Stretching or Strengthening for Plantar Fasciitis

NewsBot · Aug 22, 2014

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High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up
M. S. Rathleff, C. M. Mølgaard, U. Fredberg, S. Kaalund, K. B. Andersen, T. T. Jensen, S. Aaskov andJ. L. Olesen
Scandinavian Journal of Medicine & Science in Sports; Early View

The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6–52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9–36) in the strength group and 16 points (95% CI: 0–32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function.
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Admin2 · Aug 22, 2014

Related Threads:
Plantar fascia stretching exercise for plantar fasciitis

Craig Payne · Aug 22, 2014

For those been to a recent Boot Camp, this was the study I was talking about... but, now I read the details ...

No freakin control group!!! The strengthening was better than the stretching, but we have no idea if they were better than a placebo. Look at the RCT's on plantar fasciitis that do have a control group and that group does get better. We have no way of knowing in this study if that was the case or not!

...also many minor issues ... will have a blog post up tomorrow.

The author of the study has written abut it on Tom Goon's blog:
http://www.running-physio.com/pf-new-research/

Craig Payne · Aug 25, 2014

got the blog post up:
http://www.runresearchjunkie.com/strengthening-vs-stretching-for-plantar-fasciitis/

NewsBot · Sep 16, 2015

The above study made the list of "Top 20 Research Studies of 2014 for Primary Care Physicians."
http://www.ncbi.nlm.nih.gov/pubmed/26371571?dopt=Abstract

NewsBot · Jun 14, 2019

Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial
HenrikRielaMartin BachJensenaJens LykkegaardOlesenaBillVicenzinobMichael SkovdalRathleffacd
Journal of Physiotherapy; 13 June 2019

Question
For people with plantar fasciopathy, is a 12-week self-dosed heavy-slow resistance training program more beneficial than a 12-week pre-determined heavy-slow resistance training program?

Design
A randomised trial with concealed allocation, partial blinding, and intention-to-treat analysis.

Participants
Seventy people with plantar fasciopathy confirmed on ultrasonography.

Intervention
Both groups performed a repeated heel raise exercise in standing for 12 weeks. Participants in the experimental group were self-dosed (ie, they performed as many sets as possible with as heavy a load as possible, but no heavier than 8 repetition maximum). The exercise regimen for the control group was pre-determined (ie, it followed a standardised progressive protocol).

Outcome measures
The primary outcome was the Foot Health Status Questionnaire pain domain. Secondary outcomes included: a 7-point Likert scale of Global Rating of Change dichotomised to ‘improved’ or ‘not improved’; Patient Acceptable Symptom State defined as when participants felt no further need for treatment; and number of training sessions performed.

Results
There was no significant between-group difference in the improvement of Foot Health Status Questionnaire pain after 12 weeks (adjusted MD −6.9 points, 95% CI −15.5 to 1.7). According to the Global Rating of Change, 24 of 33 in the experimental group and 20 of 32 in the control group were improved (RR = 1.16, 95% CI 0.83 to 1.64). Only four participants achieved Patient Acceptable Symptom State: three of 35 in the experimental group and one of 35 in the control group. No significant between-group difference was found in the number of training sessions that were performed (MD −2 sessions, 95% CI −8 to 3).

Conclusion
Self-dosed and pre-determined heavy-slow resistance exercise programs are associated with similar effects on plantar fasciopathy pain and other outcomes over 12 weeks. Advising people with plantar fasciopathy to self-dose their slow-heavy resistance training regimen did not substantially increase the achieved dose compared with a pre-determined regimen. These regimens are not sufficient to achieve acceptable symptom state in the majority of people with plantar fasciopathy.
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NewsBot · Jan 15, 2020

Effects of Strengthening and Stretching Exercises
on the Temporospatial Gait Parameters in
Patients With Plantar Fasciitis:
A Randomized Controlled Trial
Suthasinee Thong-On et al
Ann Rehabil Med 2019;43(6):662-676

