The most important thing to remember when exercising with plantar fasciitis is to use pain as your guideline. Runners can be prone to plantar fasciitis due to a developing overuse injury. Once the plantar fasciitis starts, with continued exercise or impact activity, it continues to get worse. By the time it is bad enough that something needs to be done, there is already significant underlying enlargement and swelling of the plantar fascia.
It is important to remember that plantar fasciitis has both an inflammatory component and mechanical component. From a mechanical standpoint, it is important to immediately stop doing impact exercise or activities. Here are some tips for relieving pain causing by plantar fasciitis:
- No impact exercise. Low-impact activities such as aqua jogging and stationary cycling are great alternatives.
- Using of a night splint to help stretch out the the calf muscle.
- Aggressive stretching, but making certain to stretch the calf, not the foot.
- Taping the foot especially for any limited impact activities or weightbearing activities.
- Using a Bledsoe plantar fasciitis brace
- Replacing worn out shoes and wearing shoes with excellent support.
- For significant cases, the use of prescription orthotics is ideal.
- Massage therapy and ASTYM physical therapy massage
From an anti-inflammatory standpoint, the plantar fascia itself is almost always inflamed and this inflammation can be addressed by various approaches:
- Icing the foot for least 20 minutes directly after physical activity and in the evening
- An over-the-counter anti-inflammatory can be utilized per label instructions. But, it is important to realize that this can mask the pain and it is possible to then overdo it because one might think that it is healed when it is not.
- Some forms of physical therapy such as ultrasound therapy or electrical stimulationprovide an anti-inflammatory effect ORIF physically decrease deep swelling (edema).
- A cortisone injection can be beneficial. Ideally, this should be directed at the interface between the plantar fascia and the fat pad and not within the plantar fascia. An injection within the fascia increases the risk of a tear of the fascia.
More aggressive treatments:
- Dry needling-ultrasound guided injection procedure
- Platelet rich plasma (PRP) or APC+
- Surgery such as plantar fascial release or gastrocnemius lengthening procedures.
- Use pain as a reference to your allowable activity level.
- When you are in the acute phase of plantar fasciitis with pronounced pain in the morning and when you get up from sitting, it still too early to return to exercise.
- Initially, non-weightbearing exercises may be tolerated without an increase in pain that day or the following morning.
- Use of a recumbent bike, swimming or aqua jogging
After several weeks (or even a month or longer), the following are good exercise options: elliptical machine, rowing machine, outdoor cycling and spinning class.
The last phase would be returning to the most pronounced impact activities such as running, basketball or other impact sports. There should be 90-95% improvement with minimal pain before returning to these impact activities.
If you start to increase your activity level, but start having increased pain levels, you have gone too far too fast. It is time to back off very quickly. Remember that some forms of mechanical support will allow you to do more and pay less of a price.