Plantar fasciitis is one of the most common and nagging injuries of the lower body. It can happen to people of all ages and sizes, and in some people, can persist for months, up to years if left untreated. Plantar fasciitis refers to inflammation of the plantar fascia, which is a thick band of tissue that lies across the arch of your foot, from your heel to the ball of your toes that helps support the arch of your foot. Inflammation and micro tearing of the plantar fascia may be due to excessive tensile forces on the fascia, which can occur if your foot has too much mobility, but also if the bones in your foot are too rigid, which causes the plantar fascia to absorb much of the shock of your body weight whenever you take a step or put weight onto your foot.

Common causes:

  • increasing mileage or exercise duration too quickly, such as taking up running or an exercise class after a period of inactivity
  • changing shoes, or wearing shoes that are too old
  • bone spurs which may contribute to micro tears of the plantar fascia
  • sharp pain in the heel or instep of the arch getting out of bed in the morning or after sitting for >15 mins and standing up again.
  • aching in the heel or arch with prolonged standing or walking
Risk factors in developing plantar fasciitis:
  • limited ankle dorsiflexion (inability to bend foot upward from the ankle joint)
  • limited 1st toe extension (inability to bend toe upward, which affects the “windlass mechanism” which is needed to propel the foot forward during walking/running)
  • tightness in calves (which then limits ankle dorsiflexion)
  • weakness of the posterior tibialis (muscle in the calf that helps support the arch of the foot) and soleus and gastrocnemius (the “calf” muscles that attach to the achilles tendon)
  • bone spurs in the heel
  • overweight
  • runners
  • jobs that require a person to be on their feet all day
How a physical therapist can help
  • improve ankle dorsiflexion and 1st toe extension
    • to dissipate forces going through the arch of the foot, lessening the stress on the plantar fascia
  • increased flexibility of the calves
    • to increase ankle dorsiflexion, as the tendons of the calf muscles attach to the calcaneus (where the plantar fascia arises from)
  • improve strength of the posterior tibialis, which helps support the arch and controls pronation of the foot
  • improve strength of the glute muscles
    • these are powerful muscles that work to absorb shock when the foot is planted, as well as control your pelvis which reduces impact down the leg to the foot.  When these muscles are weak, your body weight is excessively transmitted to the foot, which then undertakes unnecessary forces through the foot.

Exercises

  • Calf stretch– improves flexibility of the calves and may increase ankle dorsiflexion
    • While standing and leaning against a wall or counter, place the injured foot behind you with your toes facing forward and heel on the ground, then bend the front knee until a gentle stretch is felt in the calf.
    • 2 x 30″, at least 3x daily

    • Towel curls– improves strength of the intrinsic muscles of the foot which help support arch of foot
      • Place towel on a hard surface.  Begin with the foot flat on the floor.  Keeping the heel on the floor, repetitively “scrunch up” the towel by curling your toes. 
      • 1 minute, 2x daily

    • Woodpeckers– improves strength of soleus (feet straight) and posterior tibialis (heels together with toes turned outward)
      • While standing tall with feet facing forward, let your body fall forward while hinging at the ankle joint, attempting to keep body upright without bending from the waist. Go forward until you begin to lose your position, making your muscles pull you back to starting position. Repeat.  You can also perform this exercise with your heels together and toes turned outward, to better activate the posterior tibialis.
      • 2 sets of 10 reps

      • Bridges– improves glute strength
        • Lie on your back with knees shoulder width apart, tighten abdominals and squeeze your glutes, slowly raising hips off the floor by pressing your heels into the floor. Hold, then slowly lower and repeat.
        • 2 x 10 reps with a 5″ hold at the top

      • Frozen water bottle ice massage– massages the arch and helps reduce inflammation
        • 5′ once or twice daily