For a complete resolution of Plantar Fasciitis, it is crucial to employ the right combination of exercises[1]. You must incorporate four essential types of exercises to address Plantar Fasciitis: stretching, myofascial release, strengthening, and balance[1].
The prescribed exercises may vary based on the individual's needs[2]. Factors such as kinetic chain involvement, muscle imbalances, and previous injuries should be considered [2]. As a result, please regard the following information as a general guideline rather than a specific recommendation for a particular case. Technical aspects of these exercises, including biomechanical mechanisms and physiological effects, also contribute to their effectiveness in treating Plantar Fasciitis[3].
Article Index:
Red Flags
Before beginning an exercise routine, confirm that you are dealing with a straightforward case of Plantar Fasciitis and not another condition requiring immediate medical attention[1].
Caution: In most cases, Plantar Fasciitis pain is musculoskeletal and mechanical in origin[2]. However, if there are signs of a more severe issue, it is vital to consult your physician before attempting any recommended exercise routines[2].
Seek medical attention immediately if you experience any of the following:
Swelling of the feet is accompanied by intense pain, which does not subside after two or three days[3].
Severe foot pain following physical trauma, as it is crucial to rule out potential fractures causing the pain[3].
Symptoms of significant nerve compression, such as muscle atrophy or pain that remains unchanged with increased rest or alterations in body position[4].
Signs of infection including fever above 38°C (100°F), tenderness, warmth, and redness of the foot[5].
Inability to walk or bear weight on your feet[6].
Key Exercise Principles
Principle 1: No Pain... All Gain!
In contrast to athletic training, rehabilitation necessitates performing exercises within a completely pain-free zone, creating a safe environment[1]. Engaging in activities that cause pain can foster abnormal neuromuscular patterns and potentially exacerbate injuries[2]. Additionally, exercising through pain from tissue damage may lead to central sensitization, a process that heightens the nervous system's sensitivity to pain[3]. The solution is to perform exercises within a pain-free zone[4]. Patients who have endured pain while exercising for years are often amazed at how quickly they can break their pain cycle by adopting a pain-free approach[5].
Principle 2: Cultivate Your Power
Power is distinct from strength, representing maximum efficiency without exertion, while strength demands considerable effort and energy[1]. Increased power means less energy is required for tasks, leaving more energy for healing and growth[2]. Power generation is directly related to the quality of soft tissues, such as muscles, ligaments, and tendons[3]. Healthy soft tissues, like elastic cords, can stretch (storing energy) and contract (releasing energy)[4].
However, knots in a rubber cord impair its ability to store and release energy[5]. Similarly, soft tissues can develop restrictions and adhesions from micro-tears due to repetitive motion or scar tissue from injuries[6]. These restrictions hinder the body's energy storage and release capacity[7]. Myofascial release is an effective technique for enhancing power by improving soft tissue energy storage capabilities and addressing these energy leaks that deprive the body of energy needed for healing[8].
Principle 3: Build your Aerobic Base
A strong aerobic base is crucial for recovery, regardless of the injury's location [1]. The cardiovascular system transports oxygen and nutrients to cells and removes toxins and waste products, which are vital processes for healing[2]. Aerobic exercise enhances mitochondrial function in cells, directly impacting the body's ability to produce energy for healing[3]. This improvement allows for a more efficient conversion of nutrients into ATP (adenosine triphosphate), a readily usable energy form for all cells[4]. With increased energy, the body can better focus on healing injuries and eliminating waste, promoting faster recovery [5].
Scheduling Your Routines
Most patients follow this program for four to six weeks[1]. Focus solely on stretching and myofascial release exercises for the initial two weeks. In the third week, you can incorporate strengthening exercises into your routine[1].
Perform stretching exercises six days a week, while strengthening exercises should be done three days a week with a day between each strengthening session[2]. Allocate one day per week as a rest day, during which no exercises are performed[2].
Setting Program Expectations:
Do not anticipate significant changes during the first week, as you may experience increased symptoms[3]. However, by the conclusion of the four to six-week period, you can expect a substantial reduction in symptoms and an overall improvement in function[3]. Patients often discover that they are entirely pain-free[4].
Flexibility and Myofascial Release Exercises
Complete these flexibility and myofascial release exercises one to three times daily, six days a week. These will be the only exercises you perform for the first two weeks.
