Yoga for Plantar Fasciitis

October 23, 2017    BY Amber Burke

Editor's note: The below recommendations are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional.

Plantar fasciitis, a painful inflammation or micro-tearing of the soft tissue or fascia along the arch of the foot, is quite common. It occurs in one in ten adults during their lifetimes, most frequently between the ages of 40 and 60. With noninvasive treatment, the majority of cases resolve within one year, but in rare cases, plantar fasciitis may require injections and surgery.

For almost everyone, plantar fasciitis begins in the same way. “The pain is usually felt first just in front of the heel on the big toe side of the foot, but without treatment it may eventually spread into the arch,” says Bill Reif, a physical therapist and author of The Back Pain Secret: The Real Cause of Women’s Back Pain and How to Treat It.

In Reif’s physical therapy practice, he sees plantar fasciitis most frequently in beginner runners who are dramatically lengthening their runs, often when training for a marathon. Plantar fasciitis derives from overstretch and overuse—often in conjunction with a structural factor, such as very high or very low arches, or the imperfect mechanics explored in depth below. It is most common in athletes and those who spend a good amount of the day on their feet, especially if they stand on a hard surface. Certain kinds of exercise that place great strain on the feet, like ballet and long-distance running, can increase the risk of developing the condition. Other risk factors include pregnancy, obesity, and even habitually wearing poorly fitting or very old footwear.

Plantar fasciitis is associated with tightness not only in the tissue at the sole of the foot but also in the calves and hamstrings and with decreases in the ankle dorsiflexion.

Stretching the calves (i.e., the Achilles tendon-gastrocnemius-soleus complex) has been shown to be an effective treatment for plantar fasciitis: As calf flexibility increases, foot pain often decreases. Thus, many of the stretches yoga offers can be of direct benefit to those with plantar fasciitis, particularly if those stretches are practiced with attention to proper body mechanics.

Achilles tendon-gastrocnemius-soleus complex (left leg)

But first, a word about what someone with plantar fasciitis should not do in yoga class.

What Not to Do in Yoga 

Aggravation of the tissues at the sole of the foot may result from imperfect alignment—chiefly, the repeated deviation of your foot and ankle from its neutral position, which often goes hand in hand with less-than-optimal knee tracking. “Yoga can either correct or reinforce these suboptimal patterns,” according to Reif. 

A neutral foot is one in which the heel bone (calcaneus) is vertical, as opposed to tipping inward or outward. This position of the foot enables healthy weight-bearing in both the inner and outer balls of the feet, as well as the inner and outer heels. Feet veer from neutral in two primary ways: The ankles can slope in toward each other, bringing the inner arches toward the floor (pronation); or the ankles can slant away from each other, exaggerating the inner arches (supination).

While neither foot movement is “bad,” in and of itself—in fact, both are part of every step we take—too much of either movement can lead to problems. As Reif explains, “If your foot pronates too much, or for too long, during the stride, as the weight rolls toward the big toe and the arches collapse, the plantar fascia from the heel to the arch of the foot overstretches, resulting in micro-tears.” 

Oversupinating (sometimes called “underpronation”) while walking or running also causes problems. In that case, the heel often doesn’t roll in far enough during the stride, and may even roll outward. “This tendency is common among people with high arches or tight Achilles' tendons,” says Reif. “If you oversupinate when you walk, your foot no longer properly absorbs the shock of each step, and that can aggravate the plantar fascia.”

Neither of these tendencies occurs in a physiological vacuum. Overpronation is associated with thighs and knees that slant in toward each other, perhaps pointing toward the big toes when the feet are parallel to each other. Oversupination is associated with thighs and knees that bow outward, pointing toward the little toes.

While bringing the feet into their neutral position may help with knee tracking, tracking the knees well—as explained below—may also make it easier to establish neutral feet that bear your weight effectively. You’ll notice, for example, that it’s challenging to get the bases of the big toes to root down if the knees are pointing outward.

A student with plantar fasciitis who practices yoga with her feet overpronating or oversupinating and/or her knees off-track will continue the damaging pattern that caused or contributed to the condition. Her feet may feel worse after practice. But if that student keeps her feet and knees in the neutral alignment detailed below during any yoga practice, her feet may well feel better after practice.

Aligning the Feet and Knees 

The following tips will help you refine the positioning of your feet and knees in some common yoga poses. Practice these refinements in a standing position at the top of your yoga mat, ideally in front of a mirror. 

