Plantar fasciitis is a condition in which the plantar fascia, a strong ligamentous type of tissue that supports the arch and connects from the plantar surface of the calcaneus (heel) to the phalanges (small bones) of the big toe and other toes, becomes irritated and inflamed causing pain and discomfort at the bottom of the heel. This pain can be dull or sharp or feel like a deep ache or burning sensation. Its classic symptom and most intense pain is usually experienced in the morning when getting out of bed and stepping down on your feet. Other periods of increased pain are when you stand after a period of prolonged sitting, have been standing on a solid surface for a long period of time, or after cessation of intense activities like running or jumping.
The title of this article, What is the Best Treatment to Quickly Heal Plantar Fasciitis, is a legitimate question for anyone suffering with the condition, especially when you consider that medical literature indicates that untreated plantar fasciitis typically lasts from 6 months to a year and can go much longer in some people before symptoms disappear. To most, even the low end of 6 months is an extremely long time to simply accept the pain and its negative impact on one’s quality of life.
One must also consider that the same medical literature indicates that those who have had plantar fasciitis are likely to get it again, especially if they did not engage in treatment to shorten the effects of their first bout of plantar fasciitis. Further, treatment for the quickest possible elimination of plantar fasciitis pains does not mean an occasional stretching of the calf muscles and massaging of the plantar fascia, but “consistent” engagement in a “comprehensive” program that incorporates all interventions known to address the underlying causes of the problem. An inconsistent and/or partial approach to the problem is not likely to eliminate the pain and offer the long-lasting solution you are seeking.
Risk Factors for Developing Plantar Fasciitis
In general, consistency means daily, and comprehensive means addressing all or most therapeutic intervention strategies:
- Correction or intervention strategy of any foot anatomical deviations that are contributing to stress and irritation on the plantar fascia
- Adoption of quality footwear with sturdy insoles that match the contour of the arch and support the plantar fascia in its role as an arch support structure. The addition of a heel cup or custom foot orthosis can help reduce some of the heel pain
- Stretching of tight calf muscles (gastrocnemius and soleus) to ensure proper range of motion and line of muscle pull for proper alignment
- Stretching of the plantar fascia
- Strengthen the extrinsic muscles that support the arch (Tibialis Posterior, Tibialis Anterior, Fibularis (Peroneus) Longus
- Massaging and other soft tissue mobilization interventions to the plantar fascia, and if applicable the calf muscles
- Strengthening Flexor Digitorum Longus and supportive foot intrinsic muscles
- Application of therapeutic devices to combat prolonged positional adaptations of the plantar fascia
NOTE: In the early stages of plantar fasciitis the application of RICE (Rest, Ice, Compression, elevation) is recommended to help control pain and inflammation. Specific to “ice”, it is recommended to take a small paper cup, fill it mostly full of water, and place it in the freezer. When it’s time to ice the planter surface of your foot, simply peel back to paper cut halfway exposing the ice and use it to perform ice massage in the bottom of your foot for approximately 5-10 minutes.
A CONSISTENT DAILY ROUTINE
When Awakening in the Morning
Sit on the side of your bed before stepping to the floor. Bring one leg up and cross it over the other leg and place it just proximal to the knee. In this position:
- Thumb Massage the plantar fascia. Using both thumbs, beginning at your heel and moving to your toes apply significant pressure. As you move your thumbs toward the toes, gradually spread them apart to also create a side-to-side pulling force covering the width of the plantar fascia. This will increase blood flow to the area, help warm the tissues, and provide a soft tissue mobilization effect to the plantar fascia.
- Perform 10-15 reps of this massage/soft tissue mobilization technique.
- Manually Stretch the plantar fascia. Cup the heel of your foot with one hand and with the other hand, pull the toes (especially the big toe) into a hyperextended position, hold for approximately 10 seconds, then push the toes into a flexed position. This will gently stretch the plantar fascia (as compared to the whole-body weight pressing down on the arch when you step down and bear the body’s weight) in preparation to stepping down and beginning weight bearing so that the initial stress to the plantar fascia is minimized.
- Perform 5 reps @ 10 second hold time of this stretching exercise.
- Recommended: When you step out of your bed, slip your feet into some comfortable and arch supporting padded slippers before you begin walking . . . . wherever you head to first after arising in the morning. This padded support to your feet helps alleviate the amount of stress when first weightbearing at the start of the day.
Throughout the Day – 2 to 3 Times
The plantar fasciitis sufferer needs to identify times during each day to engage in their self-administered plantar fasciitis therapy. I believe it is important to have what are often referred to as “triggers“, times or events that remind you to do something. In this case, to do the following:
- Standing Stretch of the calf muscles. In the standing position, lean forward against a wall keeping the knee of the back leg extended. You should feel a good stretch in the belly of the gastrocnemius muscle near the upper and posterior area of the lower leg. Next, while in the same position, bend the knee and lean forward to stretch the soleus muscle, which should be felt near the lower part of the posterior lower leg. Tight calf muscles have been shown to pull the calcaneus into a pronated position which places excessive stress on the plantar fascia. Developing flexibility in the calf muscles helps diminish abnormal forces being applied to the plantar fascia.
