Strength training for plantar fasciitis and the intrinsic foot musculature

NewsBot · Aug 19, 2016

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Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review
Dean Huffer et al
Physical Therapy in Sport; Article in Press

Highlights
-Plantar fasciitis a common foot condition and affects both elderly and athletic populations.
-Literature proposes that the condition should be termed a fasciosis or fasciopathy.
-An association between intrinsic foot muscle weakness and foot pain has been reported.
-High-load strength training causes high tensile loads across the plantar aponeurosis.
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The aim was to critically evaluate the literature investigating strength training interventions in the treatment of plantar fasciitis and improving intrinsic foot musculature strength.

A search of PubMed, CINHAL, Web of Science, SPORTSDiscus, EBSCO Academic Search Complete and PEDRO using the search terms plantar fasciitis, strength, strengthening, resistance training, intrinsic flexor foot, resistance training.

Seven articles met the eligibility criteria. Methodological quality was assessed using the modified Downs and Black checklist. All articles showed moderate to high quality, however external validity was low.

A comparison of the interventions highlights significant differences in strength training approaches to treating plantar fasciitis and improving intrinsic strength. It was not possible to identify the extent to which strengthening interventions for intrinsic musculature may benefit symptomatic or at risk populations to plantar fasciitis. There is limited external validity that foot exercises, toe flexion against resistance and minimalist running shoes may contribute to improved intrinsic foot musculature function. Despite no plantar fascia thickness changes being observed through high-load plantar fascia resistance training there are indications that it may aid in a reduction of pain and improvements in function.

Further research should use standardised outcome measures to assess intrinsic foot musculature strength and plantar fasciitis symptoms.
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Admin2 · Aug 19, 2016

Related Topics:
Intrinsic foot muscle volume in chronic plantar fasciitis
Foot and hip stretching and strengthening for plantar fasciitis
Stretching or Strengthening for Plantar Fasciitis
Short Foot Muscle Exercises and Foot Posture in Runners
Intrinsic muscle strength and foot pain
Muscle atrophy and plantar fasciitis
Plantar intrinsic muscles and plantar fasciitis
'Core stability' of the foot

Craig Payne · Aug 19, 2016

It was not possible to identify the extent to which strengthening interventions for intrinsic musculature may benefit symptomatic or at risk populations to plantar fasciitis
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....yet I see so many alleged 'evidence based' clinicians citing a whole lot of references to justify this approach..... go figure.

I not saying it doesn't work (and I do use load programs clinically), I just saying the evidence that many think is there, is just not really there.

NewsBot · Sep 12, 2018

The Effect of Isometric Exercise on Pain in Individuals with Plantar Fasciopathy: a randomised crossover trial.
Riel H, Vicenzino B, Jensen MB, Olesen JL, Holden S, Rathleff MS
Scand J Med Sci Sports. 2018 Sep 11

Isometric exercise is commonly recommended for immediate pain relief in individuals suffering from lower limb tendinopathies, despite the limited evidence supporting its analgesic effect. Due to the similarities between plantar fasciopathy and tendinopathies, the aim of this trial was to investigate the acute effect of isometric exercise on pain, compared to isotonic exercise, or walking, in individuals with plantar fasciopathy. We recruited 20 individuals with plantar fasciopathy for this prospectively-registered, participant-blinded, randomised, superiority crossover trial (ClinicalTrials. gov: NCT03264729). Participants attended three exercise sessions (isometric, isotonic or walking) in a randomised order, within a two-week period. Both isometric and isotonic exercises were performed standing with the forefoot on a step bench, while walking was performed barefoot. The primary outcome was pain (measured on a 0-100mm VAS) during a pain-aggravating activity. Secondary outcomes included pressure pain threshold (PPT) under the heel, and plantar fascia thickness (PFT). All outcomes were measured before and after each exercise session. There were no significant differences between the three exercises on pain (P=0.753), PPTs (P=0.837) or PFT (P=0.718). Further, there was no change in pain from before to after any of the exercises (isometric exercise 2.7mm (95%CI: -12.2; 6.8), isotonic exercise -3.4mm (95%CI: -5.0; 11.8) or walking 1.6mm (95%CI: -16.1; 12.9)). Contrary to expectations, isometric exercise was no better than isotonic exercise or walking at reducing pain in individuals with plantar fasciopathy. None of the exercises induced any systematic analgesic effect.
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NewsBot · Oct 10, 2019

