Plantar fasciitis is one of the most common causes of heel and bottom of the foot pain. I'm going to help you understand how to improve your plantar fasciitis pain. We will strategize how to use the time on your feet, figure out appropriate foot support with your shoe wear and learn some hands-on self-massage and exercises that you can do to decrease the intensity and severity your pain
Plantar Fasciitis Review
If you reference our previous video about plantar fasciitis, you'll remember that plantar fasciitis is essentially an overuse injury of the connective tissue in the bottom of your foot. That connective tissue running from the heel along the bottom of the long arch of your foot is called the plantar fascia. This structure transfers force from your calf muscles into your foot & toes, allowing you to push off effectively. It also acts as a support to the long arch of your foot. With plantar fasciitis, the plantar fascia becomes tight & breaks down where it attaches to the heel. This typically presents as pain through the bottom or inside of the heel as well as pain through the arch of the foot. Getting the plantar fascia strong & mobile is critical to fixing your plantar fasciitis.
The plantar fascia is strong but it has a limit to the amount of tension & force it can handle at any one time as well as throughout the course of the day. When rehabbing and recovering from plantar fasciitis, we want to make sure we're asking the body to do the right amount of work on the foot. If you're on your foot too much - walking too much, standing too much, et cetera - your foot will not be able to heal properly. It will not have enough time for the pain to calm down and the connective tissue to strengthen.
Timing Time on Your Feet
It's critical to figure out how much you can be on your feet before triggering your heel or foot pain. Figure out the time you can walk or stand. Or track the distance you can run or walk each day before on the onset of severe pain. The goal is to shoot just below your tolerable amount so you're allowing that plantar fascia time to heal in between periods of stressing it.
What do you do when you must be on your feet so long that they begin to hurt? Daily life requires us to be on our feet, moving around, walking, standing, doing things at home and at work. Sometimes it's unavoidable to use our feet more than what we typically would want them or feel comfortable using them.
It can be helpful to break down how long you're on your feet into smaller chunks of time so the plantar fascia & supporting muscles get more rest. In between times on your feet, you can use some of the strategies we talk about later in this video to decrease the severity of your foot pain.
The other simple strategy is to time when you're doing your aggravating activities to times when your foot is more rested. Typically this is earlier in the day but not when you’re first walking in the morning. In the case that your foot hurts worst first thing in the morning, don't go on a long walk or stand extensively when you first get up. Wait until your foot is more loosened up and warmed up, before you're walking and using that foot more. On the flip side, if your foot typically gets worse throughout the day as it gets more tired, you want to do more if you're walking in the morning or on your feet time in the morning when your foot isn't as irritated. Ultimately, you need to figure out how much your foot can handle, and then you want to break it down into manageable chunks throughout the day and use those periods of time when your foot typically feels the best.
Choosing Proper Shoes
Choosing appropriate footwear can make a world of difference in increasing how much you can stand, walk or run before triggering your plantar fasciitis pain. A good shoe can help support your foot so the plantar fasciitis doesn't have to do as much work to support your foot while you're walking, standing, and doing life.
In choosing shoes, a supportive shoe will help to decrease plantar fasciitis pain in the short term. Long term however, only relying on a supportive shoe to ‘fix’ your plantar fasciitis pain can lead to decreased foot strength and reliance on supportive footwear. It’s critical to have an honest discussion with your Podiatrist or Physical Therapist to find the best type of shoe to fit your foot type, activity goals and current & goal strength levels. The next two paragraphs walk you through shoe choices to decrease your plantar fasciitis pain.
If you have a more flexible foot, a supportive shoe will be more helpful in managing the flexibility of your foot. If your arch is flat or very flexible, a shoe with more arch support will help support the plantar fascia the most. If your heel is ‘flexible’ and tilts ‘out,’ a shoe with a supportive and stiff heel box can be helpful in decreasing how much the heel moves. This decreases the side to side tension through the plantar fascia. Now remember the plantar fascia is stronger in the ‘long’ direction of your foot, from the heel to toes. Rotational or side to side stresses created by collapsing arches or a tilted heel works the plantar fascia in it’s weaker direction. The specific shoe that is right for you will be specific to your needs & foot type; in physical therapy we will assess your foot and help you choose a proper shoe.
