{"id":1946,"date":"2025-11-03T12:51:00","date_gmt":"2025-11-03T12:51:00","guid":{"rendered":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/?p=1946"},"modified":"2025-11-03T12:51:04","modified_gmt":"2025-11-03T12:51:04","slug":"plantar-fasciitis","status":"publish","type":"post","link":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/plantar-fasciitis\/","title":{"rendered":"Plantar Fasciitis"},"content":{"rendered":"

Review: Loading The Plantar Fasciia<\/h3>\n

High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up<\/strong><\/p>\n

Plantar Fasciitis is a condition that affects both active and non active populations. It is characterised by medial heel pain were the plantar fascia attaches to the calcaneus (heel). It is particularly painful with the first few steps in the morning and after long periods of inactivity, (Jariwala\u00a0et al,<\/em>\u00a02011).<\/p>\n

Plantar fasciitis\u00a0was thought to be an inflammation of the plantar fasciia, however\u00a0current thinking\u00a0considers it a degeneration of the collegen matrix, with similar markers\u00a0to a tendinopathy, (Burchbinder, \u00a02004, Lemont, 2003).\u00a0Recent research into tendinopathies have shown that load management specific to the phase of the tendinopathy can have\u00a0better patient outcomes with regard to pain and function (Cook & Purdam, 2009).<\/span><\/p>\n

In this paper,\u00a0Rathleff\u00a0et al<\/em>, (2014)<\/a>\u00a0have extended this strategy to the treatment of plantar fasciitis. Common modalities in the treatment of plantar fasciitis include night splints, heel inserts, orthotics, stretching.<\/p>\n

The aim of this study was to compare the effectiveness of shoe inserts and plantar-specific stretching versus shoe inserts and high load strength training. The effects of both groups were documented using the foot function index (FFI). The foot function index is a validated self reported questionnaire based on pain, disability and activity imitations.<\/p>\n

Forty-eight patients with ultrasonography-verified plantar\u00a0fasciitis were block randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load strength training\u00a0 every second day (the strength group) using a computer-generated sequence created by the main investigator in blocks of 6. Randomisation complied with the CONSORT statement.<\/p>\n

Inclusion criteria was defined as:<\/em><\/p>\n

    \n
  1. Inferior heel pain for the last 3 months before enrolment.<\/li>\n
  2. Pain on palpation of the medial calcaneal tubercle or the proximal plantar fascia.<\/li>\n
  3. Thickness of the plantar fascia of 4.0 mm or greater.<\/li>\n<\/ol>\n

    Exclusion criteria was defined as:<\/em><\/p>\n

      \n
    1. Under 18 years of age.<\/li>\n
    2. History of systemic disease.<\/li>\n
    3. Prior heel surgery.<\/li>\n
    4. Pregnant.<\/li>\n
    5. Steroid injection within the previous 6 months.<\/li>\n<\/ol>\n

      Both groups were equal at baseline. Each group were given an information leaflet and gel heel inserts prior to treatment.<\/p>\n

      The High Load Strength Group<\/em><\/p>\n

      The high load strength group were required to perform heel raises from a step with a towel placed under their toes so as to increase dorsi flexion, every second day. The time under tension (TUT) consisted of 3 sec eccentric, 3 sec concentric and 2 sec isometric. Initially subjects were required to perform 3 sets of 12 rep max. After 2 weeks the load was increased sufficiently to allow for\u00a0 a 10 rep max. Simultaneously the sets were increased from 3 to 4. After 4 weeks subjects progressed to 5 sets of an 8 rep max. Progression was maintained through the trial.<\/p>\n

      \"plantar<\/a>
      concentric phase<\/figcaption><\/figure>\n
      \"plantar<\/a>
      eccentric phase<\/figcaption><\/figure>\n

      Plantar Specific Stretching Group<\/em><\/p>\n

      \"plantar<\/a>
      plantar specific stretching<\/figcaption><\/figure>\n

      Using the hand on the affected side, they were instructed to place the fingers across the base of the toes on the bottom of the foot and pull the toes back toward the shin until they felt a stretch in the arch of the foot. They were instructed to palpate the plantar fascia during stretching to ensure tension in the plantar fascia. Each stretch was performed 10 times for 10 seconds three times a day.<\/p>\n

