Plantar fasciitis is the most common source of heel pain. More recent evidence suggests that thickening and structural changes are more common than inflammation, so "plantar fasciopathy" more accurately reflects the diagnosis. Plantar fasciopathy is an overuse injury from repetitive stress to the plantar fascia. The good news is that 70-90% of patients with plantar fasciitis improve with conservative treatment within a year.
Picture via: orthoinfo.aaos.org
- Sharp pain on the bottom of your heel (most commonly) or arch of the foot
- Pain first thing in the morning or after a period of prolonged inactivity
- Pain is worse with barefoot walking
- Pain worse the weight-bearing activity such as walking or running
Not all heel pain is plantar fasciopathy! Consult a medical provider for further guidance. Other possible conditions to rule out:
- Tarsal tunnel syndrome
- Baxter’s nerve compression
- Fat pad contusion
- Heel fracture
Risk factors for plantar fasciopathy:
- Increased BMI (body mass index) in non-athletes
- Reduced ankle dorsiflexion range of motion (motion of brining foot up toward your shin)
- Work-related weight-bearing activities
- Pes planus (flat foot/excessive foot pronation)
- Pes cavus (high arch)
- Sedentary lifestyle
The exercises in this blog are meant to be starter exercises. Calf stretching has the best evidence to support it, so if your time limited, stretching should take priority.
Calf and plantar fascia stretching helps reduce pain and improve ankle dorsiflexion range of motion (one of the risk factors for plantar fasciopathy). The Achilles tendon has fibers that attach and interweave within the plantar fascia, which is one theory for why stretching the calf reduces pain. Besides pain reduction, stretching the calf can improve dorsiflexion range of motion. Reduced ankle dorsiflexion range of motion can lead to increased pronation during walking/running. Excessive pronation increases stress to the plantar fascia and over time, can lead to plantar fasciitis.
Wall Calf Stretching
Step Calf Stretching
The best exercise to strengthen the calf is the heel/calf raise. The calf consists of two powerful muscles: the more superficial gastrocnemius and deeper soleus. Adequate calf strength is important to absorb ground reaction forces when the foot hits the ground and during push off while walking or running. The stronger the calf is, the more readily it can take these forces on, instead of other structures, like the plantar fascia, absorbing them. Also, the heel raise exercise strengthens the posterior tibialis muscle, which helps to control for excessive pronation, reducing strain on the plantar fascia as discussed earlier.
In addition to strengthening the calf, strengthening the foot muscles is an important part of plantar fasciitis treatment. The arch raise exercises are one of the best ways to strengthening the intrinsic foot muscles. These exercises will take some practice! It does not seem like much is happening, but once you get the hang of it and start progressing it, your foot muscles will certainly get a workout. The key is to avoid gripping with the toes to ensure the correct muscles are working instead of compensating.
Arch Raise Series
In closing, plantar fasciitis does improve with conservative care for most people. If your pain is persistent or you want more guidance, it might be a good time to contact a physical therapist!
Disclaimer: This content is designed for information & education purposes only and is not intended for medical advice.
-Dr. Dylan Michel
Bull City Physical Therapy