3 Physical Therapy Exercises for Plantar Fasciitis

Summary

Plantar fasciitis is a condition involving pain on the bottom of the foot. Pain is usually felt with the first few steps in the morning and it can be aggravated with activities like prolonged standing or walking. In this article, we will discuss 3 physical therapy exercises for plantar fasciitis and 3 tests to assess your mobility and strength.

What is plantar fasciitis?

 

Plantar fasciitis involves pain on the bottom of the heel resulting from strain at the insertion of the plantar fascia on the heel. The plantar fascia is a band of strong connective tissue that extends from the heel to the toes.

Unfortunately, it affects approximately 2 million Americans each year. Plantar fasciitis one of the most common foot injuries that can limit your quality of life.

 

A few of the classic symptoms of plantar fasciitis include:

 

  • Pain on the bottom of the heel usually on the inside portion of the heel
  • Pain with the first few steps in the morning
  • Pain with walking, running, jumping or placing weight on the foot
  • Pain after prolonged inactivity

 

Find out if you have these 3 signs of plantar fasciitis here. 

 

Physical therapy exercises for plantar fasciitis should focus on improving the factors that contribute to the pain. There are many factors that can contribute to plantar fasciitis and a physical therapist will help you to identify the most important ones relevant to your specific situation.

What are the contributing factors to plantar fasciitis?

 

A few of the most important factors include:

 

  • A sudden increase in load to the plantar fascia
  • Increased body mass index (BMI) - except for athletic populations
  • Weakness in the hip and lower leg
  • Decreased ankle or big toe mobility

 

Your physical therapist will perform tests to measure your BMI, strength, and mobility. In addition, they will analyze your movement with activities like heel raises, balancing on one leg, and walking.

What is the importance of a physical therapy assessment?

 

There are hundreds of exercises you could do for plantar fasciitis. How do you know which exercises will help you the most?

The physical therapy assessment is a key part of recovering from plantar fasciitis because it helps you determine which exercises are likely to help you the most.

 

Physical therapy exercises have variables such as:

 

  • Number of repetitions
  • Sets
  • Resistance
  • Frequency
  • Range of motion
  • Intensity

 

An assessment will determine HOW you should be performing an exercise to achieve your desired outcome.

On the other hand, if you start performing random exercises without proper supervision or implementation, you may find yourself still struggling with plantar fasciitis months down the road.

What are the top 3 physical therapy exercises for plantar fasciitis?

 

It's in our human nature to want to know the BEST exercise for plantar fasciitis. There is no ONE best exercise.

As mentioned above, plantar fasciitis has many contributing factors. It doesn’t make sense to have one magic pill exercise that “cures” and “fixes” plantar fasciitis nor does the research support such exercise.

magic pill

Recovery from plantar fasciitis involves different exercises, stretches, and movements.

The good news is that you have the potential to restore function of your feet without surgery or pain medications.

Rather than give you three individual exercises. I am going to describe my favorite three categories of physical therapy exercises. I will show you an example of one exercise in each category in addition to a quick test you can do at home.

Describing these categories will be more beneficial to you because the specific exercises that will help you depend on the results of your physical therapy assessment.

 

My selection of exercises are influenced by three main sources:

 

  • The latest clinical practice guidelines from the American Physical Therapy Association
  • My four years of full-time practice in an orthopedic physical therapy clinic
  • Consulting with other experienced physical therapists and doctors

Exercise Category #1 – Lower Leg Strengthening

Strengthening the muscles of the lower leg and foot will help to decrease strain on the plantar fascia and facilitate recovery.

These strengthening exercises can be gradually progressed. The resistance, reps, sets, and other variables can be changed to increase or decrease the difficulty of the exercises.

Example: Single Leg Heel Raises

 

Heel raises strengthen the calf muscles. The calf muscles are comprised of the gastrocnemius and soleus. These two muscles attach to the heel by the Achilles tendon. There is a photo of these muscles further down the article.

