PLANTAR FASCITIS RESET PROGRAM

 
 

PROGRAM OVERVIEW

PROGRAM OVERVIEW
Welcome to the plantar fasciitis rehab program. This program consists of 8 phases and each phase is to be performed for at least one week before moving onto the next one. Follow our progression criteria to help you determine when it is appropriate to progress to the next phase.

At the end of phase 6, you will go through a series of tests to ensure you have achieved some important milestones. Phase 7 and 8 are for return to sport and may not be necessary based on your goals.

SESSION STRUCTURE
Each phase comprises a soft tissue, mobility and therapeutic exercise routine. The soft tissue and mobility routines should be done daily and the therapeutic exercises should be performed 3-4x weekly unless stated otherwise. Each full session (soft tissue + mobility + exercise) should last approximately 30 - 40min.

EQUIPMENT
Lacrosse ball, swissball, dumbbells (light to medium), hand towel, foam roller, ply box/step, exercise bands and a superband.

FOCUS
This program is designed to help you overcome plantar fasciitis and eventually return to full performance. The advice you will get will vary depending on whether it is a recent injury or a chronic condition but the basic structure remains the same. The program initially focuses on reducing pain while restoring mobility then it gradually progresses to stability and strengthening with a big focus on progressive loading of the plantar fascia. Eventually you will be progressed on to performance training which includes things like plyometrics.

This program is for educational purposes only. You should consult your physician prior to engaging in this program.

PHASE 1

EDUCATION

PHASE OVERVIEW
In phase 1, we focus on reducing pain and improving the flexibility of the posterior chains which includes your plantar fascia. Follow the instructions in activity modification to further help your pain.

EDUCATION
Plantar fasciitis can be difficult to treat especially if you do not do a good job early on and do not put your running on hold for a little while. We can divide plantar fasciitis in 2 categories, chronic and acute. This program is most appropriate for acute injuries meaning the onset is somewhat recent and definitely less than 3 months. If on the other hand, you have had pain for over 3 months or are in cycle of repeated plantar fascia pain, you are now in a chronic phase. Most acute injuries can be treated in 6-8 weeks with proper care. If you fall in the chronic categories, it does not mean you cannot be successful with this program, but it can take up to 6 months for healing. Progression is much slower and we recommend that you team up with a healthcare team to guide you.

Runners, you may have seen to your dismay, that our activity modification states “Do NOT run”. We mean it! Yes, it probably feels better after you have been walking around for a bit and running might not even be that bad but you do not want progress to a chronic injury which will ruin your season and maybe more. A few weeks off now is better than 6 months off later on.

A plantar fascia boot is to this day the most effective treatment strategy we have to treat plantar fasciitis according to research. It is a low cost, low effort thing you can do to heal faster. Amazon is a great place to find them and we recommend the rigid ones over the soft, sock like ones. You should aim to wear them while you sleep and/or when you spend long periods resting such as watching television.

ACTIVITY MODIFICATIONS

  1. Consider buying a plantar fascia boot.

  2. Consider buying a shoe insert to wear during the day for temporary support to give you some arch support. We recommend ones like “Superfeet”.

  3. Limit excessive walking, standing.

  4. Do NOT run.

  5. Begin a pain journal to track morning heel pain (rate from 0-10/10) when you get out of bed and take the first few steps.

PROGRESSION CRITERIA

  1. You have experienced a decrease in morning heel pain (use your journal).

  2. You spent at least one week on phase 1.

SOFT TISSUE & MOBILITY

  • 1) Gentle LAX ball plantar fascia roll (2min)

    2) Calf foam rolling (2 min)

    3) Hamstring foam rolling (1min)

  • 1) Seated plantar fascia stretch (3 rounds, 30 sec hold)

    2) Calf stretch (3 rounds, 30 sec hold)

    3) Hamstring stretch + isometrics (3 rounds, 30 sec hold)

EXERCISE ROUTINE

  • 1 ROUND

    1) Short foot exercise (10 reps, 10 sec hold)

    2) Towel scrunches (1 min)

    3) Theraband ankle 4-way (3 rounds, 12reps each)

    4) Bridge march (2 rounds, 16 reps total, alternating legs)

PHASE 2

EDUCATION

PHASE OVERVIEW
In phase 2, we progress your mobility routine while also introducing gentle loading of the plantar fascia complex.

EDUCATION
As harsh as it sounds, continue to hold off running at the moment. You can cross train with biking, swimming, etc to minimize fitness loss and get your endorphin kick.

Some exercises may seem like it has nothing to do with your foot but we promise they are there for a reason. If you are not solid in the areas above, your foot will be exposed to greater load to compensate.

