Written by Jon Kilian, Physical Therapist
Jon Kilian is a rehab and strength expert in VA who specializes in injury treatment that bridges the gap between strength and conditioning and traditional rehab. He currently is the practice manager of the clinic where he works and has rehabbed a plethora of musculoskeletal conditions of populations ranging from geriatrics to elite level athletes.
Have you ever experienced pain right on the bottom of your foot that didn’t seem to have any particular mechanism of injury? Chances are, you may have experienced, or are currently experiencing, symptoms of plantar fasciitis. This is a condition that involves the irritation of the structures that support the bottom of the foot and help with efficient force transfer through the lower extremities. When disrupted, this condition and associated symptoms can be absolutely debilitating – but the good news is it is highly treatable! Below are 12 options to educate you on self-management of this condition. As always, consult with a local physio/physical therapist or health practitioner before implementing these treatments.
Who? Plantar fasciitis has the highest prevalence in higher body mass index populations spanning the ages of 40 to 60 years with no difference between genders, and higher rates in runners (particularly distance) and those who have higher time periods of weight bearing during their jobs or lives.
What? Plantar fasciitis is typically described as an irritation or inflammation of the tissue on the bottom of your foot spanning from your heel to your toes.
When? This will most commonly affect those in the morning when they take their first steps or in other prolonged weight-bearing activities.
Where? Plantar fasciitis will generally be felt along the proximal medial plantar edge of the calcaneus (just under the right heel bone on the inside of the arch), or a bit further along towards the big toe (insertional vs. non insertional).
Why? This irritation of the fascia supporting the arch of the foot is thought to be caused by either joint or muscle mobility restrictions, weakness of the foot's intrinsic and ankle musculature, or overuse (doing too much too soon).
It is important to address this pain as soon as you can after symptoms arise due to the fact that the shorter symptom timeframes typically have a quicker response to treatment, and the longer someone has these symptoms, the harder it is to address them effectively in a timely manner.
Assessment
Not all foot pain is plantar fasciitis (PF); there are many different tissues and pathologies that involve the various structures of the feet. Common areas of pain that may suggest other tissue involvements include the backside of the heel (Achilles tendon), the plantar or bottom aspect of the heel (fat pad irritation), and pain along the inside of the calcaneus or heel (stress fracture). Once again, true PF will be reproduced with palpation of the arch of the foot closest to the heel, or further along towards the big toe. Other common symptoms include pain with initial steps after a period of nonweight bearing, increased with prolonged weight bearing, and pain that came about after a recent increase in weight-bearing activity. A quick test that can be completed to theoretically indicate PF irritation is called the Windlass test. In standing with your big toe off of a ledge, have a partner bend the toe upwards. Reproduction of pain at the bottom of the big toe, or along the arch of the foot could indicate a dysfunction with the involved structures contributing to the true cause of PF.
Treatments
Now that there is more understanding as to the specificity of “which tissue is the issue” (shout out to Sue Falsone), exercise and other interventions can be utilized to decrease pain, increase mobility and stability, and ultimately translate this newly acquired pain-free motion into systemic loading patterns to decrease the chance of re-injury.
Put out the fire
The first step is to put out the fire, or decrease immediate pain. There are many different ways of doing so, but listed are the top three ways that can be easily replicated at home with little to no specialized equipment.
1. Instrument assisted soft tissue mobilization (IASTM)
It is important to have some sort of medium so you aren’t scraping directly on the skin, but rather utilizing lotion to promote a glide. This doesn’t have to be specialized equipment; I tell my patients to use the backside of a butter knife – it works under the same mechanisms. At about a 45 degree angle, apply strong but comfortable pressure and scrape up and down the medial plantar fascia as seen in this video. The goal is to decrease pain, and create an acute localized inflammatory response that “restarts” the healing process bringing blood, nutrients and proteins that ultimately help collagen remodeling and tissue regeneration.
2. Soft tissue mobilization
You can utilize an object such as a tennis ball as seen here in order to mobilize the plantar fascia and theoretically decrease acute pains. I recommend a tennis ball versus a lacrosse ball as it is a bit more forgiving, but it is up to the individual.
3. Support taping
There are many different techniques and materials that can be utilized to tape and support the ankle/foot complex. In this video here, I use kinesiology tape which has less support and more elasticity than the commonly used athletic tape. For the patients that are more acute and flared up, I use athletic tape for more support and transition out to kinesiology tape to force them to begin to rely less on the passive treatment.
Mobility
Two different structures/tissues that can be targeted with mobility training are muscles and joints. Stretching is a common way of increasing flexibility through muscle lengthening, and self-assisted joint mobilizations can target the deeper tissues. Typically, with plantar fasciitis, we find more soft tissue dysfunction than joint limitations. Additionally, stretching has been shown to help with the acute pain response of the area and can be utilized in conjunction with the above-mentioned approach to “put out the fire.”
4. Foam roll gastrocsoleus complex
Foam rolling is a great tool that has been shown to have positive benefits on both muscle pain and flexibility. I’m using a brand called Rollga that I really like due to the ridges in the roller allowing for the heel and Achilles tendon to not be so compressed and to shift the point of contact to the medial and lateral gastrocnemius, or calf muscle. Spend a few minutes rolling through the length of the gastrocsoleus complex pausing on tender areas and even pumping the ankle a few times to mobilize the tissue under the pressure of the roller seen here.
