Can plantar fasciitis improve with movement?

Can Plantar Fasciitis Improve with Movement?

Yes, plantar fasciitis can improve with specific types of movement, particularly structured stretching exercises and controlled physical activity, though initial rest during acute pain phases is important.

Understanding Plantar Fasciitis and Movement

Plantar fasciitis is characterized by pain in the proximal plantar fascia, typically worst with the first steps in the morning or after prolonged sitting. While complete rest was once commonly recommended, current evidence supports the role of specific movements in recovery.

Benefits of Movement for Plantar Fasciitis

• Stretching exercises: Tissue-specific plantar fascia stretching has been shown to be superior to standard Achilles tendon stretching for chronic plantar fasciitis 1
• Foot-ankle exercises: An 8-12 week supervised exercise program can reduce risk factors for ulceration and improve foot-ankle joint mobility 2
• Controlled training: When combined with other treatments like corticosteroid injections, controlled strength training and stretching provides superior outcomes 3

Evidence-Based Movement Recommendations

Recommended Movements

1. Plantar fascia-specific stretching:

   • Non-weight-bearing stretches targeting the plantar fascia
   • Perform first thing in the morning before taking first steps
   • Repeat multiple times throughout the day

2. Regular calf muscle stretching:

   • Helps maintain ankle dorsiflexion
   • Reduces tension on the plantar fascia

3. Supervised exercise programs:

   • 8-12 week programs under healthcare professional supervision
   • Include stretching, strengthening, and functional exercises 2

When to Limit Movement

• During acute flare-ups: Temporarily reduce activities that aggravate symptoms
• With pre-ulcerative lesions: Avoid mechanically loading exercises 2
• After corticosteroid injections: Follow controlled training protocols 3

Treatment Algorithm

1. Initial phase (acute pain):

   • Relative rest from aggravating activities
   • Ice massage to reduce pain
   • Begin gentle plantar fascia-specific stretching
   • Use NSAIDs for pain control 4

2. Progressive phase:

   • Increase stretching frequency and intensity
   • Add strengthening exercises for foot intrinsic muscles
   • Gradually return to normal activities with proper footwear

3. Maintenance phase:

   • Continue regular stretching
   • Maintain appropriate activity levels
   • Use supportive footwear and orthotics as needed 2

Common Pitfalls to Avoid

• Complete immobilization: Prolonged rest can lead to stiffness and weakness
• Inappropriate stretching: Using non-specific stretches may be less effective 1
• Returning to full activity too soon: Gradual progression is essential
• Walking barefoot: This can aggravate symptoms and should be avoided 2
• Using only standard Achilles stretching: Plantar fascia-specific stretching is more effective 1

Special Considerations

For recalcitrant cases (symptoms persisting beyond 3 months despite conservative treatment), additional interventions may be needed alongside continued appropriate movement:

• Corticosteroid injections combined with controlled training 3
• Customized orthotic devices
• Night splinting
• Extracorporeal shock wave therapy 2

Movement plays a crucial role in the management of plantar fasciitis, but it must be the right kind of movement, appropriately timed, and combined with other evidence-based treatments for optimal outcomes.