Improve your plantar fasciitis with strengthening exercises. NOT orthotics or shoes.
|NEW STUDY PUBLISHED in The Scandinavian Journal of Medicine & Science in Sports
Continuing on with some more information on plantar fasciitis, this next post was sent to me by a reader yesterday who was wondering if I had come across this recent study published in the Scandinavian Journal of Medicine & Science in Sports. The study claims that by performing 8-12 repetitions calf raises as described below an improvement is seen in heel pain caused by plantar fasciitis over those who did stretching exercises for the calf muscle. I have been prescribing this to my patients now for over 3 years along with a gradual increase in time spent barefoot to increase foot strength and thereby reduce the symptoms of plantar fasciitis. Remember, this is a condition that is in every way similar to a tendonitis that is seen in the arm or shoulder which is treated with strengthening exercises. It should be treated no differently in the foot. After many years of seeing this condition progress into what could be dubbed as an epidemic, studies are now demonstrating that strengthening is needed over shoe gear modifications or support with orthotic devices placed into one’s shoes.
Plantar fasciitis, the heel pain caused by irritation of the connective tissue on the bottom of the foot, can be lingering and intractable. A recent study of novice runners found that those who developed plantar fasciitis generally required at least five months to recover, and some remained sidelined for a year or more.
Until recently, first-line treatments involved stretching and anti-inflammatory painkillers such as ibuprofen or cortisone. But many scientists now believe that anti-inflammatories are unwarranted, because the condition involves little inflammation. Stretching is still commonly recommended.
The exercise requires standing barefoot on the affected leg on a stair or box, with a rolled-up towel resting beneath the toes of the sore foot and the heel extending over the edge of the stair or box. The unaffected leg should hang free, bent slightly at the knee.
Then slowly raise and lower the affected heel to a count of three seconds up, two seconds at the top and three seconds down. In the study, once participants could complete 12 repetitions fairly easily, volunteers donned a backpack stuffed with books to add weight. The volunteers performed eight to 12 repetitions of the exercise every other day.
They study (a total of 48 volunteers) compared these volunteers to others who completed a standard plantar fasciitis stretching regimen, in which they pulled their toes toward their shins 10 times, three times a day.
After three months, those in the exercise group reported vast improvements. Their pain and disability had declined significantly.Those who did standard stretches, on the other hand, showed little improvement after three months, although, with a further nine months of stretching, most reported pain relief.
Conclusion: A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function.
I think we will continue to see more evidence published similar to this which demonstrates orthotics and shoes are not the answer to treating plantar fasciitis.
“NOT orthotics or shoes?” Did you read the study? All participants had special shoe inserts.
But strengthening improve the subjects not the shoes were orthotics. They were merely a control.
Anecdote alert!
This could very well just be natural regression to the mean, however I will continue. Started marathon trainjng and really only running seriously in the summer of 2012. Ran with standard running shoes (brooks ghost). I had severe plantar fasciitis. I have since ran 3 marathons, a half, a 25k, 50k and timed out at mile 67 of burning river. During this time I figured I would attempt transitioning to minimal style running. I now run in nothing with a heal-toe drop of more than 6 mm. I run occasional unshod, minimal altra And pure brooks series, all the way to hoka and maximal altra for my long runs. On IPhone video it looks like I now run with a midfoot strike. I have no plantar fasciitis symptoms anymore. It may be confirmation bias but I wonder if transitioning to a more midfoot strike has improved my plantar fasciitis and foot strength. I have not done any exercises to improve it. I basically only made the transition to low drop shoes (both minimal and maximal, which I know most rraders of this blog are not fond of).
I believe this is the study written up in the NY Times several weeks ago. The calf raise exercise bears a striking resemblance to doing calf raises while holding a pair of dumbbells, which many people have told me is the worst thing to do while experiencing PF. Truly, the most frustrating thing about this ailment is the amount of contradictory diagnoses and treatments out there. Some advocate barefoot exercises to strengthen the foot muscles, others insist that barefoot is verboten while experiencing PF. Who to believe?
BTW, I’m a masters-aged 800/1500 runner who started getting heel pain in September and decided to shut it down after the 5th Ave Mile. Six weeks later, not much has changed. What can I do to get ready for indoor season, which I should really be starting to train for soon?
Tough to treat via messaging of course. Rest, treat the inflammation and then strengthen the foot. Ive seen the barefoot actvities work and I implement them in my pracfice routinely and see great results. You have to be patient, rest when needed and stick to a single shoe. It can take weeks to many months sometimes. Injections can also speed the recovery by resolving the inflammation allowing you to function in a more natural manner without limping etc. Follow the Meffetone method for heart rate training. AND never work on speed until your injury is resolved. Run at your aerobic heart rate until your 100% then you can start intervals and tempos. Thanks for reading!!!
Thanks for the advice. It’s the “no speed work” (which I am observing) which will drive me crazy if I still can’t do any by, say, sometime in December. Unlike the vast majority of my running peers, I much prefer speed work to grinding out mile after mile on the road or trail.
I’ve had PF on both feet going on two years. It is so debilitating. I’ve only had shots on both my feet twice. The first time I felt great, the next two times I had no result. My doc sent me home with night splints, those were a joke bcuz they didn’t stretch my feet up like they were supposed to. The docs here don’t like giving me anymore cortisone shots saying I’ve had too many (only two in about two years). I’m at wits end, so my question is do you recommend the laser impulsed therapy or surgery?? How effective are these?
If you have had it for 2 years, it is most likely secondary to your activity and shoe gear. Try doing the strengthening exercises outlined in this post http://www.drnicksrunningblog.com/improve-your-plantar-fasciitis-with-strengthening-exercises-not-orthotics-or-shoes/ . Try functioning at home barefoot an hour each day and find a pair of flat athletic shoes without a heel. It takes time and a lifestyle change. Thanks!
I’ve had PF for six years, tried literally everything short of Cortizone or surgery. I started this regimen of slow calf lifts a few month ago and am now pain free, even after several grueling hikes which normally would leave me hobbled for days afterwards.
When lowering the heel, do you just lower it level with the foot, or do you drop it below the step? I’ve read that dropping below the step puts unnecessary strain on the Achilles and can make your pf worse. I’ve tried both, and seem to get better results when only dropping the heel level, rather than below the step. What’s the right way?
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Hello, have you heard of a tool called FasciitisFighter? It is from Autralia I believe and I wonder if it is recommendable. I find the exercises to be painful done barefoot but if it takes care of the PF, I am all for it. I have PF on both feet, small heel spurs and arthritis on my big right toe from martial arts, I think. But the PF is really the one that bothers me the most.
I had planter facilitis and a paralyzed toe nail for decades. Prescribed stretching and anti-inflammatory medication. It’s only when I started bodybuilding and doing calf raise, as I gave up running due to the pain. That I gained substantial relief. Calf raises (unweighted) and Hindu squats (bodyweight) is what I do three times a week, which has allowed me back running.
Keep up the good work Nick, enjoyable reads
as a podiatrist this is a great article.To start correct stretching and using compression socks or sleeves will help cure the majority of plantar fasciitis,i tell patients to go to youtube to find stretching videos that works for them
https://www.kcfootcare.com/what-we-treat/plantar-fasciitis