Anyone who has had that real burning feeling in their heel or underneath their foot knows all about Plantar Fasciitis. It can be a very annoying and painful chronic injury that can affect daily life and limit you from playing sports and simply just walking around. Most solutions involve stretches and massage with a spikey ball to relieve the pain and maybe some calf raises. While this may be effective at managing the pain, they are merely just treating your symptoms and will not actually deal with why you got this problem in the first place. In this article I will show you some of the simple steps we have proven to work with not just plantar fasciitis, but also with other leg injuries and feet stability problems. It is important to follow the process I have laid out this article and not skip steps in order for the body to be fully prepared for each progression.
What Is Plantar Fasciitis?
Plantar fasciitis is a common and often painful foot condition that affects millions of people worldwide. This injury most affects active adults between the ages of 25 and 65 years old however it is becoming more common with teenage children.
Plantar fasciitis occurs when the plantar fascia, a fibrous band of tissue on the bottom of the foot that helps to support the arch, is overloaded or overstretched. With overuse or over time, the fascia loses some of its elasticity or resilience and can become inflamed, resulting in pain.
There are a number of potential factors that can cause plantar fasciitis such as:
•foot arch problems (both flat feet and high arches)
•poor hip mobility and stability
•long-distance running
•putting on weight
•shoes with inadequate arch support or soft soles
•Sudden increase in volume of exercise
While running and putting on extra weight can play a part this is only exacerbating what is already an existing problem. Poor shoes and increase mileage of walking or running I would say are much more likely to cause problems but not always.
The two biggest factors by a mile are poor foot stability and hip dysfunction. This gives you clues as to where your solutions will be found. Where do you start?
You Must Complete An Assessment First
Before you start looking for exercises for plantar fasciitis make sure you complete a thorough postural and movement assessment first. Otherwise you are guessing and could be using exercises that make matters worse. No two people will be identical with how they move and the specifics of mobility or stability at various joints.
The first thing to investigate would be mobility restrictions in particular with the ankle and the hip. Stiffness at these two areas will greatly limit your ability to correctly stabilize and strengthen the feet. In many cases the weakness of the feet may have created this stiffness in the hip region in the first place but now you will need to work on this if you want any chance of strengthening the feet correctly.
This is a bit like the chicken and the egg conundrum and it is hard to work out which one came first. Regardless of which one started it you will still need to work on both problems.
You will find great ideas of how to complete a mobility assessment in the video below.
You can also see more detail and specific information for the ankle and hips in the article – How to complete a mobility assessment
What Foot Type Do You Have?
I won’t go into too much detail about this as I have covered this before in the article – Exercise solutions for weak feet
Most people will be told they have flat feet and that is why they have plantar fasciitis and in most cases this is true. However, there are many different foot types, so it is important to know exactly what type of foot you have before you do anything so you can make the correct adjustments. Never assume anything for you could be missing an important piece of information that solves the problem.
Below is a very simple diagram of the different foot types. If you are the neutral foot, then you most likely do not have plantar fasciitis and would not be reading this article. If however you are either the flat foot or the high arch you will have a few things to work on.
The flat foot is basically very unstable, has become over stretched along the bottom of the foot that now makes it almost impossible to become a rigid lever to create the “spring and release” energy. The key to correcting the weak foot is with improved stability strategies and STRENGTHENING!
Remember this foot type problem is all to do with instability and weakness and like any muscle or joint it needs work.
A quick note on pronation. Pronation is not bad, in fact it is absolutely essential, the problem is when you have too much of it in the case of weak feet.
This high arch foot type is exactly the opposite of the previous version and is basically stiff and rigid instead of weak and unstable. This foot type is more exposed to stress fractures and Achilles problems. This foot type struggles to decelerate and load and can often find trouble over uneven terrain.
This foot poorly absorbs shock!
Usually the ankle will be locked up with this type of foot which you would have found out in step one with the mobility assessment. I like to use the mobility exercise shown below for people with this foot type.
