Heel pain with your first steps in the morning that gradually decreases with walking is a common complaint that I hear from my patients who are suffering from Plantar Fasciitis pain. Plantar Fasciitis is the MOST common cause of heel pain that we treat as physical therapists. The unfortunate thing about Plantar Fasciitis is that it can be extremely difficult to treat (especially when chronic) because, as human beings, we have to walk on our feet. This makes it difficult to allow proper healing time when the soft tissue on the bottom of the foot is irritated and inflamed. Physical therapy exercises for plantar fasciitis have been shown to be very effective at reducing foot pain. Today I will discuss the best physical therapy exercises for plantar fasciitis foot pain relief so that you too can learn how to treat and prevent this sometimes debilitating foot pain.
- Purchase for Easy, Convenient Access Anytime
- Download for Use on Any Mobile Device or Print at Home
- Includes Additional Exercises for Comprehensive Rehab Program
- Custom Designed by Dr. Tim, PT, DPT, OCS
Purchase for Easy, Convenient Access Anytime
Download for Use on Any Device or Print at Home
Includes Additional Exercises for Comprehensive Rehab Program
Custom-Designed by Dr. Tim, PT, DPT, OCS
Table of Contents
What is the Plantar Fascia and What Does it Do?
The plantar fascia is a web-like band of fascia (tissue) on the bottom of the foot. Think of it as a broad ligament-like structure.
It stretches from the bottom of the heel bone (Calcaneus) to the base of the toes. Its job is to provide shock absorption and to support the arch of the foot during the push-off phase when walking.
Why Do My Foot and Heel Hurt?
Plantar Fasciitis is a type of foot injury that is caused by repetitive micro-trauma along the plantar fascia. Typically, the plantar fascia becomes increasingly tight over time, which leads to a continual state of tension at the bony insertion point at the Calcaneus bone. The Plantar Fascia becomes injured and inflamed causing the onset of foot and/or heel pain.
This “tightness leading to injury leading to pain” cycle tends to repeat itself daily. Once you’re off of your feet for a long period of time, whether that be several hours or days, the pain decreases because there is no longer a large stretch being placed through the irritated tissue.
However, as soon as you begin to stand or walk around again, the pain immediately returns because the tissue is back under tension again.
If you’ve had chronic plantar fasciitis (> 3-6 months), the pain may be partially due to a bone spur on the Calcaneus. A bone spur is an area where the body responds by building excessive bone due to chronic stress placed at a specific area. Chronic stress/tension, in this case, is where the plantar fascia inserts into the Calcaneus as seen in the picture below.
Many people describe this type of pain as a painful “rock in my shoe.“
On the other hand, if you are feeling pain coming from the Achilles tendon in the back of the ankle, then you are likely dealing with inflammation of that tendon in a condition called, Achilles Tendonitis.
Which Activities Can Aggravate My Foot Pain?
Activities that place the plantar fascia under tension for long durations should be minimized or avoided.
These can include but are not limited to:
Standing at a concert
Walking on the beach, and
Walking around big-box retail stores
Also, try to stay away from activities that involve quick movements such as jumping or pushing heavy objects as this places a large, quick tension force through the plantar fascia. These activities will cause increased pain and tissue irritation resulting in Plantar Fasciitis (inflammation within the Plantar Fascia).
Does Having Flat Feet or High Arches Cause Plantar Fasciitis?
In short, no. Simply having flat feet or high arches does not directly cause Plantar Fasciitis, however, they can make you more susceptible to developing Plantar Fasciitis as well as bunions, for that matter.
Remember that the plantar fascia supports the arch of the foot. If you happen to be born with flat feet, your plantar fascia already is not able to do its job well.
People with flat feet tend to overpronate when walking. Overpronating also causes increased stress and tension along the plantar fascia. Physical therapy exercises for someone with flat feet would have the purpose of strengthening the intrinsic foot and ankle muscles to provide additional support to the plantar fascia.
Alternatively, having exceptionally high arches can also lead to Plantar Fasciitis. In this case, feet with high arches already have plantar fasciae that are excessively tight as the distance between the origin and insertion of the fascia are located closer together.
Physical therapy exercises for individuals with high arches would be focused more on stretching and flexibility of the tissue.
Can Shoe Orthotics Help Reduce Plantar Fasciitis Pain?
Yes, shoe orthotics should definitely be considered as a first-line defense when someone begins having foot pain.
