Why an exercise? To understand its importance, one must first understand the pathophysiology of plantar fasciopathy. For a long time, we thought it was an inflammatory condition as mentioned earlier.
However, research has shown that there is a phenomenon of degeneration in the fibers of the plantar fascia (deterioration of collagen fibers and other changes). A high resistance strengthening program has already proven benefits for degenerative phase tendons under similar conditions such as Achilles tendinopathies or patellar tendinopathies.
The scientific article published by Rathleff et al. (2014) demonstrated that this high-intensity exercise provides a reduction in pain and symptoms after three months faster than manual stretching of the fascia.
The explanation behind the effectiveness of this exercise lies in the very biomechanics of the foot. First of all, the plantar fascia is a fibrous band that is located under your foot and that attaches to your calcaneus, the bone of your heel, to join the front of your foot on the metatarsals and phalanges, your toes. This fascia is not a muscle, so it has no contractile capacity. Impossible to ask for it voluntarily. Its role is to stabilize the foot passively.
Some believe that the arch of the foot, the curvature on the inside, holds in place only because of the arcuate geometry. However, it is the role of the fascia to hold the foot in place in combination with other muscles attaching to the foot. The foot then becomes a rigid lever for propulsion during the walking cycle. This mechanism is known under the name of the "Windlass mechanism".
To better visualize:
Pull your big toe up, this simulates the end of the walking cycle when the heel is raised.
On the other hand, you can touch the arch of the foot and feel the fascia stiffen with the amount of upward force you apply. This action also has the effect of increasing the height of your arch.
Simple exercise and accessible to all. All you need is a towel and a staircase!
Place the front of your feet on a staircase while keeping your heels hanging out. Then insert a towel under your toes so that they are as high as possible. Contract your calves, raise your heels as high as possible then release quietly to slowly descend under the step to stretch your calves.
Perform 3 sets of 30 repetitions. A repetition is 3 seconds on the ascent and 3 seconds on the descent.
For this exercise, the knees are straight and the glutes are out.
One of the major advantages of this exercise is that it can be done in conjunction with any other treatment plan already established. It is important to start it off with a few repetitions and gradually increase the number of repetitions. As a reference, I often recommend that my patients start with 60 reps per day and then gradually increase to about 5 reps per day until they reach about 180 reps per day. It may sound like a lot, but it is an exercise with the specific goal of dramatically increasing the load on the plantar fascia so that its fibers can become functional again.
I give the patient the possibility to do his repetitions in several sets and to extend them during the day. The goal here is not to do an incredible amount on the first day and not to do more afterward. I repeat it often: consistency and discipline are the keys to effective rehabilitation. For those who find the difficulty level low, I recommend doing the exercise on one foot at a time or just adding weight (eg, carry a backpack full of books).
Warning! This exercise mustn't do not cause any additional pain.
It is also not an exercise that I recommend at the first symptoms when the fasciitis is at its most acute, or when the symptoms are more present and you have difficulty putting your foot on the ground. . A simple and effective tip to know if you are ready to undertake this exercise: Start with 60 repetitions in a day, then you can gradually continue this rehabilitation program only if:
There is no pain during the rehearsals.
The pain did not significantly increase the next morning.
Another contraindication for this exercise is if you received a cortisone infiltration in the heel less than six months ago.
In conclusion, plantar fasciopathy (heel pain, plantar fasciitis, or Lenoir's spine) can be difficult to treat and many people continue to have symptoms despite the application of certain treatments. It is important to include a high resistance strengthening exercise to help the fibers to regain their function and thus completely heal the symptoms and discomforts associated with plantar fasciitis or Lenoir's spine.