If you have a high or stiff arch, shoe choice can go a few ways. Sometimes, individuals will prefer a higher arch support in the shoe. Other times a soft soled shoe with less arch support is more comfortable. Testing shoes is the best way to see what your foot wants in these situations.
Along similar vein as supportive shoes, using orthotics can be a really helpful way of supporting the arch of the foot. It won't help heel hyperflexibility quite as much however. It will support the arch so there's less twisting where the plantar fascia attaches to the heel.
Self Massage Strategies to Decrease Plantar Fasciitis
When your foot is hurting, we definitely want to be able to calm your pain levels down. Self-massage can be helpful in doing this. The key point to remember is not to start by massaging the painful areas! The soft tissue around the calf muscles essentially joins into the plantar fascia. If the plantar fascia is tight & painful, massaging the calf ‘above’ the painful spot typically can help the foot be less painful. If the inside bottom of the heel hurts, massage the inside of the calf. If it’s the outside of the heel, working on the outside and outside-back of the calf is a good place to start.
In Physical Therapy will teach you best methods of self massaging both with your hands as well as with a tool. Utilizing a plastic tool to perform Instrument Assisted Soft Tissue Mobilization of the calf & plantar fascia is one of the best ways to decrease your plantar fascia pain and increase soft tissue flexibility.
Heel Pain Exercises: Stretching & Strengthening
Calf and plantar fascia tightness is associated with plantar fasciitis. This tightness can come from poor neural tissue mobility or the tissues surrounding the muscles & tendons themselves. Combining stretching along with strengthening exercises is often the least painful and most effective way to address tightness through these areas.
When stretching out the bottom of your foot, calf or hamstring, be gentle with the intensity of the stretch and hold it for longer durations – 1 minute is a good start. A shorter, more intense stretch is more likely to flair your pain levels. A slant board, basically a ramp that you stand on, is a great way of stretching out your calves. Standing and stretching your heels over the edge of a step or stool can also be effective.
Nerve gliding exercises are typically also very helpful in decreasing plantar fasciitis pain. With true plantar fasciitis, it's just that connective tissue in the plantar fascia itself that gets irritated and broken down. Oftentimes though, the plantar nerve becomes irritated as well. Doing a nerve gliding exercise like the seated sciatic nerve glide or the supine (laying on your back) nerve gliding exercise will get the whole nerve chain from the spine to the bottom of the foot moving better. This oftentimes decreases calf tightness as well as pain when walking & standing.
Timing the nerve gliding exercises properly can dramatically decrease how much pain you have each day. Many of my patients have found it best to do the seated sciatic nerve glides at the edge of their bed before they take those first painful steps in the morning. Or if you've been sitting at your desk for a while, doing them before you're up and walking can be super helpful. Keeping the nerves moving through the calves and the hamstrings can help keep the foot from getting too tight and irritable.
Strengthening your calf, hip & foot muscles to better support the foot is critical to fully heal the broken down portions of the plantar fascia. The specific exercises will vary person to person, but in general most strengthening programs incorporate versions of heel raises, hip rotator strengthening as well as foot intrinsic muscle strengthening. In your physical therapy appointment, we will assess your movement & strength to prescribe you a customized strengthening program that fits your needs
In summary, to fix your plantar fasciitis pain we want to make sure you're asking the right amount of work from your foot. If you're overusing it, it's really, really hard to control your pain levels and recover. Supporting your foot with a proper shoe or orthotic can be helpful in decreasing your pain. Then self-massaging, stretching, nerve flossing and strengthening can all be helpful ways to decrease your plantar fasciitis pain.
If you want to fix your plantar fasciitis, can give us a call at 503-245-5710 or message us here. We’re here to get you moving at your best!