What is plantar fasciitis?
Plantar fasciitis is one of the most common diagnosis when a patient presents with a pain on the bottom of their foot. While there are numerous causes of foot pain, if the bottom of your foot hurts, especially at the heel you have probably irritated your plantar fascia. The Plantar fascia is a layer of strong and rigid connective tissue on the bottom of your foot, connected on one end to the base of your heel and to the other end at the balls of your feet. Running the length of your foot, this tissue gives shape and stability to your arch. When we are on our feet in any way the plantar fascia provides both rigidity and shock absorbing rolls. When walking or running the trailing ankle and foot bends(dorsiflexes), loading and elongating the plantar fascia. As we push off of our big toe, the elongated plantar fascia then provides a solid lever to transfer forces from your musculoskeletal system to the ground, providing forward motion. When walking or running, the leading ankle and foot extends(plantar-flexes), softening and shortening the plantar fascia. As we accept weight onto our foot, the softened plantar fascia absorbs our bodyweight and the ground reaction forces, controlling the amount of force we transfer to the ground and the amount of force that is transmitted up our leg.
Plantar fasciitis is a bit of a misnomer. The injury is the result of micro-trauma to the plantar fascia due to a dysfunction affecting the movement of the foot. However, the injury is now thought to be due primarily to a micro-tears of the fascia in the absence of inflammation.
Risk Factors - Arch height (another biggie: BMI)
The injury does not discriminate between those with high arches (too rigid), or low arches (too flexible), as the incidents of injury in these populations appear to be the same. The high-arched foot is not good at absorbing force, limiting the stretch of the plantar fascia, resulting in repetitive micro-tears in the tissue. The low-arched/flat foot, lacks the appropriate rigidity to transmit force through the foot. The result is that this foot collapses inward, loading the fascia for too long of a time with each step, again resulting in micro-tears in the tissue.
Home Treatment - Exercises
Treating plantar fasciitis requires consistent strengthening, stretching and soft-tissue mobilization for at least 2-3 months. If you have hyper-flexible/flat feet, focus your strengthening on your lower legs and hips. For the lower legs, strengthen the muscles that point the foot(plantar flexion) to restore the necessary rigidity and arch height. This can be done with heel raises. Please note, if you feel too sore to perform the exercises, skip to the stretching section and try again in a few days.
Heel Raises
Stand with your feet hip-width apart and near an object that you can use for balance. Now, simply rise up onto the balls of your feet, pause briefly at the top and then slowly lower yourself back down. Try a few sets of 10 and see how you feel the next day. If the pain in your foot has increased, back to gentle stretching for a few days. If your calfs are sore, but your foot is not, this is your exercise. If you are not fatigued or sore anywhere, progress to single limbs heel raises.
Single Limb Heel Raises
Stand with your feet hip-width apart and near an object that you can use for balance. Lift up one foot. Now rise up onto the balls of your stance foot, pause briefly at the top and then slowly lower yourself back down. Try two sets of 30 seconds on each foot, alternating. See how you feel the next day. If the pain in your foot has increased, back to regular heel raises for a few days. If your calfs are sore, but your foot is not, this is your exercise. If you are not fatigued or sore anywhere, progress to a simple but very effective calf and hip exercise combo.
Posterior Pelvic Depressions
Get good at this movement on BOTH sides. Work up to two sets of 1 minute on each side, alternating. Go slow and don’t try to break any records. Be sure to have your hands at or above the shoulders on the wall or something sturdy. Push into the object with your hands for 20 seconds, slowly building to a mild pressure. Now, focus on lifting the leg in a slight diagonal towards your mid-line, with the ankle leading the way. Lift the knee high, as you push your stance hip down into the ground, lifting up into the balls of your feet. The hip on your stance foot should drop down relative to the lifting hip.
This exercise is essential to restoring a healthy gait, and has carry over to running form. If you have back pain and don’t properly depress your pelvis when you walk(a lot of us do this!), you may find your back starting to feel better. If you have ever had a PT or trainer tell you that you are not firing your glutes properly, this is what they are talking about. Do these for a few weeks and then go show them your new glutes.
Home Treatment - Soft Tissue Mobilizations
If you have high arches/hypo-mobile feet, you will want to focus your efforts on soft-tissue mobilizations. Specifically, we want to target the plantar fascia and calf musculature. To mobilize the plantar fascia, we can use a LaCrosse ball.
Plantar Fascia Release/Massage
Place the LaCrosse ball on the floor, with the balls of you foot on the Lacrosse ball and your heel on the floor. Now press into the ball and roll your foot side to side over the ball, with your heel remaining planted on the floor. Try to envelope the ball with your foot as you move it side to side. Gradually move the position of the ball towards your heel as you move side to side. Once you can no-longer keep your heel on the ground, reposition your foot such that the balls of the feet are on the ground and the heel is resting on the ball. Continue the side to side motion. Plan to spend 2-3 minutes per foot.
Both foot types should utilize stretching as a treatment. Perform a classic calf stretch against a wall, in two knee positions.
Gastroc Stretch
Begin by standing a few feet away from a wall and leaning forward, supporting yourself with your hands. Now step back with the calf you want to stretch, and drive your heel towards the ground. Make sure your toes are pointed towards the wall and the knee on the stretched leg is straight. Hold for 1 min. Progress to the next position on the same leg.
Soleus Stretch
Bend the knee of the rear leg and hold for another minute. Repeat both positions with the other leg. Then do it all over again.
Home Treatment - Mobility
Ok. You have done your calf raises and calf stretches, lets get some more range of motion at your ankle.
Ankle & Foot Mobility
Be careful with your ankle, foot and toes with this mobilization. Don’t bounce off of end range tightness. I am rocking back and fourth in my available range of motion, gently up to my end range. When stretching the fore-foot and toes, bias your weight onto your hands to moderate the force you are placing on your knee and toes.
While traditionally more passive treatments have been used to treat plantar fasciitis, not surprisingly, the evidence of their effectiveness is mixed. Injury to the plantar fascia is almost always due to a movement dysfunction at the foot, ankle and hip. As such, corticosteroid injections, orthotics, shockwave therapy, etc., are short-term and dubious remedies to a problem that requires a movement solution. Should you find yourself with a new onset of foot pain or have been suffering from chronic foot pain, start with exercises I detailed above. If your pain is not moving in the right direction, please reach out to me via my website(button above) and we can chat about some strategies.