Plantar fasciitis is a common reason people keep physical therapy in Durham. Plantar fasciitis can interfere with a number of activities including running. In this blog post we will cover what plantar fasciitis is, how to treat it with physical therapy and provide you with three exercises you can start working on at home.
What is plantar fasciitis?
Plantar fasciitis, or plantar fasciopathy as it is more appropriately named, is a condition of the connective tissue, or plantar fascia, in the bottom of the foot. Due to incomplete mechanics of the foot or ankle combined with an unexpected increase in activity, this tissue can become irritated and create inflammation in the surrounding tissues which can lead to pain. This pain is most usually present in the bottom of the foot just in front of the heel, and is most prevalent for the first few steps in the morning. It may also occur after a lot of weight bearing activity such as standing, walking, or running.
Risk Factor for Plantar Fasciitis
Plantar fasciitis is the most common cause of heel pain, and is most prevalent in individuals aged 45-63, although it can be present at any age. It is a common condition in any scenario where someone is spending a lot of time on their feet, and is especially prevalent among long distance runners. There are a few things that predispose individuals to plantar fasciopathy including an excessively high or low arch of the foot, and a decrease in ankle range of motion.
How do I Know if Plantar Fasciitis is causing my pain?
How do you know if your heel pain is being caused by plantar fasciopathy or plantar fasciitis without seeing a physical therapist? The best way is to make sure and have a thorough examination performed by a healthcare professional. However, there is one easy test you can perform, called the Windlass test, that can help provide some clarity. In a standing or sitting position with your feet flat on the floor, use your hand to raise your big toe as much as possible. If this recreates your heel pain, you are very likely dealing with a case of plantar fasciopathy.
Physical Therapy for Plantar fasciitis
The best exercises and ways to address this condition will vary from person to person, which is why it is so important to have a thorough examination performed by a physical therapist. Exercise combined with manual therapy and / or dry needling has proven to be the most effective treatment for plantar fasciitis, however, exercises alone can still be helpful. We will provide a few examples here of some things to try to decrease your heel pain. In general, the goal of treatment with plantar fasciopathy is to increase the mobility of the tight tissue in the foot and the ankle, and to increase the strength of the intrinsic muscles of the foot to help provide more stability and support to your arch.
Exercises for Plantar Fasciitis
Ankle Dorsiflexion Mobilization
In this exercise, the goal is to improve your ability of your ankle to bend, and your knee to come over your toes. To perform this exercise, go into a kneeling position with one foot out in front of you. With your hands clasped around your calf just under the knee, lunge your knee forward over your toes until your feel a stretch either in the achilles tendon/calf, or in the front of the ankle itself.
Plantar Fascia Stretch
In this exercise the goal is to stretch and improve the length of the plantar fascia in the foot. To perform this exercise, start on your hands and knees and tuck your toes up so you are on the balls of your feet. This might be enough for you to feel a significant stretch in the bottom of your foot. If not, sit back towards your heels. As you do, the pressure on your toes will increase and you should feel an increase in the intensity of the stretch.
Short Foot
In this exercise, the goal is to strengthen the intrinsic muscles of the foot to provide support and stability for your arch without relying solely on the connective tissue (plantar fascia) of the foot. This can be a difficult exercise to perform and often takes a lot of practice, so don’t give up! Begin in a sitting position with your feet flat on the floor. Think of drawing the ball of the foot towards the heel and raising the arch. You should avoid gripping the ground with the toes too much or curling your toes under your feet. You should feel muscle activation in the bottom of your feet and along your arch, and you may feel a slight stretch in your ankles. As you practice and become more proficient in this exercise, try to move it into more functional positions like standing, balancing on one foot, and incorporating into other exercises like a squat. As the strength of the muscles in the feet increase, the demand on the plantar fascia to maintain the arch of the foot will decrease, thus decreasing irritation.
Other Pain Relief Techinques
Another important piece of treating plantar fasciitis in the initial stages is providing support to the foot to decrease irritation and pain while tissues recover and the muscle strength improves. Cycling through different footwear throughout the week, along with the use of over the counter insoles with arch support, or the use of a metatarsal pad, has been shown to reduce pain in individuals with plantar fasciopathy. These will not solve the problems that created the issue initially, but they are important tools in managing pain short term.
One last piece of advice is incorporating soft tissue massage into your routine. As mentioned previously, exercise plus manual therapy has been shown to be most effective at treating plantar fasciopathy. Although it will not be as effective as seeing a manual therapist, in a pinch, a lacrosse ball or golf ball can be helpful to work through tissues in the bottom of the foot to decrease sensitivity and pain.
What’s Next
If these exercises and tools are not assisting with your pain, there may be something else going on in the ankle knee or hip that is contributing to your pain. There are many pathologies of the foot such as muscle and tendon strains, joint and ligament sprains, or pressure intolerances that can create pain in the bottom of the foot. That’s why it is so important to have a thorough understanding of the root cause of the problem so that those can be addressed.
If you’re dealing with foot pain or plantar fasciitis, contact us today to get started on your recovery to being pain free!