Regardless of whether someone is flat-footed or if they have high arches, they should consider purchasing a pair of semi-custom, over-the-counter shoe orthotics. I consider these orthotics as semi-custom. These orthotics can be found in most shoe stores as well as hiking stores such as REI. They will cost around $40-60 per pair.
It’s important to take the pair of shoes, that you will be using with the insoles, with you so you can make sure that the insoles will fit comfortably within the shoes, and that they will not crowd your toes in the toe box of the shoe.
Hands down, my favorite brand of over-the-counter insoles is Superfeet. They are built to last with great quality. My wife and I both have Superfeet insoles in all our hiking and work shoes and we love them.
Superfeet insoles have a firm, plastic molded heel cup and arch support that help to support the arch of the foot. Supporting the arch of the foot will then reduce that constant stress and tension through the plantar fascia. Superfeet has insoles for people with flat feet (low arches), medium arches, and high arches.
Whenever I am first treating a patient who has Plantar Fasciitis, I will always start out by recommending the purchase of these semi-custom, over-the-counter, orthotics such as Superfeet. Spending $40-60, in the beginning, is much better than initially recommending the purchase of prescribed, custom orthotics that will cost well into the hundreds of dollars without first trialing the much cheaper semi-custom version.
If the semi-custom orthotics help to significantly reduce the plantar fascia pain, AND if the individual truly does have a non-ideal foot posture (flat feet or very high arches) that will likely lead to repeat chronic plantar fasciitis issues in the future, I would only then recommend the purchase of expensive, custom-molded orthotics for their shoes.
Do Plantar Fasciitis Night Splints Help Relieve Foot Pain?
Yes, night splints can also help to reduce plantar fascia pain. As mentioned before, one of the hallmark indicators of Plantar Fasciitis is when someone reports bottom of the foot pain with first steps in the morning. This is caused because the plantar fascia and calf muscles (Gastrocnemius and Soleus) tighten up throughout the night while the person is sleeping.
When we sleep, the blankets draped over our feet will pull the toes downward placing the plantar fascia in a shortened position. Over the next several hours the plantar fascia tightens up in this shortened position. As the person goes to stand up for the first time in the morning, there is a big stretch that is then placed through the plantar fascia causing a sudden onset of intense foot and heel pain.
Wearing an ankle night splint that keeps your ankle at a 90-degree bend maintains the plantar fascia at a normal resting position, which prevents it from tightening up overnight. This, in turn, helps prevent that sudden foot pain from occurring in the mornings.
- NIGHT-TIME PLANTAR FASCIITIS PAIN RELIEF
- THREE PADDED STRAPS FOR COMFORT
- DUAL TENSION STRAPS TO INCREASE STRETCH
- LIGHTWEIGHT & BREATHABLE
Should I Change the Type of Shoes That I Wear?
Does your current pair of daily-worn shoes contain any of the following characteristics:
Not have good arch support
Have little to no heel padding (i.e. women’s flats, thong sandals)
Are worn out because you’ve been wearing them for > 1 year
Then the answer would be YES! In these cases, you should change your daily shoes to a pair of tennis shoes, hiking boots, or some other pair of shoes that is more supportive, at least temporarily until your symptoms resolve.
For my older folks, I typically recommend that they purchase Hoka tennis shoes. They provide an excellent level of support and cushion, which my patients truly appreciate when they are suffering from heel pain caused by Plantar Fasciitis. I personally don’t find the look of the shoe all that attractive, however functionally, Hoka is hard to beat in terms of arch support and heel cushion. I remind my patients that wearing these shoes should be a short-term sacrifice for long-term gain. Many of my patients have remarked that wearing Hoka shoes is like “walking on a cloud.”
- BREATHABLE OPEN ENGINEERED MESH UPPER
- REMOVABLE, FOAM-PADDED INSOLE
- PROVIDES EXTRA SUPPORT AND CUSHIONING
- STABILITY RUNNING SHOE
For everyone else, I would recommend looking at Brooks or New Balance tennis shoes. Both of these companies offer great options with appropriate arch and cushion support, and they build excellent quality running/athletic shoes.
Either way, I always educate my patients on the SHOE BEND TEST.
When you’re looking for a pair of supportive shoes, whether that be tennis shoes or work shoes, take the shoe and try to fold it up into a taco shape trying to touch both ends together. If the shoe easily folds right through the center of the arch area, then the shoe has no or minimal arch support and you need to keep looking for a better pair of shoes.
However, if you try to fold up a tennis shoe with proper arch support, you will find that it actually folds near the forefoot area rather than through the arch. This is the type of shoe that we want for those with Plantar Fasciitis. The shoe will be stiff enough that it will not bend through the arch, though it will correctly allow some bend through the front, which is where we get our toe-off motion when we walk.
