Foot Training Myths For Plantar Fasciitis

Jessica Bento, Physical Therapist (Creator DVRT Restoration Certification, DVRT Rx Shoulder, Knees, Pelvic Control, & Gait Courses)

Being in pain stinks, no two ways about it! When we hurt, we just want a solution and what is so interesting to note in just the last few years is how many people turn to social media for solutions. I know this from personal experience as almost daily I have someone reaching out to me on my Instagram asking them help for this or that condition. Unfortunately, I can’t do a medical assessment over the internet so I try to refer them to the appropriate people, but I can sense the frustration and despair their pain is causing. A really common one for people is plantar fasciitis which can be a very painful issue for people.

I would have many patients I would work with that would come with plantar fasciitis issues. Very often a combination of some manual therapy, reducing activity for a bit, and some training of the feet would help tremendously. Of course, the issue was if people would keep up with their foot training, managing their activity levels appropriately and keep proper movement of the lower leg up.

Nowadays though, it isn’t uncommon for me to see people posting some pretty extreme foot training exercises all in the hope to prevent plantar fasciitis. It could be doing some type of calf raise as they do a split squat, they have the arch of their foot unsupported and so forth. Sadly, none of this is rooted in any research or being questioned if appropriate for people in either treating or preventing plantar fasciitis.

It isn’t as though plantar fasciitis hasn’t been significantly researched. Plantar fasciitis impacts around 2 million people in the U.S. and is one of the most common complaints of foot pain. Plantar fasciitis impacts both sedentary and athletic people and is often attributed to chronic overload either from lifestyle or exercise (1). For a long time, plantar fasciitis was thought to be an inflammatory condition, but more current research is demonstrating it is more of a degenerative issue (2). Contrary to many fitness pros and therapists on social media claiming that plantar fasciitis is a strength issue, research actually shows that the three most major causes are lack of ankle mobility, bodyweight, and how much time people spend on their feet during the course of the day (3).

Notice that weakness wasn’t really a cited cause. When it comes to helping plantar fasciitis, stretching and myofascial soft-tissue work on the bottom of the foot was just as effective as custom orthotics, night splints, and the like (4). To be fair though, there is evidence that strength training can help with plantar fasciitis pain, but it may not be as complicated as you may believe. A 2015 study found single leg heel raise exercises (think of standing on one leg and just coming up to your toes) as effective for reducing plantar fasciitis pain (5). What I think is really important about this was not just the strength training aspect, but that such training was termed “high loading” exercise. Meaning that this created a lot of stress in the foot and plantar fascia.

When people take this concept to even more demanding exercises (such as our example of holding a front foot heel elevated position during a split squat, or doing high loaded exercises without the whole foot supported) it could be exceeding the strength and tolerance of the plantar fascia. Often, people have no way of measuring the impact of such exercises if they are performed on any regular basis and it is questionable how effective they could be if they are only performed once in a while. Instead, we should err on less extreme, but really effective ways of putting these ideas into practice as I show below.

 

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Employing balance beam carries as I show does wonders for the foot, ankle, and glute muscles that all help make us stronger and more resilient.

Of course, as we often talk about in DVRT, a common mistake is when people get overly focused upon just the foot. A big reason that many plantar fasciitis issues come about are inappropriate foot mechanics, especially during walking or running. One of the most common issues is lack of strength of hip abductor muscles (on the outer side of the hips) and this weakness can impact both the knee and foot. That is why research does show that performing hip strengthening exercises (specifically focused on the abductor strength) helps plantar fasciitis (6). This goes back to our ideas of a kinetic chain and how one area impacts another. We can begin with such exercises as side planks and half kneeling then progressing to more sprinter stance and single leg exercises. These are some of the best ways to build up abductor hip strength in a way that will impact both the knee and foot.

Don’t miss our NEW upcoming 6-week online CEU Foot, Ankle, & Knee Masterclass where we dive into how to better understand the issues of this kinetic chain that impacts so much of how we perform and our most common injuries. Our early bird won’t last long, don’t miss it HERE

 

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References:

1. Dyck DD, Jr, Boyajian-O’Neill LA. Plantar fasciitis. Clin J Sport Med. 2004 Sep;14(5):305–9. DOI: http://dx.doi.org/10.1097/00042752-200409000-00010
2. Schwartz EN, Su J. Plantar fasciitis: a concise review. Perm J. 2014 Winter;18(1):e105-7. doi: 10.7812/TPP/13-113. PMID: 24626080; PMCID: PMC3951039.
3. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003 May;85(5):872-7. doi: 10.2106/00004623-200305000-00015. Erratum in: J Bone Joint Surg Am. 2003 Jul;85-A(7):1338. PMID: 12728038.
4. Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2003;(3):CD000416. DOI: http:// dx.doi.org/10.1002/14651858.CD000416
5. Rathleff MS, Mølgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015 Jun;25(3):e292-300. doi: 10.1111/sms.12313. Epub 2014 Aug 21. PMID: 25145882.
6. Lee JH, Park JH, Jang WY. The effects of hip strengthening exercises in a patient with plantar fasciitis: A case report. Medicine (Baltimore). 2019 Jun;98(26):e16258. doi: 10.1097/MD.0000000000016258. PMID: 31261593; PMCID: PMC6617481.