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Yoga foot exercises for PF

Posted by Julie on 6/05/04 at 12:56 (152097)

I posted these exercises some time ago, and Scott kindly put a link to them. I've now rewritten that post (and hopefully improved it) and added a new exercise at the end, for strengthening the muscles of the arch.

These are simple Yoga exercises for the feet. They're part of a series for all the joints called Pawanmuktasana. That means 'energy-releasing exercises , and they release energy by speeding the removal of toxins from the joints. They work systematically and precisely on the joints and on their associated muscles, tendons and ligaments. They are best done sitting in a chair, but can also be done lying down. (They can also be done sitting on the floor with the legs outstretched, but this is not an easy position to hold, especially for people with low back problems.)

These exercises are safe for most people, but everyone is different. As with all exercises that you are unfamiliar with, please go gently at first and be aware of how you feel while you are doing them and afterwards.

I've practised and taught these exercises for many years. I found a new and helpful dimension to them when I was dealing with PF; and my PF-suffering students have appreciated them. One has said that these exercises alone were responsible for her recovery. They have proved helpful to a number of people at heelspurs.com over the past few years.

They are effective and powerful, and helpful for people who are dealing with PF, because they are both non- weight-bearing and specific. They're also energising: the increased circulation and energy flow they stimulate may make you feel better mentally and emotionally, as well as physically.

These exercises can be helpful in cases of plantar fasciitis in several ways.

1. They improve circulation generally throughout the body. In particular they increase blood flow to the areas being worked on, which promotes healing.

2. They gently stretch the calf muscles and achilles tendons, which in time reduces the strain on the plantar fascia.

3. They strengthen the entire musculature of the feet and ankles.

4. They maintain muscle tone and improve range of motion, and thus help to avoid losing both during the 'down time of decreased activity.

TOE BENDING AND STRETCHING

This exercise works the toe joints (all 28 of them) and the entire musculature of the feet, while holding a gentle stretch through the Achilles tendons and calf muscles.

Lift one foot off the floor and extend the heel forward, so that you feel a gentle but perceptible stretch through the Achilles tendon and calf muscles. Hold this stretch while you work on your toes.

Curl your toes forward, without bending at the ankle. Don't do this so enthusiastically that you give yourself a cramp.

Then bring your toes back towards your body. Stretch them and spread them, making spaces between them. If your foot muscles are which, as most people's are, you may not be able to make these spaces at first. Persevere: with time and practice, you probably will.

Do this nine times.

Repeat with the other foot, then with both feet.

BREATHING: Breathe out as you curl the toes forward, breathe in as you stretch them.

ANKLE BENDING

This exercise, which works on the ankle joints, and on the gastrocnemius/soleus/ achilles complex. One of its effects is that it helps to increase the angle of dorsiflexion. Tightness in this area is a common contributory cause of PF, and this stretch, which is safe for most people (in contrast to weight-bearing exercises such as the 'wall stretch and the 'hanging-off-the-stair stretch ) can help to overcome this tightness without exacerbating PF or creating further problems.

Bend the feet forward at the ankles, and then bend them back, one at a time, then together.

Do each nine times with each foot, and then nine times with both feet.

BREATHING: Breathe out as you bend the feet forward, breathe in as you bend them back.

ANKLE ROTATIONS

Circle the feet at the ankles, slowly and carefully, nine times in each direction.

Do this with one foot, then with the other, then with both.

Breathe freely.

***

I've included instructions for breathing. If you co-ordinate your movements with your breathing it increases the effectiveness of the exercises because it (a) slows you down and (b) focuses your awareness on what you're doing, which is important. If you find it difficult at first to synchronise your movement with your breath, don't worry, just breathe freely. Do avoid holding holding your breath, which creates tension.

I always do these exercises in the morning before I get out of bed. I would recommend this to anyone with PF, to help avoid the 'first step' pain as well as to get the circulation going: it makes a big difference to how you feel when you do get out of bed.

They can be done as often as you like, whenever you think of it: the more the better. If you work in an office you can do them under your desk without calling attention to yourself. Whenever you've been sitting for a while, it's helpful to do them before getting up.

