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Treatment And Prevention For Plantar Fasciitis

The Plantar Fasciitis corrective exercise routines we use here at Shaping Concepts are divided into two types – those that emphasize stretching and those that stress strengthening.

There are numerous causes of plantar fasciitis and it’s best to consult with a trained fitness professional or podiatrist on the best treatment plan for your situation.

Stretching Routines For Plantar Fasciitis

The Rotational Hamstring Stretch

To perform this stretch, stand with your weight on your left foot and place your right heel on a table or bench at or near waist height. Face straight forward with your upper body and keep both legs nearly straight.

As you stand with your right heel on the table and your left foot on the ground, rotate your left foot outward (to the left) approximately 45 degrees, keeping your body weight on the full surface of your left foot (both heel and toes are in contact with the ground).

Lean forward until you feel a steady tension (stretch) in the hamstring of your right leg. Don’t increase the stretch to the point of pain or severe discomfort, but do maintain an extensive stretch in your right hamstring while simultaneously rotating your right knee in a clockwise – and then counter-clockwise direction for 20 repetitions.

As you move the right leg in the clockwise and counter-clockwise directions, stay relaxed and keep your movements slow and under control. After the 20 reps switch legs.

Lift your right leg up on to the table and repeat this clockwise and counter-clockwise stretch of the right hamstring, but this time keep the left (support) foot rotated inward (to the right) approximately 10 degrees as you carry out the appropriate movements. Perform 20 repetitions (clockwise and counter-clockwise).

Finally, repeat this entire sequence of stretches, but this time have the right foot in support and the left foot on the table for the repetitions (do 20 clockwise and counter-clockwise reps with the left foot on the table and the right (support) foot turned out 45 degrees, and 20 more reps with the right foot turned in).

What is the value of the Rotational Hamstring Stretch for treating Plantar Fasciitis?

Tight hamstring muscles can lead to limited extension and exaggerated flexion of the knee during the running stride (they tend to pull the lower part of the leg backward).

This over-flexion at the knee actually increases the amount of dorsiflexion at the ankle during the landing phase of the running stride (remember that the entire leg functions as a kinetic chain; change one thing, in this case hamstring flexibility, and that change will ripple right down the leg to the ankle joint).

Increased flexion of the ankle creates a high amount of stress on the Achilles tendon (the Achilles tendon’s ‘job’ during running is to control dorsiflexion of the ankle), which in turn pulls on the heel bone and plantar fascia.

The rotational hamstring stretch ensures that hamstring flexibility is developed in multiple planes. The hamstrings undergo movement stresses in both of these planes during the running motion and therefore must have flexibility in both planes to avoid overstressing the plantar fasciae.

The Tri-Plane Achilles Stretch For Plantar Fasciitis

To carry out this stretch stand with your feet hip-width apart and your left foot in a somewhat forward position compared to your right foot (it should be about six to 10 inches ahead). Shift most of your weight forward onto your left leg and bend your left knee while keeping your left foot flat on the ground. Your right foot should make contact with the ground only with the toes.

Move your left knee slowly and deliberately to the left. As you do so, also attempt to point the knee in a somewhat lateral direction. You should be able to feel this side-to-side and rotational action at the knee creating a rotational action in your left Achilles tendon.

Bring the knee back to a straight-ahead position, and then move it toward the right. As you move the left knee to the right, again rotate the knee somewhat, this time to the right, creating more rotation at the Achilles tendon.

When you bring the left knee back to the straight-ahead position, you have completed one rep (you should perform 20 total repetitions). Make sure that you keep most of your weight on the left leg while performing this exercise.

Repeat the entire action described above for 20 reps, but this time with your right leg bearing your body weight and doing the side-to-side and rotational movements.

What is the value of the Tri-Plane Achilles stretch for treating Plantar Fasciitis?

The Achilles tendon inserts directly into the heel bone on the back of the foot. The plantar fascia is attached to the heel bone on the underside (sole) of the foot. During the running stride each component of the body’s support system (hip, thigh, lower leg and foot) is responsible for controlling and dissipating a portion of the impact force associated with landing.

Insufficient flexibility in the Achilles tendon during the landing phase can lead to overstress of the plantar fascia, since the plantar fascia must then do more than its fair share of the work (a tight Achilles tendon tends to throw the foot forward onto the plantar fascia as impact is made with the ground, magnifying the stress on the plantar fascia).

The frontal-plane and rotational movement of the knee during the tri-plane Achilles stretch forces the Achilles tendon to undergo rotation, and this rotational component of the stretch ensures that Achilles flexibility is developed in multiple planes. The Achilles tendons, like the hamstrings, undergo movement stress in both of these planes during running.

