If you've been dealing with plantar fasciitis for any length of time, you've probably been told to stretch. Stretch the calf. Stretch the plantar fascia. Roll a frozen bottle under your foot. Rest.
These approaches have their place. But the research over the last decade has pointed clearly in a different direction, one that most people with heel pain have never heard of.
The Landmark Study
In 2014, Rathleff and colleagues published a randomised controlled trial comparing two approaches to plantar fasciitis management: a standard plantar fascia stretching protocol versus a high-load strengthening exercise.
The high-load exercise involved a single-leg heel raise performed with the toes extended over a rolled towel, a position specifically designed to engage the windlass mechanism and place targeted load through the plantar fascia. Participants performed the exercise once daily, with a progressively increasing load (using a backpack) over 12 weeks.
The results were striking. At 3 months, the high-load strengthening group showed significantly greater reductions in pain and improvements in function compared to the stretching group. At 12 months, the differences were even more pronounced.
Why Does It Work?
The plantar fascia is a load-bearing structure. Its job is to absorb and transmit force during every step you take. When it becomes irritated and painful, the instinctive response is to protect it, to reduce load, rest, and avoid anything that aggravates it.
The problem is that reduced loading leads to reduced tissue capacity. The fascia becomes less able to handle the demands placed on it, which means it takes less to aggravate it. It's a cycle that can be very difficult to escape.
High-load strengthening works by doing the opposite, progressively increasing the load through the fascia in a controlled, repeatable way. This stimulates tissue remodelling, increases tensile strength, and rebuilds the foot's ability to tolerate the forces of everyday life.
The toe extension position used in the exercise is equally important. Extending the big toe tightens the plantar fascia through the windlass mechanism, the same mechanism that naturally stiffens the arch during the push-off phase of walking. Performing heel raises in this position loads the fascia along its full length, not just at the heel attachment.
What the Research Recommends
Based on the Rathleff protocol, the recommended approach is:
- Single-leg heel raises performed with the toes extended
- A slow, controlled tempo, typically 3 seconds up, 2 seconds hold, 3 seconds down
- Progressive loading, starting bodyweight, increasing over time
- Once daily, with rest days as needed
- Continued over a minimum of 12 weeks for best results
Subsequent studies have supported and expanded on these findings. A 2015 systematic review found that foot strengthening exercises produced meaningful improvements in pain and function across plantar fasciitis populations. More recent research has continued to support progressive loading as a superior long-term approach compared to passive management.
The Practical Problem
The research is compelling. But there's a reason it hasn't translated more widely into practice: the original protocol used a rolled-up towel to extend the toes, which is inconsistent, awkward, and difficult to replicate session after session.
Slight variations in towel height, position or firmness change the load on the fascia meaningfully. Most people find it impossible to maintain the same setup every time, which undermines the progressive, consistent loading the protocol depends on.
This is exactly the problem the Fasciitis Fighter was designed to address. By providing a consistent, firm toe extension position that doesn't change between sessions, it allows the exercise to be performed the way the research intended, every time.
The Bottom Line
High-load heel raises are one of the most robustly evidenced approaches for managing plantar fasciitis available. The research is clear: progressive loading outperforms stretching alone, and the effects are durable. If you're still relying solely on stretching and rest, the evidence suggests it's worth reconsidering your approach.
Always consult your health professional before starting a new exercise program, particularly if your symptoms are acute or you have other foot conditions.
Shop the Fasciitis Fighter Range →
Medical Disclaimer: This article is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional before starting any new treatment or exercise program. If you are experiencing severe or persistent pain, please seek professional medical advice.