Objective To investigate the effects of physical therapy interventions using strengthening and stretching exercise
programs on pain and temporospatial gait parameters in patients with plantar fasciitis (PF).
Methods Eighty-four patients with PF participated in the study and were randomly assigned to the strengthening
or stretching exercise groups. All patients received 8 physical therapy interventions two times per week in the
first 4 weeks and performed daily strengthening or stretching exercises three times per day. After 4 weeks, they
continued the assigned exercise programs every day for 8 weeks. Pain visual analogue scale (VAS) scores at the
worst and in the morning and temporospatial gait parameters were evaluated at the baseline, intermediate of the
intervention, end of the intervention, and the first and second month follow-up.
Results There were significant effects of the time on the worst pain, morning pain, cadence, stride time, stride
length, total double support, and gait speed, but there was no effect on step width. In addition, the main effect of
the group and the interaction effects of the time and the group were not found in any parameters. For intra-group
comparisons, there were significant differences in worst pain, morning pain, cadence, and stride time among the
assessment times in both groups. For inter-group comparisons, there were no significant differences in all parameters.
Conclusion Both strengthening and stretching exercise programs significantly reduced pain and improved gait in
patients with PF.
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NewsBot · Apr 25, 2021

Physiotherapy Approach to Patients with Chronic Plantar Fasciitis : Comparison of the
Effects of Specific Stretching Exercise and High-Load Strengthening Exercise
Yeon-Ki Choo, et al
Journal of The Korean Society of Integrative Medicine, 2021, 9(1), 151~161

Purpose : This study was to investigate the effectiveness of ESWT and plantar fascia-specific stretching exercise vs ESWT and
high-load strengthening exercise in patients with chronic plantar fasciitis.
Methods : The subjects were randomized to extracorporeal shock wave therapy ( ESWT, for 3 weeks) and daily plantar-specific
stretching (Group Ⅰ: Stretch group) or ESWT and high-load progressive strength (Group Ⅱ: Strength group) performed every
second day. The main outcome measures were ultrasound, visual analogue scale (VAS), and Korean Foot Function Index (KFFI).
The ultrasound (plantar fascia thickness), pain intensity Ⅰ, Ⅱ (the most painful of the day?, the pain when you first step in the
morning?) and KFFI (functional performance) were compared between the groups.
Results : No significant difference was observed between the groups in the plantar fascia thickness but pain intensity Ⅰ, Ⅱ was
significantly lower in Group 2 than in Group 1 at only 12weeks and functional performance was also significantly increased in
Group 2 compared to Group 1 at only 12 weeks.
Conclusion : The high-load strengthening exercise consisting of the progressive exercise protocol, resulted in superior after 12
weeks compared with plantar-specific stretching. High-load strength exercise may aid in a quicker reduction in pain and
improvements in functional performance.
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NewsBot · Oct 6, 2023

Development of a foot and ankle strengthening program for the treatment of plantar heel pain: a Delphi consensus study
John W. A. Osborne, Hylton B. Menz, Glen A. Whittaker & Karl B. Landorf
Journal of Foot and Ankle Research volume 16, Article number: 67 (2023)

Background
People with plantar heel pain (PHP) have reduced foot and ankle muscle function, strength and size, which is frequently treated by muscle strengthening exercises. However, there has been little investigation of what exercises are used and there is no sound evidence base to guide practice. This study aimed to develop a consensus-driven progressive muscle strengthening program for PHP.

Methods
Thirty-eight experts were invited to participate in the study over three rounds. Round 1 was an open-ended questionnaire that provided the core characteristics of progressive strengthening programs designed for three different adult patient types with PHP (younger athletic, overweight middle-aged, older), which were presented as vignettes. In Round 2, experts indicated their agreement to the proposed exercises and training variables. In Round 3, experts were presented with amendments to the exercises based on responses from Round 2 and indicated their agreement to those changes. Consensus was achieved when > 70% of experts agreed.

Results
Two experts were ineligible and 12 declined, leaving 24 (67%) who participated in Round 1. Eighteen (75%) completed all three rounds. From Round 1, progressive strengthening programs were developed for the three vignettes, which included 10 different exercises and three training variables (sets / repetitions, weight, and frequency). In Round 2, 68% (n = 17) of exercises and 96% (n = 72) of training variables reached consensus. In Round 3, only exercise changes were presented and 100% of exercises reached consensus.

Conclusions
This study provides three progressive strengthening programs agreed to by experts that can be used in future clinical trials to determine the effectiveness of muscle strengthening for PHP. In addition, clinicians could use the programs as part of a rehabilitation strategy with the caveat that they may change as more research is conducted.
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scotfoot · Oct 7, 2023

NewsBot said: ↑

Development of a foot and ankle strengthening program for the treatment of plantar heel pain: a Delphi consensus study
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Here are the agreed upon exercises (below) .

