The aim of phase 2 is to significantly reduce pain and enable a normal gait pattern. with minimal discomfort. During this phase, we manage the load through your foot and try to get you back doing some of your normal exercise routines. Check the Exit Criteria below to see when you can progress to phase 3.
Treatment
To be done daily.
Cold therapy
Apply ice/cold therapy 3 to 4 times per day by either of the following methods:
- Ice pack 15-20mins
- Ice massage (freeze water in a small foam cup) – 5 to 10mins
- Ice Bath (keep toes out of water) – 10 to 15mins
Massage
Massage helps to stimulate blood flow and loosen tight tissues underneath the foot which causes pain.
Massage:
- 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 2 – 3 times
Other alternatives can be used as a roller for the sole of the foot:
- A tennis ball through the sole of the foot
- A frozen bottle of water
- A foam roller
- 5-10mins, 3-4 times per day
Taping
Tape only for activity.
Night Splint
Wear a Plantar fasciitis night splint overnight. This is a great piece of kit for treating Plantar fasciitis but can be uncomfortable.
Wear it as long as you can but remove it if pain stops you from sleeping. You should be able to wear the splint for longer and longer as your foot improves.
Stretching & mobility
1 to 2 times per day.
Toe on heel of foot
Teaching point:
- Put one foot in front of the other
- Gently press your toe into the heel of the front foot
- Bring the stretch onto that joint of the back foot
- This will stretch your plantar fascia as your big toe is stretched
- 4 to 5 sets for 30 seconds
Straight leg calf stretch
Calf stretches should be done with your leg straight to stretch the larger gastrocnemius muscle and 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 without bending your back knee
- 4 to 5 sets, each leg for 30 seconds
Bent leg calf stretch
Teaching point:
- 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
- Hold for around 20 – 30 seconds
- 4 to 5 sets
Neural flossing
Teaching point:
- Head follows foot with a single leg raise
- 3 sets of 10 reps
Note: Don’t strain! This is a gentle neural mobilization.
Strengthening (specific)
1 to 2 times per day.
Eccentric inversion
Teaching point:
- For this ankle inversion exercise a resistance band is wrapped around the forefoot and anchored to a table leg or held by a partner
- This exercise works the ankle inverter muscles as the athlete turns the foot in against the resistance of the band
- 2 sets for 5 to 6 seconds
Eccentric eversion
Teaching points:
- Ankle eversion is also sometimes known as supination and is the movement of turning the foot so the sole faces outwards (away from the other foot)
- A resistance band is very useful for ankle exercises
- 2 sets for 5 to 6 seconds
Towel scrunching
Note: For this exercise, you can use a paper towel or tea towel, or even marbles.
This exercise is performed seated.
Teaching points:
- Using your toes, scrunch the towel like they are fingers 6 to 8 times
- Repeat this exercise 4 times
Windlass heel raise
Teaching points:
- Place your big toes on a rolled-up towel
- Raise both heels for 3 seconds, hold for 2-seconds, and lower for 3 seconds
Progressions:
- Stage 1: 3 x 12 both legs every other day
- Stage 2: 3 x 10 single leg every other day
Soleus wall sit (pain-free)
Teaching point:
- Sit against the wall
- Once in a comfortable position, raise your heels from the floor
- Push through your big toe and toes and hold for 30 seconds
- 4 sets of 12 to 18 reps
Step down counterbalance squat (front)
Teaching Points:
- Hold a stick or pole directly out in front of you at chest height
- Step down using the pole as a counterbalance
- Perform the movement slowly and controlled
- 3 sets of (6 to 8 reps each leg)
Step downs counterbalance squat (side)
Teaching Points:
- Hold a stick or pole directly out in front of you at chest height
- Step down to the side using a pole for balance
- Perform the movement slowly and controlled
3 sets of (6 to 8 reps each leg)
Activation
To be done daily.