ACTIVITY MODIFICATION

  1. Continue wearing the plantar fascia boot at night and the shoe insert during the night

  2. Continue limiting excessive weight bearing activities

  3. Optimize sleep hygiene and make sure you supply your body with enough proteins.

  4. Still NO running.

PROGRESSION CRITERIA

  1. Further decrease in morning heel pain.

  2. Improved soft tissue tenderness when performing the soft tissue activities.

  3. You have spent at least one week on phase 2.

SOFT TISSUE & MOBILITY

  • 1) LAX ball plantar fascia roll (2min)

    2) Calf foam rolling with pin stretch (2min)

    3) Hamstring foam roll (1min)

    4) Glute/piriformis foam roll (1min)

  • 1) Wall great toe extension stretch (3 rounds, 30 sec hold)

    2) Calf stretch (3 rounds, 30 sec hold)

    3) Hamstring stretch (3 rounds, 30 sec hold)

    4) Superband ankle dorsiflexion (2min)

EXERCISE ROUTINE

  • 3 ROUNDS

    1) Single leg short foot exercise (10 rounds, 10 sec hold)

    2) Knee squat with towel roll (3 rounds, 12 reps)

    3) Banded leg lowering (15 reps each)

    4) Tempo heel raises (15 reps, tempo 3:1:3, 2 set)

    5) Bridge march (3 rounds, x10 reps, same side)

PHASE 3

EDUCATION

PHASE OVERVIEW
In phase 3, we progress the loading of your plantar fascia further. There is still a strong mobility component as well and we leave no stones unturned during your soft tissue sessions.

EDUCATION
Progress at your own pace and monitor that morning heel pain. Any increase in pain especially for more than a day means you need to calm things down with the exercises and your weight bearing activities.

ACTIVITY MODIFICATION

  1. Continue wearing the plantar fascia boot at night and the shoe insert during the night

  2. Continue limiting excessive weight bearing activities

  3. Optimize sleep hygiene and make sure you supply your body with enough proteins.

  4. Still NO running.

PROGRESSION CRITERIA

  1. Further decrease in morning heel pain.

  2. Improved soft tissue tenderness when doing the soft tissue activities.

  3. No foot/heel soreness from the exercises.

  4. You have spent at least one week on phase 3.

SOFT TISSUE & MOBILITY

  • 1) LAX ball plantar fascia roll + pin stretch (2min)

    2) Calf foam rolling + LAX ball pin stretch (2min)

    3) Hamstring foam roll (1min)

    4) Peroneals and anterior tibialis foam rolling (1min)

  • 1) Wall plantar fascia stretch + isometrics (3 rounds)

    2) Hamstring stretch + isometrics (3 rounds)

    3) Superband ankle dorsiflexion (2min)

EXERCISE ROUTINE

  • 3 ROUNDS

    1) Single leg short foot with DB pass around (30 sec)

    2) Kickstand deadlift (12 reps each)

    3) Tempo single leg heel raises (10 reps, tempo 3:1:3)

    4) Tibialis anterior raises (15 reps)

    5) Single leg bench hip lift (10 reps each)

PHASE 4

EDUCATION

PHASE OVERVIEW
In phase 4,  we continue to progress loading to help your plantar fascia heal and become stronger. We also progress to more advanced single leg activities.

EDUCATION
Continue to monitor your heel pain especially in the mornings as it is a true barometer of how you are doing. Runners if your heel pain is gone, don’t rush back into running just yet. No pain does not mean you are fully healed. It is a great sign you are heading in the right direction and you do not want to jeopardize all your progress.

Pay particular attention to the tempo work. Be honest with your counting as it is crucial to spend enough time under load to achieve the desired adaptation in the plantar fascia and other supporting structures.

ACTIVITY MODIFICATION

  1. Continue wearing the plantar fascia boot at night and the shoe insert during the night

  2. Continue limiting excessive weight bearing activities

  3. Optimize sleep hygiene and make sure you supply your body with enough proteins.

  4. Still NO running.

PROGRESSION CRITERIA

  1. Further decrease in morning heel pain.

  2. Improved soft tissue tenderness when doing the soft tissue activities.

  3. No foot/heel soreness from the exercises.

  4. You have spent at least one week on phase 4.

SOFT TISSUE & MOBILITY

  • 1) LAX ball plantar fascia roll + pinch stretch (2min)

    2) Calf foam rolling + LAX ball pin stretch (2min)

    3) Seated hamstring pin stretch (1min)

    4) Peroneals/anterior tibialis foam rolling (1min)

  • 1) Wall plantar fascia st\retch + isometrics (3 rounds)

    2) Hamstring stretch + isometrics (3 rounds)

    3) Half kneeling dorsiflexion + isometrics ( 3 rounds)

EXERCISE ROUTINE

  • 3 ROUNDS

    1) Single leg short foot halo (30 sec each)

    2) Single leg deadlift (12 reps each)

    3) Tempo Heel raises with towel roll (10 reps, tempo 3:1:3)

    4) Heel walk (30 sec)

    5) Toe walk (30 sec)

    6) Side bridges + clams (30 sec each)

PHASE 5

EDUCATION

PHASE OVERVIEW
In phase 5, you will continue to challenge your stability while still continuing to gradually load your plantar fascia to make it more resilient. Aim for perfect technique during stability exercises.

