Strength Training Can Improve Chronic Plantar Fasciitis

Ryan Cross, B.A. Hons (Kin), MScPT, FCAMPT
Registered Physiotherapist

Do you feel sharp pain on the bottom of your heel during the first few steps you take in the morning? Is heel pain limiting progression of your running program?  You might be dealing with plantar fasciitis.  It is difficult to pronounce, and sometimes even more difficult to recover from.  Plantar fasciitis is a common injury in the active population.  Many treatment interventions have been used to overcome this condition, but recently evidence is indicating that the use of higher intensity exercise can help alleviate symptoms associated with plantar fasciitis.

Related Article: How To Treat 7 Common Running Injuries

The Study

A study published in the Scandinavian Journal of Medicine and Science in Sports compared plantar fascia specific stretching plus shoe inserts to high load strength training with single leg heel raises that target the plantar fascia plus shoe inserts.  The primary outcome was to determine which intervention provided a greater improvement in foot function at 1 month, 3 months, 6 months, and 12 months on the Foot Function Index.

Both groups received a gel heel insert and education on plantar fasciitis, pain management, activity modification, gradual return to activity, and instruction on how to use the insert. The plantar fascia stretching group was instructed on how to properly stretch the plantar fascia.  The high load strength training group was instructed on the plantar fascia specific heel raises.  The single leg heel raises were performed on a step with a rolled towel under the toes to place all the toes in maximal dorsiflexion.  Patients started with performing 3 sets of a 12RM for 2 weeks, then 10 RM for 2 weeks, and finally 5 sets of 8 RM after 4 weeks.  This exercise was completed every other day and progressed by wearing a backpack and adding books to increase the weight.

Exercise 1:

Hold your heel in one hand and toes in the other hand. Pull the whole foot and toes back to feel a stretch along the bottom of your foot.

Exercise 2:

Stand on the edge of a step with a rolled towel under the toes. Slowly lift up onto toes (3 seconds), hold (3 seconds), and slowly lower (3 seconds)

The Results

At 3 months, the strength group had a 29 point greater improvement on the Foot Function Index compared to the stretching group.  The improvements at 6 and 12 months was similar for both groups, indicating that the strength training protocol helps to improve foot function faster than stretching. 

Takeaway

Plantar fasciitis can be a debilitating condition that takes a long time to recover from.  Stretching, orthotics, and activity modification are all important components to help get over this heel pain.  High intensity strength training is not a common intervention used to treat plantar fasciitis, but this study shows that it has potential to provide faster improvements.  If you can get better faster, then you will get back in the game faster. 

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Reference:

Rathleff, Michael Skovdal, et al. “High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up.” Scandinavian journal of medicine & science in sports 25.3 (2015).