Exercises for Plantar Fasciitis

Plantar fasciitis is a common problem of the heel in adults. The pain is typically under the heel and is worse during the first few steps after resting, such as getting out of bed in the morning. There are many different treatments that get advocated for the treatment of plantar fasciitis. These range from foot orthotics to injection therapy to exercises. There is plenty of debate as to which is the better treatment, there is a lot of evidence for many individual treatments, but next to no evidence as to which is the better treatment or which combination of treatments gives the better outcomes.

A lot of advice is given for exercises to help treat plantar fasciitis. There is plenty of good evidence that supports the use of stretching of the calf muscles as part of the treatment and there is also evidence that tighter calf muscles are a risk factor for this problem. Because of this it makes sense to make calf muscle stretching as a routine exercise to help manage plantar fasciitis.

A lot of advice is given to strengthen the muscles and if you look around a lot, you can see that advice being given as the cure for the problem. There is no evidence that strengthening the foot muscles can help. That does not mean that it doesn’t help, it simply means there is no evidence supporting it, so any recommendations for foot strengthening exercises needs to be given in that context of the lack of evidence. There is good evidence that the small muscles in the foot are weaker in those with plantar fasciitis, but it is not known if the weakness is the cause of the problem or if the muscles get weaker due to the pain from the problem. As the muscles are weaker, it does make sense that strengthening exercises be part of the rehabilitation program, but it should only be part of the program and not advocated as the treatment.

There is some suggestion that loading programs help the rehabilitation of plantar fasciitis, but that is really only based on a lot of social media hype and no strong evidence. A side effect of the advocated loading programs is that it does strengthen the intrinsic muscles, which as mention above are weaker in those who have plantar fasciitis, so there is nothing wrong with doing it as part of the rehabilitation. The problem with the advocacy of this exercise approach is the weakness of the evidence that supports it. All exercises have the potential to be useful and a stronger muscle is probably better than a weaker one, but it should not be advocated as the primary treatment.

All of these issues around the use of exercises for foot problems was discussed on a recent episode of PodChatLive. PodChatLive is a regular livestream for podiatrists and other health professionals with an interest in foot problems. In this particular episode the two hosts chatted with Talysha Reeve about many of the above-mentioned issues. Talysha is a podiatrist with a lot of expertise in exercise therapy and rehabilitation of the foot.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.