Stretches and Other Self-Care Treatments for Plantar Fasciitis

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Skip the invasive procedures. The best first-line defense for plantar fasciitis is simple: rest, ice, and calf/arch stretching.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In my last video, I talked about some of the more invasive treatments for plantar fasciitis. What are some of the less invasive options? Simple measures to provide symptom relief for foot pain include activity modification, ice, and stretching exercises.

Although it’s hard to avoid walking altogether, during the acute phase in the first week or two, reducing walking and decreasing standing time, as well as switching to non-impact exercises like cycling or swimming may help.

Applying an ice pack for short periods of time can result in marked pain relief. One common method for plantar fasciitis is to roll the affected foot on a frozen water bottle for approximately ten to twenty minutes, two to four times a day.

Instead of just treating the symptoms, how about treating one of the most common causes by reducing the muscle tightness that contributes to the initial injury? Tight calf muscles pull up on the heel, and that puts strain on the plantar fascia, which is why stretching is considered one of the most effective first-line treatments for plantar fasciitis. There are two main types: Achilles’ tendon (calf) stretching, and plantar fascia–specific stretching.

Achilles’ tendon stretching is a common runner’s stretch performed while standing and leaning into a wall, with the affected leg extended back and kept straight while the front knee is bent. Plantar fascia–specific stretching is performed while sitting down, crossing the affected leg over the opposite knee, and pulling back on the toes until a stretch is felt in the arch of the foot. While fascia-specific stretching may work better, both stretches are considered safe and effective. When they were compared head-to-head, both similarly improved plantar fascia elasticity. And, it didn’t seem to matter whether the stretches are done in a sustained manner (three minutes at a time) or intermittently (ten times for ten seconds each, alternated with ten seconds of rest). The addition of strength training doesn’t appear to help, which may make sense since the plantar fascia isn’t a tendon in the traditional sense as there is no direct muscle attachment.

Stretching exercises help relieve tension in the Achilles’ tendon during the day, and night splints can help keep it stretched overnight. When we sleep, our ankle tends to assume a plantar-flexed position, such that our toes point relatively downward. That can result in the calf muscle tightness that can make those first steps in the morning so painful for those with plantar fasciitis. That’s the rationale for using night splints to keep the foot more flexed up towards the knee.

Data from the few randomized controlled trials are mixed. This may be due in part to poor compliance due to discomfort interfering with sleep. Splints that fit on the front of the ankle (rather than the back) and keep the foot at more of a right angle (rather than pulled even further towards the knee) may be more comfortable and therefore more effective.

Some consider orthotics, also known as shoe inserts, as a first-line therapy for plantar fasciitis alongside stretching. But do they work? A systematic review of randomized clinical trials found little evidence of benefit for orthotics for any of a variety of conditions. And specifically for heel pain, placebo-controlled studies comparing either custom or prefabricated orthotics to fake orthotics found no significant pain relief.

Probably the most robust study to date randomized more than a hundred plantar fasciitis patients to sham orthotics (made of soft, thin foam), one-form-fits-all prefabricated orthotics (made of firm foam), or customized orthotics made from plaster casts of their feet. The study participants were followed for a year, and no significant differences were found in the pain or function scores among any of the three groups.

Sham orthotics are complicated, though. Even thin foam might have some effect, so it might not be a pure placebo. Alternately, the receipt of what may obviously be a sham may introduce resentful demoralization, a phenomenon in which participants randomized to a no-treatment control group may feel aggrieved, which can influence the way they report their subjective experiences.

If you do want to try orthotics, know that the custom ones personally fitted to your feet don’t seem to offer any advantage over the prefabricated ones you can buy online or at a local store at a fraction of the price.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In my last video, I talked about some of the more invasive treatments for plantar fasciitis. What are some of the less invasive options? Simple measures to provide symptom relief for foot pain include activity modification, ice, and stretching exercises.

Although it’s hard to avoid walking altogether, during the acute phase in the first week or two, reducing walking and decreasing standing time, as well as switching to non-impact exercises like cycling or swimming may help.

Applying an ice pack for short periods of time can result in marked pain relief. One common method for plantar fasciitis is to roll the affected foot on a frozen water bottle for approximately ten to twenty minutes, two to four times a day.

Instead of just treating the symptoms, how about treating one of the most common causes by reducing the muscle tightness that contributes to the initial injury? Tight calf muscles pull up on the heel, and that puts strain on the plantar fascia, which is why stretching is considered one of the most effective first-line treatments for plantar fasciitis. There are two main types: Achilles’ tendon (calf) stretching, and plantar fascia–specific stretching.

Achilles’ tendon stretching is a common runner’s stretch performed while standing and leaning into a wall, with the affected leg extended back and kept straight while the front knee is bent. Plantar fascia–specific stretching is performed while sitting down, crossing the affected leg over the opposite knee, and pulling back on the toes until a stretch is felt in the arch of the foot. While fascia-specific stretching may work better, both stretches are considered safe and effective. When they were compared head-to-head, both similarly improved plantar fascia elasticity. And, it didn’t seem to matter whether the stretches are done in a sustained manner (three minutes at a time) or intermittently (ten times for ten seconds each, alternated with ten seconds of rest). The addition of strength training doesn’t appear to help, which may make sense since the plantar fascia isn’t a tendon in the traditional sense as there is no direct muscle attachment.

Stretching exercises help relieve tension in the Achilles’ tendon during the day, and night splints can help keep it stretched overnight. When we sleep, our ankle tends to assume a plantar-flexed position, such that our toes point relatively downward. That can result in the calf muscle tightness that can make those first steps in the morning so painful for those with plantar fasciitis. That’s the rationale for using night splints to keep the foot more flexed up towards the knee.

Data from the few randomized controlled trials are mixed. This may be due in part to poor compliance due to discomfort interfering with sleep. Splints that fit on the front of the ankle (rather than the back) and keep the foot at more of a right angle (rather than pulled even further towards the knee) may be more comfortable and therefore more effective.

Some consider orthotics, also known as shoe inserts, as a first-line therapy for plantar fasciitis alongside stretching. But do they work? A systematic review of randomized clinical trials found little evidence of benefit for orthotics for any of a variety of conditions. And specifically for heel pain, placebo-controlled studies comparing either custom or prefabricated orthotics to fake orthotics found no significant pain relief.

Probably the most robust study to date randomized more than a hundred plantar fasciitis patients to sham orthotics (made of soft, thin foam), one-form-fits-all prefabricated orthotics (made of firm foam), or customized orthotics made from plaster casts of their feet. The study participants were followed for a year, and no significant differences were found in the pain or function scores among any of the three groups.

Sham orthotics are complicated, though. Even thin foam might have some effect, so it might not be a pure placebo. Alternately, the receipt of what may obviously be a sham may introduce resentful demoralization, a phenomenon in which participants randomized to a no-treatment control group may feel aggrieved, which can influence the way they report their subjective experiences.

If you do want to try orthotics, know that the custom ones personally fitted to your feet don’t seem to offer any advantage over the prefabricated ones you can buy online or at a local store at a fraction of the price.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

So, self-care for plantar fasciitis in three simple steps: rest it, ice it, and stretch it. 

If you missed the previous video, see Do Medical, Surgical, and Physical Therapy Treatments Work for Plantar Fasciitis?.

Check out my forthcoming book, How Not to Hurt, available now for preorders. (All proceeds received from the book are donated directly to charity.)

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