Crab walk with band (flat foot)
Teaching point:
- Place a resistance band around your knees and walk sideways flat-footed
- This gets the hip muscles firing and fatiguing under bodyweight load
- 2 to 4 sets, 30 seconds each way
Bridge from floor
Teaching points:
- Raise your hips up and hold for a couple of seconds before lowering
- Do 3 sets of 12 reps with a short break between sets
Single leg perturbations
This exercise activates your hip muscles.
Teaching Points:
- Perform perturbations by moving your leg out at different angles against the resistance band
- 3 to 4 sets for 30 seconds
Standing pallof press with ball
Teaching Points:
- Tie the resistance band around a stable object and place the ball between your knees
- Gently squeeze the ball and pull the band with both hands in front and extend the arms forward
- Hold for 3 seconds and repeat this 10 times
- 10 sets for a 3-second hold on each side
Movement control
To be done daily.
Standing rocker/wobble board
The following wobble balance board exercises start easy and get progressively harder. You can close your eyes if you need to make it even harder.
Teaching Points:
- 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.
- Stand on the wobble board, feet shoulder-width apart. Hold on to a chair for support if needed and rock the board forwards and backwards, then side to side.
- Stand on the wobble board, feet shoulder-width apart. Rotate the wobble board around so that the edge of the board is in contact with the floor at all times.
- Balance on the wobble board for as long as you can without the edges touching the floor.
- Rotate the wobble board in a circle but do not allow the edge of the board to touch the floor.
Note: If you do not have a wobble board then stand on one leg with your eyes closed for 30 seconds and repeat twice.
Single leg balance eyes open/closed
Teaching Points:
- Begin by standing on the injured leg for just 30 seconds
- Once this is easy, close your eyes to increase the difficulty
- 2 sets of 30 seconds
Note: balancing on one leg with your eyes closed will improve proprioception (the neuromuscular control you have over your muscles).
Proprioception is frequently damaged in foot and ankle injuries and helps to prevent you from suffering future injuries.
Forward T
Teaching Points:
- Perform in a slow and controlled way
- Stand on one leg with your knee slightly bent
- Lean forwards, open up your arms pulling the non-supporting leg backward to make the shape of a ‘T’
- Maintain balance for 4 or 5 seconds and repeat
- 1 set of 3 to 6 each leg
Quarter squat at wall
Teaching points:
- Stand next to a wall with a gym ball between you and the wall
- Perform a quarter squat on one leg using the ball for support
- This targets the posterior chain and gets the muscles firing as they work to stabilize your hip
- 2 sets of 8 to 12 reps
Single leg stance with turnouts
Teaching Points:
- Balance on one leg with the other knee bent, foot resting on the inside of the supporting leg
- Whilst maintaining your balance turn the knee out and in
- 2 sets of 8 to 10 reps
A lock at wall (leaning tower)
Teaching Points:
- Leaning tower exercise, also known as ‘A’ lock is performed against a wall
- Drive the knee upwards and hold the position
- 3 sets of 4 each leg
Functional exercises
2 to 4 times a week.
A marching drill linear
This is a functional exercise that helps transition to running and more explosive exercises later on.
Teaching Points:
- March forwards on your toes driving your knees high
- 2 to 4 sets for 10 metres each way
A marching drill lateral
Teaching Points:
- Perform marching drill sideways, aiming to be on your toes with high knees
- 2 to 4 sets for 5 metres each way
Heel-toe/spring walk
Teaching Points:
- Walk slowly across the floor
- Start with a heel strike and once you get to the forefoot push-off, come up onto the toes
- Swing the other leg forward and heel strike with the next foot to continue
- Make sure you do this slowly and under complete control
- 2 to 4 sets for 5 metres
Move on to phase 3?
Check if you are ready to move on:
Exit Criteria
In order to move onto the next phase you must:
- In general, have 3 or less out of 10 on the pain scale?
- Walk normally with 3/10 pain or less?
- Less than 3 mins of stiffness first thing in the morning?
- Do a single leg ‘heel-toe raise’ with 5 or less out of 10 pain?
- Have equal flexibility in both legs?
- Step up and down on a step pain-free?