Q: What should I consider when creating a program for a client who has plantar fasciitis?
A: Plantar fasciitis is an inflammation of the thick band of connective tissue on the underside of the foot, and is often quite painful. The irritation is normally felt with the first steps in the morning, and is often seen in people with high arches, tight Achilles tendons and those who stand for long periods of time or have leg length discrepancies.
When someone has plantar fasciitis, additional stress is placed on the plantar fascia—often with pronation (rolling toward the inside of the foot), descending stairs, standing for long periods of time or during rapid acceleration. Pain can also come from calcaneal apophysitis, or bone spurs, which occurs on the underside of the calcaneus (heel bone). Both plantar fasciitis and heel spurs can be caused by poor biomechanics in the lower body, excessive pronation or supination or maximal ankle plantar flexion and simultaneous dorsiflexion of the metatarsal phalangeal joints (as happens when wearing excessively high-heeled shoes).
Working with clients with plantar fasciitis and heel spurs means the focus should be on correct biomechanics in the entire lower kinetic chain, from the pelvis through the hips, knees, ankles and feet; with low-load or non-weight bearing exercises until more load can be accepted. A careful eccentric training program will also be helpful to normalize movement patterns.
Try these exercises from the STOTT PILATES® repertoire: Footwork on Jumpboard or Padded Footbar on the Reformer, Foot Press on Long Box with the Stability Chair™ when they are able to stand, or use the Rotational Diskboard on the Reformer for useful proprioceptive feedback to the lower kinetic chain.