℞ Plantar Fasciitis Physiotherapy Exercise Programme

1. Plantar Fascia–Specific Stretch (most important) — seated toe pull, 10 sec × 10 reps × 3 sets, before first step in the morning
2. Gastrocnemius (Straight-Knee) Calf Stretch — 30 sec × 3 reps, 3×/day
3. Soleus (Bent-Knee) Calf Stretch — 30 sec × 3 reps, 3×/day
4. Towel/Strap Stretch (Supine) — in bed before rising, 30 sec × 3 reps

℞ PLANTAR FASCIITIS — PHYSIOTHERAPY EXERCISE PROGRAMME

⚠️ Plantar fasciitis involves microtears at the proximal insertion of the plantar fascia on the calcaneus. 90–95% of cases resolve within 12 months with consistent conservative management. The cornerstone of treatment is plantar fascia–specific stretching combined with Achilles tendon stretching.

🔵 SECTION 1 — STRETCHING EXERCISES

• Position: Seated; cross the affected foot over the opposite knee.
• Action: Grasp the toes and pull them upward toward the shin until a strong stretch is felt along the arch and heel.
• Hold: 10 seconds × 10 repetitions × 3 sets
• Timing: Perform before taking the first step in the morning, before prolonged standing, and after sitting for >20 minutes.
• Why: Pre-loading the fascia before weight-bearing reduces micro-tear pain at the calcaneal insertion.

• Position: Stand facing a wall; place both hands on the wall at chest height.
• Action: Step the affected foot back ~60–70 cm, keeping the rear knee straight and heel flat on the floor. Lean forward gently.
• Hold: 30 seconds × 3 repetitions each side
• Timing: 3 times daily — morning, midday, evening.
• Tip: Feel the stretch in the upper calf, not the Achilles.

• Position: Same as above but bend the rear knee slightly (~20–30°).
• Action: Maintain heel contact and lean into the wall.
• Hold: 30 seconds × 3 repetitions
• Timing: 3 times daily, immediately after the gastrocnemius stretch.
• Why: Targets the soleus and Achilles complex, reducing tension transmitted to the plantar fascia origin.

• Position: Lying in bed before rising in the morning.
• Action: Loop a towel around the ball of the foot; pull the towel ends gently toward you, dorsiflexing the ankle.
• Hold: 30 seconds × 3 repetitions
• Timing: Ideally as the very first action upon waking.

🔵 SECTION 2 — STRENGTHENING EXERCISES

• Position: Seated with bare foot flat on a towel on a smooth floor.
• Action: Use only the toes to scrunch the towel toward you, then spread it back out.
• Repetitions: 10–15 reps × 3 sets
• Frequency: Once daily
• Progression: Add a small weight (e.g., a book) on the towel after 2 weeks.

• Equipment: 10–20 marbles or small objects + a cup.
• Action: Pick up each marble using toes and drop into the cup.
• Repetitions: All marbles = 1 set × 3 sets
• Benefit: Strengthens lumbricals and intrinsics, improving dynamic arch support.

• Position: Stand on a step edge with the ball of the foot on the edge, heels off.
• Phase 1 (Rise): Rise up on BOTH feet (concentric phase).
• Phase 2 (Lower): Shift weight to the AFFECTED foot only and slowly lower the heel below step level (3–4 seconds down — eccentric phase).
• Repetitions: 15 × 3 sets
• Frequency: Once daily (alternate days if soreness persists).
• Progression: Add load with a backpack after 3–4 weeks.
• ⚠️ Contraindication: Skip if insertional Achilles pain is present.

• Position: Seated, foot flat on floor.
• Action: Without curling the toes, attempt to shorten the foot by pulling the ball of the foot toward the heel — activating the intrinsic arch musculature.
• Hold: 5 seconds × 10 repetitions × 3 sets
• Frequency: Once daily
• Progression: Perform in standing, then single-leg standing.

🔵 SECTION 3 — SELF-MASSAGE & ADJUNCT MEASURES

• Equipment: A frozen water bottle or golf ball.
• Action: Place under the arch; roll slowly from heel to ball of foot applying comfortable pressure.
• Duration: 3–5 minutes per session
• Timing: Morning (before first steps) and evening after activity.
• Benefit: Ice reduces inflammation; rolling breaks adhesions and improves fascial mobility.

• Purpose: Maintains the ankle at 90° during sleep, keeping the plantar fascia and Achilles gently stretched overnight.
• Use: Wear every night for the first 4–6 weeks; transition to 3–4 nights/week once morning pain reduces.
• Type: Dorsiflexion splint (sock-style or rigid shell) — confirm with physiotherapist.

🔵 SECTION 4 — WEEKLY PROGRAMME SCHEDULE

🔵 GENERAL ADVICE & PRECAUTIONS

• 👟 Wear supportive footwear with a cushioned heel and arch support at all times — avoid flat shoes, flip-flops, or walking barefoot on hard floors.
• 🧊 Apply an ice pack (15 minutes, wrapped in cloth) to the heel after activity if pain flares.
• ⚖️ Maintain a healthy body weight — BMI >30 kg/m² is the single biggest risk factor for plantar fasciitis.
• 📈 Avoid sudden increases in activity; follow the 10% rule (increase weekly walking/running volume by no more than 10%).
• 🏥 Return to clinic if pain is not improving after 6 weeks of consistent exercise, or if pain worsens.
• 💉 Cortisone injection may be considered for short-term relief if conservative measures fail at 6–8 weeks (discuss with physician).