Welcome to week 3 of journal July and this week is it all about heel pain or Plantar Fasciitis (PF). This week the journal is by Michael Rathleff and colleagues who in 2015 conducted a study that looked at high load strength training in patients with PF with a 12 month follow up. I chose this journal article because I have had great results with my PF patients when I incorporate the loading exercises in to their rehabilitation.
PF is an extremely common injury especially with runners with PF accounting for 8% of running injuries seen in clinics. The symptoms of PF are a painful heel especially first thing in the morning, foot stiffness and the pain can be a dull ache or a sharp pain. Many sufferers can still have symptoms 2 years down the line and it can easily flare up even if you have been symptom free.
Before this study was published PF was treated by using orthotics, stretching, various taping techniques, night time boot and using a ball to roll the foot on. Recently there has been a lot of talk about Plantar Fascia being very similar to tendinopathy. With high load strength training exercises are an effective way to treat tendinopathy.
The study chose 48 patients all with PF and they were divided in to 2 groups, one group had shoe inserts coupled with stretching and the other group had shoe inserts with high load strength training exercises.
The stretching group had one stretch which was to put the affected foot on to the other leg to pull the toes towards the shin to feel a stretch. They then had to palpate the Plantar Fascia to keep the stretch in the foot and this was performed for 10 reps with the stretch lasting for 10 seconds each time.
The high load strength group had to perform unilateral heel raises, but a towel was placed underneath the toes. The role of the towel is to load the Plantar Fascia in order to strengthen it and the group performed 3 sets of 12 repetitions. Over the weeks the exercise was progressed by using a back pack and the weight in the back pack was gradually increased.
After 3 months the group that had performed the loading exercise had significantly less pain than the stretching group. Although after 6 and 12 months there was hardly any difference with pain and foot function between the 2 groups. Most patients would want to have less pain as quickly as possible and this simple exercise gives this outcome. The reasons why this loading heel raise works could be that it promotes collagen production, increase the load tolerance of the Plantar Fascia, improves foot strength and improves ankle range of movement which in turn will remove the excess pressure from the Fascia. Clearly more research needs to be done, so in the mean time PF needs to be treated with this loading strength exercise plus stretching for the foot and calf complex and taping.
If you are currently suffering from Plantar Fasciitis or know someone who is then please give me a bell and I can assist you.