Loading · intermediate · 3 sets of 15 reps

Eccentric Heel Drop (Step)

Rathleff and colleagues (2014) showed that a high-load strength training protocol, slow heel drops off a step with the big toe extended, every other day, produced superior pain and function outcomes at 3 months compared to the traditional plantar-fascia stretching protocol. This is the strongest single evidence-based intervention currently available for chronic plantar fasciopathy. The mechanism is thought to be remodelling of the degenerated fascia under controlled mechanical load, the same eccentric loading principle Alfredson applied successfully to Achilles tendinopathy.

Plantar fascia (loaded)Achilles tendonGastrocnemiusSoleus

This is a loaded exercise, not a held stretch

This is the Rathleff eccentric protocol

3 sets of 15 slow reps, every other day. 3 seconds down on each rep. Holds are not relevant. The active ingredient is the slow eccentric (lowering) phase: this is what loads and remodels the fascia tissue.

How to do it

1
Stand on a step with the balls of your feet on the edge and your heels hanging off
Heels off the edge
2
Hold a banister or rail lightly for balance, do not pull on it
Balance hand only
3
Rise up onto your toes using both feet, this is the lift, not the load
Both feet up
4
Shift your weight onto the affected leg and slowly lower that heel below the step over 3 seconds
Slow lower, 3 seconds
5
Step back up with both feet. Repeat for 15 reps. Do 3 sets, building over weeks
Concentric up, eccentric down

What you should feel

A controlled, loaded sensation across the underside of the foot and Achilles during the slow lower. Some discomfort during the exercise (up to 5/10) is acceptable and even expected, Rathleff's protocol explicitly allowed it. Sharp sudden pain, no.

Important note

This is NOT a stretch you hold, it is 3 sets of 15 slow reps, 3 seconds down on each. Holds are not relevant. Mis-coaching it as an isometric hold defeats the eccentric loading principle.

Easier

Both-foot eccentric (lower with both heels), or perform on a flat floor without the step. Start without bodyweight load and build over 2 to 3 weeks.

Harder

Add a backpack with light load (3 to 5 kg), or perform with the big toe extended up against the step (Alfredson-style with windlass engagement). This is what Rathleff et al used in their 2014 trial.

Don't do this if

Acute plantar fascia rupture or significant tear
Acute Achilles tendon rupture
Recent foot or ankle fracture
Balance impairment without a sturdy rail to hold

The evidence

Citation: Rathleff MS, Mølgaard CM, et al. (2014). High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scandinavian Journal of Medicine & Science in Sports

Routines that use this

8-Minute Runner Routine

Last reviewed 2026-05-12

Written by Oliver Wakefield-Smith, Founder of Digital Signet

Researches and writes evidence-based consumer health content. Not a clinician. Every clinical claim on this page links to its primary source. Email corrections.