Muscle Function and Muscle Size Differences in People With and Without Plantar Heel Pain: A Systematic Review
Journal of Orthopaedic & Sports Physical Therapy, 2019 Volume:0 Issue:0 Pages:1–35 DOI:

Study Design
Systematic review with meta-analysis.

Background
Plantar heel pain is a common condition but little is known about the relationship between muscle strength and plantar heel pain.

Objectives
To review the evidence relating to muscle strength in those with and without plantar heel pain.

Methods
We systematically reviewed the literature by searching key databases. Included studies assessed muscle strength (or endurance or size as proxies) in those with and without plantar heel pain. A modified Downs and Black quality index was used to assess risk of bias and GRADE was used to evaluate the strength of the evidence. Meta-analysis was performed where possible.

Results
Seven studies met the eligibility criteria. Hallux plantarflexion, lesser toe plantarflexion, ankle dorsiflexion, ankle inversion and ankle eversion strength were reduced in those with heel pain compared to those without, however there was inconsistency in the findings between studies. No difference was found in calf muscle endurance between those with and without plantar heel pain (SMD 0.01; 95% CI: -0.56, 0.59). Generally, foot muscle volume was smaller for people with plantar heel pain compared to those without. The quality of individual studies was generally high (score range 11 to 16 out of 17 on the modified Downs and Black quality index), however the GRADE ratings suggest the strength of this evidence is very low.

Conclusion
People with plantar heel pain have reduced strength and volume of the foot muscles, but there is no discernible change in calf muscle endurance. These findings should be interpreted with respect to the very low GRADE rating and are likely to change with further research. Accordingly, the role of muscle strength in plantar heel pain is worthy of further investigation.
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NewsBot · Dec 8, 2019

The Evalaution Of The Foot Core System In Individuals With Plantar Heel Pain
HoganKK PrinceJA HochMC
Physical Therapy in Sport 29 November 2019

Highlights
-Those with plantar heel pain displayed increased thickness of the plantar fascia.
-Plantar foot sensation was decreased in those with plantar heel pain compared to healthy controls.
-There were no significant differences in abductor hallucis morphology between groups.
-There was no significant difference in intrinsic foot muscle performance testing.
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Objective
To compare foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance, and abductor hallucis morphology in individuals with and without plantar heel pain (PHP).

Design
Cross-Sectional.

Setting
Laboratory.

Participants
Sixteen individuals with PHP and sixteen matched healthy participants.

Main Outcome Measures
Static foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance and abductor hallucis morphology were evaluated. Foot posture was assessed with the Foot Posture Index-6. Abductor hallucis morphology and plantar fascia thickness were measured utilizing diagnostic ultrasound. Plantar foot sensation was assessed at the head of the first metatarsal and medial longitudinal arch using Semmes-Weinstein Monofilaments. Intrinsic foot muscle performance was assessed using the intrinsic foot muscle test (IFMT). Mann-Whitney U and independent t-tests were used to examine between group differences.

Results
Individuals with PHP exhibited a more pronated foot posture and greater plantar fascia thickness at the proximal insertion compared to healthy controls. Plantar sensation thresholds were higher in the PHP compared to healthy controls at the head of the first metatarsal. There were no group differences in abductor hallucis morphology or IFMT performance.

Conclusions
Individuals with PHP exhibited a more pronated foot posture, thicker plantar fascia, and diminished plantar tactile sensation.
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