Treating Plantar Fasciitis with Physical Therapy
Mangiarelli Rehabilitation physical therapist Sarah demonstrates three exercises to reduce plantar fasciitis pain and restore function in the foot in the video below. Plantar fasciitis is a common cause of foot and heel pain that develops due to repeated activities that strain the plantar fascia, a thick band of tissue that runs along the bottom of the foot and supports the arch of the foot. Physical therapy is highly effective in treating plantar fasciitis, using manual therapy and therapeutic exercise to reduce pain, restore function and strength in the foot, and improve foot mechanics.
Foot Anatomy: What is the Plantar Fascia?
Your foot and ankle are the foundation for your movement, balance, and equal distribution of your body’s weight. The foot is complex, made up of 26 different bones such as the talus and calcaneus (heel bone) of the rearfoot and metatarsal and phalanges bones of the forefoot. Within the foot, there are numerous ligaments that connect bones, support the foot’s arches, and provide stability to the joints of the foot.
The plantar fascia is a key structure in the foot. Plantar fascia is a thick band of connective tissue that runs along the sole of the foot from your heel to your toes. It supports the arch of the foot and bears weight as you walk. When weight is put on the foot, the plantar fascia helps to “lock” the bones of the foot and stabilize the arches.
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What is Plantar Fasciitis?
Plantar fasciitis is one of the most common causes of foot and heel pain, estimated to affect two million people in the United States each year. Plantar fasciitis affects women more than men and is more commonly seen in those ages 40 to 60 who are overweight, have high arches, or work in jobs that require long hours standing on hard surfaces, such as teachers or factory workers. Plantar fasciitis is also one of the most common injuries among runners and athletes who engage in high-impact activities in their sport which places significant repetitive pressure on the foot and plantar fascia. Ill-fitting shoes or shoes that are old and worn can also contribute to plantar fasciitis as the shoes are no longer providing support to the foot.
When standing on your feet all day or running miles on your feet without rest, the pressure from the weight of your body stretches the plantar fascia and can lead to tiny tears in the plantar fascia fibers. When these tears heal, they form scar tissue, which can cause stiffness and pain, usually at the heel.
Over-pronation or under-pronation when walking can also contribute to the development of plantar fasciitis. Over-pronating means excessive foot mobility, leading to flattening of the foot arch and causing the plantar fascia to elongate and experience increased tensile forces that cause micro-tears. Under-pronation limits the shock absorption of the foot, making it unable to dissipate the force placed on it, causing the plantar fascia to bear the force and placing more tension in the plantar fascia, leading to inflammation and pain.
Common symptoms of plantar fasciitis include:
Heel pain that worsens when you stand up after sitting for long periods of time
Pain along the bottom edge of the foot along the arch when taking your first steps in the morning
Soreness or stiffness in the heel upon waking up
Pain that worsens with activity like climbing stairs, running, or jumping but improves with rest
Swelling/redness on the bottom of the foot over affected area
Physical Therapy Treatment for Plantar Fasciitis
Physical therapy is a highly effective treatment for plantar fasciitis. In fact, 90% of those with plantar fasciitis recover from the condition with conservative physical therapy treatment. Physical therapy treatment for plantar fasciitis can include:
Pain management using ice to decrease pain and inflammation.
Manual therapy that involves both soft tissue and joint mobilizations of the foot and ankle to improve the pliability of the plantar fascia and increase ankle joint range of motion for improved weight-bearing and walking and decreased stress on the plantar fascia.
Stretching of the calf muscles, the gastrocnemius and soleus muscles, and the Achilles’ tendon and plantar fascia.
Therapeutic exercise and strengthening of the foot and ankle muscles using resistance bands and small weights to improve balance and control in the foot. The therapist may also incorporate strengthening of the leg, hip, and gluteal muscles to help stabilize the pelvis, keep the knee from moving inward, prevent the foot from over-pronating, and ensure a balanced distribution of weight on the foot and plantar fascia when walking.
Dry needling to reduce muscle tightness and referred pain from tight muscles.
Kinesiotaping to support the inflamed plantar fascia and improve blood flow to the injured area.
Gait training to address abnormal foot mechanics contributing to plantar fascia pain.
Use of orthotics and instruction on supportive footwear to ensure appropriate cushioning and support of the foot and minimize abnormal foot movement.
Mangiarelli Rehabilitation physical therapist Sarah demonstrates three exercises you can do to reduce plantar fasciitis pain and restore function in the foot:
Numerous research studies have shown that there is strong evidence that combining manual therapy and rehabilitative exercises to treat plantar fasciitis is highly effective. A 2017 review assessed a database of 819K patients with plantar fasciitis and found that those who were referred to physical therapy for plantar fasciitis treatment had faster recovery times. Seven percent (58K) of the 819K patients studied were referred to physical therapy; those patients received manual therapy 87% of the time and supervised rehabilitative exercises 90% of the time. Researchers found that patients who received evidence-based physical therapy treatment averaged fewer visits and had a lower cost of care of $340.
In a 2022 study, researchers found that manual therapy, exercise, and insole interventions were effective in relieving plantar fasciitis pain and restoring foot function. In the study, thirty-nine patients were divided into three intervention groups: group 1 received manual therapy, exercise, and insole treatment, group 2 received exercise and insole interventions, and group 3 received only the insole intervention. Researchers measured pain, dorsiflexion range of motion, foot function, and health-related quality of life at baseline and after 6 weeks of treatment. Researchers found that all groups experienced clinical improvements in pain and function as well as improved quality of life.
Manual therapy was shown to be effective for reducing pain while increasing lower extremity mobility, while insoles helped to prevent increased pronation or supination of the foot, corrected foot posture, and improved foot arch support. Exercise interventions including stretching and foot muscle strengthening were effective in decreasing tension in the plantar fascia and maintaining foot arch support while reducing pain.
Plantar fasciitis is a common condition that contributes to foot and heel pain that physical therapy can effectively treat and reduce pain. Give us a call to set up an evaluation today and get back to your regular activities without persistent foot pain!