As for foot massage and various tools that try to alleviate the pain under the foot these can be helpful but to be honest I don’t spend much time with these as I know they are not going to change anything. If it helps to reduce the pain sensitivity it can be helpful but as long as you understand that it is not going to make you better so you spend the time focusing on what you need to do instead.
Hip Stability Test
Before we get into the strength exercise for the feet you need to assess the strength of the glutes. A very easy way to do this is with the single leg hip extension test shown below.
It is common for the gluteal muscles to become very weak when foot instability is present, reducing the body’s ability to provide hip extension during walking. While this exercise is not very effective at restoring the lost strength or stability it is great to use as a test in the beginning to see if it is working correctly or not.
Later on you will need to progress to standing exercises like deadlifts and especially the single leg exercises that will require the glutes to work very efficiently so this exercise is a good starting point. There are a lot of exercises you may need to experiment with and make adjustments for it is impossible for me to list all of the possible exercises I might use.
As this is a complex topic to explain I will break up each part of the rehabilitation process in order of what to do first. If you want to see a quick video of me going through all of these exercises in order you can watch the video below.
Why The Big Toe Is Critical For Developing A Stable Foot
The big toe in particular is essential to the stability of the foot and the entire kinetic chain, and plays a vital role in enabling you to walk efficiently. It carries about 40% of the weight of the body and is the last point of contact with the ground when walking. Your big toe acts as a pivot point, helping you push off the ground during movements like running, jumping, and squatting.
Another important fact that many people are not aware of is that proper big toe function ensures that you will be able to engage your glute muscles effectively.
But how does this work exactly?
Within milliseconds of your foot touching the ground it sends a signal to the hip to prepare for single leg stability. Any delay in hip stability will result in poor leg alignment which can result in knee problems like patella-femoral pain, ankle sprains and various hip injuries.
Here’s how it works:
1.Toe Flexion: During movements like walking and running, your big toe flexes as your foot pushes off the ground. This flexion creates tension in the plantar fascia, the connective tissue on the sole of your foot.
2.Fascial Connection: The plantar fascia is connected to the deep fascia in your leg, which, in turn, connects to the fascia surrounding your glutes.
3.Glute Activation: As you push off the ground and engage your big toe, the tension travels up the fascial lines, signalling your glutes to activate more efficiently.
The feet drive the reflex stability of the hip and in particular the big toe acts as the catalyst for optimal glute engagement. If you struggle to activate your glutes during walking try to actively dorsiflex your big toe just prior to heel strike as this helps to increase the stiffness of the foot in preparation for impact with the ground.
This is where using big toe lifts and various exercises to strengthen the big toe are vital. The only problem with these exercises is that they need a lot of repetition and volume to have any effect. You need to do these daily.
You can read more about this in the article – How the big toe influences functional stability
Learn How To Spread Your Toes & Create The Foot Tripod
Following on from the last point you will greatly benefit from learning how to spread your toes and using toe spreaders to help you.
Wearing them as often as you can when you get home will help you to develop better alignment and you can also where them when you train! You can get some of these by visiting the website Foot Collective.
In addition to this you will need to learn how to develop the foot tripod stance to prepare your foot to correctly stabilize when standing.
I like to use the idea developed by Dr Evan Oscar in his book “Exercise Solutions For Hip & Shoulder Dysfunction”, where he refers to the foot as a tripod base. This is where you are trying to keep the toes spread, and create a tripod base to stand upon.
By trying to place pressure at the heel, just behind the big toe and just behind the little toe and gently trying to pull back without any toe gripping you now have established a great base to work from where the feet are working evenly.
The best way to practice this is by walking across a balance beam or rolled up towel as seen in the video below.
Single Leg Calf Raises
Most of the exercise programs for plantar fasciitis feature the calf raise that target the gastrocnemius and soleus muscles for they have a direct influence on the plantar fascia. Unfortunately, this is as far as most programs go as people fixate on treating the area in pain. While this is a good start there is a lot more you need to do to finish the job.
