What physiotherapy (physical therapy) exercises are recommended for plantar fasciitis?

Physiotherapy Exercises for Plantar Fasciitis

A supervised exercise program including stretching, strengthening, and functional exercises is the most effective physiotherapy approach for managing plantar fasciitis. 1

First-Line Exercises

Stretching Exercises

• Plantar Fascia-Specific Stretch:

  • Sit with affected foot across opposite knee
  • Pull toes back toward shin until stretch is felt in arch
  • Verify stretch by palpating tension in plantar fascia
  • Hold 30 seconds, repeat 3 times, perform 2-3 times daily 1, 2

• Calf Stretching:

  • Stand facing wall with hands on wall at eye level
  • Place affected foot behind, keeping heel on ground
  • Lean forward until stretch is felt in calf
  • Hold 30-60 seconds, repeat 2-4 times 1, 3

Strengthening Exercises

• Toe Curls with Towel:

  • Sit with feet flat on floor
  • Place towel under foot and curl toes to pull towel toward you
  • Perform 2-4 sets of 10-15 repetitions 3

• Intrinsic Foot Muscle Strengthening:

  • Toe spreading exercises
  • Short foot exercise (arch doming)
  • Perform 8-12 repetitions, 2-4 sets 3, 1

Activity Modification

• Temporarily reduce activities that aggravate symptoms during acute flare-ups 1
• Avoid walking barefoot as this can worsen symptoms 1
• Incorporate rest periods during prolonged standing or walking 2
• Wear supportive footwear with appropriate arch support 1, 4

Progressive Program Structure

Weeks 1-2

• Focus on pain relief and gentle stretching
• Ice massage to painful area (10 minutes, 2-3 times daily)
• Begin basic stretching exercises with lower repetitions

Weeks 3-6

• Increase stretching intensity and duration
• Add strengthening exercises
• Begin gradual return to normal activities

Weeks 7-12

• Progress to functional exercises
• Increase resistance for strengthening exercises
• Focus on maintenance and prevention 1

Adjunctive Treatments

• Night Splints: Keep foot in dorsiflexed position overnight to maintain plantar fascia stretch 1, 2
• Orthotics: Custom or over-the-counter inserts to support arch and reduce tension 1, 4
• Manual Therapy: Soft tissue mobilization of plantar fascia and calf muscles 5

For Recalcitrant Cases

If symptoms persist after 8-12 weeks of consistent exercise therapy:

• Consider referral for extracorporeal shock wave therapy 1, 2
• Evaluate for corticosteroid injection (noting risks of fat pad atrophy and fascia rupture) 2

Common Pitfalls to Avoid

• Inconsistent Exercise Performance: Exercises must be performed regularly (daily) for effectiveness 1
• Premature Return to Full Activity: Gradual progression is essential to prevent recurrence 2
• Neglecting Footwear Modifications: Appropriate supportive shoes are crucial during recovery 1
• Focusing Only on Stretching: A comprehensive approach including strengthening is more effective than stretching alone 6

Most patients (approximately 90%) will improve with these conservative techniques when performed consistently for 8-12 weeks 4.