Strengthening exercise better than stretching for plantar fasciitis after 3 months

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Goodfellow Gems

"Strengthening exercise better than stretching for plantar fasciitis after 3 months"

In this randomised controlled trial both groups got shoe inserts. The control group got stretching and the intervention group got high-load strength training.

At 3 months 75% of the strengthening group was satisfied with treatment compared with 56% of the stretching group.

The high-load strength training consisted of unilateral heel raises with a towel inserted under the toes to further activate the windlass mechanism.1 The patients were instructed to do the exercise on a stairway or similar location. The towel was individualized, ensuring that the patients had their toes maximally dorsal flexed at the top of the heel rise. The patients were instructed to perform the exercises every second day for 3 months. Every heel rise consisted of a 3 second concentric phase (going up) and a 3 second eccentric phase (coming down) with a 2 second isometric phase (pause at the top of the exercise). The high-load strength training was slowly progressed. They started at a 12 repetition maximum (RM) for three sets. 12RM is defined as the maximal amount of weight that the patient can lift 12 times through the full range of motion while maintaining proper form. After 2 weeks, they increased the load by using a backpack with books and reduced the number of repetitions to 10RM, simultaneously increasing the number of sets to four. After 4 weeks, they were instructed to perform 8RM and perform five sets. If they could not perform the required number of repetitions, they were instructed to start the exercises using both legs until they were strong enough to perform unilateral heel raises. They were instructed to keep adding books to the backpack as they became stronger.

  1. Rathleff MS, Molgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, 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. or search for "doi: 10.1111/sms.12313"

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

As published in NZ Doctor 16/02/2015