Plantar Fasciitis Phase 3

Phase 3 comprises:

Cold therapy
Massage
Taping & splinting
7 stretching & mobility exercises
7 activation exercises
4 specific strengthening exercises
2 posterior chain strengthening exercises
7 movement control exercises
8 functional exercises

The aim of phase 3 is to get you to a normal gait pattern with minimal discomfort and very little early morning stiffness. The idea is to progress from low to high loading of your foot, but keeping it low impact with the ground.

Check the Exit Criteria to see when to move to phase 4.

Treatment

As required.

Cold therapy

After training or rehabilitation exercises use any of the following:

Ice pack – 15-20 mins
Ice massage – (Freeze water in a small foam cup) Protect skin – 5-10 mins
Ice Bath – (Toes out of water) 10-15 mins

Keep monitoring how much early morning stiffness you have in your foot and pain in general.

If it is painful then focus more on treatment.

Massage

Massage early morning and pre-training/activity (either):

Tennis ball through the sole of the foot 5-10 mins
Foam roller through the sole of the foot 5-10 mins

Taping

Tape your foot for activity only.

Night Splint

Wear a night splint or sock if you still have early morning stiffness or pain.

Mobility and Stretching

1 to 2 times per day.

Massage with toe mobilisation

Massage helps to stimulate blood flow and loosen tight tissues underneath the foot which causes pain.

Teaching point:

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 times for 30 seconds

Toe on heel of foot (if plantar fascia feels tight)

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

Calf stretch straight leg at wall

Calf stretches should be done with your leg straight to stretch the larger gastrocnemius 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 sets each for 30 seconds
3 – 5 x per day

Calf stretch bent leg at wall

Calf stretches should be done with your leg 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 each for 30 seconds
3 – 5 x per day

Band-assisted ankle dorsiflexion

Teaching point:

Place the band around the front of the foot
Bend the knee slightly over the foot, with the band gently distracting the joint
Hold for 30 seconds

Hip lateral step overs

Teaching Points:

Step over a hurdle or similar sideways to mobilise your hips
Begin to perform these up on your toes with a little more energy than in the earlier phases
3 sets of 8 each leg

Hip front step overs

Teaching Points:

Step forward over a hurdle or similar to mobilise your hips
Begin to perform these up on your toes with a little more energy than in the earlier phases
3 sets of 8 each leg

Activation

Every other day.

Toe walks heel in

Teaching point:

With your heels inward, walk up on your toes keeping the heels slightly up, (you should just fit a credit card under)
4 sets of 5 metres

Toe walks heel out

Teaching point:

With your heels pointing outwards, walk up on your toes keeping the heels slightly up, (you should just fit a credit card under)
4 sets of 5 metres

Lateral crab walks

Teaching Points:

Place a resistance band around your knees and walk sideways
Keep good athletic posture and stance
Step 4 or 5 times to the right
Step 4 or 5 times to the left
4 sets of 5 metres each way

Note: This gets the hip muscles firing and fatiguing under bodyweight load.

Ice skaters

Teaching Points:

Place a resistance band around your knees to increase the load on your lateral hip muscles
Walk forward and backward (on toes if you can)
Maintain a good posture by keeping your head and chest up
10 metres out and back

Single leg bridge from floor

Teaching point:

Lie on your back, knee bent, and push the hips upwards to work the gluteal muscles and hamstrings
Use one foot on the floor pushing up
Hold the position briefly and then lower
3 sets for 12 reps

Note: Make sure you squeeze the gluteal muscles and aim to maintain a straight line from the shoulder on the ground to the knee at the top point of the exercise.

Standing paloff press with leg sweep

Teaching point:

Take the weight on the standing leg
Try and sweep the other leg around 3 times without losing balance

Lateral crossovers on box

Teaching Points:

Place a resistance band around your knees and walk sideways
Keep good athletic posture and stance
Step 4 or 5 times to the right
Step 4 or 5 times to the left
3 sets of 8 to 10 each leg Note: This gets the hip muscles firing and fatiguing under bodyweight load

Strengthening (specific)

Once a day.

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 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
3 sets to 5 reps (45– 60 sec holds)

A march linear on toes

Teaching Points:

Marching drill becomes more dynamic up on your toes
2 to 4 sets of 15 to 30 seconds

A march lateral on toes

Teaching Points:

Sideways marching drill becomes more dynamic up on your toes
2 to 4 sets for 15 to 30 seconds

Strengthening (posterior chain)

2 – 4 times per week.

Single-leg Romanian deadlift (RDL)

Teaching Points:

Standing leg stays fairly straight
Reach out and backward with the free leg
Challenges stability around your hips
4 sets of 6 to 8 reps

Single leg suitcase deadlift

Teaching point:

Weight in the same arm and same leg
Also, weight in the opposite arm to leg
Challenges balance, side balance, and stability around the hip
4 sets of 6 to 8 reps

Movement control

3 to 4 times per week.

Single leg stand on rocker/wobble board

Teaching Points:

Stand on the wobble board with one leg
Rock the board from front to back and then side to side (30 seconds each)
Rotate the board in a circular motion in one direction for 30 seconds then repeat in the other direction
2 sets of 30 seconds

Forward T

Teaching Points:

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
3 sets – 6 reps for 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 10 reps

Single leg balance with skater arms

Teaching point:

Take the weight on one foot and swing the arms side to side
Maintain your balance
2 sets of 8 to 10 reps

Lunge to leaning tower at wall

Teaching Points:

Leaning tower exercise, also known as ‘A’ lock is performed against a wall
Drive the knee upwards and hold the position
2 sets of 8 to 10 reps

1-2-3 hops to stick

Teaching Points:

Perform 1 hop and stick
Then 2 hops to stick
Then 3 hops to stick
Hold the end position still to prove you have control of the movement and landing
3 sets of 4 reps for each leg

1-2-3 lateral hops to stick

Teaching Points:

Perform 1 hop sideways to stick
Then 2 hops to stick
Then 3 hops to stick
Hold stick position to prove you can balance and control the movement
3 sets of 4 reps for each leg

Functional

2 to 3 times per week.

Box jump to outside leg & stick

Teaching Points:

Jump off the box from 2 feet landing on your outside leg
Maintain control on landing
2 sets of 8 reps of each leg

Box jump to inside leg & stick

Teaching Points:

Jump off a box or step with 2 feet and land on your inside leg
Maintain end position for a couple of seconds
2 sets of 4 reps for each leg

Box jump & run

Teaching points:

Jump on the box with two feet
Jump off on one foot and then sprint away
As you land gain control and then sprint away from the outside leg and then repeat from the inside leg
2 sets of 4 each leg