Plantar fasciitis, a condition that affects the foot, is considered one of the most bothersome and restrictive orthopedic pathologies. It is prevalent in runners and approximately 2 million Americans suffer from it annually. Plantar fasciitis is characterized as inflammation in the plantar fascia and its surrounding tissues, caused by repetitive microtrauma resulting from excessive traction and loading forces. The persistent heel pain associated with plantar fasciitis is not usually an acute inflammatory issue but rather a chronic problem. In this article, we will explore the common causes and risk factors for this heel pain and provide some effective exercises for plantar fasciitis.
What Is Plantar Fasciitis?
The plantar fascia, also called the plantar aponeurosis, is a passive structure in the foot that gives support to the medial longitudinal arch. It consists of three bands: a medial band, a central band (which originates from the medial tubercle on the plantar part of the heel or calcaneus), and a lateral band. Pain reported by patients most frequently occurs at the medial tubercle on the plantar aspect of the heel, where the central band of the plantar fascia originates.
The specific cause of plantar fasciitis is not well understood, but there are several factors and conditions that are strongly linked to it. Most often, people experience plantar fasciitis pain after a period of increased or unfamiliar activity, especially following a period of inactivity. This could be due to engaging in more intense physical activity, increasing the distance you run or walk, or simply spending more time on your feet at work. Other risk factors include having a body mass index between 25-30kg/m2, having limited range of motion in dorsiflexion, and engaging in running. The medical community is starting to use the term plantar fasciopathy to describe chronic plantar fasciitis, as it can be compared to conditions like chronic tennis elbow or other chronic tendon issues, where it is more of a long-term degenerative problem rather than an acute inflammatory issue.
Common Plantar Fasciitis Findings
- Plantar medial heel pain: most noted with initial steps in the morning or after a period of inactivity as well as prolonged weight-bearing.
- Symptoms may appear after an increase in weight-bearing activity (running, walking).
- Bone spur on the heel (due to excessive tension from the plantar fascia causing periosteal lifting of the bone).
- An antalgic (painful) gait pattern due to pain originating from the plantar fascia
In this article, we will define an inefficient windlass mechanism, which is one of the risk factors linked to developing plantar fasciitis. Other risk factors include stiffness in the gastroc-soleus complex, high BMI, poor ankle joint dorsiflexion, and running.
Overpronation Versus Underpronation
Whenever walking or running, pronation is a natural movement that occurs at the foot. The ground is first struck by your heel as you take a step. Following that, your foot will naturally transition from the outer part to the inner part.
When it comes to foot pronation, it is possible for someone to either overpronate or underpronate, which can be caused by a lack of control in the foot and ankle complex, experiencing pain, or a combination of these factors. It is important to note that plantar fasciitis is not only a risk for those who overpronate, as individuals who underpronate can also develop this condition. The issue lies not in the actual pronation, but rather in the length of time one remains in the pronated position.
- Overpronation : This leads to a flattening of the medial longitudinal arch (MLA) causing the plantar fascia to elongate and have increased tensile forces causing microtears. This type of foot has too much mobility.
- Underpronation : Limits shock absorption and unable to dissipate forces so the fascia takes the brunt of the load. This type of foot has too much rigidity. A stiff GSC will encourage a person with a very mobile (planus) foot to unlock the midfoot and pronate excessively as compensation, placing stress on the fascia. A stiff GSC in a person with a stiff (cavus) foot will also apply more tension to the fascia due to the inability to absorb shock and dissipate forces.
Exercises to Help Plantar Fasciitis
You can obtain pain relief for plantar fasciitis by engaging in stretches and exercises that enhance the strength of the foot in this particular area. By loosening the ligament known as the plantar fascia, you can effectively reduce both stress and inflammation which are the primary causes of foot pain.
Toe Curls with a Towel
The initial method for alleviating pain caused by plantar fasciitis is attempting toe curls using a towel.
Step 1: Place a small towel on the floor and position yourself in a chair with your feet resting on the towel.
Step 2: Utilize your affected foot to scrunch your toes onto the towel and attempt to draw it closer to you.
Step 3: Release tension in your toes and release the towel. Carry out this action 10 times, once or twice every day.
Gastrocnemius Stretch
The gastrocnemius stretch is considered one of the most effective stretches for plantar fasciitis. It is a straightforward stretch that can be performed anywhere as long as there is a wall for support.
Firstly, position yourself in front of the wall and place your hands on it. Then, extend your affected leg backwards while making sure that both of your feet are on the ground and facing the wall. Lastly, bend your unaffected leg at the knee.
Step 2: Position yourself towards the wall, causing a sensation of stretching in the calf muscle of your back leg.
Continue to maintain this pose for a duration of 30 seconds, followed by a period of relaxation. Repeat this process six times throughout the day.
Tennis Ball Roll
To complete this exercise, make sure you have a tennis ball or a similar small ball. If you don’t have one, you can substitute it with a cylindrical object like a water bottle.
Step 1: Take a seat on a chair and position the ball underneath your foot that is experiencing discomfort.
In step 2, perform a back-and-forth rolling motion with the ball beneath the arch of your foot to effectively stretch the ligament of the plantar fascia.
Step 3: Keep rolling for a duration of three to five minutes. You have the option to perform this stretch twice daily.
Toe Extension
You can do the toe extension stretch for plantar fasciitis anywhere at any time, making it one of the easiest stretches.
Step 1: Take a seat on the floor or on a chair, ensuring that the leg experiencing the issue is crossed over the leg that is unaffected.
Step 2: Utilize one hand to firmly grasp your toes, then proceed to flex your toes and ankle upwards as much as possible. The objective is to experience a sensation of stretching in both your calf muscle and the arch of your foot.
Step 3: Proceed to massage the arch of your foot using your available hand.
Step 4: Maintain this position for a duration of 10 seconds and subsequently release. Repeat this sequence for a span of two or three minutes, engaging in the activity two to four times per day.
Plantar Fascia Stretch on a Step
In order to perform this stretch, it is necessary to find a location where there is a step available.
Step 1: Position yourself on a step and ensure that your uninjured foot remains level. Gently move your injured foot backwards until the front part of the foot rests on the step’s edge.
Step 2: Gradually lower the heel of the foot experiencing discomfort by bringing it closer to the floor, until you perceive a tension in both the calf muscle and the foot’s arch.
Step 3: Maintain this stretch for a duration of 30 seconds. It is recommended to perform this exercise four to six times per day.
