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High Load Strength Training For Pain and Foot Function in a Patient with Plantar Fasciitis: A Case Report

Hongying Chen

Background: Plantar fasciitis is one of the most common causes of heel pain [1-3]. Stretching exercise is a popular treatment method to alleviate symptoms. However, it may not be appropriate for patients who demonstrate no limitation of metatarsal phalangeal joint (MTPJ) range of motion (ROM) [4]. High-load strength training has shown better treating effect than plantar specific stretching but without consideration of differences between patients with or without ROM limitation. This case report was to investigate the effect of high-load strength exercise in treating a patient who presented without first MTPJ ROM limitation, in terms of pain reduction and foot function improvement. Case description: A 26-year-old female diagnosed with right plantar fasciitis for less than two months. The patient presented with tenderness to palpation at the medial tubercle of the right calcaneus, decreased active ROM on bilateral ankle dorsiflexion and decreased muscle strength of ankle dorsiflexors, plantarflexors and extensor halluces longus. The 1st MTPJ extension was at the higher end of the normal limit. Outcomes: Therapy was administered twice a week for 5 weeks. The treatment plan included the conventional treatment and the high-load strength training. Heel pain decreased from 6/10 to 0, and foot function index decreased from 6.1% to 1.7%. Ankle dorsiflexors and plantarflexors strength increased from 4 to +4, and the extensor halluces longus strength increased from -4 to 4. Discussion: This case supported the point of view that for patients with plantar fasciitis, who demonstrated weak plantarflexors but without 1st MTPJ ROM limitation, treatment should focus more on strengthening exercise instead of stretching exercise.