Single leg heel raise starting position crop

Starting position

Balance on one leg and keep the knee straight. Place your fingertips on a wall for support if needed.

Single leg heel raise 2 crop

Ending position

Elevate the heel off the ground as high as you can while keeping the knee straight.

If single leg heel raises are too hard or cause pain then you can do double leg heel raises with both feet on the ground.

Test Your Calf Strength

 

The test for calf strength is very similar to the exercise shown above; however, the movement is performed with specific protocol.

I will summarize the basic elements of the protocol; however, a physical therapist can help you perform this test with better precision. The photos are the same as above.

Single leg heel raise starting position crop

Starting position

Balance on one leg and keep the knee straight. Place your fingertips on the wall for balance. The bent leg should not touch the leg on the ground.

Single leg heel raise 2 crop

Starting position

Elevate the heel as high as you can while keeping the knee straight. Perform as many heel raises as you can.

When do you stop the test?

Stop the test when the knee starts to bend or when you can no longer lift the heel as high as your first repetition.

The image on the right shows my knee starting to bend. Stop the test when you notice the knee bending.

The knee bends because the calf muscle starts to fatigue and can no longer maintain the knee in a straightened position.

Also, stop the test if you start using your hands or fingertips to help you elevate the heel off the ground.

Single leg heel raise knee bending crop

How many heel raises can you do?

 

A 40-49 year old male should be able to complete 32 heel raises.

A 40-49 year old female should be able to complete 24 heel raises.

 

If you were unable to complete the normal values for your age range, then there is weakness in the calf muscle. The majority of people I test in the clinic have calf weakness which can be one contributing factor to plantar fasciitis.

Exercise Category #2: Mobility

Improving the mobility of the calf muscle, ankle joint, and big toe will be beneficial. Big toe mobility has the largest contributing role to plantar fasciitis.

The standing calf stretch can be used to improve ankle mobility by stretching the two main muscles of the calf: the gastrocnemius and soleus.

A brief look at the anatomy of the calf muscles:

achilles-tendon-main

Tightness in the gastrocnemius and soleus muscles can limit dorsiflexion of the ankle joint.

The standing calf stretch helps to improve dorsiflexion of the ankle joint.

Example: Standing Calf Stretches

Standing calf stretch crop

Standing calf stretch with the knee straight

Stretches the gastrocnemius muscle.

Standing soleus stretch crop

Standing calf stretch with the knee bent

Stretches the soleus muscle.

Dorsiflexion involves movement of the ankle upwards. Approximately 20 degrees of dorsiflexion is needed for daily activities.

Adequate dorsiflexion will reduce strain on the plantar fascia and improve the mechanics of your body.

 

dorsiflexion

Test Your Ankle Mobility

 

Now, we’ll do a test to check if you have adequate mobility in the ankle. A lack of mobility in the ankle can be a contributing factor to several common injuries including plantar fasciitis.

DF Test Start position crop

Starting position

Start in a lunge position with the toes of the front foot 5 inches from the wall.

DF wall test ending position crop

Ending position

Lunge forward and try to touch the front knee to the wall while maintaining the arch in the front foot.

When do you stop the test?

DF wall test pronation crop

Starting position

Start in a lunge position with the toes of the front foot 5 inches from the wall.

DF wall test heel up crop

Starting position

Start in a lunge position with the toes of the front foot 5 inches from the wall.

The goal of this test is to touch the knee to the wall without the arch collapsing or the heel lifting off the ground while keeping the knee in alignment with the ankle.

The inability to touch the knee on the wall shows a lack of ankle mobility.

Exercise Category #3: Foot Strengthening

The muscles on the bottom of the foot and lower leg are important to avoid plantar fasciitis.

A flat or overpronated foot can play a role during increased levels of activity or load.

The image on the right shows overpronation of the feet. The arch is collapsed and the big toe is starting to drift inward.

