Strength training reduces pain for people with plantar fasciitis

Plantar fasciitis is a common cause of inferior heel pain. Plantar fasciitis is characterized by increased thickness of the plantar fascia (flat band of tissue that connects the heel bone to the toes), and pain in the bottom of the foot near the heel. The prevalence in the general population range from 3.6% to 7.0 % . It accounts for approx. 8% of all running-related injuries. Results from several studies suggest that plantar fascia-specific stretching, as well as strength training, are effective treatments.

It is a common problem to still suffer from pain 2 years post diagnosis. Focus is now on finding better treatments. A randomized controlled study investigated the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training consisting of heel raises in people with plantar fasciitis. The study had a total of 48 participants, randomized into two different groups. The first group did high-load strength training consisting of unilateral heel raises with a towel underneath the toes to further stretch the plantar fascia.

The second group did plantar fascia-stretching, using the hands to flex the foot and the toes. Both groups received heel inserts. Participants who did strength training were instructed to perform the exercise every second day for 3 months. They started at 3 sets of 12 repetitions. The load was increased by adding books in a backpack which they carried during the exercise. They kept adding books to the backpack as they became stronger. The second group was instructed to stretch the plantar fascia at 10 sets of 10 s each, three times a day.

Studie outcomes

The primary outcome was a self-reported questionnaire (FFI) that assessed foot function, pain, disability, and activity limitation. The lower the score the less pain and disability the person experienced. By the 3 months follow up the strength group had an FFI-score of 29 points lower compared to the stretch group. They were generally also more satisfied with the results of the treatment.  There were no significant difference between the groups during the 6 and 12 months follow-up, although the FFI-score dropped for both groups.

Both groups had a significant reduction in the thickness of the plantar fascia, without any significant difference between the groups. In conclusion, an exercise protocol consisting of high-load strength training resulted in superior foot function and reduced pain at 3 months compared with plantar specific stretching. However, in the long run, both stretching or strength training will probably speed up the rehab process compared to no intervention at all.

Post provided by Maria Ekblom, a member of #teamEBT, licensed physiotherapist and personal trainer.

Rathleff M, Mølgaard C, Fredberg U, Kaalund S, Andersen K, Jensen T 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. 2014;25(3):e292-e300.


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