Scientists now believe that anti-inflammatories are unwarranted, because plantar fasciitis involves little inflammation, contrary to common lore.
High-load strength training consisted of unilateral heel raises with a towel inserted under the toes and a weighted backpack.
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.
Ask Well: Plantar Fasciitis Relief
By GRETCHEN REYNOLDS
SEPTEMBER 15, 2014 5:15 AMSeptember 15, 2014 5:16 pm
A sturdy box and a backpack can help with heel pain.Credit Michael Skovdal Rathleff
Q Can I get relief for plantar fasciitis?
Asked by Marilyn • 610 votes
A If you have stairs or a sturdy box in your home and a backpack, timely relief for plantar fasciitis may be possible, according to a new study of low-tech treatments for the condition.
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.
But the new study, published in August in the Scandinavian Journal of Medicine & Science in Sports, finds that a single exercise could be even more effective. It 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.
Other volunteers 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.
The upshot, said Michael Skovdal Rathleff, a researcher at Aalborg University in Denmark, who led the study, is that there was “a quicker reduction in pain” with the exercise program, and a reminder of how books, in unexpected ways, can help us heal.
Scand J Med Sci Sports. 2014 Aug 21. doi: 10.1111/sms.12313. [Epub ahead of print]
High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.
Rathleff MS1, Mølgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL.
Author information
Abstract
The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day.
High-load strength training consisted of unilateral heel raises with a towel inserted under the toes.
Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. 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.