Bunions develop when the big toes start to deviate inward as shown in the image.

It will be beneficial to strengthen the muscles that support the arch of the foot to provide more structural support to the foot.

Overpronated feet

Overpronated feet

Example Exercise #3: Standing Arch Lifts

 

Arch lifts can be performed in a standing or seated position. The goal is to activate and strengthen the muscles that raise the arch of the foot to reduce excessive strain on the plantar fascia during activities.

Pronated foot side view crop

Starting position: arch flat

In the image above, the arch of the foot is flat.

Supinated foot side view crop

Ending position: arch lifted

Raise the arch of the foot. Think of bringing the big toe and heel together to raise the middle portion of the foot.

Why is the arch lift important?

The posterior tibialis is one muscle used to raise the arch of the foot. 

 Weakness in the foot and excessive pronation can strain the posterior tibialis tendon. 

Consequently, it is common for people with plantar fasciitis to experience pain in the posterior tibialis tendon due to this strain.

The arch lift exercise is one way to promote pain-free strength in the foot.

tib posterior

Test Your Arch Control

 

Let’s take a closer look at the exercise above. It is important to learn how to control the position of your foot. Take time to practice arch control.

Ankle pronation crop

Starting Position

Let the arch of the foot collapse inward by dropping the middle part of the foot to the ground.

Ankle Neutral crop

Ending Position

Raise the arch of the foot by pushing the big toe into the ground. Keep all the toes on the ground and try not to let your knee move in or out as you raise and lower the arch.

Were you able to voluntarily raise the arch of the foot?

 

If you had difficulty with the arch lift, keep practicing.

If you have trouble controlling the foot with this simple activity, then it will be harder to control the foot during more complex activities like walking, running or playing sports.

Improving your foot strength and control will help you to recover from plantar fasciitis.

Honorable Mention: Activity Modification

 

Activity modification is not an exercise, but it probably the most important concept to cover when discussing physical therapy exercises for plantar fasciitis.

During the initial phases of recovery, it is often beneficial to reduce and modify activities to decrease strain on the plantar fascia.

In severe cases of plantar fasciitis, a doctor will prescribe a boot for someone with unbearable pain. A boot is an extreme example of reducing activity.

Once the pain and sensitivity has calmed down, one can transition out of the boot. Most people do not need a boot, but it may be necessary in certain situations.

The goal of a physical therapy exercise program is to gradually reintroduce activity and prepare the plantar fascia to tolerate the activity demands of your normal daily routine.

 

What activities would you start doing today if you had no foot pain?

Keep following my information to recover from plantar fasciitis.

What are your next steps?

 

Schedule an assessment with a physical therapist if you continue to struggle with pain on the bottom of your foot.

Take action today and make a wise investment in your longevity.

Need guidance? Click here.

Read these articles to learn more about plantar fasciitis:

Watch this video on plantar fasciitis and subscribe to our YouTube channel:

References

Martin, R. (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy,44(11). Retrieved January 8, 2019.

Lim, A., How, C., & Tan, B. (2016). Management of plantar fasciitis in the outpatient setting. Singapore Medical Journal,57(04), 168-171. doi:10.11622/smedj.2016069

Nahin RL. Prevalence and pharmaceutical treatment of plantar fasciitis in United States adults. Journal of Pain. March 26, 2018. Epub ahead of print.

Heel Pain—Plantar Fasciitis. Thomas G. McPoil, et. al. Journal of Orthopaedic & Sports Physical Therapy 2008 38:4, A1-A18

Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Spor 2014:n/a-n/a doi: 10.1111/sms.12313[published Online First: Epub Date]|.

Marc's profile crop

About the author: Dr. Marc Robinson, PT, DPT, Cert. MDT is a physical therapist based out of San Diego, California. He teaches individuals how to manage pain and injuries better using evidence-based exercise and neuroscience. His easy-to-understand approach empowers individuals to live an active life with greater freedom of movement.