REF-920 · Rathleff et al., 2014 · Scandinavian Journal of Medicine & Science in Sports, Vol. · Paper · PubMed

High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up

A-fairly strong evidenceMeasured on a mixed groupWritten before October 2026, being re-checked

Patients whose plantar fasciitis was confirmed by ultrasonography were randomised to one of two programmes, both with shoe inserts: daily plantar-specific stretching, or high-load progressive strength training every second day. The strength work was single-leg heel raises with a towel placed under the toes.

At the 3-month primary endpoint, the foot function index was 29 points lower in the strength group than in the stretch group. No between-group differences were seen at 1, 6 and 12 months, and none of the secondary outcomes differed. The authors conclude that high-load strength training may help reduce pain and improve function more quickly.

Participants

Forty-eight patients with ultrasonography-verified plantar fasciitis. Age, sex, activity level and group sizes are not given in the abstract.

Protocol

Stretch group: shoe inserts and daily plantar-specific stretching.
Strength group: shoe inserts and high-load progressive strength training, performed every second day — unilateral heel raises with a towel inserted under the toes.
Primary outcome: foot function index (FFI) at 3 months. Additional follow-ups at 1, 6 and 12 months.

Key Results

Primary endpoint, 3 months: FFI 29 points lower in the strength group than in the stretch group [95% confidence interval (CI): 6-52, P = 0.016].
At 1, 6 and 12 months: no differences between groups (P > 0.34).
12-month FFI: strength group 22 points (95% CI: 9-36), stretch group 16 points (95% CI: 0-32).
No differences in any of the secondary outcomes.

Practical Application

In forty-eight patients with ultrasound-verified plantar fasciitis randomised to shoe inserts plus daily stretching or shoe inserts plus heel raises with a towel under the toes every second day, the strength group's foot function index was 29 points lower at 3 months (95% CI 6-52), and the groups did not differ at 1, 6 or 12 months. To "do heel raises help plantar heel pain?": in this trial they gave a better self-reported result at 3 months than stretching; by 12 months both groups had reached similar scores.
The advantage is one of speed, not of the final result — the authors' own wording is "may aid in a quicker reduction in pain".
The abstract gives no load, sets, repetitions or progression; the base cannot prescribe the protocol from this entry.
Inference, not tested here: the participants were patients, not runners, and nobody's running was measured, so the trial cannot say when or how to run with heel pain.
Not from this paper; the base's own practice: the assistant does not name this condition from a description of heel pain and leaves the loading programme to a clinician; triage and return rules are in SYNTH-73.

Limitations

The between-group difference appears at one time point (the primary endpoint) with a wide confidence interval; no secondary outcome differed.
Both groups also had shoe inserts; there is no group without treatment.
Self-reported outcome; exercise interventions cannot be blinded to participants.
Patients, not athletes; activity level and group sizes are not given in the abstract.
Written from the abstract and record metadata only (full text not read).
How this entry was checked and changed
Why this level

parallel RCT with n=48; the between-group difference is significant only at the primary endpoint and its confidence interval is wide