High-load strength training (HLST) has been suggested for the management of persistent plantar heel pain (PHP). The theory behind HLST is that repeated controlled loading of the plantar fascia will enhance tissue healing by stimulating collagen production.
The HLST consists of progressive single leg heel-raises with a thin towel or a t-shirt rolled up under the toes to produce the windlass effect and maximally load the plantar fascia. HLST is simple and must be done EVERYDAY, once a day!
Concentric phase: 5 seconds
Hold on top: 3 seconds
Eccentric phase: 5 seconds
The goal is to perform just one set of 10 slow single leg calf raises and gradually increase the load by putting on heavy backpack filled with books.
If single calf raises are not possible due pain or weakness then you can go up with both feet but come down with one.
Week 1-4: One set of 10 repetitions or less based on ability
Week 5-12: One set of 10 repetitions with a back pack made progressively heavier with books
The patient must be educated on “good” versus “bad” pain. If pain is reproduced or increased during the exercise and stays worse for the rest of the day but is no worse the next day, then that is considered as “good” pain. If the pain is still worse the following day then that is considered as “bad” pain which means that the load or the repetitions must be reduced.
You may show your patient the MOVE poster as rest certainly does not cure plantar fasciitis.
Reference: Caratun R et al Stubborn heel pain: Treatment of plantar fasciitis using high-load strength training. Can Fam Physician. 2018 Jan;64(1):44-46.