Chiswick-Physio BLOG

 

The Best Plantar Fasciitis Stretches
Plantar Fasciitis
Plantar Fasciitis Stretch

Brief explanation of plantar fasciitis

The foot’s arch is supported by muscles, tendons, ligaments, and a thick structure called the plantar fascia. This fascia is a very strong, ligament-like structure that attaches to the bottom of the heel bone and spans out to the bottom of the toe joints. The plantar fascia is made of type I collagen, which provides excellent tensile strength and resistance to stretch and tension. This unique structure enables the foot to absorb shock on initial impact with the ground and propels the foot during the push-off phase during walking and running.

Plantar Fasciitis, also known as plantar heel pain or plantar fasciopathy, is characterised by tiny tears in the tissue due to repeated stress on the area over time. Though it is more common in people who are not very active, It can account for up to 8% of running-related injuries and can affect up to 10% of people in their lifetime.

Treatment of plantar fasciitis

There is no single solution for treating a condition, as different people react differently to exercise and other forms of treatment.

Without a clinical assessment, predicting which exercises will help alleviate plantar fasciitis symptoms can be difficult. Therefore, it is recommended to follow the “TEST is BEST” approach, meaning one should test the exercise and see if it reduces the pain score before and after exercise. As a result, some experimentation may be required to determine which exercises will be effective in self-treating plantar fasciitis.

The variability and extent of exercises needed to safely return to higher-load activities like running are vast, exceeding the scope of this blog. These often require individualised guidance from a physiotherapist, whose expertise ensures appropriate timing and intensity of activities, minimising re-injury risk and promoting optimal recovery.

Activity modification and education

Activity modification and patient education are crucial in managing plantar fasciitis. Educating patients about proper footwear, stretching techniques, and gradual activity progression can alleviate symptoms and prevent exacerbation. Patients can promote healing by modifying activities that strain the plantar fascia, such as excessive running, walking or standing. Additionally, understanding the importance of rest and incorporating supportive measures like orthotics or taping can enhance recovery. You can effectively manage plantar fasciitis through activity modification and informed engagement, leading to improved outcomes and decreased recurrence.

Let’s explore the different treatment options used at Chiswick-Physio for the early-stage treatment of plantar fasciitis.

Top plantar fasciitis stretches

Stretching the plantar fascia is a common treatment. Although it was once believed that stretching elongated the fascia, this is no longer true. Due to the fascia’s structural properties, it is impossible to stretch. Stretching may increase stretch tolerance and provide other benefits, but it does not elongate the fascia. We will explore the different types of stretches, their effects, and their benefits.

Plantar-specific stretching

A key function of the plantar fascia is to provide tension of the undersurface of the foot for propulsion when walking or running. You need good ankle dorsiflexion and great toe extension to create this force.

The DiGiovani stretch can improve the ankle and toe range if there is a restriction. Sit down and cross the affected leg over the non-affected one. Place fingers on the base of the toes and pull back towards the shin. Hold for 10 sec and repeat ten times, three times a day.

Plantar Fascitiis stretch

Standing toe extension and dorsiflexion against the wall

This stretch can also be performed to help improve great toe and ankle movement if it is a factor. However, it is difficult to manage the amount of load placed through the plantar fascia with this technique, and it is advised to be performed when symptoms are less acute and irritable.

Stand facing a wall. Place the toe of your irritable foot on the wall while keeping your heel on the ground. Keep your knee straight and move your irritable leg towards the wall. Hold this position for 10 seconds and repeat this movement for ten repetitions.

Standing Toe Extension

Mobilisation with movement

If ankle mobility is restricted alone, you can try a mobilisation with movement technique. Improving ankle mobility helps to improve the plantar fascia’s ability to absorb and transmit forces during weight bearing.

Place the irritable foot on the step with a strong resistance band around the front of the ankle and around the leg at the back. Move your body weight forward as far as possible by bending the knee of the front leg. Keep the sole of the foot on the step, and don’t allow the heel to lift. Slowly straighten and bend the front knee for a period of 1 minute. Repeat twice, three times a day.

Mobilisation with movement

Heel drop over step

It is now understood that there is a strong correlation between calf tightness and the severity of heel pain with plantar fasciitis. Stretching and improving calf mobility can help in reducing symptoms. An eccentric protocol is recommended rather than the prolonged static stretching of the calf that has previously been employed.

