Physical Therapy Management Of Plantar Fasciitis


Plantar fasciitis is a self-limiting condition is which the chief compliant is debilitating pain on the plantar surface of the heel. The pain is typically the worst with the first steps in the morning due to the relaxed, shortened position the fascia assumes during sleep. Pain may also increase with prolonged durations of being on your feet or after long periods of inactivity. The shortening of the plantar fascia during inactivity, as well as tightness of the Achilles tendon have both been found to contribute to this pain. Other factors include high body mass index and inappropriate footwear.1

Guide to Physical Therapy Practice

Practice Pattern

Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation


The Guide suggests that over the course of 2 to 4 months, patient/client will demonstrate optimal joint mobility, motor function, muscle performance, and range of motion and the highest level of functioning in home, work (job/school/play), community, and leisure environments.

Expected Number of Visits

It is anticipated that 80% of patients/clients who are classified into this pattern will achieve the anticipated goals and expected outcomes within 6 to 24 visits during a single continuous episode of care.


The following flow chart is taken from The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010 to provide a guided approach to treatment.1

The first approach to treatment is typically self-directed and aims to decrease pain and increase range of motion. It includes the following:

  • Rest and/or Activity Modification- Discontinue aggravating sports such as running or cut back on the mileage. If your occupation requires a lot of time on your feet, take small breaks when ever you can.
  • Ice- Apply directly to the affected area for 15 minutes a couple times a day. Rolling your foot on a frozen water bottle works well.
  • Anti-inflammatory drugs- It has been shown that the use of NSAIDs may provide pain relief and a decrease in disability.2
  • Stretching- Evidence supports the effectiveness of performing plantar fascia and Achilles tendon stretches in decreasing pain and functional limitations. Stretches should be held for 20-30 seconds and repeated 3 times, 2-3 times a day. It is recommended to stretch before stepping out of bed in the morning.3
    • Plantar fascia stretch- cross the effected leg over the unaffected leg and pull back on the toes and dorsiflexing the ankle.
    • Towel stretch- long sit, placing a towel around the ball of your foot and pull back.
    • Calf stretch- stand with the effected leg behind the other. Keeping your heel of the effected leg on the ground and the knee straight, lean into the wall until you feel a stretch in the back of your calf. This stretch can be repeated with the knee bent.
    • Step stretch- Place the ball of your foot on the edge of a step and lower your heel to the ground, stretching your calf muscles.

Approximately 90% of patients will see results within 6 weeks using this conservative approach. If improvement occurs, patient should continue therapy until symptoms fully resolve. However, if symptoms persist, one should progress to further treatment options which may include:

  • Night Splints- They keep the plantar fascia and the calf in a lengthened state during sleep to avoid tightness. Some studies have shown night splints to minimize pain, however, evidence is not consistent.4-6
  • Foot Orthoses- Commonly recommended to provide arch support, reducing stress on the plantar fascia. Studies show orthotics decrease pain and may even increase functional ability in patients with plantar fasciitis.4,7,8
  • Injections- Corticosteroid injections demonstrated to reduce pain however, they have been associated with plantar fascial rupture and post-injection pain lasting on average from 5 to 7 days.7
  • Shock-wave Therapy - Noninvasive therapy used to promote healing of the degenerating tissue. This is typically a last resort before considering surgery. Side effects may include pain after and during the procedure, local swelling, and numbness.9

Plantar fasciotomy may need to be considered only if all conservative treatments have been exhausted.


  1. Thomas JL, Christensen JC, Kravitz SR, et al.; American College of Foot and Ankle Surgeons Heel Pain Committee. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49 (3 suppl):S2
  2. Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. The efficacy of oral nonsteroidal anit-inflammory medication in the treatment of plantar fasciitis: A randomized, prospective, placebo-controlled study. Foot & Ankle International. 2007;28: 20-23.
  3. Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow up. J Bone Joint Surg Am. 2006;88(8): 1775-81.
  4. Lee  SY, McKeon  P, Hertel  J.  Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis.  Phys Ther Sport.  2009;10(1):12–18.
  5. Neufeld SK, Cerrato R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg. 2008;16(6):338-346.
  6. Jariwala A, Bruce D, Jain A. A guide to the recognition and treatment of plantar fasciitis. Primary Health Care. 2011;21(7):22-24.
  7. Uden H, Boesch E, Kumar S. Plantar fasciitis-to jab or to support? A systematic review of the current best evidence. J Multidiscip Healthc. 2011;4: 155-164.
  8. Chia  KK, Suresh  S, Kuah  A, Ong  JL, Phua  JM, Seah  AL.  Comparative trial of the foot pressure patterns between corrective orthotics, formthotics, bone spur pads and flat insoles in patients with chronic plantar fasciitis.  Ann Acad Med Singapore.  2009;38(10):869–875.
  9. Rompe  JD, Furia  J, Weil  L, Maffulli  N.  Shock wave therapy for chronic plantar fasciopathy  Br Med Bull.  200781–82183–208.
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