Mobilizing for Plantar Fasciitis

Plantar fasciitis causes pain along the bottom of the foot either with activity or at rest that can range from uncomfortable to debilitating. The pain results from inflammation of the plantar fascia, the thick band of connective tissue on the bottom of the foot that supports the foot’s arch. It is especially common in young volleyball athletes – they spend a tremendous amount of time running, jumping and landing on hard court surfaces, may be rapidly growing in size and strength, and as a result develop brutally tight tissues throughout their lower body.

Here’s one way to think about fixing plantar fasciitis (and pretty much any irritation related to tight, restricted tissue) for the long run.

While the inflammation causing the pain is in the plantar fascia, keep in mind that your entire skeleton is essentially encased within a web of ligaments, muscle, tendons, and fascia. Ultimately, all of this tissue is connected – just like a spiderweb.

In most cases with young athletes, plantar fasciitis results from plantar fascia that is abnormally tight and restricted. Since the underlying problem with plantar fasciitis is abnormally tight connective tissue on the bottom of the foot, how can you best fix the discomfort?

Just as you would loosen your belt if it was uncomfortably tight, the key to permanently resolving plantar fasciitis is loosening up your foot’s connective tissue. Here’s where things get interesting – freeing up enough slack to reduce tension in the inflamed tissue cannot be accomplished by just focusing on the irritated tissue alone. While the plantar fascia certainly needs some direct attention, you must look both above and below the area of discomfort to reduce tension throughout the entire web.

Thinking from below to above, here is an example of this process at work, with page numbers illustrating the techniques in Supple Leopard:

1. Make sure you have full plantar flexion (ability to point your toe). Standing on the non-affected leg and bracing yourself for balance, press the top of your foot (also known as the dorsal surface) into the floor and slowly peel it up, thus flexing the joints where your toes join the feet. With the toe joints held in a flexed position, slowly roll your foot from side to side.

2. Now focusing on the plantar fascia itself, start by smashing the bottom of your foot with a lacrosse ball. With the ball under your heel, move slowly over the ball from side to side. After a few deep back-and-forth passes, advance the ball slightly and repeat. When you identify areas that feel especially tight or ropey, spend some extra time there and press more weight into the ball. You can also use a flossing technique over tight areas – pause over an area of tightness, press down to create more pressure, and then slowly raise and lower your toes to draw the tissue back and forth across the ball while it is pinched under pressure. [SL 393]

3. Another technique for the plantar fascia is “strumming” the bottom of the foot against the end of a foam roller. While standing on a foam roller with the unaffected foot and supporting yourself for balance, place the affected foot on the edge of the foam roller, press down to create pressure, and slowly slide the foot sideways and off the edge. In this case, we are mobilizing the tissue perpendicular to its fibers – since the fibers run along the foot, we create pressure across the foot. [SL 395]

4. The next stop above the plantar fascia is the ankle and heel cord. First, ensure that the skin slides unrestricted over the top of the heel cord and sides of the ankle. Use the lacrosse ball to loosen up any skin that does not slide freely – the skin over the back of your ankle should slide as freely over the tendons and bones as does the skin over the back of your wrist. [SL 388]

5. Focusing again on the heel cord, use a flossing technique while pinching the heel cord with your fingers, or perhaps resting it on a barbell or kettlebell handle. [SL 379]

6. Moving up from the heel cord, we now tackle the calf muscles – these are the prime movers of the foot, so it’s worth spending a lot of time here. We start with smashing – generating slow, rolling pressure waves across the tissue. Calf smashing can occur against a foam roller with body weight, with a foam roller and a partner applying pressure, or with your body weight and Starrett’s “bone saw” technique using the tibia. Once smashing identifies a “hot” area of interest, add flossing by deepening pressure over the area while flexing and extending the foot. [SL 376]

7. There is one calf muscle in particular that elevates the arch, called the tibialis posterior. This muscle runs behind the tibia, the front bone of your lower leg. Using the lacrosse ball, creating a pressure wave across the medial (inner) side of your shin is a great way to free up this tissue. Flossing and contract/relax by moving your foot while you apply pressure is also useful. Make sure to apply deep pressure, and seek out areas that are especially tight or painful. Spend your time there until you create change in the tissue. [SL 368]

8. The classic calf stretch against a wall, both with knee straight and knee bent, is also effective if performed with attention to PNF hold-relax technique. Remember, you’re not just going to lengthen a muscle by stretching it to end range. The key is to reach end range, contract the muscle for at least five seconds, and then seek a bit more range as you relax and breathe deeply for ten seconds. Finally, note that PNF hold-relax stretching is a “power tool” that results in increased range of motion by neurologically-mediated muscle relaxation and inhibition. Theoretically, this inhibition could work against you and potentially cause injury if you are preparing to compete. Therefore, PNF hold-relax should only be used as a cool-down technique, and not before practice or competition[1]. [SL 383]

These first eight mobilizations are a great start, but the forces affecting the plantar fascia do not stop at the knee. Hip mobility can also play a role – especially if tight hips prevent you from keeping your feet pointed straight ahead when you run. Duck-footed gait is a setup for arch collapse and excess stress on the plantar fascia, so mobilizing the hips to help keep feet pointing forward and straight ahead is essential. Valuable techniques include a half-kneeling hip opener or more aggressive couch stretch [SL 331] and various forms of mobilizing in the bottom position [SL 303-313]. It’s also important to ensure that your hips have full capacity for internal rotation when your leg is behind you (in extension), so test and mobilize internal rotation as well. [SL 317]

One last high-yield suggestion: especially if you are struggling with plantar fasciitis, avoid both flip-flops and elevated heels. Flip flops (or any sandal that does not surround the heel) interfere with normal arch creation as you walk, and any shoes with an elevated heel relative to the toes are shortening your calves by the same amount. Even running or cross-training shoes often have a half-centimeter or more of heel drop – ideally, try to spend most of your day in “zero drop” shoes.

Finally, here is an early mwod video illustrating many of these techniques:

References

[1] Carter, A., Kinzey, S., Chitwood, L., & Cole, J. (2000). Proprioceptive neuromuscular facilitation decreases muscle activity during the stretch reflex in selected posterior thigh muscles. Journal of Sports Rehabilitation, 9(4), 269-278.