avatarClyde Staley, PT, DPT

Summary

Plantar fasciitis is a common foot condition that can be managed and treated through modified exercise and targeted strength training to reduce pain and prevent recurrence.

Abstract

Plantar fasciitis causes debilitating heel pain, often due to improper loading of the plantar fascia, which is exacerbated by weakness in the foot's arch stabilizer muscles, sudden increases in activity, poor footwear, and changes in activity type. Contrary to resting, the article advocates for continuing exercise with modifications to manage and treat the condition. This includes non-weight-bearing cardiovascular exercises like cycling and swimming, as well as resistance training using machines or floor exercises that minimize heel pressure. The key is to address the root causes of plantar fasciitis by improving single-leg balance, calf strength, tibialis posterior control, ankle mobility, glute strength, toe strength, and core strength. The article suggests specific exercises to incorporate into a training routine to alleviate pain over time and reduce the chance of its return, emphasizing the importance of a strong core and lower body to decrease the load on the feet.

Opinions

  • Rest and icing may provide initial relief, but the long-term solution for plantar fasciitis involves active rehabilitation and exercise modification.
  • Plantar fasciitis is often a result of misuse rather than overuse, indicating a need for proper conditioning and gradual increases in activity levels.
  • Continuing to exercise with plantar fasciitis, while modifying training to accommodate the condition, is beneficial and does not exacerbate the injury if done correctly.
  • A comprehensive exercise program targeting specific muscle groups is crucial for both treating and preventing plantar fasciitis.
  • Engaging in a virtual consultation with a licensed physical therapist can provide personalized guidance for managing plantar fasciitis through exercise.

How to Exercise with Plantar Fasciitis

Photo by Erwans Socks on Unsplash

Plantar fasciitis is debilitating. Not being able to take a step without a sharp pain in your heel makes walking a chore. How is it possible to do strenuous exercise when walking across the room is such a challenge?

What is Plantar Fasciitis?

Plantar fasciitis is a general term for pain in the heel on the bottom of the foot. The plantar fascia is the connective tissue that helps support the arch of your foot. When the plantar fascia is improperly loaded, irritation and pain occurs. Pain usually occurs gradually, without any specific event causing it. Pain is often most severe when first getting out of the bed in the morning, and usually gets worse over time. Putting pressure on the heel, such as when standing and walking, intensifies pain. This can make walking and strenuous exercise very painful.

What Causes Plantar Fasciitis?

A common misconception is that plantar fasciitis occurs from overuse; walking too much, spending too much time standing, or overexerting yourself. This isn’t entirely accurate; plantar fasciitis is often caused by misuse. Plantar fasciitis happens when your body isn’t accustomed to the demands you’re putting on it.

Some actual causes of plantar fasciitis include:

  • Weakness and decreased muscular control of your arch stabilizer muscles
  • Drastically increasing your activity levels without adequate preparation (such as running a 5k on the first day you’ve gone running in months/years)
  • Poor or worn out footwear
  • Changing the type of activity you perform (such as walking on uneven terrain for extended periods of time when you haven’t done so in a long time)
  • Weakness or dysfunction of your core, hip, and thigh musculature

All of these examples place a new type of load on your feet and the muscles that support your feet. There are a few key muscles, primarily the posterior tibialis muscle, that are responsible for stabilizing the arch of your foot. If these muscles are being overloaded, or are not functioning properly, they will not properly maintain the arch of your foot, putting extra load on the plantar fascia. When the plantar fascia get overloaded, the result is inflammation and subsequent pain.

How to Exercise With Plantar Fasciitis?

Having plantar fasciitis does not mean stopping exercise altogether. In fact, this is the exact opposite approach you should take. There are two keys to consider when exercising with plantar fasciitis.

  • Modifying your training so that you can have an effective workout despite heel pain
  • Performing exercise with the intent to treat symptoms and prevent recurrence of heel pain

Resting and rolling your foot on a frozen water bottle are reasonable approaches for the initial stages of plantar fasciitis. However, the key to getting past plantar fasciitis is to address the cause of the pain in the first place, while continuing to train in a manner that prevents worsening of pain.

Modifying Your Training

While walking and weight-bearing exercise may be a challenge with severe plantar fasciitis pain, your training can be modified so that you can still have an effective workout.

If running or walking is too challenging with heel pain, try non-weight-bearing cardiovascular exercise such as cycling or swimming. These activities provide just as much benefit as running/walking, but with less impact on your feet when pain is most severe. Tactics such as interval training can be used to provide a challenge and keep the workout engaging (if low-intensity steady state exercise isn’t your thing).

For resistance training, resorting to machines may be the best approach in the short term if standing movements such as squats and lunges are too painful. Supine (flat on your back), quadruped (on hands and knees), and sitting exercises should put less pressure on your heels and allow you to challenge your core musculature at the same time.

If you can still perform weight-bearing exercise in a limited capacity, listen to your body and reduce the duration or frequency of your training if pain starts to increase. Some exercise is still far better than no exercise, and as long as pain doesn’t increase by more than 1–2 points on a 0–10 pain scale, you’re doing more benefit than harm by continuing to train.

Exercising to Treat Plantar Fasciitis

Contrary to popular belief, rest is the opposite thing we want to do when managing plantar fasciitis, especially after the first 48–72 hours of symptom onset. Remember, heel pain is the result of misuse, not overuse. To treat plantar fasciitis and reduce pain recurrence, we must adjust our exercise to restore proper movement mechanics and properly load our feet and connective tissues.

Some areas to address in your exercise program include:

  • Single-leg balance
  • Calf strength
  • Tibialis posterior muscle control (arch support)
  • Ankle mobility and flexibility
  • Glute strength and muscle control
  • Toe strength and flexibility
  • Core strength and control

This may sound like a lot, but most of these areas can be addressed simultaneously or with a few simple additions to your training. Keeping our ankles mobile and strong is critical for proper mechanics with prolonged standing, walking, and running. Having strong glutes reduces the load placed on our feet and ankle musculature. Having a strong core reduces the load on all of the joints in our lower body, including our feet and ankles.

Some examples of exercises to include in your training (if you’re not doing them already) include:

  • Calf raises (knee straight and knee bent)
  • Glute bridges (double and single-leg)
  • Lunges
  • Step-Ups
  • Planks
  • Plantar fascia and toe-flexor stretch with towel
  • Active-assisted ankle dorsiflexion with movement
  • Soleus passive stretching
  • Tall-kneeling tibialis anterior stretching
  • Single-leg balance with Arch Doming

Try performing these or similar movements 1–2 times per week and watch your plantar fasciitis pain go away slowly over time, and continue doing them after pain subsides to reduce the likelihood of recurrence.

Bottomline

Plantar fasciitis is painful and debilitating, but that doesn’t mean you have to live with it forever, or stop exercising altogether. Modifying your training in the short term, and implementing exercise to address your heel pain are essential to maintaining a healthy lifestyle and reducing the duration and recurrence of pain long-term. Speak with a licensed physical therapist if you’re in need of more specific guidance or struggling to implement these approaches into your routine.

Thank you for taking the time to read my work. If you’re looking for more guidance on how to get over plantar fasciitis pain, or how to exercise through ongoing heel pain, click here for a virtual consultation with me.

If you’re interested in more fitness and training related content, follow me on Instagram here, and check out my other Medium articles.

Fitness
Physical Therapy
Exercise
Wellness
Pain
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