Plantar heel pain, including pain along the plantar fascia, is one the most common diagnoses in the foot. Individuals often experience pain with the first step in the morning or after prolonged sitting. Symptoms limit their ability to perform many standing, walking, and recreational activities. Researchers have found minimal inflammatory cells within the plantar fascia among patients with heel pain indicating an ongoing healing process of the tissue (plantar fasciosis) similar to what is noted in tendon healing. The lack of inflammation is one reason for the failure of anti inflammatory treatments, such as medications and injections, in the management of this condition.
In addition, researchers are finding significant atrophy and weakness in the arch muscles of the foot within this population. These signs are even more pronounced among patients with long term orthotic use. Conversely strengthening of the arch musculature has been shown to be a promising treatment to reduce sensitivity and symptoms from the tissues of the foot. A new review of the evidence highlights the importance of these exercises.
Osborne and colleagues in the Journal Of Sports And Orthopedic Physical Therapy reviewed the available evidence on muscle structure and performance among patients with plantar heel pain (2019). Authors found weakness in the foot and ankle musculature within the studies,, but results were most consistent in the foot. Patients with plantar heel pain demonstrated significant atrophy and weakness of the foot musculature compared to their asymptomatic peers. This review supports the utilization of foot strengthening exercises to improve the performance of this muscle group in an effort to reduce abnormal forces across the injured tissues in patients with plantar heel pain.