PLANTAR FASCIITIS - RESEARCH
Plantar fasciitis (PF) is the bane of many runners and its one of the most common conditions we treat at Aevum Physio. Hundreds of runner’s from the Sutherland Shire and Illawarra region come into our clinic every year with this condition.
Most previous treatment studies on plantar fasciitis have used a combination of orthotics, plantar specific stretching or similar non-exercise intervention. These interventions have proven successful to some degree and we know they are superior to placebo treatment. However a large proportion of patients still have symptoms two years after the initial diagnosis.
Most Physio’s who see these patients in the clinic will agree that they can be hard to fix – especially if they have a long symptom duration. So we definitely need to start thinking about new ways to treat the condition. An interesting thing is that we are starting to realise that there are some similarities between plantar fasciitis and tendinopathy or tendinitis. We know from the literature that high-load strength training appears to be effective in the treatment of tendinopathy. A similar approach to plantar fasciitis therefore seems to make sense.
High-load strength training consisted of unilateral heel-raises using a fasciitis fighter to further activate the windlass-mechanism (image above). A recent research trial showed that using heel-rises consisting of a three second concentric phase (going up) and a three second eccentric phase (coming down) with a 2 second isometric phase (pause at the top of the exercise) was ideal. The high-load strength training was slowly progressed throughout the trial as previously reported by Kongsgaard et al. They started at 12 repetition maximum (RM) for three sets. After two 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 four weeks, they were instructed to perform 8RM and perform five sets. They were instructed to keep adding books to the backpack as they became stronger.
There are still lots of unanswered questions about why high-load strength training may work in the treatment of plantar fasciitis. One explanation could be that high-load strength training may stimulate increased collagen synthesis which help normalise tendon structure, increase load tolerability of the plantar fascia and thereby improve patient outcomes. Another explanation may be that the exercise help improve ankle dorsal flexion range of motion as well as improving intrinsic foot strength and ankle dorsal flexion strength, or in my opinion… all of the above.
The loading paradigm for treatment of plantar fasciitis is by no means a miracle treatment. However, it does provide us with the first evidence that high-load strength training may be the road towards more effective treatments for plantar fasciitis. The key message to patients is that they need to perform the exercises (otherwise they are unlikely to work) and they need to be performed slowly (3s up, 2s pause at the top and 3s down) to decrease risk of symptom flaring and with enough load starting by 12RM for three sets and working their way down to 8RM for five sets.
Fasciitis fighters can be purchased from our shop and if you have been suffering ongoing heel pain that is stopping you running, let our team know so we can get you back asap.