Standing on the edge of a step with both feet, raise onto your toes as far as possible. Lift the unaffected leg. Slowly lower the heel of the affected leg to drop below the step level. Place the affected leg down and raise on both feet again (Raise on both feet, lower on the affected leg only). Repeat, keeping both legs straight. Repeat three sets x 15 twice daily.

Top strengthening exercises

The common narrative with plantar fasciitis is that the load exceeds the plantar fascia’s capacity to cope, resulting in degradation of the collagen fibres and pain. Therefore, increasing the capacity to tolerate more load helps to reduce the pain over time. The key message is that strengthening exercises should not be used alone in managing plantar fasciitis; a multi-pronged approach should exist.

Progression of load and reduction of reps should be over a prolonged period and determined by irritation using the traffic light analogy. Let’s look at some exercises that can be used with people with plantar heel pain.

Short foot exercise

A good starting point for most sufferers of planter heel pain may be short foot exercise, which helps strengthen the foot’s small intrinsic muscles.

Focus on one foot at a time, and use the muscles in your arch to help draw your big toe toward your heel. You should feel a tightening of the arch. Keep the toes long and avoid clawing of the toes Hold for 5 secs and release. Repeat ten times, alternating each foot 3 times daily.

Short Foot

Digital Flexion

This exercise aims to help strengthen the toe flexors to help manage the forces needed in walking and running.

Sit straight in a chair with a resistance band looped around your big toe. Hold the other end of the band in both hands. Keeping your other toes firmly on the floor, allow the band to raise your big toe. Push your big toe back towards the floor against the band’s resistance, keeping the big toe long and avoiding clawing the toes. Hold the big toe down on the ground for 10 seconds x 10. Always ensure your other toes remain on the floor and do not claw.

Digital Flexion

Heel Raise 

The calf complex is the main shock absorber for the foot and ankle, and it manages up to 2 x BW during walking and 6-8 x BW during running. Strengthening this area is therefore important in managing plantar heel pain. This exercise has many variations, and it is recommended to start on a flat surface rather than over the edge of a step.

Stand up straight, facing a wall or supportive surface. Position a rolled towel on the floor. Place your toes onto the towel. Perform a calf raise, pushing up onto your toes. Hold this position for 2 seconds. Control the movement as you slowly lower your heels to the floor. Ensure you keep your knees straight throughout the movement. A key clinical point is that calf raises must be done slowly to decrease the risk of symptom flaring (3s up, 2s pause at the top and 3s down). Repeat 8-12 reps and three sets daily.

Progressions can be achieved by doing the exercise eccentrically, over the edge of a step and with load.

Heel Raise

Split Squats 

This exercise winds up the planter fascia by placing the irritable leg behind and replicates a similar position to toe-off during the walking and running gait.

Take a large step forward on your unaffected leg. Allow your back heel to lift and balance on your big toe. 80% of your weight should be on your front leg. Drop your hips directly down between your two feet, allowing both legs and hips to bend so that your knees are at 90 degrees and the shin of your front leg is vertical. Push back up to the starting position and repeat slowly. 3 x 10-15 repetitions.

Split Squats

Long Lever Bridge

This is a great exercise for working all the posterior chain muscles used in walking and running without placing too much load on an irritable plantar fascia.

Lie on your back, your feet on the floor, and your legs bent slightly. Squeeze your buttocks, roll your pelvis off the floor and straighten your hips. Hold the pelvis up throughout the exercise. Push through your toes to raise the heels. Hold this position for 5 seconds, and then lower your heels. Repeat the heel lift ten times, then lower your pelvis; repeat three times.

Long Lever Bridge

Cardiovascular exercise

If you experience heel pain, it may limit your functional activities like walking. This can lead to a decrease in your general fitness level. To prevent this, it’s important to address cardiovascular exercise. If running is not an option, you can consider cross-training. Several cardio exercises, such as swimming, rowing, and cycling, put less strain on the plantar fascia. However, being mindful of any pain during aerobic activity is important. If you experience pain after exercising, you may need to adjust the duration or intensity of your workout.

Additional tips for managing Plantar Fasciitis

Injections

Steroid injections are sometimes used for treating plantar fasciitis, but they may only provide temporary relief while increasing the risk of long-term complications. They pose several risks, such as tissue weakening, increased pain, and weakening of the fat pad in the heel, which helps shock distribution during weight bearing. Repeated or prolonged use of these injections can cause collagen degeneration and may worsen the condition with an increased risk of plantar fascia rupture. It is important to note that steroid injections only mask pain and do not address the underlying biomechanical issues, which can delay proper treatment.

