Comparative Efficacy of High-Load Strength Training versus Multimodal Physical Therapy in Chronic Plantar Fasciopathy

Abstract

Background: Plantar heel pain, commonly referred to as plantar fasciopathy, affects a significant percentage of both athletic and sedentary populations. While conventional conservative physical therapy (stretching, manual therapy, and modalistic electrotherapy) remains the standard of care, modern tendinopathy frameworks suggest that targeted collagen loading via high-load mechanical strength training may yield superior structural remodeling and functional outcomes.

Objective: To compare the clinical efficacy of high-load progressive resistance strength training against a comprehensive multimodal physical therapy protocol in patients presenting with chronic plantar fasciopathy over a 12-week intervention period.

Methodology: A single-blind, randomized controlled trial was conducted with 120 adult participants (ages 21 to 65) diagnosed with unilateral chronic plantar fasciopathy persisting for over three months. Participants were randomized (1:1 ratio) to receive either High-Load Strength Training (HLST, n = 60)—consisting of progressive calf raises with a rolled towel under the toes—or Multimodal Physical Therapy (MPT, n = 60), comprising plantarspecific stretching, joint mobilization, low-level laser therapy, and custom orthotic fitting. Outcome measures included the Visual Analog Scale (VAS) for first-step morning pain, the Foot Function Index (FFI-R), and ultrasound-measured plantar fascia thickness (PFT) at baseline, 4 weeks, 12 weeks, and a 24-week post-intervention follow-up.

Results: At 12 weeks, both groups demonstrated clinically meaningful improvements; however, the HLST group achieved significantly greater reductions in first-step morning VAS score compared to the MPT group ($p < 0.001$). FFI-R disability scores demonstrated superior long-term functional recovery in the HLST group at 24 weeks ($p = 0.004$). Sonographic evaluation showed a statistically significant reduction in plantar fascia thickness in the HLST cohort ($p < 0.01$).

Conclusion: High-load progressive strength training provides superior short- and long-term functional pain relief and anatomical tissue adaptation compared to traditional multimodal physical therapy in chronic plantar heel pain..