What Is the Plantar Fascia, Really?

The plantar fascia is a thick band of connective tissue that runs from your heel bone (calcaneus) to the base of your toes. It’s not a muscle—but it plays a crucial role in supporting the arch of your foot, absorbing shock, and helping you walk, run, and stand efficiently. You can think of it like a built-in suspension bridge that stores and releases energy with every step.

It’s also under constant load. Every time your foot hits the ground, your plantar fascia helps manage and distribute that force. When it’s working well, you barely notice it. But when it’s irritated or overloaded, it can become incredibly painful—especially with your first few steps in the morning or after long periods of standing.

What Causes Plantarfasciitis?

Plantarfasciitis is one of the most common causes of heel pain, especially among runners, dancers, walkers, and people who stand for long periods. Despite the "-itis" in the name, recent research suggests the condition is more degenerative than inflammatory—meaning it’s less about acute inflammation and more about micro-tearing, thickening, and breakdown of the tissue over time (Rathleff et al., 2015).

So what causes it? In most cases, it comes down to overload without enough load tolerance. Think of:

Sudden increases in activity (like a new walking or running routine)
Weakness in foot and ankle stabilizers
Limited ankle dorsiflexion (hello, tight calves)
Poor foot mechanics or reduced shock absorption
Wearing unsupportive footwear on hard surfaces
Prolonged standing or repetitive strain

But here’s the key point: it’s rarely just a local issue. Plantarfasciitis often reflects a global lack of strength and control through the foot-ankle-knee-hip chain.

Why Loading—Not Just Stretching—Matters

Traditionally, treatment has centered around passive strategies like stretching the calf, massaging the arch, or wearing orthotics. While those might reduce short-term symptoms, they don’t address the underlying tissue resilience.

Recent high-quality studies (Rathleff et al., 2014; Davis et al., 2021) support a shift toward progressive loading protocols that actively strengthen the plantar fascia and supporting muscles. Think of it like building up the tissue’s capacity to tolerate stress again—just like rehab for tendinopathy.

“Loading is medicine. When done progressively, it stimulates tissue remodeling, increases tensile strength, and restores function.”
—Rathleff, 2015

And for Pilates and movement professionals? That’s where we shine. We have the tools to help clients strengthen, not just soothe.

A Pilates-Informed, Evidence-Based Approach

Here are three exercises you can incorporate into your teaching that align with the latest plantarfasciitis rehab research. Each focuses on loading the fascia and surrounding structures while reinforcing functional movement patterns:

1. Toe Scrunches (Intrinsic Foot Strengthening)

This targets the small stabilizing muscles of the foot—often weak and underused. Adding a towel or small resistance band under the toes increases the challenge. Intrinsic muscle training has been shown to improve medial arch control and reduce strain on the plantar fascia.

2. Single Leg Heel Raises (Eccentric & Concentric Load)

This is the cornerstone of plantarfasciitis loading protocols. Focus on slow, controlled movements through full range—especially the eccentric lowering phase. Over time, this strengthens the calf-plantar fascia complex and increases tissue capacity.

3. Pilates V Footwork (Whole Chain Integration)

This isn’t just about the foot. Practicing footwork in Pilates V loads the foot, ankle, knee, and hip in a coordinated pattern. It encourages proper alignment, controlled dorsiflexion, and balanced pressure through the forefoot and heel—key components of pain-free gait.

Talia’s Rehab Favorite: The Short Foot Exercise

As a physiotherapist, one of my go-to rehab exercises for plantarfasciitis is the short foot exercise. It’s simple, powerful, and backed by growing evidence showing how strengthening the intrinsic foot muscles can support the arch and reduce strain on the plantar fascia.

The goal of the short foot exercise is to activate the small stabilizing muscles of the foot—especially the abductor hallucis—to improve arch control and foot posture during standing, walking, and dynamic movement.

How to Perform the Short Foot Exercise

Start Seated: Sit in a chair with your feet flat on the ground, toes relaxed.
Create the Short Foot: Without curling your toes, gently draw the ball of your foot toward your heel, creating a subtle dome through the arch. You should feel the arch lift slightly, without gripping through the toes.
Hold and Release: Hold for 3–5 seconds, then slowly release. Repeat for 10–15 reps per side.

How to Progress It

Intermediate: Practice the same movement while standing on two feet, then progress to a single-leg stance for more challenge and control.
Advanced: Integrate the short foot into dynamic movements like lunges, squats, or balance work. You can also add a resistance band for extra feedback.

This exercise isn’t flashy, but it builds the kind of deep, foundational strength the foot needs to function well—especially for anyone recovering from plantarfasciitis. It pairs beautifully with Pilates-based footwork and loading strategies to create a well-rounded, evidence-informed approach to healing.

The Takeaway

If you're dealing with plantarfasciitis—or working with clients who are—don’t just chase the pain with stretches and passive strategies. Focus on rebuilding strength from the ground up. Strengthen the foot, strengthen the fascia, and connect it all back to functional, full-body movement.

Because healing doesn’t come from doing less—it comes from doing the right kind of more.

References

Cheung, R. T. H., & Sze, L. K. (2016). Intrinsic foot muscle training: A review of exercise programs. Journal of Physical Therapy Science, 28(11), 3123–3128.
Davis, I. S., et al. (2021). Evidence-based treatment of plantar fasciitis in the 21st century. Journal of Orthopaedic & Sports Physical Therapy, 51(1), 1–8.
Rathleff, M. S., Moelgaard, C., Lykkegaard, O., & Jensen, T. T. (2015). High-load strength training improves outcomes in patients with plantar fasciitis: A randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 25(3), e292–e300.
Wearing, S. C., Smeathers, J. E., Urry, S. R., et al. (2006). The pathomechanics of plantar fasciitis. Sports Medicine, 36(7), 585–611.

Strengthen, Don’t Stretch (Again): Rethinking Plantarfasciitis Rehab