Can Pilates ease Plantar Fasciitis pain?

A case study

Mona A. Alblehed 02.02.2018

Riyadh, Saudi Arabia

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Abstract

Plantar Fasciitis is the known term of heel pain or arch of the foot especially during the

morning. Approximately two million patients are treated for this condition every year.i It can be

due to several reasons such as having a high arch or a flat foot. Doctors and Physical therapists

suggest several methods to ease the pain besides having a good and well-constructed Pilates

program. A night splint, calf stretch, and orthotics are some of the suggested things to do alongside

the program. In this paper, I discuss the anatomy review of the foot and then discuss a case with

detail. I have taken myself as the client as I was diagnosed with Plantar Fasciitis two years ago. I

discuss the program that I did for myself and what differences did I notice before and after following

an organized Pilates program that is designed specifically to help me manage the pain.

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TableofContents

ABSTRACT 1

ANATOMICALDESCRIPTION 4

INTRODUCTION 6

CASESTUDY 8

CONCLUSION 12

BIBLIOGRAPHY 13

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AnatomicalDescription The foot consists of bones, joints, muscles and soft tissues. A joint work of the four is what helps

us perform our daily activities such as walking and running.

The foot anatomy is generally divided into three parts:

• The front of the foot

(forefront): contains

phalanges (the toes) and

metatarsals (longer bones).

• The middle of the foot

(midfoot): A collection of

bones that form the arches of

the feet. It contains the

cuneiform, cuboid, and

navicular bones.

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• The back of the food (hindfoot): This forms the heel (calcaneus) and the ankle (tibia and

fibula).iii

The largest bone in the foot is the calcaneus. Besides the bony part of the foot, there are the

muscles, tendons and ligaments that make up the rest of the foot. The foot and ankle contain 26

bones (One-quarter of the bones in the human body are in the feet.), 33 joints, and more than

100 muscles, tendons and ligaments. These components work together to provide the human body

with the necessary balance, strength and mobility to perform activities. Many structural problems

in the foot can cause pain elsewhere in the body such as developing back pain due to poor foot

alignment or support.iv

Generally, the foot relies heavily on tendons. Tendons are fibrous tissues that connect

muscles to bones and ligaments are fibrous tissues that connect bones to other bones.). The largest

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and strongest tendon of the foot is the Achilles tendon, which extends from the calf muscle to the

heel. Its strength and joint function facilitate running, jumping, walking up the stairs, and raising

the body onto the toes.

Moreover, ligaments hold the tendons in place and stabilize the joints. The longest of these,

the plantar fascia, forms the arch on the sole of the foot from the heel to the toes. By stretching and

contracting, it allows the arch to curve or flatten, providing balance and giving the foot strength to

initiate the act of walking. Medial ligaments on the inside and lateral ligaments on outside of the

foot provide stability and enable the foot to move up and down.

The word fascia is a Latin word meaning “a

band”. It denotes the layer of fibrous

connective tissue that surrounds different

organs, muscles, bones, blood vessels and

nerves. v The plantar fascia is the fibrous tissue

layer on the plantar surface of the foot that

connects the heel bone to the toes.

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It supports the arch of the foot and protects the sole from injuries. It passes behind the ankle and

gets attached on the posterior surface of heel bone (calcaneus). The plantar fascia is located between

a key muscles of the foot. The tibialis posterior (which connects the lower leg to the arch and

underside of the foot) and tibialis anterior (which runs across the tibia, fibula and ankle to the medial

arch of the foot) are the closest two major muscles that are located near the plantar fascia.

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IntroductionPeople suffering from Plantar Fasciitis usually have symptoms of pain in the heel. The pain

is at its worst in the morning, when a person’s muscles are all stiff and tight. Some people suffering

from Plantar Fasciitis might have symptoms of pain in the arch or along the side border of the foot

instead of the heel. Generally speaking, people with heavier weight or people with weight bearing

jobs which requires standing for long hours tend to suffer more from Plantar Fasciitis. However,

there have been many incidents where light people and people with desk jobs suffer from Plantar

Fasciitis as well.

If a person is said to be heavy, very active, or have flexible feet they might suffer from

Plantar Fasciitis. In addition, the way a person walks affects the probability of suffering from

Plantar Fasciitis. If a person places great pressure on the front of the foot, that person is straining

the plantar fascia which will cause an inflammation eventually. Moreover, as the foot is connected

to the calve through the Achilles tendon, any tightness in the Gastrocnemius or Soleus muscles or

the Achilles tendon will cause pain in the plantar fascia.

