help reduce tension in the plantar fascia, the tissue under the sole of your foot that causes heel pain.

4. Calf Heel Raises Standing on Step: Place a small rolled up towel near the edge of a step. Stand on the step, placing your toes on the towel. Drop your heels, then lift your heels. At the top of the movement, hold and then repeat the exercise raising and lowering your heels. This exercise has been recommended for strengthening the calf muscles, and also as a treatment for plantar fasciitis.

5. Eccentric Strengthening: Stand with your toes on the edge of a step or a box. Hold onto something stable for support if required. We will assume the leg you are trying to strengthen is your left leg (the injured side). Lift your left leg off the step, and go onto your toes on your right leg. Now place your left foot beside the right, and place all your weight on your left leg. Drop your heel downwards below the level of the step. Use your right leg (non-injured leg) to lift yourself back to the start position. Make sure you keep your leg straight during the exercise. This exercise can help strengthen the calf muscle and may be useful for treating Achilles tendinopathy.

Plantar fasciitis is a common condition that can cause discomfort and pain. Nevertheless, with the proper treatment and care, you can reduce pain and increase mobility. Resting your foot, wearing the proper footwear, stretching, icing, and visiting a doctor or physical therapist can all help reduce pain and enhance your quality of life.

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