***

ARCH STRENGTHENING

Here is another exercise to help strengthen all the muscles of the plantar (sole of the foot) area.

Sit upright and comfortable in a chair (preferably a straight-backed chair) with your bare feet flat on the floor.

Draw your toes along the floor towards you without lifting or curling them, so that your arch and instep lift. Keep your toes on the floor as you do this: they will move closer to your heels.

(NOTE: keep your toes straight; don't curl them. This is the difficult part. What you're doing is isolating and working the muscles of your arch to lift your instep, but because you aren't accustomed to using these muscles, your mind (which has to send the message to any muscles you want to exercise) doesn't as readily 'connect' with them as readily as it does with the toes. That's why the instruction is 'draw your toes towards you rather than 'use the muscles of your arch to lift your instep .)

Hold for a few seconds, breathing freely. Then release.

Do this with each foot a few times; then with both feet.

As with all exercise, go gently at first: you may feel a little discomfort, and that's ok, but avoid pain. It's a subtle movement, but it's quite strong. If you feel it isn't right for you and you are the best judge of that - please stop.

You can do this exercise whenever you think of it. If you're at work, you can do it under your desk without anyone noticing. :)

***

I hope you will find these exercises helpful.

All good wishes for your healing.

Re: Yoga foot exercises for PF

Ed Davis, DPM on 6/05/04 at 14:55 (152111)

Julie:

My personal hypothesis behind PF is weakness of the intrinsic musculature of the foot. Fascia, by definition, is a supporting structure for muscles. Perhaps that is not totally true in the foot. We do know that the intrinsic foot muscles (those muscles that orginate and end in the foot) are severely atrophied in modern man. I can think back to my first year of podiatry school, cadaver lab -- there was NOT ONE cadaver in the lab in which the intrinsic musculature was well developed.

There was a study in which the Russians cured PF with Russian stimulation, that is, by deeply but painfully recruiting and hypertophying plantar musculature with an electic current. Russians stim. is used in the US on electrotherapy machines but very sparingly.

As such, the exercises that strengthen the intrinsics may lead to the key to many a difficult case.
Ed

Re: Yoga foot exercises for PF

Julie on 6/05/04 at 15:08 (152112)

Ed

I agree. I feel sure that strengthening is one of the keys to avoiding PF, to getting over it, and to avoiding recurrence. Perhaps, though, in long-lasting, chronic cases, where tissue degeneration has taken hold, exercise may be less helpful. What is your view on that?
.

Re: Yoga foot exercises for PF

Robert J on 6/05/04 at 15:18 (152114)

Dr Ed--

Your description of Russian Stim is both fascinating and gruesome. Exactly how did the Russians use electrical stimulation to strengthen the foot muscles? I'm picturing steel probes embedded in the foot and a scene that is out of the torture chamber. And did the Russians ever publish their results in a Journal? Hey, if they were successful, why doesn't somebody try it here in the US? PF is torture anyway...

Re: Yoga foot exercises for PF

Ed Davis, DPM on 6/05/04 at 15:27 (152116)

Julie:

The primary blood supply to fascia is from the attached muscle.
As a consequence, a healthy 'muscular' arch/foot should be the best way to 'feed' the fascia. ESWT can cure the degeneration, without question -- I can show this again and again via sonography where you can see the tendon remodel itself. We don't need tens of millions of studies as some have suggested (on the ESWT board) to prove what we already can see. Once the fascia is 'cured' then the improved musculature will be maintainance. Although, don't discount our body's ability to heal given the proper conditions so adequate plantar musculature may be of great value even in modest cases of tendon degeneration.

Occasionally, it may be okay to 'cheat' a little bit by augmenting exercise of the intrinsics with application of testosterone containing cream as exercise, in the presence of inadequate levels of this hormone will not have its desired effect. We are a bit off the edge of mainstream thinking here but that is okay -- I am looking into my mental 'crystal ball' here to see how we are going to approach this in the future.
Ed

Re: Yoga foot exercises for PF

Ed Davis, DPM on 6/05/04 at 15:36 (152118)

Robert:

The Russians did publish this -- I don't recall where. The concept was derived from finding ways to hypertrophy muscles in olympic athletes. As you remember, that in the old days, they held little back.

