Strength training for Plantar Fascia pain

At least one in 10 people will experience plantar fascia (foot) pain in their lifetime, and although it is relatively common, there are many misconceptions around how best to manage this pain. 

Those suffering will experience intense, but quite localised pain through the arch of the foot and around the bottom of the heel bone. It is often worse with those first few steps in the morning (or after periods of rest). It can make it near impossible for some people to walk around with bare feet, and has a significant impact on ability to do normal day to day tasks, not to mention the added difficulty of engaging in sport or exercise. 

The term plantarfasciitis is still in circulation, however that term has now evolved into platarfasciopathy. This change in terminology reflects a better understanding of what is happening at a cellular level. There is minimal evidence of inflammation, and instead the pathology aligns more closely with what happens with a tendinopathy – a disorganisation and structural change of the collagen fibres that make up the connective tissue. This may explain why patients report limited success with treatments that are aimed at reducing inflammation – such as medication, ice and cortisone injections. Other current treatment options have focused around stretching of the plantar fascia, however at least 40% of patients continue to have ongoing symptoms 2 years after diagnosis, which suggests there is more to successful management. 

High load strength training has been shown to be effective in managing both Achilles and Patellar tendinopathies, as the loading promotes collagen synthesis. This idea has started to be explored in plantarfasciopathy due to the similarities with tendinopathy. 

A recent study by Rathleff tested a strengthening protocol of single leg heel raises with the toes extended over a rolled towel. This toe position helps to activate the windlass mechanism (a pulley system in which the small muscles of the feet work together with the plantar fascia to transfer load). The exercise was performed every second day for 3 months, and the load was gradually increased by adding a backpack filled with books. At the 3 month mark, the exercise group showed a 29 point improvement in foot function compared to a group that performed static stretching only.  

Another idea that has been explored to develop strength of the small muscles within the feet is the use of minimalist footwear. This footwear aims to mirror barefoot walking as closely as possible, forcing the muscles in the feet to work harder. Although it has been shown that this footwear can increase muscle strength, there is no evidence to support this as a treatment option in symptomatic people. 

High load strength training is a promising treatment to improve  pain and function in those suffering from plantar fascia pain. Further research to determine the best type, intensity and volume of strength training is needed to strengthen our understanding and ability to individualise exercise prescription for those in pain. 

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