When applying strength methods specifically aiming at the calf make sure you emphasize endurance. For example, with single leg calf raises I will prefer to aim for high repetitions of low loads, over high intensity loading for maximal strength gains. Many calf related injuries occur once fatigue sets in and the calf muscles are heavily reliant on endurance.
With the single leg calf raise I aim for at least 30 repetitions on each leg as an indicator of great endurance. If you fail to reach 30 reps, or if there is a difference between each leg I will know that there is a weakness that will be exposed during running or sports.
Watch the video below for more detail.
You Must Strengthen The Single Leg Stance
If you are this point this is where you are going to make the biggest changes.
All of the single leg stance exercises are the best to develop the strength required for the feet and hip. With the feet they demand control of pronation and for the hip they demand control of three key functions we discussed earlier. This helps to stabilize the hip, act as a hip rotator, and lock the head of the femur into the socket, creating a very tight and stable hip joint during gait. This prevents the ball and socket joint from rattling around during walking and running.
You could use a stack of isolated glute exercises and foot exercises to improve this but to really finish the job you need to use exercises to tie it all together.
The best exercise I have found that achieves the goal of using foot stability and hip stability together is the hip airplane.
This exercise is a variation of the single leg Romanian deadlift. The major differences with this exercise versus the standard single leg RDL is the added rotational movement of the hip in the air and the proprioception demands needed to maintain balance. The RDL and especially the single leg RDL are known as great exercises for lower back pain and hip pain as it works perfectly to realign the femoral head back deep into the hip socket glutes by releasing the hip and strengthening the glutes.
With so many moving parts it can take some time to truly master this movement but the pay-off is fantastic for hip and knee related injuries like patella-femoral syndrome.
Why?
Due to the rotation of the hip in the air the body would normally begin to rotate inwards at the foot and the hip to follow. Unfortunately, the single leg stance prevents this from happening as you will fall over instantly. Instead, the body senses the loss of stability and begins to counter the rotation with an opposing rotational force to maintain the single leg stance. This torsion effect is what engages the glutes, the muscles of the foot and ankle, and most importantly the VMO muscle of the knee. The VMO plays a pivotal role in providing knee stability and is often very weak with those suffering with knee pain.
The proprioception part comes into it when you take your eyes off the horizon. With the traditional single leg exercises you can keep your eyes fixed on a point ahead which enables you to maintain good balance and control. This version takes that ability away from you and forces your ankle and feet to work twice as hard which is fantastic for improving knee stability and hip strength.
Once you have mastered the hip airplane you can add load with the Bulgarian Deadlift.
The Sensa Mat Is A Great Tool For Plantar Fasciitis
One fantastic tool that I use a lot with people with plantar fasciitis, bunions, or any type of foot weakness is the sensa mat. This is a small mat you stand on that has 100 small rubber spikes in it that simulates rocks and stones outside.
The feet are loaded with thousands of nerve receptors that are very sensitive and designed to help us move. They tell the brain where you are, if you are balanced enough to move yet, and basically instigate movement before it even begins. The better the feet are functioning, the better the signal all the way up the kinetic chain, and the more efficiently we can move.
Weak feet sense massive pain standing on the sensa mat but this is good pain. This is the lazy nerve receptors working again and this can have a massive effect on strengthening the weak muscles of the feet.
I have seen this in my studio for over 10 years and it is incredible how quickly it can improve the function of the feet.
You can read more about this in the article – Why I love the sensa mat for strengthening the feet
Learn How To Integrate Into Functional Movement
At this point you are almost finished. Most people who are at this point have much less pain but can still sense the feet and even the hips are not quite strong enough. This is where you need to teach the body how to work together using functional training methods to create fluid, efficient movement.
While we have made good progress with strengthening in the single leg stance this is not the same thing as controlling motion. You still need to learn how to do this to finish the job. This is something I have discussed in great detail in the article about the gait cycle and why it is so difficult to restore walking when someone has an impairment from disease or injury.
