Proximal plantar fasciitis, a common cause of heel pain, theoretically may be caused by partial tearing of the plantar fascia and inflammation at its insertion on the medial tubercle of the calcaneus. Nonsurgical treatments include shoe modifications, shoe inserts, non-steroidal anti-inflammatory drugs (NSAIDs), cortisone injections, stretching exercises, physical therapy, night splints, casting, or any combination of these treatments. Symptoms generally resolve within 10 months, although some patients continue to have severe and disabling pain. DiGiovanni and associates compared a tissue-specific plantar fascia stretching protocol with a standard Achilles tendon stretching program.
Patients with plantar fasciitis (confirmed by maximal pain on palpation of the medial calcaneal tubercle) who did not respond to non-surgical treatments were included in the study. The patients were randomized to receive instructions on a plantar fascia stretching program or an Achilles tendon stretching program (see accompanying table). Patients in both groups were told to hold the stretch for a count of 10 and to repeat the stretch 10 times, three times daily. In the plantar fascia stretching group, the first stretching set was to be done before the participants took their first steps of the day; in the Achilles tendon stretching group, the first set was to be done before the participants got out of bed each morning. All patients received prefabricated soft insoles and a three-week course of therapy with an NSAID (celecoxib), and all watched an educational video about plantar fasciitis.
|Plantar fascia stretch|
|Sit with the affected leg crossed over the contralateral leg.|
|Using the hand on the affected side, place the fingers across the base of the toes on the bottom of the foot and pull the toes back toward the shin until a stretch is felt.|
|Confirm tension in the plantar fascia by palpation using the contralateral hand.|
|Achilles tendon stretch|
|Stand facing a wall and place the affected leg behind the contralateral leg.|
|Point the toes of the affected foot toward the heel of the front foot and lean toward the wall.|
|Bend the front knee while keeping the back knee straight and the heel firmly on the ground.|
The patients were followed for eight weeks. Of the 82 patients who completed the study, all reported overall pain reduction. However, the plantar fascia stretching group reported greater improvement of pain and function, as well as greater patient satisfaction.
The authors conclude that the plantar fascia stretching program is superior to the Achilles tendon stretching program for resolving symptoms of chronic plantar fasciitis, and that the stretching is most effective when it is performed before the first steps in the morning or after prolonged sitting or inactivity.