The Foot Specialty

Practice

Plantar Fasciitis

Plantar fasciitis is probably the most Fibrous Band of Plantar

common cause of heel pain in adults. The plantar
fascia is a thick band of fibrous connective tissue
that attaches to the heel bone, runs across the
bottom of the foot and then fans out to attach at
Area of pain
the base of each toe, about the ball of the feet Heel bone
(Figure 1). It provides support for the arch of the (calcaneus)
foot, helps to lift the arch during normal walking,
and also acts as a shock absorber during walking
and running.

Overuse of this band of fascia (ligament),

most commonly during weight-bearing activities Treatments for Plantar
such as running or even extended periods of
standing, can cause small, repetitive tears in the Fasciitis include:
fibers that make up the fascia.
• Icing
The resultant inflammation and swelling • Exercises
produces the pain of plantar fasciitis. Damage is • Rest
most common in areas where the stress on the • Steroid Injections
connective tissue is greatest and where the fascia • Orthotics
is thinnest, as it curves around the heel. Pain • Splints
usually occurs at the attachment at the heel or in • Use of non-steroidal anti-inflammatory drugs
the arch itself. Plantar fasciitis is particularly (NSAIDs) to treat pain and inflammation
common in older people because the heel fat pad
that normally protects the plantar fascia in this
region thins with age. Patients with plantar
fasciitis typically feel sharp pain in the heel,
mainly on rising in the morning and at the Stretching Exercises
beginning of a walk or run, that may fade as the
foot warms up. The pain may also occur with Exercises are not only effective for the
prolonged standing and is sometimes relief of active plantar fasciitis, but also help to
accompanied by stiffness. minimize recurrence of this painful condition. This
brochure will provide practical instruction in the
use of some of these simple exercises.

Exercises for recovery from or prevention

of plantar fasciitis are generally divided into two
types: 1) Stretching Exercises, 2) Strengthening
Exercises.

Stretching exercises are used to increase

the flexibility of the muscles of the thigh and calf
and of the plantar fascia itself. Tightness in the
muscles of the leg can result in disproportionate
stress being applied to the plantar fascia during
walking and running, increasing the risk of injury. while bending both knees, putting a little more
Stretching exercises for the plantar fascia itself weight on the back leg. Continue until you feel
can increase the flexibility of the fascia and thus stretching in your lower calf. Hold the stretch for
reduce the potential for damage. Five examples 30 seconds and repeat 2-3 times on each side.
of stretching exercises with illustrations follow:

A. WALL GASTROCNEMIUS STRETCH

D. HAMSTRING STRETCH
The gastrocnemius is one of major muscle groups
in the calf. To stretch this The hamstring is a major
muscle, place your hands muscle of the thigh that
against the wall and stand with runs from just below the
both feet flat on the floor, one knee to the buttocks and
foot forward of the other lifts the lower leg and
(Figure 2). Keep the rearmost bends the knee.
leg straight and the foot pointed straight ahead.
Lean forward without arching the back, placing If the hamstring is too tight, the bend in the knee
your weight on the forward leg while bending it during walking and running is exaggerated, which,
at the knee. You should feel stretching in the in turn, results in increased pull on the heel bone
mid-calf of the straight leg. Hold the stretch for and too much tension in the plantar fascia.
10-15 seconds, release, and then repeat 6-8
times. Reverse the position of the legs and then To stretch the hamstring, lie with your back flat to
stretch the other leg. the floor with your eyes focused upward. Grasp the
back of the thigh with both hands and, with the leg
bent, pull the thigh until it is perpendicular to the
floor and then slowly straighten the knee (Figure 5).
B.
A. Repeat the exercise with the other leg.

The gastrocnemius can also

be stretched using a simple
exercise that can be
E. SEATED PLANTAR FASCIA STRETCH
performed while standing
on a stair (Figure 3). Stand
During normal walking, the
with the ball of the foot on
plantar fascia lengthens
the edge of a stair and
and then shortens as the
heels off the step. While foot lands. If the plantar
holding the banister for balance, rise as high as fascia is insufficiently
possible on the toes and then lower yourself elastic, repetitive length-
slowly as far as you can without rolling the foot ening and shortening can
inward or outward until you feel a stretch in the result in damage to the
calf. Hold this position for 1-2 seconds and then fibers of the fascia with
repeat 10-20 times. subsequent inflammation.
Exercises that stretch the
C. SOLEUS STRETCH plantar fascia can improve
its flexibility and help it
withstand the stresses that
The soleus is the other major
are placed on it without damage.
muscle in the calf. To stretch
this muscle, assume a position
similar to that for the Wall The plantar fascia can be easily stretched while
sitting. Sit on a chair or on the edge of a bed with
Gastrocnemius Stretch but with
one leg crossed over the other (Figure 6). Place the
both of the legs bent and the
fingers of the hand of the same side as the crossed
buttocks dropped (Figure 4).
leg across the base of the toes and pull the toes
Make sure your feet are facing back toward the shin while keeping the leg steady
straight ahead and not turned until stretch is felt in the bottom of the foot. Repeat
out. Gently lean into the wall the exercise five times for each foot. This exercise is
and keep your heels on the floor particularly effective when done before taking the
first steps of the day and after prolonged sitting or B. TOE WALKING
inactivity.
With your body erect and your hands
F. ROLLING STRETCH behind your back, walk on your toes
with the toes pointed straight ahead
The rolling stretch (Figure (Figure 9). As the foot is placed down,
7) is another simple way to allow the heel to come as close as
stretch the plantar fascia. possible to the floor without touching.
To perform this exercise, sit Then rise on the toes as high as
on the edge of a bed and possible before pushing off the
place your foot on a hard ground. Taking very short steps, walk
cylindrical object such as a across the room. Repeat the exercise
plastic water bottle or a with the toes pointed outward 30° and
ball. Roll the foot over the then with the toes pointed inward 30°.
object while maintaining pressure against it.
Continue rolling for 30-60 seconds, stop, and then
repeat for a total of five times. This stretch should
be performed three times per day. For pain relief
while performing the exercise, use a water bottle
C. HEEL WALKING
filled with cold water or chill the ball in the
refrigerator prior to performing the exercise.

With your body erect and your

hands behind your back, lift your
STRENGTHENING toes as high as you can and walk
across the room on your heels with
EXERCISES the toes pointed straight ahead
(Figure 10). Take very short steps
These exercises are designed to and do not allow the toes to touch
strengthen the muscles in the foot and ankle that the ground. Repeat the exercise
support the arch of the foot. Strengthening these with the toes pointed outward 30°
muscles will take stress off the plantar fascia. All and then with the toes pointed
of these exercises are best done barefoot. Three inward 30°.
examples with illustrations follow:

A. TOWEL TOE CURLS

SUMMARY
Lay a hand towel on an
uncarpeted floor and place
the bare foot on the towel
(Figure 8). Keeping the Inflammation of the plantar fascia, most
heel on the floor, curl the commonly as a result of overuse, is a painful
toes, pulling the towel and potentially debilitating condition. Icing,
toward you. Continue rest, and use of nonsteroidal anti-
pulling the towel with the inflammatory drugs (NSAIDs) can relieve the
toes until it is bunched pain but do little to treat the underlying causes
under the arch of the foot. of plantar fasciitis. Regular performance of a
Repeat this procedure 10 series of leg and foot exercises is not only an
times with each foot. As your feet get stronger, effective treatment for the pain of plantar
resistance can be increased by placing a soup can fasciitis but also an effective deterrent for
or other weighted object on the end of the towel. recurrence of this painful condition.

Please check with your doctor or podiatrist

before starting any exercise routine.