Foot Pain Relief - Self Myofascial Release
Foot mobility is of paramount importance in the prevention of injuries, the enhancement of sports performance, and the management of various foot conditions such as plantar fasciitis and bunions. Appreciating the far-reaching impact of foot mobility on the entire kinetic chain, including the ankles, knees, hips, and lower back, is essential. Targeted exercises can yield significant improvements by recognizing the interrelated nature of foot mobility and conditions like plantar fasciitis and bunions.
Sam's Daily Five Hip and Leg Stretches
Successfully resolving cases of Plantar Fasciitis often means addressing a larger kinetic chain. This routine increases flexibility in several regions, from calf muscles to hips.
Strengthening Exercises
Start these strengthening exercises in week 3, for 15 to 20 minutes daily, three to four days weekly.
Effective Foot and Toe Strengthening
Strong ankles, feet, and toes are essential for injury prevention and optimal sports performance. The anatomy and biomechanics of the foot and ankle complex play a vital role in maintaining the body's stability, balance, and movement.
Foot & Ankle Strengthening Routine - Using a Theraband (Follow Along Video): This foot and ankle strengthening routine works the flexors, extensors, and internal and external foot rotators using a theraband.
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Balance Exercises
Begin incorporating balance and proprioceptive exercises in week 4 of your program. We recommend starting with beginner-level exercises for the initial one or two weeks, allowing your body to adapt and build foundational skills. As you gain confidence and improve your balance, gradually progress to more advanced exercises to further enhance your stability and proprioception, promoting optimal recovery and long-term benefits.
Improve Your Balance - Exercises for Beginners
Balancing exercises are essential components of both Rehabilitation and Sports Performance training. These exercises should not be overlooked, as they can enhance one's ability to stabilize the body during functional movements. Incorporating simple balance exercises into a progressive training program can improve balance and prevent injuries.
Improve Your Balance - Advanced Exercise
Balance exercises can be of great benefit to people of any age. Balance exercises improve your ability to control and stabilize your body's position. Balance exercises greatly reduce injury risk, rehabilitate current injuries, or increase your sports performance.
Aerobic Exercise
When suffering from plantar fasciitis, it is essential to choose low-impact aerobic exercises that reduce stress on the feet while still promoting cardiovascular fitness. Some recommendations include the following:
Swimming: This non-weight-bearing exercise is gentle on the feet and joints while providing a full-body workout.
Water Aerobics: Water buoyancy reduces stress on the feet, making water aerobics an excellent low-impact exercise option for those with plantar fasciitis.
Cycling or Stationary Biking: Cycling allows you to maintain cardiovascular fitness without putting excessive pressure on your feet.
Elliptical Training: Elliptical machines provide a low-impact workout, minimizing stress on the feet while still working your lower body and improving cardiovascular fitness.
Rowing: Rowing machines engage the upper and lower body, offering a low-impact workout that minimizes foot stress.
For individuals with plantar fasciitis, it's important to introduce aerobic exercise to avoid exacerbating the condition gradually. To achieve optimum results, it is generally recommended to aim for at least 150 minutes of low-impact aerobic exercise per week, spread across several days. This could be broken down into 30 minutes daily, 5 days a week, or shorter sessions if needed.
However, each person's condition and fitness level may vary, and it's crucial to listen to your body and consult a healthcare professional before starting or modifying an exercise program. Your healthcare professional can help tailor aerobic exercise's frequency, duration, and intensity to suit your needs and ensure a safe and effective recovery.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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References
Taunton, J. E., Ryan, M. B., Clement, D. B., McKenzie, D. C., Lloyd-Smith, D. R., & Zumbo, B. D. (2002). A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine, 36(2), 95-101.
Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., ... & Carcia, C. R. (2014). Heel pain—plantar fasciitis: revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.
Riddle, D. L., Schappert, S. M. (2004). Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot & Ankle International, 25(5), 303-310.
Cheung, R. T., Sze, L. K., Mok, N. W., & Ng, G. Y. (2016). Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis. Journal of Science and Medicine in Sport, 19(9), 713-715.
Bolívar, Y. A., Munuera, P. V., & Padillo, J. P. (2013). Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis. Foot & Ankle International, 34(1), 42-48.
Sullivan, J., Burns, J., Adams, R., Pappas, E., & Crosbie, J. (2015). Musculoskeletal and activity-related factors associated with plantar heel pain. Foot & Ankle International, 36(1), 37-45.
DiGiovanni, B. F., Nawoczenski, D. A., Lintal, M. E., Moore, E. A., Murray, J. C., Wilding, G. E., & Baumhauer, J. F. (2003). Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain: a prospective, randomized study. The Journal of Bone and Joint Surgery, 85(7), 1270-1277.
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