Plantar fasciitis is marked by pain on the inside of the heel at the bottom of the foot and it usually starts slowly and builds over time.   The pain is often described as a "throbbing" pain without numbness that is worsened with increased weight on the feet and going up and down stairs.  The first few steps in the morning cause the worst pain.

The Plantar Fascia

The Plantar Fascia

What is the plantar fascia? The plantar fascia is a thick band running along the bottom of the foot1.  It starts from the heel and extends to the toes. The plantar fascia acts as a support and creates the arch of the foot.  As we walk, the band tightens and helps to propel us forward through the windlass mechanism2. It also helps with shock absorption1,2.  The plantar fascia consists of three bands, the medial, central and longitudinal. The medial band is the most likely source of pain in plantar fasciitis. Plantar fasciitis is a common cause of pain in the foot,  up to 15% of all foot patients1. Plantar fasciitis is marked by pain on the inside the heel at the bottom of the foot, which usually starts slowly and builds over time3.  Pain is often described as throbbing4 without numbness and is worsened with weight on the feet and stairs. The pain is worst with the first few steps in the morning5.  This is due to the shortening of the plantar fascia as we sleep5.  This pain in the morning  will gradually reduce as the tissues are stretched with movement.

What Causes Plantar Fasciitis?

Plantar fasciitis can be caused by excessively loading the tissues of the foot3.  This may include extended time in standing, standing on hard surfaces, standing with unsupportive footwear, a sudden increase in walking/running or a change in walking/running surface2.  Both high and low arches are related to the development of plantar fasciitis.  Excess body weight has also been shown to increase the stress on the feet. Changes in the lower body's movements are most strongly associated with plantar fasciitis, such as tight calves or hamstrings.  These factors should be considered as they will need to be changed for a long-lasting resolution of pain.

What Causes Plantar Fasciitis?

Exercises for Plantar Fasciitis

Exercises for Plantar Fasciitis

Plantar Fasciitis will commonly last for 12-18 months, with symptoms reducing after six weeks of treatment1.  As mentioned in the last paragraph, the first treatment should be reducing the load on the tissues of the feet.  This can be done through more supportive shoes and orthotics or reducing running/walking time.  We then focus on stretching the plantar fascia, calf and hamstrings.  Both muscles of the calf, the soleus and gastroc, should be stretched.  This can be done through the bent knee and straight knee calf stretches (Advanced Stretching Program).  We can also focus on releasing tight tissue in the plantar fascia and calves using a foam roller or hardball (Myofascial Release Exercises).  Finally, functional strengthening should be introduced as the pain subsides.  These exercises focus on various ways of strengthening (eccentric and concentric) in different positions (standing, sitting).  These exercises further focus stabilizing the lower leg and foot by strengthening the foot intrinsic muscles, Tibialis Anterior , Tibialis Posterior and the plantar fascia (Top 10 Strengthening Exercises).

About These Exercises

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About These Exercises

References

References

1. Lim, A., How, C., & Tan, B. (2016). Management of plantar fasciitis in the outpatient setting. Singapore Medical Journal, 57(04), 168-171. doi: 10.11622/smedj.2016069

2. Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., ... & Godges, J. J. (2014). Heel pain—plantar fasciitis: revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.

3. Hasegawa, M., Urits, I., Orhurhu, V., Orhurhu, M. S., Brinkman, J., Giacomazzi, S., ... & Viswanath, O. (2020). Current concepts of minimally invasive treatment options for plantar fasciitis: A comprehensive review. Current Pain and Headache Reports, 24(9), 1-11.

4. Johnson, R. E., Haas, K., Lindow, K., & Shields, R. (2014). Plantar fasciitis: what is the diagnosis and treatment?. Orthopaedic Nursing, 33(4), 198-204.

5. Cole, C., Seto, C. K., & Gazewood, J. D. (2005). Plantar fasciitis: evidence-based review of diagnosis and therapy. American family physician, 72(11), 2237-2242.


Free Physiotherapy Exercises
Plantar Fasciitis - Advanced Stretching Program Download
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Plantar Fasciitis - Myofascial Release Exercises Download
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Plantar Fasciitis - Top 10 Strengthening Exercises Download
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