How to Strengthen Your Plantar Fascia

Plantar fasciosis is not primarily a running injury – it’s more a lifestyle injury. Many runners seem to suffer from chronic plantar fasciosis pain. Fortunately, the approach to treating it is fairly straight forward.

Technically, fasciosis, refers to degeneration of the tissue, which is far more common than fasciitis – the conventionally used term. Fasciitis implies true inflammation and occur in situations such as infection or auto-immune attack. Similarly, Achilles tendonosis is more common than tendonitis.

The strong, springy plantar fascia tendon maintains the arch of the foot. It creates tension between the calcaneus (heel) and the metatarsal heads, forming a depressable arch which acts as the foot’s primary spring.

The plantar fascia is designed to manage a limited amount of stress. The intrinsic muscles (those solely in the foot) and extrinsic muscles (those attaching the foot to the lower leg) receive signals from the nerves and fascia, and it’s these muscles which absorb and manage most of the load.

When those muscles become dysfunctional or weak, the load is transferred to the plantar fascia, where repetitive stress causes microtrauma and eventually plantar fasciosis.

The only way to sustainably fix plantar fasciosis is to address the root causes. Is the runner suffering from fallen arches, or is it failing arches? Building foot strength and moderating impact, is the best place to begin.

Paradoxically, shoes which offer lots of support weaken the foot, causing more foot instability. Other factors can contribute to plantar fasciosis, such as misaligned and weak big toe, tight and shortened calf muscles, obesity or transitioning too quickly from supportive footwear to flat shoes or bare feet.

Interestingly important new research has found strengthening as opposed to stretching the plantar fascia appears to offer a faster route to recovery.

The research says -

“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.”

Using what is known about high-load strength training to treat tendinopathy they reasoned a similar approach could work for plantar fasciitis. So, they recently completed a study where they investigated the effect of a high-load strength-training program compared to a standard plantar specific stretching program in the treatment of plantar fasciitis.

Their approach was to exploit the windlass mechanism during single-leg calf-raises by using a towel to dorsal flex the toes. They theorised; the windlass-mechanism would cause a tightening of the plantar fascia during dorsal flexion of the metatarsophalangeal joints while high-loading of the Achilles tendon is transferred to the plantar fascia because of their close anatomical connection.

The strength programme they implemented consisted of heel rises for three seconds concentric (going up) followed by three seconds eccentric (going down) with a two second isometric phase (pause at the top).

The first two weeks the patients performed 3 sets of 12 reps, then the load was increased, and reps reduced to 10 and after four weeks they were instructed to perform 5 sets of 8 reps with increased load.

After a 3 month follow up the patients randomised to the high load strength training all saw improvements in function, suggesting this led to a quicker reduction in pain and given most want the path which leads to the fastest recovery time this represents possibly a better plan than just stretching.

Of course, we are individuals and pain is multi-factorial and complex therefore whilst this is not a miracle treatment if you’ve had or have PF perhaps this is worth a shot.