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Almost half of Plantar Fasciitis sufferers (45.6%) will continue to report symptoms ten years after onset. (1) These patients are not suffering from chronic inflammation (Plantar Fasciitis), instead, they have weakened and degenerated tissue (Plantar Fasciosis).  Conservative treatment of plantar fasciitis, including manual therapy, stretching, myofascial release, orthotics, physical therapy modalities, and night splints may improve short-term symptoms for inflamed tissue. However, chronic Plantar Fasciosis (PF) often requires strengthening exercises for long-term results.  Proper rehab for PF should focus on enhancing tissue resiliency and capacity to prevent re-injury. 

How do you strengthen the plantar fascia?

Incorporate high load strength training (HLST) into your treatment protocol for PF. HLST is a proven method to rebuild degenerated tissue that occurs in plantar fasciosis. The purpose of HLST is to stress tendons with a high tensile loads to stimulate collagen production and, ultimately, expedite recovery. In patients with PF, loading the Achilles tendon in conjunction with dorsiflexion of the metatarsophalangeal joints generates high-load tensile forces across the plantar fascia. 

Caratun et al. recommend 1 set of 10 repetitions per day for weeks 1-4. The authors recommend using the unaffected leg to assist in the concentric movement phase if the patient cannot perform at least ten repetitions unassisted per day.  During weeks 5-12, the patient adds resistance.  The authors recommend using a book bag with books to achieve repetition maximum (RM) weight at which the patient can perform ten repetitions with good form but is muscularly exhausted afterward.  This weight will gradually increase with weekly strength gains. (2)

Keep in mind the ability and demands of our patient’s activities. Elite athletes may benefit from up to 3-4 sets of 25 per day.

Plantar Fascia Strengthening

Stand with the ball of your foot on the edge of a step with a small rolled-up towel under your great toe. You may use the handrail for stability. Begin standing “tippy-toe,” then slowly drop back down to stretch your calf. Perform as directed. For a less intense stretch, place your uninvolved foot flat on the step to control the amount of stretch on the opposite leg.

Plantar Fascia Strengthening

Stand with the ball of your foot on the edge of a step with a small rolled-up towel under your great toe. You may use the handrail for stability. Begin standing “tippy-toe,” then slowly drop back down to stretch your calf. Perform as directed. For a less intense stretch, place your uninvolved foot flat on the step to control the amount of stretch on the opposite leg.

Rathleff et al. (2015) demonstrated superior self-reported outcomes after three months with HLST exercises compared with traditional plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function. (3)

ToePro Exercises

With your hands in front of you on a wall or stable surface, place the tips of your toes into the center of the front crest of the ToePro. Shift your weight to the outside of your feet to raise your arches. Next, raise your heels while pressing down firmly with your toes, gradually shifting weight from your outer to your inner forefoot. Focus on driving your inner forefeet and toes firmly into the foam, holding this position for a few seconds, and then returning to the start position. Repeat at a moderate pace of 2-seconds going up and 2-seconds going down. Your toes should be forcefully grasping the crescent-shaped toe crest throughout this exercise. Gradually build up to 4 sets of 25 repetitions. Do not rest for more than 30 seconds between sets. The last two sets should be performed with your knees slightly bent. Finish the exercise by holding your heels 1-inch off the ground for up to 60 seconds. Try to balance with hands close to but not touching the wall for the final 60 seconds. Repeat as directed (daily)

“As demonstrated by Goldmann et al., exercising your toes in an actively lengthened produces 4-times the strength gains associated with conventional exercises, such as elastic band exercises and marble pickups. Just six weeks of performing isometric toe exercises with the toes stretched resulted in significant increases in horizontal jump distance. This compares to six months of training with elastic bands and marble pickups, which resulted in no appreciable increase in the ability to bear weight beneath the toes.”  (4)

Every patient deserves “best practice” treatment, rehabilitation, advice, and condition-specific education.  As an evidence-informed provider, you must develop processes within your practice to ensure that your patients receive the best possible care.  One of the benefits of ChiroUp is to learn from the top providers around the world.  Check out the Expert Advice section within the ChiroUp condition references to learn more about what the top providers are doing for plantar fasciitis.

Not a member of ChiroUp? Take a gamble on the one product that will ethically transform your practice.  Deliver a service that your patients want to buy—Excellent Clinical Care!  ChiroUp tells your patients WHAT you do and WHY you do it with the research to back it up.  Each month we will provide enough value that you can’t imagine practicing without it.  Try it for free now.

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References
  1. Hansen L, Krogh TP, Ellingsen T, Bolvig L, Fredberg U. Long-term prognosis of plantar fasciitis: a 5-to 15-year follow-up study of 174 patients with ultrasound examination. Orthopaedic journal of sports medicine. 2018 Mar 1;6(3):2325967118757983. Link
  2. Robert Caratun, Nicole Anna Rutkowski, Hillel M. Finestone. Can Fam Physician. 2018 Jan; 64(1): 44–46.
  3. S. Rathleff, C. M. Mølgaard, U. Fredberg, S. Kaalund, K. B. Andersen, T. T. Jensen, S. Aaskov, J. L. Olesen. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up Scand J Med Sci Sports 2015: 25: e292–e300
  4. Michaud T, The Positive Wink Sign: A New Diagnostic Test for Evaluating Toe Flexor Weakness. Accessed 11/5/2021 https://cdn.shopify.com/s/files/1/2565/7146/files/TheWinkSign4.21.pdf?v=1616159825

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