Injury Articles,  Rehabilitation

The Ultimate Guide to Treating Plantar Fasciitis

What is the Plantar Fascia?

The plantar fascia is a thick, fibrous band of connective tissue. Its origin is the medial surface of the heel, running along the sole of the foot like a fan, being attached at its other end to the base of each of the toes.

It is a tough, resilient structure that has a number of critical functions during running and walking:

  • It stabilises the metatarsal joints during impact with the ground.
  • It acts as a shock absorber for the entire leg.
  • It forms the longitudinal arch of the foot and helps to lift the arch to prepare it for the ‘take-off’ phase of the gait cycle.

A force equal to almost 3 times your body weight passes through the foot with each step.  On running, this is much higher and typically happens 90 times a minute.

Plantar Fasciitis

Plantar Fasciitis is thought to be a degenerative process rather than inflammatory due to damage of the plantar fascia in the form of micro-tears due to overuse.

Damage tends to occur near the heel, where stress on the fibres is greatest, and where the fascia is the thinnest. The fascia broadens as it extends towards the toes.

Plantar Fasciitis is often associated with calcaneal spurs. These are depositions of calcium where the fascia suffers most damage.

Signs & Symptoms:

1. Painful to walk first thing in morning

2.Feet are painful after standing, walking, running, specifically in the Plantar Fascia origin

3.Some Shoes are better than others

4. Tender on the sole of the foot closest to the heel.

Risk Factors / Causes:

1. Over Weight Increases the risk.

2. Flat Feet (Pronation Distortion Pattern)

3. Loss of Ankle Mobility

4. A sudden increase in training load

5. Poor Footwear

Treatment of Plantar Fasciitis

Initial Plan:

1.No Barefoot Walking

2.Wear Orthotics

3.Before Moving after rest – write the alphabet with your foot in mid air.

4.No Running

5.Find a Local Supplier of  Shockwave Therapy

Self Assessment:

So once you’ve taken care of the initial plan its time to assess yourself to figure out whats

causing your problem and what areas to focus on in your efforts to treat plantar fasciitis

and to prevent it coming back.

1. Foot Posture

If your feet look like this:

Then you need orthotics. Before you do anything else go see a local podiatrist or orthotist.

If your feet are a little less extreme then you may get away with not having orthotics, but in both cases you will want to do these following exercises to strengthen up your foot arches and work on the stability of your foot and ankle.

Fix 1. Towel Grab

Fix 2. 1 Leg Balancing

Fix 3. 1 Leg Mini Squats with Toe Taps

2. Big Toe Extension

Do these tests to determine 1. If you lack big toe extension 2. If its due to joint immobility or soft tissue restriction.

If you lack big toe extension, as you walk you’ll roll your foot into over pronation to compensate for the lack of mobility. This is usually one of the biggest causes of bunions.

Fix: Joint Restriction – Calf Raises with big toe extension

Fix: Soft Tissue Restriction – Calf Stretches 

& Plantar Fascia Rolling

3. Ankle Mobility

Do this test:

While doing the knee to wall test, if you have over 10cm then its good, 6cm or less is bad. Also look for symmetry between feet As above, if you lack ankle mobility, your compensatory pattern is to over-pronate.

Fix: Ankle Mobility Restriction – Knee Wall Tests

Fix: Ankle Mobility Restriction – Ankle Mobilisation

Fix: Soft Tissue Restriction – Calf Stretching

4. Pelvic Stability / Pronation Distortion Pattern

Is your problem from further up? Do you lack hip stability and glute strength that you cant control the biomechanics of the lower limb. Does your knee fall inwards? Tibia Internally Rotate? Feet Drop in and over pronate?

Have a look at this picture and compare it to yourself.

Fix: Clams

Fix: Side Lying Leg Raises

Fix: Side Plank

Fix: Monster Band Walks

Fix: 1 Leg Squats

Fix:  Bulgarian Split Squats

5. Glute Strength (or Weakness)

Following on from the previous point, are your glutes weak so that it allows the above posture to occur?

Test 1: Glute Bridge 60 seconds

Test 2: 1 Leg Glute Bridge 30 seconds

Summary 

If you are suffering with plantar fasciitis or even if you are not currently but noticed that you have flat feet or worse, the pronation distortion pattern shown above,  then this is what your are going to do:

Initial Plan:

No Barefoot Walking Until Pain Free

Wear Orthotics

No Running until you can walk pain free. 

Get Some Shockwave Therapy 

Week 1 

Roll Your Feet with a Tennis Ball / Spiky Ball 1-2 minutes per foot each day 

Stretch Your Calves (Gastroc / Soleus) 6 times per day for 1 minute each 

Week 2 

Continue with above but add in:

Big Toe Extension 

Ankle Mobility

Move into strengthening:

Isometric Calf Raises 45seconds x 5 every day at least (hold with heel at different heights to work full range)

Towel Grabbing for 2 minutes twice per day

1 – Leg Balancing 1 Minute per side each day

Week 3

Replace Isometric Holds with:

Concentric Double Leg Calf Raises (3 x 20 per day – 3/3/3 Tempo)

Week 4

Replace Double Leg Calf Raises with:

Concentric Single Leg Calf Raises (3 x 15 per day – 3/3/3 Tempo)

Glute Strengthening: Glute Bridges / Clams / Side Planks / Monster Band Walks

Week 5

Eccentric Calf Raises:

Up on 2  and Lower on 1 (3 x 15) 

6 second decent. 

Week 6

Eccentric Calf Raises:

Up on 2  (box or step) and Lower on 1 (3 x 15) – 6 second decent.

Bench Eccentric Lowers (3 x 15)

Maintenance:

Roll Feet 3-4 times per week 

Stretch Calves Daily 

Ankle Mobility / Achilles Strengthening /  Glute Strengthening 2-3 times per week. 

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