Doctors and physical therapists recommend several methods to treat Plantar Fasciitis or at

least ease the pain. One of the most effective methods is to stretch the calve muscles on daily basis

if not more than once. It might be recommended that the patient uses a night splint to stretch the

calf muscle at night. Furthermore, physicians recommend using orthotics or inserts. Orthotics are

helpful in the treatment of plantar fasciitis. Because of the pad in the arch, they limit and restrict

motion of the foot. This reduces the traction on the plantar fascia. In addition, the pressure that the

orthotic places on the plantar fascia protects the plantar fascia insertion point where most of the

damaged ligament lies. There have been studies that demonstrate that, over the short-term, arch

supports help people heal plantar fasciitis.vii

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Moreover, it is recommended that a person suffering from Plantar Fasciitis change their

shoes regularly, and make sure not to wear soft shoes but rather supportive ones. Newer and stiffer

shoes generally restrict the movement of the toes and the arches which are considered an important

contributor to the stress on the plantar fascia. Alternatively, if the person is a runner or does

excessive training, it is recommended that they moderate their activity to help recover the

inflammation. Lastly, in some extreme cases, an injection of Botox or other liquids might be used.

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CaseStudyName: Mona A. (myself)

Age: 27 years old

Limitation: I have been diagnosed with Plantar Fasciitis two years ago. I suffer from pain around

the heel area as well as my arches. The pain is at its worse in the morning and when I lift heavy

stuff or stand for a long time. I can’t jump for a continuous minute without shooting pain in my

plantar fascia. I am not able to run for long distances or any distance at some points.

I started with physical therapy long before I started to implement my Pilates practice on

myself. My therapist had my stretch my calves before any exercise and she asked me to moderate

my level of activity as she thought I did excessive exercise which was not helping with my case. I

went to the physio twice a week and did several exercises and stretches. I thought that doing Pilates

would benefit me as it is one of the few exercise methods that works on foot alignment as well as

strengthen the feet and increase its stability of the ankle.

In the beginning, I examined myself and tried to define any misalignments in my body and

in my feet precisely to try and figure out what are the corrections that I should do to ease the pain.

I video recorded myself when walking, when jumping and when doing my regular exercise regime

such as running. I concluded that my stance is not balanced, I have supinated feet when walking

and standing. As for my running, I tend to place all the pressure on my toes which elevates the

pressure on my plantar fascia and causes the pain. I tend to always stand on my right leg more than

the left. This explains why the pain on my right foot tends to be more severe than my left foot.

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A sample of the program that I conducted on myself is below.

Block Sample workout Warm up Mat

• Pelvic Curl • Spine Twist Supine • Chest Lift • Chest Lift w/Rotation

Footwork Reformer • Parallel Heels • Parallel Toes • V toes • Open V heels • Open V Toes • Calf Raises • Prances • Prehensile • Single Leg Heel • Single Leg Toes

Abdominal Work Reformer • Hundred Prep • Coordination

Hip Work Reformer • Frog • Circles (Down, Up) • Openings

Spinal Articulation Reformer • Short Spine • Long Spine

Stretches Reformer • Hamstring Stretch Group

(Standing, Sitting, Kneeling lunge)

Full Body Integration (F/I) Cadillac • Sitting forward

Arm Work Cadillac • Standing Arm Series

Full Body Integration A/M N/A Leg Work Wunda Chair

• Leg Press Lateral Flexion/Rotation Wunda Chair

• Side Stretch • Side Kneeling stretch

Back Extension Wunda Chair • Swan on floor

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Notes on the program:

Warm Up - Focus is on the pelvis but I emphasize on grounding the feet to start activating them

from the beginning of the session

Footwork - This part of the session is the most beneficial for me as it is one of the few exercise

that actually target the feet. I was told by my physio to strengthen my feet and try to stabilize them

to help reduce the pain. This helped me a lot in activating and strengthening.

I noticed that I tend to put more weight on my right foot and the foot alignment is lightly supinated.

Abdominal Work - Abdominal strength is essential for the overall health of the body and there is

no time when a person doesn’t need abdominal work.

Hip work - It is beneficial as it works on stabilizing the pelvis. It will also strengthen the iliopsoas

muscle as well as abductor and adductors.

Spinal Articulation - I would alternate between spinal articulation exercises and do about 5 reps

every time as I know that those exercises are good for the spine in the long run as well as the posture

overall.

