Plantar fascia strengthening: Why you should do it and how.

People commonly use stretches to help them recover from plantar fasciitis. But one often overlooked component of treatment is plantar fascia strengthening.

Many people fear that exercising their foot and plantar fascia will cause more pain or worsen their injury.

However, research shows that strengthening your plantar fascia may help ease your pain and improve your function quicker than stretching initially. It could also help prevent re-injury.

Why does strengthening help your plantar fascia?

Load vs. capacity

When you stand, walk, run, or jump, your plantar fascia needs to be strong enough to withstand the forces (load) passing through it.

When you load your plantar fascia with more than it can tolerate (beyond its capacity), it becomes injured, inflamed, and sore.

If this is a once-off situation, and you rest it properly, it will heal, and you will feel better within a few days to weeks.

However, if you overload it repeatedly and don’t give it a chance to recover between each injury, the plantar fascia starts to develop changes in its structure.

How structural changes affect your plantar fascia's strength

If you continue to aggravate your injury over a long period, the connective tissue fibers change. Eventually, the plantar fascia loses its smooth and organized structure and, as a result, also some of its strength.

Over time, the plantar fascia begins to behave and respond to stress and strain more like tendinopathy. And, instead of tissue inflammation causing most of your symptoms, the loss of tissue strength causes the majority of your symptoms.

When your plantar fascia loses some of its strength, it is less resilient. And it can’t take on the same loads as before, meaning smaller loads can injure it and make it flare up easily.

It explains why you may experience worsening plantar fasciitis symptoms over time. And why it may seem like even light, everyday activities can set the pain off.

How to help your plantar fascia heal

Initially, it would be best to let your symptoms settle down and reduce the load on your plantar fascia. You can do this by lowering your running mileage and reducing your time on your feet.

Then, you would need to start rebuilding the strength in your plantar fascia.

It’s essential to slowly increase the load on your plantar fascia and build its load tolerance (capacity) to match your individual needs. One of the best ways to do this is through specific plantar fascia strengthening exercises.

The best type of strengthening exercises for your plantar fascia

What the science says

Type 1 Collagen fibers are connective tissue fibers that make up your plantar fascia. Studies have found that high load strengthening exercises can stimulate collagen production in injured tissues.

Researchers have also found that progressive high load strengthening programs can help restore your plantar fascia to health quicker than stretching (within 3 months). A progressive program is one that starts with easy low load exercises but slowly build in intensity and load as the tissue strengthens.

However, there is currently no evidence that long-term (12 months +) strengthening works better than stretches for your plantar fascia.

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How to strengthen your plantar fascia

Before we provide instructions on how to do specific plantar fascia exercises, we recommend these guidelines:

1. Start at the right level for your injury

The exercises aim to maximally load the plantar fascia to get it as strong as it needs to be for your activity levels.

Since you need to work to your maximum levels during the exercises, it’s crucial to start at the appropriate level for your condition and abilities.

If you start at a too difficult level or load your plantar fascia more than it can cope, your pain will likely worsen.

Fortunately, the Exakt app helps you know what exercises to do, when to start, and when to progress to the next ones. So, you never have to guess, and you can be confident that you won’t worsen your condition.

2. You don't need a rolled-up towel under your toes for the exercises to be effective

Some researchers suggest that you place a rolled-up towel under your toes while doing the exercises.

The rationale is that it pulls your toes into more extension (up and away from your heel), which places more tension on your plantar fascia—further loading and strengthening it.

However, there is no good evidence of whether this positioning improves outcomes better than without the towel.

In our experience, this position may irritate your toes.

We have found that doing regular heel raise exercises correctly at the right time and staying consistent with your program works just as well as using the towel. But it has the added benefit of not agitating your toes as much.

So, our advice is to try each method (i.e., with and without a towel) and see which one works best for you.

3. Pain with plantar fascia exercises

It may be slightly uncomfortable while you are doing the exercises. However, there should be no significant increase in your pain after doing the exercises, or in the 24 hours following them.

If you experience more pain the next day, it is best to reduce your repetitions until you find a level that does not increase your pain the next day.

4. Don't forget to train your plantar fascia's fast loading ability too.

In the later stages of your rehabilitation, you should include exercises that rapidly load your plantar fascia—for instance, hopping or jumping.

These activities mimic the loads you will experience while running. So, by training them, your plantar fascia prepares for running and ensures you have the strength you need before you start. This limits the risk of re-injury.

Plantar fascia strengthening exercises

Double leg calf raises

Instructions

1. Hold onto a stable object for balance.
2. Stand on a soft surface or wear shoes if it feels more comfortable.
3. Standing with your feet hip-width apart.
4. Keeping your knees straight, move up onto your toes.
5. Slowly lower your body down until your heels touch the floor (it should take approximately 3 seconds to lower your body down).
6. Immediately move back up onto your toes.
7. Aim for 20 repetitions, but do not force this. If you find it difficult, do as many repetitions as is comfortable, adding more as your strength improves.
8. Rest for 60 seconds.
9. Complete 3 sets.

Top tips: You don’t have to lift all the way up if it is uncomfortable. If you’re doing this in bare feet, you must stand on a soft surface. Otherwise, it can hurt the ball of your foot.

When to progress: Once you can do 3 sets of 20 repetitions without any discomfort, you can move on to the next exercise: Single leg calf raises.

Single leg calf raises (Progression from double leg)

Instructions

1. Hold onto a stable object for balance.
2. Stand on a soft surface or wear shoes if it feels more comfortable.
3. Lift one foot off the floor.
4. Keeping your knee straight, move up onto your toes.
5. Slowly lower your body down until your heel touches the floor (it should take approximately 3 seconds to lower your body down).
6. Immediately lift back up onto your toes.
7. Aim to do 15 repetitions, but again do not force this. If you find it difficult, do as many repetitions as you can do with good technique, adding more as your strength improves.
8. Rest for 60 seconds.
9. Complete 3 sets.

Top tip: Doing these exercises slowly, forces your brain to work harder and develops better control.

When to progress: Once you can do the full 3 sets of 15 repetitions on one leg, it is time to start adding weights. How much weight you add and what you aim to achieve will depend on how much you weigh. The app guides you through this process and lets you know when you’ve done enough.

Conclusion

Start your recovery for plantar fasciitis today

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Plantar fasciitis can be tricky to manage because it has so many different causes. Fortunately, the research shows that, with conservative treatment, about 80% of people’s symptoms resolve within a year.

Getting an early diagnosis and starting proper treatment at the right time is key.

If you’ve left it a little late, don’t worry! The most important thing is to get started. The sooner you start, the better.

One of the best ways to help you recover is a well-structured, progressive high-load strengthening program.

Exakt Health is here to help. The app takes you through the plantar fascia rehabilitation program step by step and enables you to get back to running. It also helps keep you running pain-free in the future.