Words By Sam Cook

Heel pain is the most common musculoskeletal complaint that Podiatrists treat. There are multiple sites over the heel where chronic pain can develop. In this blog, we will focus on Plantar Fasciitis (pain under the base of the heel) and current treatment methods. It is estimated that up to 10% of the population will experience Plantar Fasciitis, with symptoms commonly effecting one’s ability to perform routine daily activities or exercise, and impacting on their quality of life.

Plantar fasciitis can be frustrating for both the sufferer and therapist, due to the stubbornness of the injury. Treatments for the injury are constantly being changed and updated with new studies and literature. Here we will primarily discuss the use of high load strength training for relief of Plantar Fasciitis.

What is Plantar Fasciitis?

To understand Plantar Fasciitis, we must first understand the function of the affected structure, the plantar fascia. The plantar fascia is a strong connective tissue that begins under the base of the heel, and runs to the ball of the foot. It plays a very important role in providing strength and integrity to the arch of the foot.

Plantar fasciitis can be caused by a multitude of differing factors in the feet, such as foot biomechanics, increased body mass index (BMI), footwear, recent sudden increase in activity, and high loading activities. These factors can cause overuse of this connective tissue, leading to chronic pain through a gradual decline in the strength and quality of the tissue. Pain is commonly experienced upon standing on the feet after periods of rest, or lengthy periods of weight bearing activity.

Treating Plantar Fasciitis

Common treatment options for plantar fasciitis include stretching of the plantar fascia and calf muscle group, custom foot orthotic therapy, footwear prescription or modification, and shockwave therapy. It has been believed that stretching of the plantar fascia provides significant relief in the medium to long term. A recent study by Scandinavian researchers, Rathleff et al, compared the success of stretching the plantar fascia, to a high load strength training program.

The study was performed with 48 subjects over a 12 week period, with one group who performed stretching of the plantar fascia, and the other group performed the high load strength training. The stretching group performed a 10 second stretch of the plantar fascia, repeated 10 times, at three times a day. The strengthening program involves the following:

  • Roll a towel, and place near the edge of a step.
  • The towel is placed under the toes, to bend the toes upwards (dorsiflex), thus activating the plantar fascia
  • A unilateral (single leg) heel raise is performed over 8 seconds – 3 seconds for the heel raise, hold for 2 seconds, and another 3 seconds to lower the heel past the edge of the step.
  • This is repeated 12 times, for three sets, every second day.
  • After two weeks, you are to add weight to your person (via books in a backpack or something similar), decrease the repetitions to 10, and perform 4 sets, every second day.
  • After another four weeks, more weight is added, repetitions are reduced to 8, and it is performed for 5 sets every second day.

They found that the high load strength program provided more symptomatic relief at a 3 month review.

Important points to take away from this study are

  • The vast majority of participants were considered overweight
  • The sample size of the study was relatively small
  • The vast majority of the participants had been suffering heel pain for more than 7 months ie It was chronic in nature
  • The long term effect (results at 6 months and 12 months) was very similar between both the stretching and strengthening groups

This particular treatment may not suit every case of plantar fasciitis. Should you find this exercise doesn’t improve or resolve your symptoms, a range of other treatments that compliment these exercises are available to be utilised by your podiatrist at an arranged appointment.