Of all the exercises mentioned likely "digital platarflexion banded" is the only one that will produce meaningful results. Ironically ,this exercises was missed out in a recent paper that compared isolated foot exercises with functional exercises.

Versions of the short foot exercise that do not allow the ball of the foot to lift are not about the intrinsic foot muscles . Recent research graphically shows that electrical stimulation of the abductor hallucis will see the foot shorten and the ball of the foot lift clear of the ground . A video shows this clear as day .

Vignette (patient) Stage Exercise Sets Repetitions Weight Frequency
1. Younger athletic adult Stage 1 Hallux plantarflexion banded 4 6 to 12 8 RM Daily
Digital plantarflexion banded 4 6 to 12 8 RM Daily
Heel raise 4 6 to 12 8 RM Daily
Short foot exercise seated 4 8 to 15 BW Daily
Stage 2 Toe spread out 3 8 to 15 BW Daily
Heel raise standing digits dorsiflexed 5 6 to 10 8 RM Daily
Short foot exercise standing single leg 3 8 to 15 BW Daily
Stage 3 Heel raise standing single leg digits dorsiflexed 5 8 to 15 10 RM Daily
Walking lunges 3 12 to 25 20 RM Daily
2. Overweight middle-aged adult Stage 1 Short foot exercise seated 4 8 to 12 10 RM 2nd daily
Hallux plantarflexion banded 3 6 to 10 8 RM 2nd daily
Lesser digit plantarflexion banded 3 2 min BW 2nd daily
Stage 2 Toe spread out 3 6 to 10 8 RM 2nd daily
Heel raise standing digits dorsiflexed 5 6 to 10 8 RM 2nd daily
Short foot exercise standing 3 6 to 10 8 RM 2nd daily
Stage 3 Heel raise standing digits dorsiflexed 5 6 to 10 8 RM 2nd daily
Walking lunges 3 12 to 20 15 RM 2nd daily
3. Older adult Stage 1 Digital plantarflexion banded 4 8 to 12 10 RM 2nd daily
Short foot exercise seated 4 8 to 12 10 RM 2nd daily
Single leg standing 2 2 min BW 2nd daily
Stage 2 Toe spread out 3 6 to 10 8 RM 2nd daily
Heel raise seated 5 6 to 10 8 RM 2nd daily
Digital plantarflexion banded 3 6 to 10 8 RM 2nd daily
Stage 3 Heel raise standing 3 6 to 10 8 RM 2nd daily
Chair squat

scotfoot · Oct 7, 2023

Here is a link to that "clear as day" video on twitter.
https://twitter.com/i/status/1624819118464503808

There are two exercises out there, strict short foot, in which there is no toe flexion and which exercises the tib post, tib ant, and the peroneals, and doming, a short foot variant which also involves the IFM and which sees the ball of the foot leave the ground . Nobody seems to want to properly define these exercises and so confusion reigns.

Simon Spooner · Oct 8, 2023

scotfoot said: ↑

Here is a link to that "clear as day" video on twitter.
https://twitter.com/i/status/1624819118464503808

There are two exercises out there, strict short foot, in which there is no toe flexion and which exercises the tib post, tib ant, and the peroneals, and doming, a short foot variant which also involves the IFM and which sees the ball of the foot leave the ground . Nobody seems to want to properly define these exercises and so confusion reigns.
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Why not write a letter to the Editor/ authors in response to the paper and send to the Journal?

scotfoot · Oct 8, 2023

Simon Spooner said: ↑

Why not write a letter to the Editor/ authors in response to the paper and send to the Journal?
Click to expand...

Not a bad idea . I did exchange a few words about the paper with John Osborne via Twitter, and I passed on details of a recent study that shows single leg calf raises are really a non starter when it comes to strengthening the toe flexor muscles. This even with an exercise progression lasting 11 weeks and involving ever increasing weight across test subjects shoulders.

I have no idea why the experts think dorsiflexing the toes will make any difference to the calf raise exercise and there is no evidence to support a "consensus acceptance" of calf raises that I am aware of . It is really just "groupthink", IMO.

Toe flexion against resistance bands is at least included, and programs that include this are likely not to be a complete waste of time.

