Tips to help your treatment of plantar fasciopathy (PF)
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Treat PF like a tendinopathy - load it rather than performing manual therapy on the area. Stop pressing, needling or rubbing the plantar fascia insertion, as this is likely to be ineffective and further irritate the already irritated structures.
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Isometrics can be commenced in a midrange position, with bilateral or unilateral heel raises from the floor. Hold these for 30-45 seconds and repeat 3-5 times. Reassess for an improvement in the patient's pain and function following isometric loading. Exercises for sedentary patients are likely to need to commence at a lower level and increase at a slower rate.
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Progressively increase load to incorporate high load strengthening, particularly in runners. Heel raises incorporating toe extension can be used as an exercise progression as soon as tolerated.
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Manage your patient's load - reduce your patients running load, time on the feet. Your patient should be able to walk for 3-5 km pain free, without subsequent morning pain, before re-commencing running.
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Utilise taping techniques to offload and support the plantar fascia. An improvement in pain, function with taping or orthotics is needed to justify their inclusion in a treatment program. If you are unable to use pain as a guide within treatment eg if the patient only has startup pain, ensure orthotics or taping do not decrease single leg balance.
Other relevant links
5 Minute Physio tip - Why stretches won't get your plantar fasciopathy patients better