Shockwave Therapy

For those unfortunate enough to experience Plantar Fasciitis for longer than three months, Extracorporeal Shock Wave Therapy (ESWT) may be an option. It involves delivering precise mechanical energy pulses to the affected fascia tissues, which helps promote and stimulate localized healing. As with other treatment methods, it must be done in conjunction with active exercise.

Taping

Plantar fasciitis is often treated with taping techniques like low-Dye variations. Taping helps reduce stress on the plantar fascia, support the arch, and promote proper foot alignment. It also enhances proprioception and reduces abnormal foot motion and strain on the irritated tissue. Taping is commonly combined with other treatments as part of a comprehensive approach to managing plantar fasciitis.

Taping

Footwear and insoles

Changing footwear is an easy method for individuals with plantar fasciitis to modify symptoms. However, no evidence suggests the optimal shoe design to help reduce symptoms. The correct shoes for any individual are only found by trial and error.

Any insert into a shoe, such as orthotics, heel cups and heel raises, has been shown to reduce pain and improve function in the short term. Interestingly, prefabricated foot orthotics are more effective than expensive bespoke and custom-fitted shoe inserts.

The recommendation for both shoes and orthotics is to ensure they have a heel cup and that the heel is raised. This will decrease force on the Achilles and fascia, reducing symptoms.

Precautions

The main precaution is to avoid progressing exercises too quickly, as this can worsen symptoms. This means that you should not push yourself too hard during exercises and should not increase the intensity of your workouts too rapidly. Instead, following the “traffic light” analogy of progression is recommended. This analogy involves gradually increasing activity levels based on the response to your pain. If the pain worsens, you should stop or reduce the activity. If the pain remains the same, you can continue the activity at the same level. If the pain improves, you can gradually increase the activity level. By adhering to this analogy, you can better manage and avoid worsening your symptoms.

Conclusion

In conclusion, it is recommended that not one form of treatment should be used alone in managing this condition, and it should be a multi-pronged approach. A successful recovery involves a variety of treatment options, and no two people are the same. Thankfully.

The key is that each individual should take a ‘Test is Best’ approach to assess whether the exercise or treatment helps to reduce symptoms. Activities must be progressed slowly to avoid irritation, and progressing to high-load activities is best achieved under the guidance of a physiotherapist who can help with the correct treatment choice at the correct stage of recovery.

Frequently asked questions

Is rest or exercise better for plantar fasciitis?

Activity modification is preferable to complete rest for plantar fasciitis as total inactivity leads to deconditioning, potentially prolonging recovery. Adjusting activities to reduce stress on the foot while maintaining low-impact exercises promotes healing and prevents muscle weakening, supporting long-term recovery and overall foot health.

What should I avoid with plantar fasciitis?

With plantar fasciitis, avoiding high-impact activities like running or jumping, wearing unsupportive footwear such as flip-flops or high heels, prolonged standing or walking on hard surfaces, sudden increases in activity levels, and ignoring pain signals. Instead, choose supportive shoes, gentle mobility exercises, and gradual activity progression.

How can I speed up my plantar fasciitis recovery?

To expedite plantar fasciitis recovery, employ a multifaceted approach: adhere to prescribed treatments such as stretching and strengthening exercises, wear supportive footwear, maintain a healthy weight to reduce strain on the foot; and consult a healthcare professional for personalised guidance.

Is heat or cold better for plantar fasciitis?

The effectiveness of heat or cold therapy for plantar fasciitis varies depending on individual response and the degree of irritation. Generally, cold therapy (ice packs) is favoured during the early and acute stages, while heat therapy (warm compresses) may alleviate stiffness and promote circulation with long-term chronic sufferers.

What causes plantar fasciitis to flare up?

Gradual progression in activity and avoiding overstretching are essential to manage symptoms effectively. Ignoring warning signs like foot pain or discomfort can exacerbate symptoms, and it is important to progress exercises considering the traffic light analogy. (link to blog)

Further reading

High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up

https://pubmed.ncbi.nlm.nih.gov/25145882/ 

Clinical and Biomechanical Effects of Low-Dye Taping and Figure-8 Modification of Low-Dye Taping in Patients With Heel Pad Atrophy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940598/#:~:text=Low%2Ddye%20taping%20(LDT)%2C%20was%20first%20developed%20by,7%2C8%2C9%5D

Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values

https://bjsm.bmj.com/content/bjsports/early/2021/05/09/bjsports-2019-101970.full.pdf

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