Every year, over 3 million people in the US may report having plantar fasciitis. While it may be one of the more common orthopedic conditions, thankfully it’s usually easy to self-diagnose and treat.
What Is Plantar Fasciitis?
The plantar fascia is a thick bundle of connective tissue at the bottom of your foot. It helps to maintain the arch in your foot and connects from the calcaneus (heel bone) to your toes on the plantar aspect (bottom) of your foot.
When your toes dorsiflex (come upward off the ground), the plantar fascia gets pulled and should help create an arch in your foot. When this ligament undergoes a lot of stress, it can get inflamed and become a source of pain.
So if you’re not properly using your foot muscles or if they’re weak, you may be putting an excessive strain on the plantar fascia.
Plantar Fasciitis symptoms
- Localized, sharp pain at the bottom of the foot near the heal.
- Sharp pain with first steps (just getting out of bed or up after sitting for a while) or in the morning.
- Decreasing pain as you continue to walk and loosen up.
If you have these symptoms, your plantar fascia is most likely inflamed.
Plantar Fasciitis Treatment Strategy
The number one thing to do if you have plantar fasciitis is to increase your flexibility by stretching. You’ll want to stretch your entire posterior lower extremity chain including the plantar fascia itself, the ankle and calf, and the hamstrings.
Secondarily, it is recommended that you begin to practice strengthening your feet and legs so that you can eventually use your muscles to help maintain proper alignment without allowing your foot to excessively collapse, which may re-aggravate your plantar fascia.
To assist with your foot posture, you can use an orthotic (to help maintain the arch in your foot) or a heel lift (decreases the mechanical load on the plantar fascia itself).
Short Term Recommendations To Alleviate Pain
The pain can be excruciating, so the first thing to do is to try to minimize this. You can try using a simple heel lift which helps to decrease the mechanical load on the plantar fascia. This should help with those first few steps until your regular stretching makes this more tolerable.
In addition, you can use a plantar fascia stretching splint which you can wear to sleep. This will help to stretch your ankle overnight so that you’ll be more flexible early in the day.
Lastly, if you notice that your feet excessively pronate and your arches collapse, try using an orthotic to help support your arches. By preventing your feet from pronating and flattening all the way, you’ll prevent the plantar fascia from getting fully stretched.
Lower Body Stretching For Plantar Fasciitis
By improving your flexibility in your entire lower extremity, you’ll decrease the strain on your plantar fascia.
1. Ankle stretch
The ankle stretch is best done with your full body weight. Keep your foot pointed straight ahead and push your knee forward while driving the heel into the ground. If your midfoot flattens, fold up a pillowcase to help support your arch (otherwise the stretch moves from the ankle to the middle of your foot). Hold 3 sets x 30 seconds.
2. Calf stretch
Similar to the ankle stretch, but repeat with the leg straight.
3. Plantar fascia stretch
Pull your foot up to your hands, and pull back the toes to stretch the plantar fascia. In addition to stretching it, use your knuckles or a massage tool to rub against the bottom of your foot to help break down some of the excessive scar tissue that may have built up. Try longer sets of 3 x 1 minute.
4. Hamstring Stretch
Two ways to do this one. You can do the easier one laying down with your leg up in the air (either use a stretching strap or place your leg on the wall) to help increase hip flexion with your leg straight. Or you can incorporate this stretch into many of your exercises. Perform a hip hinge with your knees straight until you feel the stretch in your hamstrings. Hold this for at least 30 seconds.
Foot Posture & Strength For Plantar Fasciitis
When doing any standing exercise, you’ll want to have good posture for the upper body as well as for your foot. The domed or “short foot” position is where you want your foot to be. Your foot should be like a tripod, with one point of pressure at the heel, and one point on either side of the forefoot.
When trying to maintain your arch, the forefoot behind the big toe should never come off the floor. To help cheat and get into the position, you can pull your toes up which will increase your arch. Then keep the arch as you relax your toes. Practice getting into this position before you do any standing exercise.
6. Static & Dynamic Balance
First, start with just standing on one leg. If you’re able to maintain balance with a proper arch, all of your foot muscles will be in their strongest position and you will maximize their recruitment.
Try this progression, and perform each one for either 10 seconds straight, or 5 reps without loss of balance
- Static standing
- Static standing with eyes closed
- Single leg hip hinge
- Single leg side kicks
- Single leg on bosu ball (flat side up)
- Single leg with halos (try 10% bodyweight)
7. Slow Heel Raises Off A Step
Perform calf and foot strengthening by doing single leg heel raises. By doing this off of a step, you’ll allow your heel to drop down further which will increase the stretch of the movement. Also, by doing this slowly, you’ll increase the time under tension, which will help stimulate more growth and healing in your connective tissues.
So don’t rush through this one by doing single leg hops, but instead try to make each repetition last for at least 4 seconds. Once you can perform 20 repetitions without too much fatigue, start doing this while holding a weight (try going up with about 10% body weight increments).
Long Term Plantar Fasciitis Advice
Your body will respond to the loads that you apply to it. Similar to an astronaut that gets weaker in space, if you live a sedentary life, your foot strength and tolerance will become accustomed to your lifestyle. To increase your tolerance, focus on your foot posture and modify your exercise regimen to include balancing and single leg exercises which will significantly improve your foot strength.