The Rotational Plantar Fascia Stretch

Stand barefoot, with your feet hip-width apart and with your left foot in a slightly forward position – two to three inches ahead of your right foot. The bottoms of the toes of your left foot should be in contact with a wall in front of you (the wall should be creating a forced dorsiflexion of the toes, so that the sole of the left foot is on the ground but the toes are on the wall), and your left knee should be bent slightly. Keep your weight evenly distributed between your right and left foot to start the exercise.

Slowly rotate your left foot to the inside so that most of the weight is supported by the “big-toe side” of the foot. Then, slowly rotate your left foot to the outside, shifting the weight to the “little-toe side” of your foot. Repeat this overall movement for a total of 15 repetitions. Next, simply repeat the above sequence with your right foot.

Note: As you become more comfortable with this exercise, gradually shift more of your weight forward onto the forward, ‘stretched’ foot and ankle. This shift in weight will increase the intensity of the stretch.

What is the value of the Rotational Plantar Fascia Stretch?

The plantar fascia runs the length of the foot from the heel bone to the toes. During a running stride, the plantar fascia undergoes a rather sudden lengthening and then shortening during the landing phase – much like a rubber band that is suddenly stretched and then allowed to shorten.

This elastic event requires the plantar fascia to be sufficiently flexible and strong to handle such stress. Insufficient elasticity in the plantar fascia combined with the tendency to over-pronate (which puts extra stretch on the plantar fascia) will almost certainly lead to problems.

Strengthening Exercises for the Plantar Fascia

Toe Walking
Barefoot, stand as tall as you can on your toes. Balance for a moment and then begin walking forward with slow, small steps, with each step being about 10 to 12 inches in length. As you do this, maintain a tall, balanced posture. Walk a distance of about 20 feet for a total of three sets.

What is the value of this exercise?
The muscles of the feet require good strength to control the forces associated with landing on the ground during the running stride. This toe-walking exercise helps to develop the strength and mobility in the muscles of the foot and calf, as well as the plantar fascia and Achilles tendon.

Toe Grasping
To perform this exercise, stand barefoot with your feet hip-width apart. In an alternating pattern, curl the toes of your right foot and then your left foot down and under, as though you are grasping something with the toes of each foot. Repeat this action (right foot, left foot, right foot, etc.) for a total 25 repetitions with each foot. Rest for a moment, and then complete two more sets. You can also try picking up objects like golf balls with your toes for this exercise.

What is the value of this exercise?
Toe grasping develops strength, coordination and flexibility in the muscles of the foot that run parallel to the plantar fascia and help support the arch of the foot. This exercise also strengthens selected stabilizing muscles of the calf and shin.

Additional Recommendations
Since PF is the result of mucle imbalances you should work to improve strength and flexibility in the entire chain (from hips to feet). This is best accomplished by performing exercises that integrate instead of isolationg the leg muscles. Functional strength training exercises be it from bodyweight to any type of external resistance can be used (dumbbells, free weights, kettlebells, bands, medicine balls, etc).

Some good exercises include: squats, lunges, single leg RDL’s, step-up’s, bulgarian squats, and hip bridges just to name a few. Avoid “isolation” machines like the hamstring curl, leg extension, leg abduction/adduction, and the like. The fixed isolation can further exacerbate muscle imbalances and actually make your situation worse.

Consult with a certified personal trainer who is knowledgeable in kniseiology or with an athletic trainer, physical therapist for instruction. Please keep in mind if you currently have a bad case of PF, you’ll need to start slowly with the exercises to avoid aggravating your condition.

For additional information on treatment and prevention of plantar fasciitis, check out this great resource from Kenny Myers: “21 of the best blogs for people with plantar fasciitis.”

Note On Using Orthotics For Plantar Fasciitis

Prescribing orthotics for pf is assuming the problem lies directly with the feet. Remember tight hamstrings and other muscle imbalances are typically at the root cause of pf, and the orthotics will do nothing to correct the real problem.

You’ve got to think of your plantar fascia as being part of an interactive chain of muscle and connective tissue which runs from your hip down through your toes. If you want to correct PF you have to work on the entire chain.

Even if your PF problem is truly the result of “weak feet”, does it make more sense to install a brace under your feet as a patch fix – or work on eliminating the problem by improving overall foot (and leg) strength?

While I’m not saying you shouldn’t look at orthotics or use them for that matter- they can be helpful. What I am saying is so you shouldn’t look at them as the “single solution” that will fix your PF problem.

Also remember that icing, anti-inflammatories, etc. are only temporary cures for PF. They do not provide a fix. The only true plantar-fasciitis correction strategy is to increase the overall strength and flexibility of your legs and feet as part of the program.

Shane Doll CPT, CSCS is a certified Charleston Personal Trainer, fitness expert, speaker, and founder of Shaping Concepts Personal Training Studios. Learn more how you can receive a FREE trial of his Charleston personal training programs and experience the Shaping Concepts difference for yourself.
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