Purchase a pair of shoes that PASS the SHOE BEND TEST!
Also, if you happen to be one of those individuals who enjoy wearing sandals or flats all day long, then it’s time to stop. Again temporarily. You might want to consider a quality pair of sandals such as Birkenstocks or OluKai sandals. Both of these provide excellent arch support for those unwilling to stop wearing sandals altogether.
Supportive shoes should be worn daily during any activities that will be performed in weight-bearing positions (i.e. standing, walking) for longer periods of time > 15-30 minutes. Continue to wear these until the foot pain has decreased to minimal levels and is much more manageable.
Will a Foot Massage Hurt My Plantar Fasciitis?
No, a light foot massage will not further injure the plantar fascia. Actually, I highly recommend that a version of self-massage be performed several times throughout the day on the foot. The plantar fascia pain is directly related to the level of tightness in the plantar fascia. In order to combat this, you can easily grab a 3-pack of tennis balls and place them around both your house and your workplace. I recommend having several of them because the old saying, “out of sight, out of mind” tends to be quite true in this case.
Without question, there should be one tennis ball placed on your bedroom nightstand. This one is to be used first thing in the morning. Sit at the side of the bed and gently roll the bottom of the foot along the arch. This should produce a “hurts so good” massage-like sensation. It will have some tenderness along with it as well, but it will likely feel like a “good hurt” kind of pain, rather than a bad hurt. Do this for 3-5 mins before standing up.
Other strategic places to place the other tennis balls include the office desk at work and the living room coffee table.
If you’re looking for a higher-end product that can be used elsewhere around the body, and have a much longer lifespan, then I would highly recommend a RAD Trigger Point Release Kit. Tennis balls will gradually soften up over-time and your dogs will likely get ahold of them at some point. The RAD massage balls are made of a high-density rubber material that is perfect for soft tissue mobilization.
- RELIEVE ACHES AND PAINS
- INCREASED MOBILITY, FLEXIBILITY AND WELLNESS
- RECOVER LIKE A PRO
- PROMOTE FASTER POST-EXERCISE/WORKOUT RECOVERY
- BODY MAINTENANCE MASTER
- TRAVEL SIZE
Should I Get a Corticosteroid Foot Injection?
In some severe or chronic cases, some doctors may recommend a corticosteroid injection (anti-inflammatory injection). Yes, these injections can and do help relieve chronic Plantar Fasciitis pain. However, this should be reserved as a last resort.
I may be a bit biased, but I always recommend that patients begin with a trial of physical therapy exercises for treating plantar fasciitis to see if a customized exercise program will, by itself, help to relieve the foot pain. I firmly believe that physical therapy exercises and education can ultimately help these patients even if they eventually still end up getting an injection down the road. Learning these physical therapy exercise techniques can still be very useful to those suffering from Plantar Fasciitis as they will likely experience plantar fascia pain again in the future.
In addition, it has been well documented that receiving a corticosteroid injection does weaken the collagen tissue in the plantar fascia and can result in the rupture of the tissue. This is especially true of athletes that are attempting to return to sports quickly after the injection, so we definitely want to be conservative when recommending these injections.
Prior to consideration an injection, you may want to consider trying Voltaren Gel, which is an over-the-counter nonsteroidal anti-inflammatory (NSAID) gel that soaks through the skin and reduces the inflammation of the soft tissue beneath the application area. It is very effective for tissues that are relatively superficial (i.e. the Plantar Fascia). Be sure to check with your doctor to make sure it is safe for you to take anti-inflammatory medications prior to doing so.
- TWO 3.5oz/100g TUBES OF VOLTAREN PAIN GEL
- POWERFUL TOPICAL PAIN RELIEF
- NONSTEROIDAL ANTI-INFLAMMATORY
- NUMBER 1 DOCTOR RECOMMENDED TOPICAL PAIN RELIEF
Can Physical Therapy Exercises Help Relieve My Plantar Fasciitis Pain?
Absolutely, physical therapy exercises can help relieve Plantar Fasciitis pain by addressing both:
Strength
Flexibility
The BEST Physical Therapy Exercises for Plantar Fasciitis!
