Digiovanni, J Bone Joint Surg Am 2003 - Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain

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Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain

DiGiovanni, Baumhauer, et al.·J Bone Joint Surg Am·2003·344 citations·RCT

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Background

Approximately 10% 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 chronic plantar fasciitis who are managed with the structure-specific plantar fascia-stretching program for eight weeks have a better functional outcome than do patients managed with a standard Achilles tendon-stretching protocol.

Methods

101 patients who had chronic proximal plantar fasciitis for a duration of at least 10 months were randomized into one of 2 treatment groups.
The mean age was 46 years.
All patients received prefabricated soft insoles and a 3-week course of celecoxib, and they also viewed an educational video on plantar fasciitis.
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 8 weeks.

Results

82 patients returned for follow-up evaluation.
With the exception of the duration of symptoms (p < 0.01), 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 = 0.02) and item 2 (first steps in the morning; p = 0.006).
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 plantar fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of proximal plantar fasciitis. These findings provide an alternative option to the present standard of care in the nonoperative treatment of patients with chronic, disabling plantar heel pain.

Copyright remains with the authors and publisher.

Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain

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Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain

DiGiovanni, Baumhauer, et al.·J Bone Joint Surg Am·2003·344 citations·RCT

|

Background

Approximately 10% 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 chronic plantar fasciitis who are managed with the structure-specific plantar fascia-stretching program for eight weeks have a better functional outcome than do patients managed with a standard Achilles tendon-stretching protocol.

Methods

101 patients who had chronic proximal plantar fasciitis for a duration of at least 10 months were randomized into one of 2 treatment groups.
The mean age was 46 years.
All patients received prefabricated soft insoles and a 3-week course of celecoxib, and they also viewed an educational video on plantar fasciitis.
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 8 weeks.

Results

82 patients returned for follow-up evaluation.
With the exception of the duration of symptoms (p < 0.01), 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 = 0.02) and item 2 (first steps in the morning; p = 0.006).
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 plantar fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of proximal plantar fasciitis. These findings provide an alternative option to the present standard of care in the nonoperative treatment of patients with chronic, disabling plantar heel pain.

Copyright remains with the authors and publisher.

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