• How to Treat Plantar Fasciitis With Exercise

How to Treat Plantar Fasciitis With Exercise; Part 2

Last time, in part 1 of this series, we discussed how plantar fasciitis occurs and its symptoms. The number of different treatment options available are just as numerous as the possible causes.

Initial treatment often simply involves avoiding activity that will aggravate the injury and to reduce any inflammation in the area. There is also the option of steroid injections in the injured area.  

Robert Crawford, MD in a 1999 study state that pain relief can be a short term treatment, but sustained pain relief is not a long-term solution.  If used in conjunction with other treatment methods it’s a viable measure to be taken, although John R Sellman, M.D in 2004 suggests that this treatment could increase the risk of plantar fascia rupture occurring.  

Shock wave treatment is another option being explored.  In 2003 Jan D. Rompe explored this method in a study that utilised extracorporeal shock wave treatment that aims to decompress the nerve endings and is used if it is thought that the calcaneal branches of the tibial nerve are trapped.

They found that their treatment improved the pain in 12 of their 20 subjects by around 50%, but 6 of the 22 subjects in the control group also noted similar improvements.

There are also more inexpensive, less invasive measures that can be seen as long term means for reducing pain caused by plantar fasciitis.

Exercise as Treatment

When looking at exercise as a treatment and/or rehabilitation tool for plantar fasciitis, activities such as stretching, massage, strengthening exercises, motor control re-education and biomechanical correction are some methods that can be utilised.

 Shoe inserts are believed to relieve the tension of the plantar fascia by maintaining the medial longitudinal arch height, but can also alter biomechanical risk factors such as hyperpronation, excessive rearfoot eversion or increased internal rotation depending on the individual.  

It has been suggested by Benedict DiGiovanni in 2003 that the combination of prefabricated shoe inserts and a stretching program was the most effective measure of reducing symptoms in sufferers of acute plantar fasciitis.

This is further supported by Craig Young who in 2001, states that stretching can correct functional risk factors such as tightness in the gastrocnemius and weakness of the intrinsic foot muscles.  

This method of rehabilitation fits with Kibler’s “weak link” model for explaining the causes of plantar fasciitis, where the tight structure is altering the normal mechanics of the foot.  

In the same study Young prescribes the use of a slant board when standing for prolonged periods in time, rolling the foot over a tennis ball and towel stretching to be done before getting out of bed .

These suggestions can be seen to be functional in that it is unlikely one would be able to stop work/standing for an extended period of time to recover.  

Similar exercises have been researched by Ivano A Costa (2007), who suggests that a combination of stretching, strength exercises, theraband and foot proprioception exercises should be performed in conjunction with one another for optimal results.

It is suggested that the theraband exercises, such as leg extensions and curls, are performed around three times per week as 2-3 sets of 15-20 repetitions and proprioceptive activities like 1 leg standing eyes open and closed and wobble board should be performed.

Comparisons of an Achilles tendon stretching program and a specific plantar fascia stretching protocol were conducted by DiGiovanni where both protocols show improvement in subjective pain levels, but the plantar fascia specific protocol having better overall results.  

Other exercises that may be undertaken in order to increase foot stability surrounding the plantar fascia are foot towel scrunches and scoops.

Prevention is better than the cure

Although these treatment options have been proven to have success in some patients, it’s easier if the injury could be avoided in the first place.

In a study by Ben Kibler and others 1991, pre-season and pre-participation examinations of the foot for possible weaknesses could be conducted in order to enhance early risk identification.

An emphasis on encouragement to stretch and undertake tasks to increase strength in and around the ankle structures may also prevent the condition. 

In summary, there is a range of causes and treatments for plantar fasciitis as a result of exercise.  There are no key indicators or stand out treatments to date for recognising and rehabilitating it however research has identified many avenues to look into. Research in this area may lead to predicting the occurrence of plantar fasciitis and avoiding the condition entirely.

References:

Kibler, W,B., & Goldberg, C. (1991). Functional Biomechanical Deficits in Running athletes with Plantar Fasciitis. (The American Journal of Sports Medicine. (19) 66-71.

Young, C,C., Rutherford, D,S., & Neidfelt, M,W. (2001). Treatment of Plantar Fasciitis. American Family Physician. 467-474.

Costa, I,A., & Dyson, A. (2007). The integration of acetic acid iontophoresis. Orthotic therapy and physical rehabilitation for chronic plantar fasciitis: a Case Study. 66-74

DiGiovanni, B,F., Nawoczenski, D,A., Lintal, M,E., Moore, E,A., Murray, J,C., Wilding, J,C., & Baumhauer, J,F. (2003). Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients with Chronic heel pain. The Journal of Bone and Joint Surgery. 1270-1277.

Emma Russo

Product Specialist

Emma is part of our Sports Scientists and Product team. She is the product owner of our individual elite athlete product, FitYou. She graduated with a Bachelor’s degree in Exercise and Sports Science.

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