Physical Medicine and Rehabilitation for Plantar Fasciitis 

The main issue regarding physical medicine and rehabilitation for plantar fasciitis is that chronic plantar pain leads to increased limping; this can produce an antalgic gait pattern that may hinder and possibly decrease mobility to levels that are unacceptable for the performance of activities of daily living (ADLs), including work and recreation.

For further information on this topic, see the Medscape Reference article Plantar Fasciitis.

The mainstay physical therapy for plantar fasciitis is stretching.^[1] Many authors advise against considering surgical referral and intervention until a minimum of 6-9 months of comprehensive nonsurgical treatment has been completed.

There are a number of ways to stretch the plantar fascia and the Achilles tendon. For patients who report that the most severe symptoms occur with the first steps after awakening, stretches should be performed before the patient even gets out of bed.

This can be accomplished by keeping a long towel at the bedside. Upon awakening, the patient can stretch the plantar fascia by using the towel to cause passive dorsiflexion of the ankle, with each hand pulling one end of the towel, using the midportion of the towel to pull on the plantar aspect of the forefoot region. Other techniques for stretching the Achilles tendon include passive stretch while standing and nighttime ankle-foot orthoses to keep the feet in neutral at night (thus stretching the Achilles tendon).^[2]

The plantar fascia also can be stretched by having the patient, while seated, roll a soda can between the sole and the floor. Using a cold can of soda may give further symptomatic relief through local cooling.

Passive stretching of the plantar fascia also can be achieved by using one hand at the plantar aspect of the forefoot region, then dorsiflexing the foot.

A study found non–weight-bearing stretching exercises specific to the plantar fascia to be superior to the standard program of weight-bearing, Achilles tendon–stretching exercises in patients with chronic plantar fasciitis.^[3] Another study suggests that static progressive stretch bracing may be an effective alternative option to static stretching exercises. The study showed no significant difference between static stretching exercises and static progressive stretch braces in terms of pain relief or functional improvement.^[4]

Massage of the plantar fascia, accomplished by running the thumb or fingers lengthwise along the fascia, can be beneficial for patients with plantar fasciitis. The physical therapist may complete this technique during therapy sessions and may instruct the patient or family members on how to continue the massage independently at home.

Application of ice is an important part of the treatment process to reduce pain and inflammation. Ice should be applied after exercise and may be performed either as an ice massage for 5 minutes or by applying an ice pack for 15-20 minutes. The physical therapist also may recommend other modalities, such as ultrasonography, phonophoresis, or iontophoresis, to assist further with pain relief and reduction of inflammation.

In some cases, taping of the plantar fascia by an athletic trainer or physical therapist can help decrease stress on the fascia, enabling the patient to better tolerate activity. Taping techniques are used to distribute force away from the stressed and irritated fascia and to provide some relief from discomfort caused by weight-bearing activities.

If the patient needs to decrease activity level because of this condition, remember to suggest alternative means of maintaining strength and cardiovascular fitness (eg, swimming, water aerobics, other aquatic exercises). Generally, in patients with plantar fasciitis due to work-related causes, the physical therapist can perform work-hardening activities with physician supervision.

The patient should be instructed to contact the physician before the scheduled follow-up appointment if there is significant progression of the symptoms or if there are any local signs of infection at the injection site.