       <\/p>\n

      Outcomes Measured<\/em><\/p>\n

      After 3 months the strength group had a significantly better FFI score (CI 95%, P=0.016). However after 12 months there was no significant difference between groups. The authors have noted that exercise compliance may have impacted upon this. As exercises were home based, there was a lack of supervision. They contend that subjects probably stopped their exercises once their pain reduced to an acceptable level. In light of this the high load strength group still showed a quicker reduction in pain, disability and activity limitation after 3 months. This implies there is a place for high load strength training in the management of plantar fasciitis.<\/p>\n

      Some limitations of the study surrounds randomisation, as consecutively selected subjects were not definitive. This may raise an issue of selection bias. As highlighted by the authors, exercise adherence and correct technique could not be controlled as the subjects performed home exercises. A possible gender bias may have occurred as 66% of subjects were female. However this couldn\u2019t have been avoided given subjects were supposedly selected consecutively.<\/p>\n

      The strengths of this study lie in its comparability to other studies in relation to loading, plantar fasciia thickness and BMI. Also all subjects were equal at baseline. All subjects were given the same heel inserts, patient education and instructions on the intervention according to each group. Outcomes were measured using the foot function index which has been well validated for foot and ankle pathologies, (SooHoo\u00a0et al<\/em>, 2006).<\/p>\n

      In conclusion, I found this to be a very thorough RCT. It has highlighted the need for further studies into loading, frequency and compliance. Given that the primary outcome was better in the high load\u00a0strength group, I would advocate its use in the rehabilitation of plantar fasciitis.<\/p>\n

       <\/p>\n

      References<\/p>\n

      Buchbinder R. (2004) Plantar Fasciitis.\u00a0The New England Journal of Medicine<\/em>, 350:21.<\/p>\n

      Cook JL, Purdam CR. (2009)\u00a0Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy.\u00a0Br J Sports Med<\/em>: 43: 409\u2013416.<\/p>\n

      Drew BT, Smith TO, Littlewood C. (2014) Do structural changes (eg, collegen\/matrix) explain the response to therapeutaic exercises in tebdinopathy: a systematic review.\u00a0British Journal of Sports<\/em>\u00a0Medicine<\/em>\u00a048:966-972.<\/p>\n

      Jariwala A, Bruce D, Jain A. (2011) A Guide to the Recognition and Treatment of Plantar Fasciitis.\u00a0Primary Healthcare<\/em>, 21:7: 22-24.<\/p>\n

      Lemont H, Ammirati KM, Usen N. (2003) Plantar fasciitis: a degenerative process (fasciosis) without inflammation.\u00a0Journal Am Podiatr Med Assoc<\/em>, 93:234-237<\/p>\n

      SooHoo NF, Samimi DB, Vyas R, Botzler T. (2006) Evaluation of the validity of the foot function index in measuring outcomes in patients with foot and ankle disorders.\u00a0Foot and ankle journal<\/em>, 27:1:38-42.<\/p>\n

      Rathleff MS, Molgaard CM, Fredberg U. (2014) High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up.\u00a0Scan Jour Med Sci Sport<\/em>.<\/p>\n","protected":false},"excerpt":{"rendered":"

      Review: Loading The Plantar Fasciia High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up Plantar Fasciitis is a condition that affects both active and non active populations. It is characterised by medial heel pain were the plantar fascia attaches to the calcaneus (heel). It is particularly painful […]<\/p>\n","protected":false},"author":1,"featured_media":1947,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[20],"tags":[],"class_list":["post-1946","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lower-limb"],"acf":[],"_links":{"self":[{"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/posts\/1946","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/comments?post=1946"}],"version-history":[{"count":0,"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/posts\/1946\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/media\/1947"}],"wp:attachment":[{"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/media?parent=1946"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/categories?post=1946"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/liberatingsolution.tech\/design-demo\/leinster-physical-therapy\/wp-json\/wp\/v2\/tags?post=1946"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}