What exercises are recommended for an adult patient with plantar fasciitis?

Recommended Exercises for Adult Plantar Fasciitis

For adult patients with plantar fasciitis, prescribe plantar fascia-specific stretching exercises combined with supervised physiotherapy including manual therapy techniques, performed twice weekly for 8 weeks, as this produces superior outcomes compared to home programs alone. 1

Primary Exercise Intervention: Plantar Fascia-Specific Stretching

Plantar fascia-specific stretching produces larger pain score reductions than calf stretching alone and should be the cornerstone of your exercise prescription. 1 This involves:

• Daily stretching when pain and stiffness are minimal (typically before bedtime or after warm-up) 2
• Hold each stretch for 10-30 seconds in the terminal position where slight resistance is felt 2
• Perform movements slowly, breathing throughout each stretch 2
• Precede stretching with a warm shower or moist heat application 2

Supervised Physiotherapy Program

Combine exercise with hands-on techniques performed twice weekly for 8 weeks, including: 1

• Myofascial release
• Joint mobilization
• Soft tissue mobilization

This supervised approach demonstrates significantly better improvements in pain, function, balance, proprioception, foot sensation, and flexibility compared to home programs alone. 1

Gastrocnemius-Soleus Stretching Protocol

While plantar fascia-specific stretching is superior, gastrocnemius-soleus stretching exercises are more effective than tendo Achilles stretching alone for symptom reduction. 3 Include these as supplementary exercises:

• Perform daily stretching targeting the gastrocnemius-soleus complex 3
• Use the same technique: hold 10-30 seconds, breathe during stretch, perform when pain is minimal 2

Strengthening Component: Eccentric Exercises

Add eccentric exercises as part of comprehensive management, extrapolating from evidence in other tendinopathies. 1 These should be:

• Introduced after initial pain control (typically week 3-4)
• Performed on non-consecutive days
• Started at low intensity (10-15 repetitions) for previously sedentary patients 2

Activity Modification During Treatment

Decrease cyclical repetitive loading during the treatment phase by: 1, 4

• Reducing prolonged standing, walking, and running that aggravate symptoms
• Avoiding complete immobilization to prevent muscular atrophy and deconditioning 1
• Modifying activities regardless of chosen treatment modality 4

Exercise Prescription Structure

Structure your prescription using the FITT-PRO framework: 2

Frequency

• Stretching: Daily (plantar fascia-specific and gastrocnemius-soleus) 2, 3
• Supervised physiotherapy: Twice weekly for 8 weeks 1
• Eccentric strengthening: 2 days per week on non-consecutive days (once introduced) 2

Intensity

• Stretches should produce slight subjective sensation of resistance without pain 2
• Modify intensity when joint is inflamed by decreasing range of motion or hold duration 2

Time

• Hold static stretches for 10-30 seconds 2
• Treatment duration: 8 weeks minimum for supervised program 1

Type

• Plantar fascia-specific stretching (primary)
• Gastrocnemius-soleus stretching (supplementary)
• Manual therapy techniques (myofascial release, joint mobilization)
• Eccentric strengthening exercises

Three-Phase Exercise Session Structure

Each exercise session should include: 2

1. Warm-up (5-10 minutes): Repetitive low-intensity range-of-motion exercises 2
2. Training period: Provides overload stimulus for stretching and strengthening 2
3. Cool-down (5 minutes): Static stretching of muscles 2

Monitoring and Progression

• Reassess at 2-week intervals initially, then monthly once stable progression is established 5
• If symptoms persist beyond 3 months despite conservative treatment, consider advanced imaging and alternative interventions 1
• Modify exercises to avoid pain or when the joint is inflamed 2

Common Pitfalls to Avoid

• Do not prescribe vague instructions like "evaluate and treat" without specific parameters 6
• Avoid calf stretching as the sole intervention—plantar fascia-specific stretching is superior 1
• Do not recommend complete rest—this leads to muscular atrophy and deconditioning 1
• Do not rely on home programs alone—supervised physiotherapy with manual therapy produces superior outcomes 1

Sample Specific Prescription

"Perform plantar fascia-specific stretching daily before bedtime: hold each stretch for 20 seconds, repeat 3 times. Attend supervised physiotherapy twice weekly for 8 weeks including manual therapy. Add gastrocnemius-soleus stretching daily using the same technique. Reduce prolonged standing and running during treatment. Precede stretching with 5-minute warm shower." 2, 1, 3