Electric stim. machines are popular in the offices of physical therapists and there are quite a few different types of currents with varying physiologic effects. This is a very under-studied area. There are types of currents that are used to recruit muslce fibers, the purpose of which is to prevent atrophy for people with casts on or after surgery. The electrodes are placed on the surface and tend to recruit muscle fibers closest to the electrodes. In order to recruit more fibers, the current must be increased and, at a point, it becomes intolerable. We tend to under-use this modality due to the pain involved, that is, it is used but at a current level that is 'comfortable'. ie. not recruiting muscle fibers very deep. Of course, if a patient was realy ready to 'bite the bullett' and the therapist determined, this could be effective as a modality in this venue.
Ed

Re: Yoga foot exercises for PF ps

Ed Davis, DPM on 6/05/04 at 15:43 (152119)

Julie: You may note that the 'bulk' of treatment empahasis is on how we can passively increase circulation to the fascia eg. light therapy, etc. but active circulation increase is more long lasting. One of the 'proofs' is found in examining 'primitive' cultures where intrinsics are not atrophied. I was often asked during the running craze of the 1980's how the great olympic runners of Kenya did so well without shoes. I think that, retrospectively, we if we examined them, we would find very strong intrinsic musculature in their feet.
Ed

Re: Yoga foot exercises for PF

Pam S. on 6/05/04 at 17:16 (152125)

Hi again Julie and Dr. Ed too:
Thx for the revision Julie. I think I have the move right. I might also add, my pt is very into strengthening. On most days, without fail, I do the towel crunches, Julie's new move, I also have those pt bands tied to my bed post and I wrap the band around the foot and I point my foot down and to the side with quite a bit of tension to the band. That is also supposed to stregthen the arch. Sorry Dorothy, this is not clear at all for us visual learners!!!! Pam ps this is probably not a new move to most of us who have been to pt but you never know. Most of the pts I have been to in the past have had me doing standing arch work, like standing on one foot with the arch raised. This pt does not agree with that at all.

Re: i meant "and" Julie's new move

Pam S. on 6/05/04 at 17:17 (152127)

just so you would not read that as if the towel crunch IS Julie's new move. Are we getting carried away here. I think I need to get a life. HAAAA

Re: Yoga foot exercises for PF

Julie on 6/06/04 at 03:01 (152145)

Ed

Off the edge of mainstream thinking is generally a good place to be: it allows a wider perspective. :)

In observing the effectiveness of the simple yoga stretching/strengthening exercises on students who have had PF, I came to the conclusion that healthy/strong plantar musculature is an important factor in healing. (It follows - working backwards - that weak musculature must be a contributing factor to the condition.) But I have wondered how useful exercise, even specific, targeted exercise, would be in cases of tissue degeneration, and it's encouraging that you feel that it probably is useful. Of course, it stands to reason that improving blood supply is going to help whatever the state of the tissues. The body does heal itself: we just need to know how to help it do so. This is the main focus of all my teaching.

The big issue for people with PF is how to exercise effectively - i.e. to bring about the desired result - without doing more damage. This has been my chief preoccupation for the past four years here. I've been glad to see a gradual moving away from the aggressive weight-bearing stretching that used to be advised (and which anyway has no bearing on muscle STRENGTH!) and may still, for all I know, be the advice of many podiatrists.
.

Re: Yoga foot exercises for PF

vrinda p on 7/28/04 at 06:34 (156374)

will try the exercises immediately.

Re: Yoga foot exercises for PF

kris on 12/27/04 at 04:09 (166177)

thanks for posting this excercise It gives me great relief.

Re: Yoga foot exercises for PF

Julie on 12/27/04 at 08:26 (166179)

I'm very glad, Kris - thanks for letting me know.

Continue with the exercises: they are strengthening for the foot muscles, and should help in the longer term as well as give you immediate relief.
.

Re: Yoga foot exercises for PF

Mimi on 7/11/08 at 10:45 (248398)

It's really difficult to do exercise 4 (arch strengthening) without curling the toes! My toes just wont move back towards the heel without curling!! Has anyone mastered this...and if so please tell me!! Many thanks for these exercises by the way! Mimi