I like to start with cable exercises that use the slings of the body. In particular the posterior oblique sling and anterior oblique sling.
The anterior sling combines the serratus anterior, rhomboids, obliques on one side of the body to work with contra-lateral adductors and quadratus lumborum on the other side of the body to help decelerate the body and create efficient movement with actions like throwing a ball and gait. Most of the exercises using this sling are pushing movements.
The posterior sling is where the glute max of one hip works with the latissimus dorsi of the opposing side to create tension in the lower back region called the thoracolumbar fascia. The action of these muscles along with the fascial system is to prevent rotation of the pelvis when we walk and enable you to store energy to create more efficient movement. Most of the exercises that use this sling are pulling movements.
Where the anterior sling provides deceleration this sling provides propulsion with gait it is the opposite with throwing actions.
Each sling has a corresponding partner on the opposing side and as they both cross the midline they help to connect the upper body with the lower body to either accelerate or decelerate movement.
Also it must be stated that this criss-cross connection enhances the stability of the trunk and spine and is why exercises that use these slings are referred to as core strengthening exercises.
Control Motion With The Walking Deadlift & Walking Lunge
Once you have mastered those movements you can then introduce more loaded leg exercises like the walking deadlift and walking lunge.
I prefer to start with the walking deadlift first as it is much easier and also promotes more glute strength than the lunge.
Once you have mastered that you can introduce the walking lunge which will seriously test your overall leg strength as much as your foot stability. The main difference between the previous version is you will use your quadriceps a lot more as the knee is loaded on each step.
There are many versions of the walking lunge but start with the simple one before progressing to the more challenging exercises later as you improve.
Final Step – Learn How To Jump & Land
This last step may not be necessary for everyone such as an older adult or someone with knee or hip problems but it is vital for a younger person who plays sport. This prepares the foot to absorb shock and decelerate the body during landings from a jump.
You will see several examples of how to do this in the video shown below.
I also suggest to read the article – How to strengthen weak ankles to see more ideas for this.
Here Is Proof That This Works
When I came to my first PT session, I could barely walk without pain in my right foot from plantar fasciitis.
At the start, the exercises were difficult unfamiliar and extremely challenging, having wanting to quit and never return. But, I knew that I had to persevere and understand that my condition didn’t happen because of recent events. This was a result of physical neglect over a long period of time and my bad habits catching up with me.
So now months later, plenty of stretching and weight training my feet are both stronger, pain free and very flexible. Nick’s training was definitely integral to my improvement but following through at home everyday was key.
Without Nick, I don’t know where I would be.
Thanks so much for your patience and guidance.
Cheers mate
Tony Dariol
Do You Need More Help?
If you currently suffer with hip, knee, or back problems you will find our online programs are a great resource that take you through all of the assessments and corrective exercises to get you back to full strength and out of pain. All of these programs are downloadable videos that come with PDF instructions manuals.
Go to the ONLINE SHOP to find out more and get a copy.
Summary
As you can see from this article there is a lot more to plantar fasciitis than doing a calf raise and rolling a spikey ball on the bottom of your foot. The interaction of the hips and the feet is something I often see ignored as people spend all their time looking at the area in pain.
Always remember that to truly fix a postural or movement dysfunction you must find the source of the problem and you can only effectively do this firstly via an assessment to find the weaknesses. Then secondly, using a process of teaching the body how to efficiently move with functional movements. If you get bogged down with isolated strengthening and stretching you will only get to a point where you can manage things instead of getting rid of them for good.
I hope this article gives you plenty of ideas of where to look and what to do.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
•Barefoot Strong – By Dr Emily Splichal
•Whole Body Barefoot – By Katy Bowman
•Born To Run – Chris McDougal
•The Vital Glutes – By John Gibbons
•Movement – By Gray Cook
•Corrective Exercise Solutions – by Evan Osar
•Diagnosis & Treatment Of Movement Impairment Syndromes – By Shirley Sahrman
•Anatomy Trains – by Thomas Meyers