This is the acute phase where the aim is to protect your foot, reduce pain, and inflammation. Use the information below to determine whether you should continue on phase 1, or move directly to phase 2.
Chronic injuries:
- Painful for more than a couple of weeks.
- Is less than 3/10 on the pain scale.
- Some stiffness first thing in the morning.
If you have a chronic injury reduce training by 50% and skip through phase 1 and begin at phase 2.
Acute on chronic:
- Long-term chronic injury
- But has flared up recently with more acute pain.
If you have an acute or chronic injury start at Phase 1
Acute injuries:
- Less than 2 weeks old.
- Significant pain and stiffness first thing in the morning which lasts for more than 3 minutes.
If you have an acute injury start at phase 1
Mark this task as completed to continue.
Check the Exit Criteria in today’s tasks to move to phase 2.
Treatment
3 to 4 x per day.
Cold therapy
Apply ice or cold therapy for 15 minutes, 3 to 4 times a day to reduce the pain and inflammation.
Ice massage. (Freeze water in a small foam cup) 5-10 mins. Protect the skin.
Ice Bath. (Toes out of water) 10-15 mins.
Rest
Acute injuries:
- Complete rest is required. No weight-bearing exercise at all
- Offload your foot as much as possible until symptoms improve
Subacute injuries:
- Active rest may be appropriate. Reduce training volume/intensity by 50%
- If symptoms persist then reduce by half again
Chronic injuries:
- Active rest is probably the most appropriate
- Move onto phase 2 of the program if you have a chronic injury
Shoes: wear shoes that provide relief from loading e.g. training shoes with good ”cushioned” support. Hard flat shoes do not protect your foot.
Podiatry: consider seeking professional assessment or gait analysis to identify any biomechanical dysfunction.
Support Socks: provide compression to the lower leg and foot which may help relieve symptoms.
Note: If you have an acute injury, you may wish to consider a CAM boot (Controlled ankle motion) such as an Aircast boot, to completely offload and allow you to settle in the early stages.
Taping
Plantar fasciitis taping – a simple taping technique that provides excellent support to the arch of your foot. This is especially important if you cannot avoid standing or walking.
Night Splint
A Plantar fasciitis night splint is worn overnight to keep help prevent tissues from tightening up overnight. It can be uncomfortable at first but try to gradually increase the time you wear it.
Often by the time, you can manage 4 hours or more your early morning pain will be significantly reduced. An alternative that works in a similar way is known as a ‘Strasburg sock’.
Mobility & Stretching
2 to 3 times a day.
Foot massage with MTP joint flexion
Massage helps to stimulate blood flow and loosen tight tissues underneath the foot which causes pain.
How to massage the arch of your foot:
- Take your big toe and gently flex it, then massage throughout the plantar fascia
- As it releases take your big toe into a further range
- Repeat this 3 – 4 times a day
Alternatives are:
- Tennis ball through the sole of foot 5-10mins
- Frozen bottle of water and use as a roller for the sole of foot 5-10mins
- This can be done 3-4 times per day
Toe on heel of foot
Teaching points:
- Place one foot in front of the other
- Gently press your toe into the heel of the front foot
- Bring the stretch onto the joint of the back foot
- This will stretch your plantar fascia as your big toe is flexed
- Hold this for about 30 seconds
- 4 sets
Sustained calf stretch with band
Teaching Points:
- Wrap the resistance band or belt around both feet
- Hold the other end of the resistance band and pull it gently towards you until you feel the stretch in your calf
- Keep your legs straight to maintain the stretch and hold for 1 – 2 minutes
- 1 set
Bent knee calf stretch
Calf stretches with your knees bent to target the deeper soleus muscle.
Teaching Points:
- Place your hands on the wall and step forward with the foot you are not stretching
- Keep your toes pointed forward and your back heel on the ground and lean into the wall
- Bend the knee and ease in to feel a stretch lower down at the back of your leg
- 4 sets for 30 seconds
Neural Flossing
Teaching points:
- Head follows the foot as you turn tension on and off with a straight leg raise
- Repeat this 15 – 20 times
Note: Do not strain, this is a gentle neutral mobilization
Strengthening
1 to 2 times per day.