EDUCATION
Runners if you have had no heel/foot pain in the mornings for 2 weeks, you may begin a gradual run-walk progression. We suggest starting with 1 min run - 2 min walk for 5 rounds and go from there. Pay attention to signs that you need to back off such as tightness or discomfort in the foot/heel in the morning after your run or after periods of activity. Keep the progression slow and steady but be ready to stay at the same level or take a step back until your foot gives you the green light.

We are gradually weaning off the shoe insole this phase. What does it mean? It means that you will begin by removing the insole for an hour/day and gradually remove it for longer periods of time. You can progress by 30 min or hour increments. Stay on the lookout for any return/worsening of your symptoms which would grant a halt of the progression until the symptoms are back to normal.

ACTIVITY MODIFICATION

  1. Continue wearing plantar fascia boot at night.

  2. Wean off the shoe insole if tolerated over the course of the next 2 weeks.

PROGRESSION CRITERIA

  1. Minimal to no morning heel pain/discomfort.

  2. You spent at least one week on phase 5.

  3. No foot/heel soreness from the exercises.

SOFT TISSUE & MOBILITY

  • 1) LAX plantar fascia roll + pin stretch (2min)

    2) Calf foam rolling + LAX ball pin stretch (2min)

    3) Seated hamstring pin stretch (2 min)

  • 1) Wall plantar fascia stretch + isometrics (3 rounds)

    2) Hamstring stretch + isometrics (3 rounds)

    3) Standing dorsiflexion + isometrics (3 rounds)

EXERCISE ROUTINE

  • 3 ROUNDS

    1) Single leg short foot halo (40 sec)

    2) Tempo single leg heel raise with towel roll (12 reps, tempo 3:1:3)

    3) Side bridge with hip abduction (30 sec each)

    4) Single leg RDL with knee tuck (10 each)

    5) Toe walk (45 sec)

    6) Heel walk (45 sec)

PHASE 6

EDUCATION

PHASE OVERVIEW
Phase 6 is the last rehab focused phase before we introduce you to more sports specific activities if that is your goal. Continue to aim for perfect technique at all times. Phase 6 also contains a checkpoint with tests to ensure you have hit certain milestones which should minimize your risk of re-injury in the future.

EDUCATION
We have designed a checkpoint with several tests to ensure that you have hit some benchmarks and minimize the risk of re-injury in the future. We feel strongly about those and we take all of our one-on- one clients through these tests before we begin any training with them. If they don’t score well, we focus on that prior to beginning any serious training and so should you!

Do not panic if you do not score well on some of those tests. It simply means you need to continue working on phase 6 a little longer and maybe increase loading a little more.

ACTIVITY MODIFICATION

  1. Discontinue plantar fascia boot if you do not have pain anymore.

  2. Do not increase run volume more than 10% each week during the run-walk progression.

  3. Perform Phase 6 checkpoints.

  4. Continue to be careful with your running progression and be ready to back off at any sign of heel/foot pain/discomfort.

PROGRESSION CRITERIA

  1. No morning heel pain or during activities.

  2. You obtained passing scores on phase 6 checkpoints.

  3. You have spent at least one week on phase 6.

For your progression beyond this phase, please click the “Phase 6 Checkpoint” Tab

SOFT TISSUE & MOBILITY

  • 1) LAX ball plantar fascia roll + pin stretch (2min)

    2) Calf foam rolling + LAX ball pin stretch (2min)

  • 1) Wall plantar fascia stretch + isometrics (3 rounds)

    2) Standing dorsiflexion + isometrics (3 rounds)

EXERCISE ROUTINE

  • 3 ROUNDS:
    1) RNT single leg squat with short foot (12 reps)

    2) Single leg heel raise with towel roll (15 reps, tempo 3:1:3)

    3) Side plank with hip abduction (30 sec each)

    4) Walking single leg deadlift + overhead reach (6 reps each)

    5) Heel hover split stance bent over row (12 reps each)

PHASE 6 CHECKPOINT

Congratulations on making it to phase 6. Your foot should feel a lot better by now and you probably want to go back to your previous activities. In order to do so with the least risk of re-injury, we recommend that you take those few tests. Rushing back to your previous activities without having appropriate scores may put you at greater risk of experiencing heel pain again.

  • Purpose: Evaluate the available range of motion of your great toe in extension, or how much your great toe can move upward. It is especially important for activities such as running and walking but also lunging and while in a split stance.

    Method:
    Position:     Half kneeling position with the up leg being the one tested and the shin is vertical. No shoes.

