Plantar Fasciitis is a common athletic injury of the foot. While runners are most likely to suffer from plantar fasciitis, any athlete whose sport involves intensive use of the feet may be vulnerable. The risk of plantar fasciitis increases in athletes who have a particularly high arch, or uneven leg length, though improper biomechanics of the athlete’s gait and simple overuse tend to be the primary culprits. Cases of pf can linger for months at a time, with pain increasing and decreasing in an unpredictable pattern. Often, pf discomfort may nearly disappear for several weeks, only to re-emerge full- blown after a single workout. About 10 per cent of individuals who see an osteopath for plantar fasciitis have the problem for more than a year.
I. Stretching Routines
A. The Rotational Hamstring Stretch
Stand with your weight on your left foot and place your right heel on a table or bench at or near waist height. Face straight forward with your upper body and keep both legs nearly straight. As you stand with your right heel on the table and your left foot on the ground, rotate your left foot outward (to the left) approximately 45 degrees, keeping your body weight on the full surface of your left foot (both heel and toes are in contact with the ground). You are now ready to begin the stretch. Lean forward with your navel and shoulders until you feel a steady tension (stretch) in the hamstring of your right leg. Don’t increase the stretch to the point of pain or severe discomfort, but do maintain an extensive stretch in your right hamstring while simultaneously rotating your right knee in a clockwise - and then counter-clockwise - direction for 20 repetitions. As you move the right leg in the clockwise and counter- clockwise directions, stay relaxed and keep your movements slow and under control. After the 20 reps, remove your right leg from the table and rest for a moment. Then, lift your right leg up on to the table and repeat this clockwise and counter- clockwise stretch of the right hamstring, but this time keep the left (support) foot rotated inward (to the right) approximately 10 degrees as you carry out the appropriate movements. Perform 20 repetitions (clockwise and counter-clockwise) before resting. Finally, repeat this entire sequence of stretches, but this time have the right foot in support and the left foot on the table for the repetitions (do 20 clockwise and counter- clockwise reps with the left foot on the table and the right (support) foot turned out 45 degrees, and 20 more reps with the right foot turned in).
B. The Tri-Plane Achilles Stretch
Stand with your feet hip-width apart and your left foot in a somewhat forward position compared to your right foot (it should be about six to 10 inches ahead). Shift most of your weight forward onto your left leg and bend your left knee while keeping your left foot flat on the ground. Your right foot should make contact with the ground only with the toes. You are now ready to begin the stretch. Move your left knee slowly and deliberately to the left. As you do so, also attempt to ‘point’ the knee in a somewhat lateral direction. You should be able to feel this side-to- side and rotational action at the knee creating a rotational action in your left Achilles tendon. Bring the knee back to a straight-ahead position, and then move it toward the right. As you move the left knee to the right, again rotate the knee somewhat, this time to the right, creating more rotation at the Achilles tendon. When you bring the left knee back to the straight-ahead position, you have completed one rep (you should perform 20 total repetitions). Make sure that you keep most of your weight on the left leg while performing this exercise. Repeat the entire action described above for 20 reps, but this time with your right leg bearing your body weight and doing the side-to-side and rotational movements.
C. The Rotational Plantar Fascia Stretch
Stand barefoot, with your feet hip-width apart and with your left foot in a slightly forward position - two to three inches ahead of your right foot. The bottoms of the toes of your left foot should be in contact with a wall in front of you (the wall should be creating a forced dorsiflexion of the toes, so that the sole of the left foot is on the ground but the toes are on the wall), and your left knee should be bent slightly. Keep your weight evenly distributed between your right and left foot to start the exercise (see note below). You are now ready to begin the stretch. Slowly rotate your left foot to the inside (pronation) so that most of the weight is supported by the 'big-toe side’ of the foot. Then, slowly rotate your left foot to the outside (supination), shifting the weight to the 'little-toe side’ of your foot. Repeat this overall movement for a total of 15 repetitions. Next, simply repeat the above sequence with your right foot.
II. Strengthening Exercises for the Plantar Fascia
A. Toe Walking with Opposite-Ankle Dorsiflexion
Barefoot, stand as tall as you can on your toes. Balance for a moment and then begin walking forward with slow, small steps (take one step every one to two seconds, with each step being about 10 to 12 inches in length). As you do this, maintain a tall, balanced posture. Be sure to dorsiflex the ankle and toes of the free (moving-ahead) leg upward as high as you can with each step, while maintaining your balance on the toes and ball of the support foot. Walk a distance of 20 metres for a total of three sets, with a short break in between sets.
B. Toe Grasping
Stand barefoot with your feet hip-width apart. In an alternating pattern, curl the toes of your right foot and then your left foot down and under, as though you are grasping something with the toes of each foot. Repeat this action (right foot, left foot, right foot, etc.) for a total 50 repetitions with each foot. Rest for a moment, and then complete two more sets. Try pulling yourself across the floor (smooth surfaces work best) for a distance of three to six feet as you become more skilled at this exercise.