What are the specific exercises for plantar fasciitis, Achilles tendinosis, and bursitis?

Specific Exercises for Plantar Fasciitis, Achilles Tendinosis, and Bursitis

For optimal treatment outcomes in plantar fasciitis, Achilles tendinosis, and bursitis, eccentric strengthening exercises combined with specific stretching protocols are the most effective exercise interventions, with superior outcomes compared to traditional approaches. 1, 2, 3

Plantar Fasciitis Exercises

Specific Stretching Exercises

1. Plantar Fascia-Specific Stretch 3, 4

   • Sit with affected foot across opposite thigh
   • Place fingers across base of toes and pull toes back toward shin until stretch is felt in arch
   • Confirm stretch by palpating tension in plantar fascia
   • Hold 10 seconds, repeat 10 times, 3 sets daily
   • Perform especially before first steps in the morning and after prolonged sitting

2. Simultaneous Achilles Tendon and Plantar Fascia Stretch 2

   • Stand facing wall with hands on wall at eye level
   • Place affected foot behind you with heel flat and toes pointed straight ahead
   • Bend front knee while keeping back knee straight and heel down
   • Additionally, curl toes of affected foot against a wall or step edge
   • Hold 30 seconds, repeat 3 times, twice daily

Strengthening Exercises

1. High-Load Progressive Heel Raises 5

   • Stand on edge of step with towel rolled under toes
   • Perform single-leg heel raises with full range of motion
   • Add weight gradually (backpack with books)
   • 3 sets of 12-15 repetitions every other day
   • This approach showed superior outcomes at 3 months compared to stretching alone

2. Toe Curls with Towel

   • Sit with feet flat on floor, place towel under forefoot
   • Curl toes to scrunch towel toward you
   • 3 sets of 10-15 repetitions daily

Achilles Tendinosis Exercises

Eccentric Strengthening Exercises 1

1. Eccentric Heel Drops

   • Stand on edge of step with forefoot only
   • Rise up on toes using both feet
   • Lower heel slowly below step level using only affected leg
   • 3 sets of 15 repetitions twice daily
   • Progress to weighted version (holding weights or wearing backpack)

2. Eccentric Heel Drops with Bent Knee

   • Same as above but with knee slightly bent to target soleus muscle
   • 3 sets of 15 repetitions twice daily

Stretching Exercises

1. Gastrocnemius Stretch

   • Stand facing wall with hands on wall
   • Place affected foot behind with knee straight and heel down
   • Lean forward until stretch is felt in calf
   • Hold 30 seconds, repeat 3 times, twice daily

2. Soleus Stretch

   • Same position as above but with back knee slightly bent
   • Hold 30 seconds, repeat 3 times, twice daily

Bursitis (Retrocalcaneal/Haglund's Deformity) Exercises

Stretching and Mobility

1. Gentle Achilles Tendon Stretches 1

   • Similar to Achilles stretches above but with less intensity
   • Hold 15-20 seconds, 5 repetitions, 3 times daily
   • Avoid aggressive stretching during acute phase

2. Ankle Mobility Exercises

   • Ankle circles: 10 circles in each direction, 3 times daily
   • Alphabet tracing: use foot to "write" alphabet in air

Strengthening

1. Isometric Heel Raises
   • Stand with feet flat, rise slightly onto balls of feet
   • Hold position for 10 seconds
   • 10 repetitions, 3 times daily
   • Progress to dynamic heel raises as symptoms improve

Exercise Progression Protocol

Phase 1 (Acute - First 1-2 Weeks)

• Focus on gentle stretching and pain control
• Ice massage: roll frozen water bottle under foot for 5-10 minutes, 3 times daily
• Avoid aggravating activities

Phase 2 (Sub-acute - Weeks 2-6)

• Introduce progressive strengthening exercises
• Continue stretching with increased duration
• Begin low-impact aerobic activities (swimming, cycling)

Phase 3 (Remodeling - Weeks 6+)

• Progress to high-load strengthening
• Sport-specific exercises for athletes
• Gradual return to previous activity levels

Common Pitfalls to Avoid

1. Insufficient Exercise Dosage

   • Research shows specific protocols require consistent application
   • Plantar fascia stretching must be performed at least twice daily 3, 4
   • Eccentric exercises for Achilles tendinosis require 12 weeks of consistent performance

2. Premature Return to Activity

   • Full rehabilitation typically requires 8-12 weeks
   • Returning too quickly can lead to symptom recurrence

3. Overlooking Biomechanical Factors

   • Foot pronation, limited ankle dorsiflexion, and tight calf muscles should be addressed
   • Appropriate footwear and possibly orthotics may be needed alongside exercises

4. Neglecting Progressive Loading

   • Tendons require progressive loading to remodel properly
   • Gradually increasing exercise intensity is crucial for optimal outcomes

5. Focusing Only on Stretching

   • Combined approaches of stretching and strengthening show superior outcomes
   • High-load strength training demonstrated better results than stretching alone for plantar fasciitis 5

These specific exercise protocols have demonstrated significant improvements in pain and function, with studies showing 77-94% of patients reporting decreased pain and functional limitations with the plantar fascia-specific stretching protocol at two-year follow-up 4.