    Tools: Phone for inclinometer, partner

    Standards of testing: In a half kneeling position, set your phone/inclinometer on the top of your foot (1st ray) and zero it. Then, place the phone on your big toe just below the joint. In this position, pull your big toe upward as far as you can while your partner maintains the ball of your foot on the ground. Repeat with both sides.

    Common mistakes: Allowing the ball of your foot to lift off the floor.

    Scoring criteria: Pass/Fail

    Pass: able to reach 75 degrees.

    Fail: unable to reach 75 degrees.

    Note side to side difference and the presence of pain.

  • Purpose:
    Evaluate the available range of motion of your ankle in dorsiflexion, or how much your foot can move upward toward your lower leg. It is especially important for activities such as walking, running and even biking. Deficits can also impact your squat and lunge.

    Method:

    Position: Half kneeling with the up leg being the one tested. No shoes.

    Tools: Phone inclinometer.

    Testing procedure: In the half kneeling position, zero your phone/inclinometer on the flat ground and place it on the edge of the shin of the up leg. Move your knee forward while keeping your heel on the ground until you can no longer go forward. Make sure your knee is aligned with your second toe. Write down the measure obtained from your phone.

    Common mistakes:

    • Not keeping your heel on the ground

    • Letting your knee dive inward or outward

    Scoring criteria: Pass/Fail

    Pass: at least 40 degrees of dorsiflexion.

    Fail: less than 40 degrees of dorsiflexion

    Note any side to side difference and the presence of pain.

  • Purpose:
    Evaluate hip mobility while maintaining core stability which is essential to any sports or activities in which you use one leg at a time.

    Method:

    Position: supine

    Material: partner and dowel.

    Testing procedure:
    Laying flat on your back with both legs straight, and the dowel or pillar is placed at mid thigh. Raise one leg while keeping it straight and observe the position of the foot relative to the dowel. Your down leg must also remain straight and on the ground. Repeat maneuver with the opposite leg.

    Common mistakes: allowing your knee to bend on either side, not setting the dowel mid thigh.

    Scoring criteria:

    3/3: foot past dowel.

    2/3: more than half of foot is past the dowel.

    1/3: less than half to no foot is past the dowel.

    Note side to side difference.

    Score of zero if pain in the leg or low back.

If you do not score well on those tests, we highly recommend that you continue with Phase 6 exercise routine. Additionally these are mobility tests and you should continue with the soft tissue and mobility sections of Phase 5 as it is more comprehensive than Phase 6.

PHASE 7

EDUCATION

PHASE OVERVIEW
In phase 7, the stability exercises become even more challenging and we also reintroduce some power development moves such as a single leg box jump.

EDUCATION
Progress at your own pace and monitor that morning heel pain. Any increase in pain especially for more than a day means you need to calm things down with the exercises and your weight bearing activities.

ACTIVITY MODIFICATION

  1. Do not increase run volume more than 10% each week.

  2. Do not try to add intensity until you have reached your normal run volume

  3. Consider performing our foot/ankle recovery session 2-3x weekly (available on the website in the recovery tab).

PROGRESSION CRITERIA

  1. You have spent at least one week on phase 7.

  2. You have not experienced setbacks.

EXERCISE ROUTINE

  • As needed (refer to previous phases for instructions)

  • As needed (refer to previous phases).

  • 3 ROUNDS
    1) Heel hover suitcase lunge hold (30 sec)

    2) Creeper carry (40 sec)

    3) Walking single leg deadlift with reach (heavier dumbbell/medicine ball)

    4) Anti-rotation press march(30 sec each)

    5) Single leg box jumps 1 to 2 (8 reps each)

PHASE 8

EDUCATION

PHASE OVERVIEW
Phase 8 is the final phase of this rehab program. Congratulations on getting to the finish line! This phase has more bouncy type plyometrics, increased loading and advanced foot stability.

EDUCATION
Consistent strength training is one of the easiest and proven ways to minimize injury while also improving performance. We highly recommend you continue with a strength plan. Consider checking out our sports specific strength plans and/or complete our training questionnaire for personalized recommendations on where to begin your journey.

ACTIVITY MODIFICATION

  1. Once you have reached your baseline mileage for a few weeks without issues, gradually add back intensity.

  2. Consider performing our foot/ankle recovery session 2-3x weekly (available on the website).

PROGRESSION CRITERIA

  1. You have spent at least one week on phase 8.

  2. You experienced no setbacks.

SOFT TISSUE & MOBILITY

  • As needed (refer to previous phases for instructions)

  • As needed (refer to previous phases for instructions)

  • 3 ROUNDS

    1) Heel hover suitcase lunge (8 reps each)

    2) Split stance forefoot high/low taps (30 sec each)

    3) Offset creeper carry (30 sec each)

    4) Triplanar hops (30 sec each)