- Purchase for Easy, Convenient Access Anytime
- Download for Use on Any Mobile Device or Print at Home
- Includes Additional Exercises for Comprehensive Rehab Program
- Custom Designed by Dr. Tim, PT, DPT, OCS
Purchase for Easy, Convenient Access Anytime
Download for Use on Any Mobile Device or Print at Home
Includes Additional Exercises for Comprehensive Rehab Program
Custom-Designed by Dr. Tim, PT, DPT, OCS
Strength:
Physical therapy strengthening exercises should target the smaller foot intrinsic muscles that can directly assist to support the foot and arch. Additionally, the calf muscles should also be strengthened as they indirectly support the arch.
The foot intrinsic muscles can be sometimes difficult to master as people tend to have lost the ability to easily isolate these muscles. If, at first, you find it hard to perform the required movements of these exercises. Try to not become frustrated. It takes time and practice to re-learn these finer movements.
Flexibility:
Stretching and massage of the calf muscles (Gastrocnemius and Soleus) and the plantar fascia should be performed daily to reduce tensile stress through the irritated tissue.
Plantar Fasciitis Strengthening Exercises
Seated Short Foot Exercise
- Shorten the arch of your foot by sliding the base of the big toe towards your heel in an attempt to raise the arch higher.
- Try not to curl your toes as that will allow compensations with your toe flexor muscles, rather than strengthening the foot intrinsic muscles in the arch area.
- If performed correctly, you will feel a cramping-like tension within the muscles in the arch area of the foot
- Perform: 3 sets x 10 repetitions – 1x/day
Seated Toe Spreading
- Attempt to separate all of your toes to the sides
- Place special attention to moving the big toe inward
- Perform: 3 sets x 10 repetitions – 1x/day
Seated Toe Flexion/Extension
- Pull your big toe upwards while simultaneously curling your remaining four toes downwards
- Then do the exact opposite, curl your big toe downwards while lifting your other four toes upwards
- Perform: 3 sets x 10 repetitions – 1x/day
Seated Towel Curls
- Keep the heel planted, grab the towel with your toes and slide it towards you, release the towel, then repeat
- Perform: 3 sets x 10 repetitions – 1x/day
Seated Marble Pickup
- Use these Marbles
- Pick the marbles up with your toes, turn the foot to the side, and release them into a container
- Perform: 3-4 minutes. 1-2x/day
Seated Toe Flexion Exercise with Band Resistance
- Use these Theraband Resistance Bands
- Place resistance band around the base of all of your toes
- Curl your toes down and away from you in to the resistance of the band
- Perform: 2-3 sets x 15 repetitions. 1x/day
Ankle Band 4-way Resistance Exercises
Ankle Plantarflexion
- Use these Theraband Resistance Bands
- Place the resistance band down around the “ball of the foot” (forefoot)
- Perform: 2-3 sets x 15 repetitions. 1x/day
Ankle Dorsiflexion
- Use these Theraband Resistance Bands
- Pull the band straight up toward your shin
- Perform: 2-3 sets x 15 repetitions. 1x/day
Ankle Inversion
- Use these Theraband Resistance Bands
- Pull the band “down and in” simultaneously (think diagonal direction)
- Perform: 2-3 sets x 15 repetitions. 1x/day
Ankle Eversion
- Use these Theraband Resistance Bands
- Pull the band “up and out” simultaneously (think diagonal direction)
- Perform: 2-3 sets x 15 repetitions. 1x/day
Heel Raises Standing
- Use these Theraband Resistance Bands
- Knees straight at all times
- Can perform this single leg if double leg is too easy
- Perform: 2-3 sets x 15 repetitions. 1x/day
Plantar Fasciitis Flexibility Exercises
Gastrocnemius Calf Stretch - Knee Straight
- Stretch is felt on the back leg (straight knee)
- Ensure that the toes are pointed straight forwards and the knee is fully straight
- Perform: 2 sets of 1-minute hold duration – 2x/day
Soleus Calf Stretch - Knee Bent
- Stretch is felt on the back leg (bent knee leg)
- Ensure that the toes are pointed straight forwards
- Perform: 2 sets of 1-minute hold duration – 2x/day
Tennis Ball Rolling - Seated
- Use these: Tennis Balls or RAD Massage Balls
- Perform: 3-5 minutes – several times per day
How Long Should it Take Before My Foot Pain Decreases After Starting These Exercises?
Noticeable decreases in foot pain should be immediate with the flexibility exercises, however, the pain with standing activities will likely continue for 2-4 weeks depending on how irritated the plantar fascia tissue was when you began to do your physical therapy exercises.
Also, understand that if you have a job that requires you to stand throughout the day or maybe you just aren’t willing to temporarily place your running regimen on hold, your foot pain will likely be slower to respond to these exercises as you are continuing to aggravate the tissue.