- Perform 3 reps of this described stretching technique for both the gastrocnemius and soleus muscle, holding the stretch position for 10-30 seconds.
- Standing Stretch of the Plantar Fascia. In the standing position with toes hyperextended and placed against a wall or specifically designed device, lean forward. This will focus the stretch on the plantar fascia. A tight plantar fascia pulls on the heel bone and creates a tensile traction force which produces pain.
- Perform 5 reps of this described technique, holding the stretch position for 10 seconds.
- Strengthen the calf muscles while the toes are hyperextended. In the standing position and with balls of your feet positioned on the edge of a stair or elevated platform and toes hyperextended and butting up against a structure, perform heel raises while keeping the toes in the hyperextended position. It is important to strengthen these muscles as strong muscles are better able to handle the stresses and strains placed on them without becoming injured or irritated. Further, strengthening the muscles while simultaneously stretching the planter fascia (toes hyperextended) provides a double targeted therapeutic stimulus to help heal plantar fasciitis.
- Perform 2-3 sets of 10 reps
- Note: There are devices specifically designed to facilitate this exercise
- Strengthen the extrinsic muscles that help support the arch. Specifically strengthen the Tibialis Posterior, Tibialis Anterior, and Fibularis (Peroneus) Longus muscles. While there are ways to work these muscles individually, I recommend that they be strengthened together using a device that challenges all these muscles when performing a back-and-forth movement that is also rich in stimulation of the proprioceptors within the muscles.
With only the involved foot standing on the device, support your body with a hand placed on a nearby wall, and repeatedly move your foot inward (inversion) and outward (eversion). This causes these three muscles to contract concentrically to overcome the resistive forces and to contract eccentrically to control or decelerate the movements – both serving to strengthen these muscles that contribute to supporting the arch.
- In a controlled manner perform multiple side-to-side movements
- Strengthen the Flexor Digitorum Longus and certain intrinsic muscles of the foot that support the arch. The Flexor Digitorum Longus and a few intrinsic muscles of the foot (muscles that originate in and act upon the foot) also help support the arch. In a seated position, place a towel on the floor in front of you. Place your foot on the towel and then proceed to pull the towel toward you by reaching your toes forward on the towel and then flexing your toes, pulling the towel toward your foot. Strengthening these muscles can help take some stress off the plantar fascia and therefore should be a part of comprehensive rehab program for planter fasciitis.
- Perform 2-3 sets of pulling the towel by reaching and then flexing the toes to pull the towel toward your foot. Pull as much of towel toward foot as possible
- Massage the Plantar Fascia. The morning massage of the plantar fascia was with your hands/thumbs while you sat at the side of your bed. Another way to massage the plantar fascia is to roll your foot back and forth across a small plastic ball or other device specifically designed for this purpose, or you could just use a golf ball.
- Perform for as many minutes that your busy schedule will allow
Before you Crawl into Bed at Night and During the Night
When we sleep at night our feet naturally assume a position of planter flexion (foot and toes pointed) and toe flexion (curled). This places the calf muscles and the plantar fascia in a “shortened” position. Then when you arise in the morning and place your foot on the ground to bear weight, it stretches or elongates the plantar fascia that has basically shortened during night. To prevent or minimize this effect:
- Apply a night splint. A night splint (soft brace, hard brace, or sock) positions the toes in an extended position and the ankle in a dorsiflexed position. This applies a gentle stretch to the plantar fascia so that it is already prepared to accept the weight of stepping when you arise in the morning. It should be noted that using a night splint has shown in studies to be an effective adjunct to treatment of plantar fasciitis. However, some people have difficulty wearing the splint and sleeping well.
- An alternative. If you do not want to or find it difficult or uncomfortable to wear the night splint sock, performing the same plantar fascia massage and stretch exercises that are performed in the morning is recommended before going to bed at night.
- Ice massage. If time permits, the application of an ice massage, especially during a time of flare up, can help soothe the pain.
Summary Chart of the Daily Comprehensive Treatment Plan for Plantar Fasciitis
Morning – Before Getting Out of Bed
Thumb massage of plantar fascia
Manually stretch of plantar fascia
Throughout the Day (2-3 times)
Standing stretch of calf muscles
Standing stretch of plantar fascia
Strengthen calf muscles with heel raises with toes hyperextended
Strengthen the Tibialis Posterior, Tibialis Anterior, and the Fibularis Longus
Strengthen the Flexor Digitorum Longus and intrinsic foot muscles
Massage of plantar fascia
Before Going to Bed at Night
Apply a night splint sock ______
Thumb massage of plantar fascia
Manual stretch of plantar fascia
By applying a “consistent/daily” and “comprehensive” therapeutic intervention program of effective and proven exercises of treatment to quickly heal plantar fasciitis as described above, you can dramatically speed your recovery from this chronic condition.
Lynn Perkes is a full-time faculty member at Brigham Young University-Idaho teaching courses in Kinesiology and Biomechanics, Applied Kinesiology and Assessment, Therapeutic Exercise, and other Physical Therapist Assistant classes. He writes part-time for ProHealthcareProducts.com, who sells healthcare, medical, therapy, fitness, and personal protective equipment and supplies.