Functional Outcome in Patients with Chronic Plantar Fasciitis Treated with Plantar Fascia Stetching vs Tendoachilles Stretching Exercises

Abstract

Introduction: Approximately ten percentage of patients with plantar fasciitis have development of persistent and often disabling symptoms. A poor response to treatment may be due, in part, to inappropriate and nonspecific stretching techniques. We hypothesized that patients with chromic plantar fasciitis who are managed with the structure-specific planter fascia-stretching program for eight weeks have a better functional outcome than do patients managed with a standard Achilles tendon-stretching protocol.

Methods: Sixty five patients who had chronic proximal planter fasciitis for duration of at least ten  months were randomized into one of two treatment groups. All patients received prefabricated soft insoles and a three-week course of naproxen. The patients received instructions for either a plantar fascia tissue-stretching program (Group A) or an Achilles tendon-stretching program (Group B). All patients completed the pain subscale of the Foot Function Index and a subject-relevant outcome survey that incorporated generic and condition-specific outcome measures related to pain, function, and satisfaction with treatment outcome. The patients were reevaluated after eight weeks.

Results: sixty one patients returned for follow-up evaluation (78 total feet). Covariates for baseline measures revealed no significant differences between the groups. The pain subscale scores of the Foot Function Index showed significantly better results for the patients managed with the plantar fascia stretching program with respect to item 1 (worst pain; p = 0.002), item 2 (first steps in the morning; p=0.018) and combined items 1 to 7(p=0.033). Analysis of the response rates to the outcome measures also revealed significant differences with respect to pain, activity limitations, and patient satisfaction, with greater improvement seen in the group managed with the plantar fascia-stretching program.

Conclusions: A program of non-weight-bearing stretching exercises specific to the planter fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of proximal planter fasciitis. These findings provide an alternative option to the present standard of care in the non-operative treatment of patients with chronic, disabling plantar heel pain.