Plantar fasciitis is the result of degenerative irritation of the plantar fascia origin at the medial calcaneal tuberosity of the heel as well as the surrounding perifascial structures.
Plantar fasciitis (PF) is a common disorder of the foot and it’s a stubborn one. It has tendency to affect those between the ages of 40-60 but because of its pathogenesis it can appear in most age ranges. The exact cause of the condition is unknown but it is thought to be understood that overload and muscular tightness are key drivers of the condition and therefore this directs our treatment choices.
There are many ways to treat plantar fasciitis and conservative treatment can generally be placed into three categories.
- Control inflammation (e.g NSAIDS)
- Manage pain (e.g taping)
- Promote healing and improve function (e.g shockwave, stretching)
Stretching is the most commonly used conservating treatment for PF and aims to manage the pain as well as promote healing by treating one of the underlying caused of the conditon – achilles tendon tightness. Stretching also doesn’t come with the side effect profile of corticosteroid injections or shockwave therapy therefore offering a safe first line treatment for all.
The two most common stretches used to treat PF are achilles tendon / calf stretching and plantar fascia-specific stretching. Both the calf muscle and PF connect with each other and work across the ankle in all movement of the foot and ankle. Ultimately there is conflicting evidence in support of either stretch for PF.
But it’s unclear which is most effective. A recent systematic review published in the Journal if Bodywork and Movement Therapies reviewed the literature to tell us which treatments you should be using in clinical practice. In this blogpost we will summarise the findings for you.
The systematic review was registered to PROSPERO and adhered to the PRISMA statement meaning the methods were well reported included the full search strategy. The key words are shown below, the databases serched were WoS, PEDro, CINHAL and Scopus which goes above what is recommended by Cochrane.
stretching[All Fields] AND (“fasciitis, plantar” [MeSH Terms] OR (“fasciitis” [All Fields] AND “plantar” [All Fields]) OR “plantar fasciitis” [All Fields] OR (“plantar” [All Fields] AND “fasciitis” [All Fields])) AND (“randomized controlled trial” [Publication Type] OR “randomized controlled trials as topic” [MeSH Terms] OR “randomized controlled trial” [All Fields] OR “randomised controlled trial” [All Fields]) – Search Terms Used
The eligibility criteria is also shown in full along with an appropriate data collection metholodgy and risk of bias was asessed using the Cochrane Collaboration RoB Tool. Refman was used to perform statistical analysis and meta-analysis nd evidence quality was assessed using the GRADE approach.
Overall 8 studies were included within the review and of these four were deemed to have a low risk of bias with the majority of studies being moderate or low quality. Studies, similar to those included within the review are more likely to appear as moderate to low quality due to the inability to blind participants and due to the small sample sizes.
Results and Clinical Implications
The results of the systematic review show that stretching is an effective conservative treatment strategy for people suffering with PF particualrly plantar fascia-specific stretches. Any stretch is best for longer term management and therefore using shockwave or taping as an adjunct treatment to help those in the short term alongside stretching is a fair strategy to adopt.
The foot and ankle is a difficult part of the body to get right. It’s a joint that can often feel foreign to a physio because we tend to bias our training towards other lowerlimb joints in our lower limb training.
Kevin Bruce is a podiatrist who has summarised all you need to know about the models of the foot to enable you to apply your biomechanical knowledge to common conditions with some models of foot function. Be sure to check out his course which is linked to below.