Tadasana (Mountain Pose)
Position your feet a few inches apart, aiming your middle toes forward, so that the outside edges of your feet are parallel to the outside edges of your mat.

Are your ankles sloping in toward each other, with your inner arches dropping toward the mat? In this case—pronation—you will be standing on the inside of your heels. Or are your ankles slanted away from each other, with your inner arches lifted and the bases of your big toes lifting up from the mat (as in the photo below)? In this case—supination—you will be standing on the outside of your heels. (It may help to have someone, like a yoga teacher, sitting behind you and looking at your heels.)

In either case, lift each heel and reposition it, placing it back on the mat so that you are standing on its “center.” 

Press down with the four corners of each foot. (While there is certainly more than one effective way of conceptualizing a rooted foot, we’re using “four corners” here so that we can practice rooting both the inner and outer balls of the feet, and the inner and outer heels.) If you tend to pronate, it will be important for you to root the outer heels and the bases of the pinky toes. If you tend to supinate (i.e., lift your arches and disconnect the bases of your big toes from the mat), it will be important for you to press down with the inner heels and the bases of the big toes. Once you have rooted through the corners that are particularly challenging for you, send weight into all four corners.

Hold here for several deep breaths, memorizing the sensations that signal that you are in neutral foot and ankle alignment.

Utkatasana (Chair Pose)
From tadasana, place your hands on your hips. Bend your knees on an inhale, noticing their tendencies.

Do your knees tend to veer inward, toward your big toes (likely the case if you overpronate) or outward, toward your little toes (which is likely the case if you oversupinate)? Aim your knees toward the centerlines of your feet, tracking them toward the second or third toes.

Press your feet into the floor and straighten your knees on the exhale, still tracking your knees toward your second or third toes. 

Repeat this movement several times.

Simply working toward neutral feet and knees in all your yoga poses, and throughout your daily life, may begin to alleviate plantar fasciitis symptoms. Healthy knee tracking may also relieve the hamstring tightness associated with plantar fasciitis. (For more on relief of hamstring tightness through healthy alignment, read Get Unstuck: Alignment Help for the Hamstrings.)

But to target plantar fasciitis symptoms more directly, try the poses below while maintaining the foot and knee alignment that you practiced above.

Poses to Relieve and Prevent Plantar Fasciitis

Reif suggests a series of stretches for the hamstrings, calves, ankles, and feet to alleviate the fascial tightness implicated in plantar fasciitis pain. In the poses where your feet are on the floor or a wall, it will be easy to translate the alignment above into practice. In poses where your feet are off the ground, and neutral feet may be more elusive, imagine pressing your feet against a wall or the ceiling so that one side of the foot doesn’t come back toward you more than the other.

“And be cautious,” advises Reif. “Go slowly: You don’t want to cause tears. You should never feel pain during these poses, just a stretching sensation.”

Calf stretches for plantar fasciitis have been shown to be effective whether they are practiced intermittently or held. You can practice the active stretches below according to your preference: Hold them for three minutes each, or do five sets of twenty seconds each, taking a few deep breaths between sets. 

Practice the entire series once each day. In addition, perform a few of the poses that feel most productive for you two or three times throughout the day. 

You will need a wall, a yoga block, a yoga strap or towel, and one or two 10-pound sandbags.

Runner’s Stretch at Wall 
This stretch is for your gastrocnemius and Achilles tendon. In step 4, the variation with the back knee bent will channel the stretch to the soleus muscle.

1. Stand about a foot from the wall, placing your hands on the wall at about belly height.

2. Step your left foot two or three feet back behind you. Aim the toes of both your front and back feet toward the wall in front of you.

3. Lean forward on a diagonal, keeping your spine long (i.e., hinge your torso over the hips without rounding your back) and your back heel grounded, as you bend your elbows until you feel a stretch in the left calf muscles. (If you don’t feel a stretch, try stepping your back foot farther back.) Hold here for several breaths.

4. Now, bend your left (back) knee, keeping your left heel down (or as near to the ground as you can) and directly in line with the ball of your left foot.

5. Root down with the ball of your back foot, and reach back through your back heel. Hold here for several breaths.

Release the pose, and then repeat the sequence on the other side. 

