Heel pain research: strength vs stretching, and the 2023 guideline
This page lists the studies Walkito is built on, what they found, and where their evidence stops. There are four: a trial on heel pain, a trial and a review on flat feet, and the 2023 clinical guideline for heel pain.
For heel pain from plantar fasciitis, the 2023 guideline gives stretching its top grade, A, and strength training a B. In a trial of 48 people, heavy heel raises eased pain faster than stretching, and by twelve months both groups were even.
For flexible flat feet, one trial of 52 people found that six weeks of exercise changed the shape of the arch. A 2024 review of short-foot training found no significant difference overall, and one arch measure improved only in programs longer than six weeks.
Are heel pain and flat arches the same problem?
Heel pain and the shape of the arch are two different problems, and the research measures them in different ways. The heel pain trial below scored pain and daily function. The arch studies measured the shape of the arch, not pain.
The heel pain trial was scored on the Foot Function Index. The arch studies were scored on navicular drop and arch angle, two measures of arch shape.
So a result for one is not proof for the other. The arch studies do not show that arch training eases pain. Calf strength work is not meant to change the shape of the arch. Walkito works on both as separate goals: pain-free mornings, and a 60-second arch hold. Up to three goals can be active at once, and pain comes first when you have pain.
The arch goal is meant for flexible flat feet, where the arch comes back when the foot is off the ground. Walkito does not check which kind you have. If your arch stays flat even off the ground, leave the arch goal aside and see a clinician. How the goals share a week is on the plan page.
Is strength training better than stretching for plantar fasciitis?
For plantar fasciitis, strength training brought relief sooner than stretching, and by twelve months the two were even. In a trial of 48 people with plantar fasciitis confirmed by ultrasound, everyone wore shoe inserts. One group did heavy heel raises every other day. The other group stretched the plantar fascia every day. At three months, the strength group was clearly ahead on pain and daily function. At twelve months, the two groups were even.
Scored on the Foot Function Index (pain and function): 29 points lower in the strength group at three months (95% CI 6-52, p = 0.016), and 22 against 16 at twelve months, not a significant difference.
So strength work brings the improvement forward. It does not make it bigger. That is the only claim Walkito makes for strength work: sooner, not more. It never promises a cure.
The heel raise in Walkito follows this trial. You stand on one leg on a step, with a towel under your toes. You take three seconds to rise, hold for two, and take three to lower, on strength days, three a week, never two in a row.
It sits near the top of Walkito’s calf exercises, which get harder one level at a time. It never comes in the first week, which keeps load off the plantar fascia at the start. The exercise and its starting dose are in plantar fasciitis exercises and stretches.
Can exercise change a flat arch?
Exercise can change the shape of a flexible flat arch, and the evidence says to give it six weeks or more. In a trial of 52 people with flexible flat feet, a six-week program improved the arch more than in the control group. The program mixed short-foot training (pulling the ball of the foot toward the heel so the arch lifts), ankle work, hip strengthening and stretching.
Navicular drop improved by 0.4 cm and arch angle by 16 degrees more than in the control group.
A 2024 review combined the studies of short-foot training. It found no significant difference overall compared with control groups. One arch measure improved only in programs longer than six weeks, and the authors say larger studies are needed. The review pooled studies of flat feet in general, and most did not make clear whether people had symptoms.
Meta-analysis outcomes: navicular drop and Foot Posture Index, neither significantly different from control overall. Navicular drop improved significantly only in the subgroup of programs longer than six weeks.
That is one reason Walkito’s plan has no end date. The arch goal stays in the plan until you reach it, instead of stopping on a date that might come before the point where this evidence applies. The exercises and their starting doses are in flat feet exercises.
What does the 2023 guideline recommend for plantar fasciitis?
The 2023 clinical guideline for plantar fasciitis grades each option by the strength of its evidence, and A is the top grade. The guideline was published in the Journal of Orthopaedic & Sports Physical Therapy. A grade marked “against” means the guideline advises not to use that option. The last column says what Walkito does with each one.
| Option | Grade | In Walkito |
|---|---|---|
| Plantar fascia and calf stretching | A | In the plan from week one |
| Manual therapy (hands-on work on the joints and soft tissue of the leg and foot), from a clinician | A | Not part of Walkito |
| Taping alongside other physical therapy, for better pain and function over up to 6 weeks | A | Not part of Walkito |
| Night splints for 1 to 3 months, if your first steps each morning keep hurting | A | Not part of Walkito |
| Resistance and strength training | B | The core of the plan, one level at a time |
| Low-level laser therapy and dry needling, from a clinician | B | Not part of Walkito |
| Orthotics on their own, for short-term pain relief | B against | Not recommended on their own |
| Orthotics combined with other care | C | Not part of Walkito |
| Therapeutic ultrasound added to stretching | A against | Not included |
For load, the same guideline advises learning how to change the load on your feet at work, in sport and in daily life. That advice is graded E, which means it rests on theory, not trials. Walkito changes the load instead of stopping. On a high-pain morning the session gets shorter and lighter, but it still happens. What that means if you run is in the heel pain guide.
Can heel pain come back after it eases?
Heel pain can come back after it eases, so Walkito’s plan has no fixed length and no last week where the exercises stop. The plan is built one week at a time around a focus goal. When you reach a goal, it moves to maintaining: it keeps a place in the plan at a lower dose, and the next goal takes its place.
Tests continue every 28 days after the first goal is reached, so a slide in the numbers shows up instead of being guessed at. None of this promises the pain will not come back.
What Walkito measures, and what it doesn’t
Walkito tracks progress with 3 physical tests that take about 4 minutes: single-leg calf raises until you can’t do another, how long you can hold the arch, and single-leg balance. The tests come every 14 days until you reach your first goal, then every 28. They are measured, not estimated, and using the app more cannot push them up.
Walkito can also read walking asymmetry from Apple Health: the percentage of time your steps with one foot are faster or slower than your steps with the other foot. iPhone estimates it on its own. Walkito compares it only with your own starting point, never with other people’s numbers. It will tell you when your walking pattern changes. It will never tell you that the change means you are injured.
What Walkito is not
Walkito is an exercise program. It does not diagnose or treat any condition, and it does not replace a clinician. How these pages are written and checked is on the About page. Questions about the app itself are answered in the FAQ.
The arch trial above was run on flexible flat feet, where the arch comes back when the foot is lifted off the ground. The 2024 review pooled studies of flat feet in general. Rigid flat feet are a structural problem that exercise will not change.
See a clinician first if
- your pain followed an injury or a fall
- it comes with numbness, tingling, burning, swelling or warmth
- it wakes you at night
- it is sharp or getting worse
- squeezing the heel hurts
- one arch has flattened suddenly as an adult
The full list is in the heel pain guide.
Updated