Let’s Talk About: Plantar Foot Pain
You have heel pain, and your brain instantly goes there: plantar fasciitis. The boogey monster of all runners.
Don’t panic! There has been lots of research over the past decade as to what plantar fasciitis is and why it’s so difficult to treat. They’ve discovered that in many cases, there are actual structural changes in the fascia that make it less resilient to stress. The change in the fibers due to this process can be progressive and cascade into more problems if the fibers are not rehabbed properly. The typical phrase used in the medical community is “degenerative changes” but I hate that shit. It makes the issue sound scarier than it actually is, and it’s not helpful.
Here’s the good news! This structural fiber change shows signs that it can be rehabilitated. The key to this is load management and time.
Studies suggest that placing a moderate load on the fascia produces a positive environment for rehabilitation. The result is a strengthening in the structure of the fiber and a reduction in the inflammatory component.
In short, with proper rehab, we can load the tissue in a way that is tolerated and promotes the healing process. With progressive load over months – not dates or weeks – we can move the fascia in a positive direction and make it more resilient to the stress of running.
A note about “plantar fasciitis”
Despite what most of the medical and running community will tell you, not all heel pain is plantar fasciitis! You may have an inflammatory component to your foot pain but it is clear that that inflammatory component is almost never a stand alone. Additionally, you cannot strictly diagnose plantar fasciitis by location and pressing on the tissue. There are many structures on the bottom of the foot that can be INVOLVED with plantar foot pain. The good news is that for the most part, these structures are also load-dependent and can be progressively rehabilitated along with the fascia.
Exercises to Prevent & Treat Rehab Plantar Foot Pain
The Disclaimer: Unless you’re actually seeing us as a patient, we are not your medical provider! All exercises here are meant to be jumping-off points for prehab/rehab – they are by no means an exhaustive list, nor at they an all-encompassing solution. If you believe you have an injury, always make an appointment with a medical provider to have yourself assessed. If you want to see us, click the “Book Appointment” button on the top right!
Stair Toe Holds
Toe holds place a tolerated stress load on the fascia, muscles, and tendons of the foot.
Because we spend all day in shoes, our feet rarely interact with the ground. This lack of interaction means that we have lost our ability to use and control our feet properly. This leaves the fascia, muscles, and tendons at a loss when it comes to stress capacity.
Toe holds can be a bulletproof way of addressing some of these issues.
Keep in mind, these shouldn’t be painful!
Place all 10 toes onto a step. Your foot “knuckles” should be off the stair.
Using only your toes, hold your body weight for 10 seconds.
Keep even pressure across your big toes → think “press down” not “squeeze and wrap your toes around a stick.”
Lower and repeat
Work up to 30 reps of 10-second holds over 2-4 weeks.
Progress to single-leg toe holds for 3-4 weeks.
Calf Raise with Rolled Towel Under Toe
Calf raises are a progression from the toe holds. They place the fascia and tendons of the foot in an elongated position which is great for tissue adaptation. However, some people don’t tolerate it, so be mindful and do not continue these if you feel pain.
Roll up a towel and place it on a stair.
Extend the toes over the towel (as you did in the stair toe holds), keeping the metatarsal joint (big knuckle) on the ground.
Raise yourself up onto your toes over the course of a 2-second count
Hold for one second at the top
Lower back to a neutral position over the course of a 2-second count
Do not squeeze in your toes until the very top! Repeat for 30 reps.
Up-and-outs
Up-and-outs target the tibialis posterior muscle. It’s similar to a standard calf raise, with a twist - as you raise and lower, you’ll change your foot position to target this muscle more specifically.
Find a stair, ledge, or book.
Place your foot on the stair with your heel off the step.
Begin to raise your heel with even pressure across the ball of your foot. The most pressure should start behind the big toe.
As you raise your heel, roll your foot out so that the force of pressing ends up being placed mostly towards the 4th and 5th toes (the soles of your feet will begin to face each other).
Hold at the top and then slowly lower your foot over a four-count. As you lower, transition your weight from the outside of your foot to the inside of your foot, so that only the part of your foot right behind the big toe is touching the stair.
Hold at the bottom and repeat.
Work up to 3 sets of 10 a day, and then increase to twice a day.
Progress to perform up-and-outs using only one leg.
Nerve Flossing
A healthy nerve is a quiet nerve and for a nerve to be healthy it must be mobile! Nerves that don’t move well get pissed easier and talk more ( with pain!) and so this drill addresses the nerve most commonly involved in plantar foot pain.
With a band, rope or belt around your foot lay flat on the ground or in bed.
Pull your toes and foot to your knees by flexing at the ankle. We call this dorsiflexion
Rotate your ankle out so that your pinky to is the closest to your knee
Lift your leg up with a straight knee and maintain the ankle position until you feel a gentle stretch. Most people feel the stretch in the calf or hamstring but a stretch anywhere is fine.
Once you reach the stretch pause and use the band, rope, or belt to hold your leg in the air, not your hip flexor
Point your toe like a ballerina and not that the original stretch sensation is gone. Hold for 1 second
Return your foot to pulling the foot and toes up to the knee and then rotate out so the pinky toe is the toe closest to the knee and hold 1 second
Repeat 30 reps
Key Takeaways
Plantar pain is a complex presentation for almost everyone. There often are layers that take time to peel back. Inflammation can be one of them but it is almost never the only component.
Don’t try to massage away the pain. You cannot fix this by smashing your foot on a golf ball. In fact, you may be doing more harm than good.
Load and time are key to recovery. The key to fixing plantar pain is loading the area in a tolerated, progressive manner for a minimum of 12 weeks. This means maintaining your foot strength by engaging in rehab sessions at least 4-7 times per week. Almost all plantar foot pain needs to go through a prolonged, tolerated, progressive loading protocol that allows the tissue to become resilient enough that the stress of running no longer produces a negative cellular response.
Patience, patience, patience. No one wants to hear this but there is no way around it. Cellular change in the body takes time. Sometimes it can take months to make significant progress, but if you stick to the plan, you will make progress.