Calf and Plantar Fascia Stretch With Yoga Block at Wall
This pose, for which you could also use a “foot rocker” like this one, is a more intense stretch for the Achilles tendon, gastrocnemius, and soleus. The toe extension makes it a stretch for the plantar fascia as well.

1. Position a block at its lowest setting against the wall, like a step. Stand in mountain pose facing the wall with your toes facing forward, an inch or so away from the yoga block.

2. Step the ball of your left foot onto the upper edge of the yoga block, keeping your left heel grounded. Continue to point both your right toes and left toes straight ahead.

3. If you don’t yet feel a stretch, lean forward slightly while keeping your left leg straight, bringing your fingers to the wall. (It’s all right if your right heel lifts up off the ground.) Hold here for several breaths.

4. Now, bend your left knee slightly, and hold here for several breaths.

Step off the block, and repeat this sequence on the second side.

Foot Stretch from Tabletop (to Thunderbolt/Vajrasana Variation)
This stretch targets your plantar fascia.

1. Come to hands and knees position on your yoga mat.

2. Curl your toes under, pointing your heels straight up. (Work on pointing your toes forward, instead of letting them veer toward the outer edges of your yoga mat, as they may be inclined to if you have bunions. If you cannot point your toes forward because of the toe-drift caused by bunions, or because your toes lack this range of motion, skip this pose.

3. Slowly sink your hips back toward your heels until you feel a stretch along the soles of your feet.

4. If you don’t yet feel a stretch, you can bring your spine upright and bring your hands to prayer in front of your chest. Hold for several breaths.

Straight Leg Raise (Supta Padangusthasana) With Bottom Foot at Wall
This stretch targets the plantar fascia as well as the Achilles-gastrocnemius-soleus complex and the hamstrings. You will need a yoga strap (or belt or towel) and a wall. (Pressing your feet against the wall as you lie down will help you to keep a neutral foot, and to lightly stretch the plantar fascia and calves.)

1. Lie on your back with both feet against a wall, your heels against the floor, and your toes pointing straight up toward the ceiling.

2. Bend your left knee toward your chest, and put your strap or towel toward the top of the arch of the left foot. Keep your right foot pressed against the wall.

3. Straighten your left leg, aiming the sole of your left foot up toward the ceiling and pointing your left toes straight back. Your arms can be bent or straight as you grasp the strap, but be sure to relax your shoulders toward the mat.

4. Work to draw the inside and the outside of your foot evenly down toward your left hip, so that it looks as though your left foot is standing on the ceiling. Check on your right foot and make sure it’s still pressing against the wall, toes pointing up toward the ceiling. Hold here for several deep breaths.

 Release, and repeat this stretch on the second side.

Big Toe Pull from Thread the Needle
This stretch is for the plantar fascia. “The longest part of the plantar fascia connects to the big toe,” says Reif. “We can stretch this band of tissue by pulling the big toe back toward the shin.” Below, the pose is instructed supine, from thread the needle, but it could be practiced seated in a chair as well, with one ankle crossed over the opposite knee.

1. Still lying on your back, bend both knees—taking the strap off your left foot—and place both feet on the floor a few inches away from your sitting bones. Cross your left ankle over your right knee, flexing the foot slightly so the sole of the foot is pointing away from you.

2. Draw your legs toward your chest, and cup the heel of the left foot with your right hand.

3. With your left hand, grasp the left big toe. As you inhale, draw the toe back toward your left knee. Exhale and move the left big toe toward the heel of the left foot. Repeat this several times.

 Release and repeat the big toe pull on the second side.

Legs up the Wall With Sandbags
This is a gentle stretch for the plantar fascia and Achilles-soleus-gastrocnemius complex. Some people may also experience it as a stretch in the hamstrings. You will need a wall and one or two 10-pound sandbags. (And someone to drape those sandbags over your feet.)

1. Sit with one of your hips flush against the wall. Then, turn to bring both legs toward the wall as you lie down on your back, extending your legs up the wall. Ideally, your legs will be vertical, with the backs of the thighs resting comfortably against the wall. Drape your arms out to your sides, or rest your hands on your belly.

2. Have someone drape one sandbag over the entirety of the soles of your feet. Stay here for two or three minutes, taking deep, relaxed breaths.

3. After two or three minutes, if you’d like more of a stretch, have your helper add another 10-pound sandbag to your feet, and remain for another few minutes.