•Note: Spinal Articulation was done in my 1-10 sessions because I am not a beginner and

took several Pilates sessions before. If I were doing this for a client, I would include it after 11

sessions if I see that the client has the ability to do it safely.

Stretches – The Hamstring Stretch group exercises were beneficial as they worked on stretching

my hip flexors as well as my tight hamstrings.

Full Body Integration – This exercise stretches my hamstrings very well and it does stretch my

calves as well due to the feet are position that is against the columns. Calf stretch is specifically

very helpful in the case of Plantar Fasciitis and it loosens the Achilles tendon which pulls on the

Plantar Fascia if it is tight and thus causes pain.

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Arm Work - I would use this to make sure that I have stability in my feet when standing. I tend to

lean more to the right so I have to keep watching my posture in the mirror in a side view and front

view and keep correcting the misalignment.

Leg Work - I would focus on the foot alignment and that the weight is equally distributed in the

standing foot. I tend to lean forward a bit as I do the leg presses. More focus should be towards

balancing my body in a straight line.

Lateral Flexion/ Rotation - This feels good on the body at the end of the session. It gives my

lateral flexors the stretch it needs. It also helps control my abdominals and specifically my oblique.

Back Extension - This works to strengthen the back extensors which helps with the overall posture

when performing daily activities.

The program and description mentioned above describes the session that I would do

regularly. I change some of the exercises in some of the blocks just to target muscles in a different

way. I would add repitions if I feel an exercise is becoming easier or I would add resistance

depending on the exercise as well as the objectives and muscle focus.

After doing the session, I would hold a Thera Band or any band and stretch my calves to

loosen my Achilles more and release the tension that is causing the pain in the bottom of my foot.

I try to stretch my calves as much as possible during the day. I have noticed that the more I stretch,

the less pain I get in my foot in the morning and during the day in general. If the pain is still there,

I would get a tennis ball and rub the bottom of my foot against it.

Each block of the program works as a complement to the other blocks and the program is

only complete if I conduct all blocks in every session. The sessions are supposed to make the pain

more manageable and should make me be more aware of my foot misalignments and postural

problems in general. As mentioned in the table above, I would focus so much on the footwork as it

is the only place where I actually work my feet and be able to stabilize and strengthen them.

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ConclusionI have noticed a big difference in my pain level since I started to do Pilates and precisely

focusing on my feet and the alignment. I have more manageable pain and I am able to run almost

without any interruption due to pain. My runs are usually disrupted by the pain and I am forced to

stop, or I can continue the run but struggle the day after. Although there is still a long way ahead of

me, I can see some results and progress already. I noticed that what helped me the most in being

conscious of my misalignments is that I started the sessions by filming myself and then viewing the

video after. The more I watched myself, the more I was aware of my misalignments. I am excited

to continue working on my feet problems and strengthening my muscles and my whole body using

Pilates and specifically following the BASI block system while doing it.

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Bibliography

i “Our knowledge of orthopaedics. Your best health.” Plantar Fasciitis and Bone Spurs -

OrthoInfo - AAOS, orthoinfo.aaos.org/en/diseases--conditions/plantar-fasciitis-and-bone-spurs.

ii “Foot Pictures Recent Anatomy Of The Tendons And Ligaments On Metatarsalgia Metatarsal

Injury Causes And Treatm - Geoface #830565e5578e.” Geoface,

geoface.info/fbcf/e557895e92c8/foot-pictures-recent-anatomy-of-the-foot-tendons-and-ligaments-

c269aa.

iii "Hoffman, Matthew. “Picture of the Feet.” WebMD, WebMD, www.webmd.com/pain-

management/picture-of-the-feet#1.

iv “Pilates and Neuropathy”, Megan Huston, Research Paper, March 2016.

v “Plantar Fascia Anatomy”, N/D, Docpods, 2012.

vi Hyatt, Michael. “How to Avoid Running Injuries.” Michael Hyatt, 8 June 2016,

michaelhyatt.com/how-to-avoid-running-injuries/.

vii “Plantar Fasciitis”, wholefoot.com, NA, 2013.

AdditionalResourcesusedinthepaper

Ø Isacowitz, Rael, and Karen Clippinger. Pilates anatomy. Human Kinetics, 2011.

Ø Calais-Germain,Blandine.Anatomyofmovement.EastlandPress,2014.

Ø Calais-Germain,Blandine,andAndreéLamotte.Anatomyofmovementexercises.

EastlandPress,2008.

Ø Isacowitz,Rael.Pilates:yourcompleteguidetomatworkandapparatusexercises.

HumanKinetics,2014.