Improving Plantar Fasciitis Condition with “Cable Toe Pressdown Holds” Exercise

I’m going to start this blog post with simply saying that you really don’t want to have this chronic condition as your feet gets inflamed if you stand too long on your feet too long and to some extent limiting . It’s typically an overuse injury from either weighting too much or adding on too much running volume too soon or similar method of exercise; in other words, not enough tissue tolerance. I remember like it was yesterday that the inner part of both feet would hurt as soon as I would wake up and stand; I’m sure most PF suffers can relate at some point in their healing journey. In my case, I’ve had it for around 8 years. I’ve come a long way and haven’t experienced the painful stepping out of bed since very early on in the COVID lockdown. During some periods in the ‘COVID era’, I would attempt to heal with via: using tape on the bottom of my foot, really standing off of my feet using a rolling stool, 3 sessions of shockwave therapy, and improving flexibility. I would like to credit taping the bottom of the feet strategy since it did in fact reduce the symptoms and I felt like it was healing it. The tape would do the work that the plantar fascia is supposed to do, one being keeping the bones and muscles in place and mitigating forces. Overall, the symptoms may have improved, but there would always be a limit where if I did too many steps, my feet would have radiating inflammation for the rest of the day, tapering on day 2 or 3. The capacity wasn’t very much triggering at a mile worth of walking. This was my reality before committing to strengthening my toes as my last resort with anticipation of starting a job, certified nursing assistant in a nursing home, where I was going to be standing / walking for the majority of my shift which it ended up averaging 10K steps a shift.

Search for a Plan

Before starting a CNA program to work in a nursing home for 6 months, I was searching for a different way to heal my foot since I will be committed to working for 6 months as part of the contract so I had to make improvements or my work experience will be more unpleasant than it needs to be. I found three studies that showed a correlation between performance on toe strength and calf strength test and lower symptoms; Source 1, source 2, source 3. That was enough for me to make that my main focus for the majority of the months; it was 5 months. I also remember doing the Rathleef protocol, single calf raises with a towel under the toes and controlled eccentic portion and toe grabs with weights, and I vaguely remember making some progress. It was a few years ago when those were performed and I wasn’t diligent in the tracking or stuck to it long enough, longest being a month. The search for the right exercises along with experimentation was a bit before and after I started the program. After a few exercises, the one that I could quantitatively track, easily progress / increment, and perform was what I call “Cable Toe Pressdown Holds”.

The exercise (how to) : “Cable Toe Pressdown Holds”

I performed it at the inner side of the cable machine complex where it has 2 pulleys attached to the weights and set the pulley to the bottom. I chose bottom side because I can start the exercise with the toes already flexed without having to worry about the balance of the feet to attachment equilibrium, exposure to a lot of weight, overall very minimal variability. The attachment is simply the same attachment as the one you’d use for lateral raises or pec flys. How it would look like is the cable lies between the toe griped handle, resisting the handle roll via pressing on the floor with soleus and toes and the pulley handle is parallel to the floor.

The plan

My plan was to track my steps, with the health app on my iPhone, during my shift to see when I would start to feel the pain locally as well as when it would radiate on the whole bottom of my foot. The good news is that there was a correlation between my toe strength improvements and the step amount it would take to start flaring up (easily tolerabe). I would also do single leg seated calf raises with the goal of being able to 1RM 200, that I’ll settle at 170lbs. My rationale was that I want to at some point be able to run pain-free. There are two muscles in the calves: soleus and gastrocnemius. Straight leg calf raises work both muscles and bent knee exercises mainly just works the soleus due to the gastrocnemus muscle being already bent and its a knee flexor. A source pertaining to the gastrocnemius muscle and soleus muscle. Since the knee is pretty much always bent when absorbing impact and well as pushing off of the foot, the soleus is the muscle to focus on strengthening. I chose single leg instead of regular just because it’s less weight to manage and can use both feet to reset.

Data

Notes about Data

1. From experience, 2 seconds of isometrics is equivalent to a rep.
2. The weight recorded is what is read on the cable stack and not the actually amount with the real value being hald of what is labeled.
3. Soon after I got certified on 7/14/24, I bought some Dr. Sholes PF insoles to use exclusively for work.
4. The reason for the four days that exceed 10K days, was because those days are when I was doing double shifts (16 hour shifts).

Moving on from Toe Exercises

Once I was able to complete 60 seconds of “150”lbs / 75 lbs, I figured it was time as it was beginning to be too heavy to pull to my feet and set it up in a favorable position for my feet. With sufficient healing including a 7 day break from work due to developing left shoulder injury, I felt like running for 20 minutes at a park to test my tolerance on 10/16/24. Pain on my right foot did appear, but just the outer section of the foot and not the typical inner side of the foot. This to me indicates stronger tissue, but maybe too dependent on the insoles. 2 hours after my run, I experienced nagging/flaring acute point in the center including the inner side of my foot.Next day (10/17), slightly more ache and frequency than usual. (10/18), it slightly hurt to step on the floor when I woke up and was able to walk outside for 10 minutes before my shift no issue. My regular shift that way went smoothly as usual, so pretty back to baseline in a positive way. Before my 6 months was about to end, I knew that I had to do at least one shift without the insoles to make this experiment more honest. On 11/16, I did just that and the outcome was that the pain spots were much more localized and usually appeared on the outer side just like the run a month ago, but more localized, less painful, but sharper like a bruise instead of a flare up.

Post-6 month contract at skilled nursing facility

On (11/30/24), I spontaneously decided to go for a 3 miles run to test my foot tissue capacity. I decided to use the shoes that I used for work since it had the PF insoles. I started to feel something on my left foot at the 1.6-1.7 miles mark, but luckily it went away as I was determined to complete it at 31:48 which is decent for not having a running routine since before the COVID lockdown. An hour or so later after running, my left foot was started flaring up, pain scale of 5-6/10 which gradually subsided 4-5 hours later. The next day (12/1/14), there was no residual pain from yesterday and I was able to stand for 30 mins to an hour with no flare up at sight at a casual mini-Xmas concert performed by family members at Santa Monica with a 100-200 person audience. At this time of writing (12/2/24), both of my soleus still has a strong dosage of DOMS (delayed onset muscle soreness).

Closing

Overall, doing the toe exercises and calf exercises paid off and I highly recommend investing time in getting those stronger to long-term progress. In addition, taping the bottom of the feet and having a good physical therapist (2019?) also made a noticable difference. My plantar fascia tolerance is fundamentally stronger than it was 6 months ago with less frequency in flare ups. With work-related standing jobs, I feel secure as long as I don’t do anything reckless outside of work. As for running, my 1RM on the single leg seated calf raises is 123lbs and struggle to do a few reps of 90lbs which doesn’t give me full confidence yet on running since each foot will have to absorb my bodyweight ranging from 160-175lbs. So for now, I’m going to run once a week at most and continue implementing seated calf raises. I feel hopeful in one day being able to run a few days a week and perhaps going back to sprints and track workouts. Hopefully this post has been resourceful for plantar fasciitis sufferers.