Savasana With Feet Against the Wall
1. Scoot away from the wall enough that you can straighten your legs on the floor and bring your feet against the wall, heels resting on the floor. Allow your feet to turn out, as they naturally would when you lie on your back, but keep their soles against the wall.

2. Relax here for several minutes. 

Countering Plantar Fasciitis Throughout the Day (and Night!)

Two or three times a day, practice the stretches above that were most valuable to you. Aim to keep your feet in their neutral position as you stand, walk, and even when you sit. Notice that your ankles may drop inward or outward while you’re seated, just as they do when you stand: Aim to neither pronate nor supinate your feet when seated. If your feet don’t comfortably touch the ground, put support under them—such as blocks or phone books to help keep them in their neutral position. 

When walking or standing for long periods, Reif advises: “Never go barefoot, especially when walking on the beach. The sinking of your feet into the sand as you push off will accentuate your tendency to overpronate or oversupinate.”

Reif also emphasizes that arch support is vital, pointing out that old shoes can actually increase the amount of supination or pronation. “To treat any symptoms or pain that may be caused by supination or pronation, consider over-the-counter arch support cushions or heel cups. In the early stages, for very painful heel or plantar fascia pain, a soft heel lift or heel cup will generally alleviate pain, especially if the pain is under the calcaneus (heel bone). Even if the pain is only in one foot, it’s best to wear these in both shoes to maintain even height. Once you have adequately lengthened your calves, and your symptoms have started to abate, you should wean off this added support,” he says.

However, if symptoms don’t abate with the use of over-the-counter insoles, consult a physical therapist or doctor who can show you how to use athletic tape to support the bottom of your foot or prescribe orthotics for you.

Rolling the arches of your feet with something fairly firm, like a foot roller or lacrosse ball can help release restrictions in the plantar fascia. For added pain relief, “Roll a frozen water bottle under your feet,” suggests Reif. He recommends rolling the feet two to three times per day for three to five minutes. (Rolling your feet out may be most convenient when you’re seated—while working at your desk, for instance—but you can certainly also roll your feet while you stand. Standing will produce more intense sensations, and you may wish to bring one of your hands to a wall or the back of a chair for stability.)

The pain of plantar fasciitis is often worse in the morning, and some people may find themselves walking on the balls of their feet those first few steps of the day, unable to get their heels to land. According to Reif, this is because of the positions we sleep in. “Sleeping on your stomach can shorten the calf muscles, so can sleeping in a fetal position, or on your back with tight sheets that pull your toes down. In these positions, the calf muscles (gastrocnemius and soleus) shorten. When you get up, they’re unable to lengthen immediately, causing a pulling on the plantar fascia as you stand.”

To sleep with the feet in the neutral position that keeps the calf muscles lengthening, some medical professionals recommend night splints or boots that hold the feet in dorsiflexion, ideally with the legs straight. While these boots or splints can be helpful, patient compliance is sometimes poor because the boots are unwieldy and uncomfortable. Instead, Reif recommends special night socks called “Strassburg socks,” which have a strap that pulls your toes back toward your shins.

For those who can sleep on their backs and whose plantar fasciitis is less severe, keeping the soles of the feet against the footboard—in the “savasana with feet against the wall” position shown above, even for a short period in the night—may help alleviate your symptoms.

It’s also a good idea to massage and flex feet before you get out of bed. “And practice your runner’s stretches in your morning shower,” adds Reif. “The warmth of the shower will help release some tightness.” 

While managing plantar fasciitis may at times feel arduous, careful attention to maintaining the alignment of your feet—throughout the day, at night, and as you stretch—may leave you feeling more grounded, and even send the stabilizing benefits of neutral feet rippling upward. “Long-term habits of pronation or supination can lead to injury of the knees, hips, and to deleterious consequences for your spinal alignment,” explains Reif. “But by bringing your feet back neutral you may well prevent injury up this kinetic chain.”

#asana solutions Photography: Andrea Killam

Amber Burke
Amber Burke lives in Abiquiu, New Mexico. She teaches alignment-based and restorative yoga privately (and occasionally at Ojo Caliente Mineral Springs), as well as various writing classes at UNM Taos. With her anatomically-focused articles, she aims to broaden the interface between yoga and physical therapy. She and Bill Reif, MPT, are hard at work on a book for yoga practitioners with injuries and pre-existing conditions. She is a graduate of Yale, the Johns Hopkins Writing Seminars MFA... Read more>>

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