Plantar fasciitis is a really common injury that a lot of athletes, especially runners, deal with at some point during their training. It is most easily recognized as persistent pain in the bottom, or sole, of the foot and heel with standing and walking. That first step in the morning is a real pain in the foot (haha!) when you’re dealing with plantar fasciitis. Fortunately, you don’t just have to just deal with it. Physical therapy can be a game changer (pun intended). There’s a lot you can do to get rid of the pain and get back to doing the activities you enjoy.

What is plantar fasciitis?

Plantar fasciitis is a condition resulting from inflammation of the plantar fascia, which is the band of fibrous tissue on the sole of your foot extending from your heel to your toes. The pain typically starts in the bottom/sole of the foot, right along the heel, and extends out toward the middle of the foot. Pain is usually at its worst first thing in the morning, when standing up after sitting for a long period of time, and with prolonged walking or standing activities. You might even notice that your pain will worsen or improve depending on your choice of shoewear. The pain sometimes decreases as you get up and move around, but in cases with more severe inflammation and irritation, the pain is constant. 

What causes plantar fasciitis?

There are many different reasons that you might experience plantar fascia pain. It can stem from overuse, sudden increase in activity level (usually walking or running), walking in improper footwear, or muscle and joint imbalances in the foot, knee, or hips. In some cases, your foot pain can be caused by issues and imbalances in the low back. Whatever the reason, it all results in consistent and persistent pain that feels like it’ll never go away (luckily, that’s not the case). 

There’s a lot you can do to get rid of this pain. Physical therapy is one of the best and most direct ways to identify the root of the problem and get you feeling better fast. Treatment usually starts with an initial evaluation where we look at your mobility, strength, and movement patterns to identify the source of the pain (hint: as I said earlier, it’s not always the plantar fascia’s fault - sometimes it can be coming from your low back). Then we use a combination of hands-on treatment and exercises to address your specific needs and get you on the road to recovery.

Hands-on treatment, referred to as manual therapy, usually involves some massage, scraping, fascial release, and mobilization of the joints and tissues in the foot and ankle. Your exercises will help to improve activation of the little stabilizer muscles in the foot (called the foot intrinsics), strengthen the muscles of foot and lower leg, improve stability and balance, and increase mind-body awareness to decrease the strain on the plantar fascia.  All together, your program will decrease inflammation surrounding the muscles, tendons, and ligaments in your foot, reduce your pain, and get you back on track with your training.

What are the best exercises for plantar fasciitis?

In most cases, there are a few exercises I recommend doing to start the healing process. Of course, every patient does better with a program customized to their needs, but in the meantime, here are some of my favorite exercises to get started with to kickstart your recovery:

1. Ankle ABCs - Write the entire alphabet with your foot and toes prior to getting out of bed in the morning, before standing up from sitting down, and before going walking or running. This activates the muscles and ligaments in the foot and prepares them for the load of walking.

2. Seated (and progress to standing) alternating heel and toe raises - Sitting in a chair gently raise your heels off the ground, lower them to the ground, and then raise your toes off the ground as far as possible (while maintaining heel contact on the ground), then lower to starting position. Only move through a range of motion that doesn’t increase your pain level. Repeat. Start with 2-3 sets of 10-15 each direction (toes up, heels up). Starting in a seated position will make this exercise more comfortable and reduce irritation. Progress to standing when this exercise feels too easy to do seated. Pro tip: once standing heel raises are feeling easy progress to doing them on the edge of a stair

3. Barefoot single-leg standing balance - This one is a little more advanced, but very beneficial. Without shoes on, place your foot on the floor, ensuring your toes, middle of the foot, and heel are in good contact with the floor. Then raise your other foot off the ground to work on your balance. If this move is too painful or difficult, keep a toe or two (from the other foot) down to modify the exercise. Your goal is to balance for 30-60 seconds on each foot, Repeat 2-3 times per foot. If this exercise becomes too easy, add trunk rotations or a kick with the opposite leg to challenge your balance and activate foot muscles. 

4. Tennis ball roll-out - Start in a seated position for this one. Grab a tennis ball (or golf ball), place it on the floor, and then place the sole of your foot directly on the tennis ball. Gently roll the sole of your foot back and forth along the tennis ball for about 2 minutes, making sure not to add so much pressure that the exercise is irritating and painful. We’re trying to increase circulation and decrease tension in the foot muscles with this exercise, not increase your pain.

Treatment for plantar fasciitis

My best recommendation is to find a physical therapist who regularly treats plantar fasciitis in runners and athletes and schedule an appointment. Often times it takes a combination of manual therapy techniques (massage, scraping, cupping) and a custom exercise plan to get the best results. Getting started sooner rather than later helps you recover more quickly and efficiently, and reduces your time spent on the sidelines because of pain. You don’t just have to deal with plantar fascia pain or “wait it out” - you’ve got options.

If you’re local to the Tri-Cities, WA area, contact Game Changer Physical Therapy located in Kennewick, WA.

I’m Kacie Shively, PT, DPT, a physical therapist for athletes who specializes in working with runners. As a result, I frequently treat runners who are experiencing plantar fasciitis and help them return to running (and walking) quickly and without pain. Find out more information and determine if physical therapy would be beneficial for you by booking a free 15-minute discovery call via my scheduling link that’s listed below. I’m always happy to help! If you want to learn more about physical therapy for runners, check out my recent blog here.