Plantar Fasciitis: Strenght Training, Intrinsic Foot Muscles


Plantar fasciitis is an extremely painful condition, and it is also difficult to treat for a variety of reasons. Patients who present this condition to their doctor may have a hard time understanding why the treatment options available are relatively limited. This brief summary can help people suffering from plantar fasciitis look at this problem from the point of view of the therapist. This can help patients evaluate alternative treatments like physical therapy.

Etiology of Plantar Fasciitis

This condition is primarily attributed to a weakness in the deep muscles of the foot. This weakness can cause slight deformations to occur as the patient adds weight to the area. The pain increases when the foot is not warmed up, and this causes pain during the first few steps in the morning. If it remains untreated, these few steps can actually tear the fascia in the foot. Since there are different degrees of fasciitis, it is necessary to obtain a complete evaluation from your physician. This information is essential when deciding on a course of treatment. The option to use physical therapy is indicated when the muscles of the foot are demonstrably weak or similar pathologies are present in the foot.

The assumption that weakness within the internal muscles of the foot causes plantar fasciitis is not based on empirical evidence. Most of the existing literature does not seek to establish any connection between muscle weakness and plantar fasciitis. This is still a popular working theory, so it should be used in the context of the potential benefits for patients. Physical therapists still tend to use this theory to construct a plausible regimen for the patient; however, patients should also understand that this approach does not draw upon any conclusive literature. Existing protocols that are based on the muscle weakness theory are beneficial for some patients. This is the basis for physical therapists who advocate for this course of treatment. Patients should understand that there is no established agreement in the research fields and that there is no documented correlation between muscle weakness and plantar fasciitis.

Treatment Options

Since treatments rely on muscle strengthening exercises to establish a baseline for improvement, this is the approach we will take, if only for the sake of brevity. Studies found that the patients with plantar fasciitis, the program for a progressive elevation of the heel provided more relief than merely stretching alone. No changes in the thickness of the plantar fasciitis were found. There were also preventative studies performed on patients who were currently asymptomatic, yet displayed signs of hypertrophy within the intrinsic muscle groups of the foot. This group responded positively to minimalist footwear and specific exercises targeting the flexor hallicus longus and brevis muscle group.

Our clinic strives to improve the range and quality of motion for all of our patients. We are constantly reviewing the existing literature on plantar fasciitis to craft treatment plans that are informed by actual documented cases. Refining outcomes for patients is the highest priority when using the physical therapy approach for treating plantar fasciitis. The use of strengthening protocols is indicated because of the positive results experienced in previous clinical trials. As this literature becomes more available, we will continue to adjust our treatment protocols to reflect the latest innovations in reducing foot pain while increasing strength and function.


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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