Isometric inversion
Exercises involving eversion and inversion help strengthen the muscles which help to control the ‘rolling’ action at the ankle. Isometric means there is no movement at the joint throughout the exercise.
Teaching Points:
- For inversion, turn your foot inwards against resistance
- Hold for 5 – 6 seconds, rest for 3 seconds and repeat initially 4 times
- 4 sets of (5 x 6 secs) pain-free
Isometric eversion
Exercises involving eversion and inversion help strengthen the muscles which help to control the ‘rolling’ action at the ankle.
Isometric means there is no movement at the joint throughout the exercise.
- For eversion, turn your ankle outwards against resistance
- Hold for 5 – 6 seconds, rest for 3 seconds and repeat initially 4 times
- 4 sets of (5 x 6 seconds) pain-free
Isometric dorsiflexion
Teaching Points:
- Wrap a resistance band around the forefoot and anchor it to a fixed point in front of the foot
- Start with the foot pointed away and pull the foot up so the toes point to the ceiling
- 4 sets of (5 x 6 secs)
Isometric plantarflexion
Teaching Points:
- Hold the band, then pull it against a fixed foot
- Keep the foot in neutral
- Resist the force from the band
- Perform 5 sets of 6-second holds, have a short rest, then repeat
Stay within the limits of pain – If it hurts then wait longer before starting this exercise.
Towel scrunching
Teaching point:
- To strengthen the muscles use either a tea towel or paper towel, scrunch it up using your toes as fingers
- You could also try this using marbles
- Repeat this for 30 seconds or until the muscles feel fatigued
- 3 sets
Soleus wall sit (pain-free)
Teaching points:
- Sit against the wall and slide down
- Once in a comfortable position raise your heels from the floor
- Push through your toes, holding the position for 30 seconds
- Progress up to 60 seconds
- 2 sets to 5 reps (30 – 60 sec holds)
Activation exercises
Daily.
Clam in hip flexion
Teaching Points:
- Lie on your side with your knees bent and slightly forward so your hips are in flexion
- Raise your knee up in a slow, controlled movement and return to the start position
- If you begin to find this exercise easy then you can increase difficulty with a stronger band
- 2 sets of 30 seconds
Clam in hip extension
Teaching Points:
- Performing the clam exercise with your knees moved further back places your hips into extension
- This targets the muscles on the outside of the hip in a slightly different way
- It is important to do these exercises on both sides
- If you begin to find this exercise easy then you can increase difficulty with a stronger band
- 2 sets of 30 seconds
Bridge from a bench/chair
This works the gluteal muscles in particular, as well as bringing your core into play.
Teaching Points:
- Place a band around your knees to increase the tension on the outside hip muscles as you perform the exercise
- Raise your hips by driving through the heel and squeezing your glutes, hold for 12 seconds
- 3 sets
Movement control
1 to 2 times per day.
Seated rocker/wobble board
Teaching point:
- Whilst sitting down place the wobble board under the feet and slowly rotate it a number of times in each direction
- This is good for improving ankle range of motion and control
- 4 sets of 30 seconds
Double leg stand eyes open/closed
Teaching point:
For double leg stand eyes open and then closed:
- Hold your balance, then eyes open
- 4 sets for 20 seconds
- Progress to single-leg stand if this is too easy
- 4 sets of 30 seconds
Move on to phase 2?
Check if you are ready to move on:
Exit criteria
You are ready to move on to phase 2 when:
- Pain levels are 5/10 or less
- You can walk normally including up and downstairs with 5 or less out of 10 pain?
- Your foot is painful/stiff in the mornings for less than 30 mins
If you have a long-term chronic injury, then you may need to move to phase 2 immediately.
However, if your injury is acute, then more time on phase 1 is required.