High-Load Strength Training to Treat Plantar Fasciitis


If you have ever lived with the pain and discomfort of plantar fasciitis, it may seem counterintuitive to overload an already painful foot with exercise. In fact, most traditional treatment protocols encourage rest, orthotics and gentle stretches to promote healing. Unfortunately, PF can be stubborn, often lasting a year or more after diagnosis, causing frustration for both patients and therapists.

Now, recent research has got us reconsidering how we approach and treat plantar fasciitis.

Randomized Study for PF Treatment

In 2006, a paper written by Scott Wearing pointed out the similarities between the plantar fascia and tendons of the lower leg in terms of pathology and response to load. Eccentric loading has since become a standard treatment for leg tendinopathy. Nearly a decade later, Michael Rathleff et al. (2014) conducted a study to see if high load strength training would be effective in treating plantar fasciitis.

The randomized study of 48 patients with plantar fasciitis assigned participants into one of two groups. During the three-month study, the first group was given shoe inserts and performed daily plantar-specific stretches, while the second group was given shoe inserts and performed high load progressive strength training exercises for the plantar fascia, every-other day.

Assessment at the end of three months revealed superior self‐reported outcomes in the strength group compared to the stretch group. The authors concluded that, “High‐load strength training may aid in a quicker reduction in pain and improvements in function” of the plantar fascia.

Plantar Fasciitis Therapy at NYDNR

At NYDNR, we never stop looking for new and better ways to treat common disorders. Our team of sports medicine doctors embrace the newest technologies and cutting edge therapies to help our patients heal quickly and completely.

In addition to physical therapy, our toolbox of therapies for plantar fasciitis includes:


Dry needling for plantar fasciitis: This unique, inexpensive and minimally invasive therapy involves puncturing the plantar fascia and periosteum multiple times with an empty hypodermic needle, then injecting steroids into the perifascial tissue, all with ultrasound guidance. The procedure invokes a hyperemia response in the circulation-poor plantar fascia, recruiting platelets to heal damaged tissue. The entire procedure takes about 15 minutes and has a high success rate, with most patients reporting full recovery within two to three weeks.


Extracorporeal shock wave therapy for plantar fasciitis: ESWT also relies on the body’s own natural healing response to disruption. Non-invasive shock waves delivered to the plantar fascia cause micro-trauma to the otherwise circulation-poor tissue, invoking a healing response that causes the formation of blood vessels that increase nutrient delivery to the affected tissues, accelerating healing.

All treatment plans at NYDNR are individualized to meet the needs of every patient. If you are suffering from plantar fasciitis in NYC, contact us today, and see what a difference innovation and technology can make in eliminating plantar fasciitis pain.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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