Reviewed by Mark Boyland PT, DPT, CSCS
Plantar fasciitis is a common diagnosis with symptoms including pain at the heel, difficulty walking, and increased foot pain usually for the first few steps in the morning or when walking after a period of immobility. While there are many treatment options available we will review two studies which examined primarily exercise interventions on the treatment of plantar fasciitis pain. Effects of Strengthening and Stretching Exercises on the Temporaspatial Gait Patterns in Patients with Plantar Fascitis: A Randomized Control Trial and Effect of a home-based stretching exercises on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis. Both study participants were educated by a Physical Therapist on proper execution of these exercises and received a written home exercise program with instructions on how to perform and progress exercises.
The study which compared strengthening vs stretching group had 84 participants, a sizeable group, whereas the stretching only study had only 20 participants. Participants were selected if they had only plantar fascial pain without other systemic conditions or other forms of lower extremity pain. The strengthening vs stretching group was monitored for 12 weeks whereas the stretching only group was monitored for just over 3 weeks.
Interestingly enough the general pain, time of the worst pain, gait parameters, and muscle strength improved regardless of stretching only or strengthening only in either study. However, there was limited changes on multisegmental mobility of the foot before and after interventions and there were no significant between group differences in any of the noted parameters. However, both studies had significant decreases in pain from baseline to the first 2 weeks with progressively improving symptoms in following weeks, though not as significant.
Both studies provided the exercise protocols including sets, reps, progressions, and approximate time to complete assigned exercises. The PMCID will be provided for free article access to review both protocols via Pubmed. The strengthening vs stretching study was a more traditional protocol including 3 sets of 10-15 repetitions of 4 strengthening exercises or 3 repetitions of 30 seconds with 10 seconds rest for the stretches. Patients were instructed to complete these exercises 3 times per day. The stretching vs strengthening study exercises took between 6-10 minutes to complete per session. The stretching only study had 3 stretching exercises which were performed for 20-30 seconds with 10 seconds rest for 10 sets 5 days a week over 3 weeks, the stretching only study took about 20 minutes to complete their exercises.
For Therapists: Recent research has been guiding us to introduce a progressive loading program to help manage and improve our patient’s symptoms. These two studies provide a framework on how to provide this progressive loading to your patients and that you have 3 options to provide your patients, pending their compliance/preference for exercise. There seems to be no agreement between these two papers as to what a minimal/maximal dose of exercise intervention at this time, however 20-30 minutes of dedicated exercise seems to be a good start.
For Patients: Plantar Fasciitis can be a difficult condition to recover from and that pain improvements can continue for up to 12 weeks after beginning an exercise program. Your therapist can provide you with a stretching and/or a strengthening program to help manage/improve your symptoms depending on what you feel that you prefer. This condition can be self-managed at home for the most part and your Therapist should be progressing you on a weekly to bi weekly basis pending your overall symptoms. However, before you begin self-treating, a Physical Therapy Evaluation is critical to rule out other diagnoses or pathologies
References
Effects of Strengthening and Stretching Exercises on the Temporospatial Gait Parameters in Patients with Plantar Fasciitis: A Randomized Control Trial. PMCID PMC6960082
Effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis. PMCID: PMC7493445