Strengthening Vs. Stretching For Plantar Fasciitis


For many years, people have argued and debated whether strength training or stretching is better for treating plantar fasciitis. As a rule, any type of self-treatment program should be avoided. It is important to follow a doctor’s recommended plan since each person’s health history, weight, age and tissue damage severity vary. When talking to a doctor, it may be helpful to ask about a combination of reducing the amount of stress on the plantar fascia along with increasing the strength of the tissue over time. Recent research shows promising results for strength training versus stretching.

A Successful High-load Strength Training Experiment

This study had a follow up time of 12 months after the initial treatment regimen. In the experiment, there were two groups of people. The first group of participants received special shoe inserts, and they followed a specific stretching regimen designed for improving plantar fascia tissue. A second group of individuals used the same special insoles along with high-load strength improvement. There were 48 participants, and the assignment to groups was completely random.

The Strength Training Group

The plan for this group of individuals consisted of putting a towel below the toes while doing unilateral heel lifts. For reporting, success was measured after 30 days, 90 days, 180 days and 360 days. The foot function index was used as a way to gauge the outcome. After 90 days, this group’s FFI was 29 points lower than the other group. After a full year had passed, there were no disparities in numbers between the two groups. This shows that strength-building exercises improved pain and physical function faster than a simple regimen of stretches. The constant factor of using the same insoles between the two groups ensured an equal chance for outcomes.

Significance Of This Experiment

This study is especially interesting and critical because of a few factors. First, the sample size strengthens it as well as the randomization of assignment. Also, it was not designed with initial bias toward one option over the other. It was simply meant to find the more optimal choice of two useful therapies. The year-long follow up period provided a more comprehensive look at the results on a long-term basis. Additionally, the researchers adhered to the consort statement, which is not a priority among many other studies.

Criticisms Of This Experiment

Every study has some weaker points. In this experiment, the researchers could have strengthened their arguments even more by explaining and detailing the randomization of the study and measuring specifics of the participants. Another major issue was the lack of a placebo group. These are a few additional criticisms:

● The baseline characteristics of the groups included some major differences.
● The results of the study may have been somewhat overstated.
● The original end point was extended.
● Each group had several dropouts.
● Primary outcome raw values were not reported.

Overall, the results showed a reason for cautious optimism in strengthening exercises over stretches alone. This is certainly an important option to discuss with a doctor. After being diagnosed with plantar fasciitis, work with a trusted physician who is an orthopedic specialist, a sports medicine specialist or a podiatrist.


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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