5. Target stretching of the plantar fascia
This video shows a quick and easy method of stretching the plantar fascia utilizing the big toe extension range of motion. This can be utilized to either lengthen tissue or aid in pain reduction. Note: getting too aggressive here can actually flair the symptoms up, so keep it a mild intensity.
6. Stretching of the posterior ankle
An important distinction is how to bias both the gastrocnemius (calf) and soleus muscles as seen here. The gastrocnemius is most targeted with a straight knee position while the soleus muscle can be biased by driving the knee over the toe while allowing the knee to bend – both are important when addressing any ankle dorsiflexion restrictions which could contribute to plantar fascia pain.
7. Ankle DF self-mobilization
This is a great way to self-mobilize the joint as you stretch the tissues surrounding the ankle. Adding weight to the knee is an optional way of increasing the intensity. If there are joint mobility restrictions, this could lead to shortened tissue adaptations, and the drill shown can help clear up both. I first came across this specific treatment from Kelly Starrett and his book Becoming a Supple Leopard.
Stability
Many of the concepts in this section are based on utilizing the increased range of motion and pain reduction of the previous sections and cementing it with strengthening of the involved tissues. This will include both the intrinsic muscles of the foot as well as muscles up the kinetic chain supporting the arch and overall ankle stability, ultimately transitioning to control during systemic activities. It is important to note that the foot is designed to have movement in and out of the rigid arch (pronation and supination), so the goal is to not only stabilize this, but also have increased control of these movements during everyday life activities as required for correct movement.
A great starting point to increasing stability of the arch and activating the intrinsic
musculature responsible for this is by simply actively creating an arch. Aaron Horschig speaks a lot on the cue of “tripod foot” and gripping the ground with your feet during activities such as squatting to increase overall stability of the movement stemming from proper force transfer through a stable and rigid arch of the foot.
9. Great toe flexion
This exercise targets a few muscles such as Flexor Hallucis Longus and Brevis which flex the big toe and support the medial longitudinal arch. Theoretically, when weak or inhibited, this can put more strain on the plantar fascia causing irritation of the tissue. As a bonus, the band may also elicit a stretch of the PF when allowing it to pull the big toe up prior to flexing.
10. Heel raise with great toe flexion
This exercise combines the isolation of big toe flexion (arch support) and continued control of this with an increasingly global demand through range of motion. Isolation of the rigid arch is important, but means little if control is lost as soon as you start walking or performing other activities not in a neutral position.
11. Posterior tibialis raise
Much like the last step, this exercise activates a number of muscles, but also one in particular that supports the arch through plantar flexion and inversion of the ankle/foot complex called the posterior tibialis. This is continuing the transition of isolation of intrinsic foot musculature to a more global pattern of movement requiring other muscles to work in tandem with a supported arch for a given pattern.
12. Banded squat
In my humble opinion, the squat is the most functional movement you can complete. Humorously, I had a colleague by the name of Jamie that used to say “if you can’t fix it with squats, you’re probably going to die”. Now, while a hyperbole, there is some truth to it as this movement, when done correctly, can address a plethora of dysfunctions and injurious physiological states.
For our purposes here, the two bands (one around the knees, and one around the ankles) help to reinforce good kinematic principles of the lower extremity cueing the body to create a rigid foot and arch while performing a full body exercise. It is important to maintain the “tripod foot” and the arch by pressing the big toe into the ground and maintaining tension through both bands. This, again, is the theoretical transition from the skill of controlling arch movement in an isolated fashion to activities of daily living.
As previously stated, these treatments are most effective the sooner they are implemented after symptoms arise as outcome measures are shown to be significantly better than if these exercises are implemented after a time.
Disclaimer: The content written for Brainz Magazine by the author is for information and educational purposes only. It is not intended for medical advice nor does it take the place of medical advice from a qualified doctor or other healthcare provider. The information provided should not be used as a diagnostic tool to suggest, confirm, contradict, or rule in/out any medical diagnoses. Readers should consult with their own qualified healthcare team for individualized health concerns, questions, or treatment.
Jon Kilian, Physical Therapist
Jon Kilian is a leader in where musculoskeletal rehab and strength and conditioning collide for a variety of populations. As a Physical Therapist, he knows how to give the body an environment to adapt and heal from injuries and as a strength specialist he knows how to load them to prevent those injuries from happening again. Kilian has a passion for introducing people to the true strength and resiliency they are capable of and reminding them that there is an athlete inside of us all. His mission: to disseminate information, promote strength, and return independence to the individual.
References:
Huffer, D., Hing, W., Newton, R., & Clair, M. (2017). Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Physical therapy in Sport : Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, 24, 44–52. https://doi.org/10.1016/j.ptsp.2016.08.008
Kim, J., Sung, D. J., & Lee, J. (2017). Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: Mechanisms and practical application. Journal of Exercise Rehabilitation, 13(1), 12–22. https://doi.org/10.12965/jer.1732824.412
Koc, T. A., Jr, Bise, C. G., Neville, C., Carreira, D., Martin, R. L., & McDonough, C. M. (2023). Heel pain – plantar fasciitis: Revision 2023. The Journal of Orthopaedic and Sports Physical Therapy, 53(12), CPG1–CPG39. https://doi.org/10.2519/jospt.2023.0303
Wiewelhove, T., Döweling, A., Schneider, C., Hottenrott, L., Meyer, T., Kellmann, M., Pfeiffer, M., & Ferrauti, A. (2019). A Meta-Analysis of the effects of foam rolling on performance and recovery. Frontiers in Physiology, 10, 376. https://doi.org/10.3389/fphys.2019.0037