NewsBot · Feb 26, 2024

Comparing High-Load Strength Training with Plantar-Specific Stretch and Manual Therapy for Plantar Fasciitis Pain.
R., Divya Bharathy; Kamalakannan M.; Ramana K.; Anitha A.
Indian Journal of Physiotherapy & Occupational Therapy, 2024, Vol 18, p20

Background: The plantar fascia, a substantial band of tissue running along the bottom of the foot from the heel bone to the toes, is involved in the inflammation and irritation of the condition. One in ten people will experience plantar fasciitis at some point in their lives, making it a prevalent condition. Purpose: To compare the effectiveness of High-load strength training with plantar stretch and manual therapy on pain and functional recovery in subjects with plantar fasciitis. Materials and Methods: Thirty participants were randomly assigned to experimental (High-load strength training with plantar stretch) and conventional (manual therapy) groups. The numerical pain rating scale (NPRS), and foot and ankle ability measure (FAAM) were used to evaluate the pre-test. The same test was used to determine post-treatment values after six weeks of treatment. Results: A significant difference was observed between the experimental and control groups (P = <0.0001). High-load strength training and plantar stretching play an important role in patients with plantar fasciitis. Conclusion: The combination of specific plantar stretches and high-load strength-training activities produce significant functional benefits and rapid reduction of pain.
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NewsBot · Feb 26, 2024

Effectiveness of High Load Plantar Fascia Resistance Training among Athletes with Plantar Fasciitis.
Ramya D.; Anitha A.; Ramana K.; Kamalakannan M.
Indian Journal of Physiotherapy & Occupational Therapy, 2024, Vol 18, p749

Background: Plantar fasciitis is a common condition characterized by pain and inflammation in the plantar fascia, a thick band of tissue that runs along the bottom of the feet, connecting the heel to the toes. It is particularly prevalent among athletes who engage in activities that involve repetitive impact, such as running, jumping. Athletes with plantar fasciitis often undergo a structured rehabilitation program that incorporates high load resistance training alongside other interventions such as stretching, massage, orthotic devices, and modifications in training and footwear. Purpose: To compare the effectiveness of High Load Plantar Fascia Resistance Training with ultrasound and Intrinsic Muscle strengthening with ultrasound among athletes with Plantar Fasciitis. Materials and Methods: Total of 60 subjects were selected from Sri Sai Ortho General Clinic based on the selection criteria and randomly divided into two groups; High load plantar fascia resistance training (HLST) with ultrasound (n=30) and Intrinsic muscle strengthening with ultrasound (n=30). The subjects were assessed for pain intensity using NPRS and using LEFS, for pre and post-test values. The interventions were given for 2 weeks. Study period: November 2022 to March 2023 Result: The result of the study revealed that both exercises are effective but (HLST) with ultrasound was more effective and significant in terms of decreasing pain and improving functional mobility. Conclusion: Hence the study concludes that HLST was more effective in managing plantar fasciitis in terms of both relieving pain as well as functional mobility among athletes with plantar fasciitis.
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NewsBot · Apr 30, 2024

Impact of anti-gravity muscle training protocol on plantar pressure, pain threshold and foot posture on chronic painful heel: an RCT study
S. Gotecha et al
Comparative Exercise Physiology: 19 Jan 2024

Chronic painful heel (CPH) is a symptom of an underlying condition caused due to obesity, excessive foot pronation, tightness of Tendo-Achilles (TA), excessive running, and sedentary life. The antigravity muscles (AGM) atrophy results due to long working hours in sitting, leading to their deteriorating relationship with gravity thereby reduced sensitivity to its force. Hence, need arises to explore training effects of AGM protocol on CPH condition. A randomised controlled trial was conducted on thirty individuals with CPH allocated randomly to two study groups viz. AGMT (n = 15) and Control group (n = 15) who received intervention for twelve sessions over four weeks. Control group received conventional physiotherapy in form of therapeutic ultrasound and exercises while AGMT received conventional physiotherapy using the AGMT protocol. Outcomes assessed were plantar pressure and foot posture assessed using Harris mat, muscle strength by dynamometer, pain threshold with pressure algometer, and foot functions using Foot and Ankle Ability Measure Scale (FAAM) which were taken at pre- and post-training. The between group analysis of data revealed that foot posture, plantar pressure and muscle strength, pain threshold were significantly better in the AGMT group than in the Control group (

=
0.0001), while pain intensity (P = 0.3952) and foot functions (P = 0.2372) were equally effective in both the study groups. In conclusion, the AGMT protocol along with conventional physiotherapy proved to be a promising training protocol for individuals with CPH showing positive outcomes in comparison to conventional therapy alone, suggesting to incorporate AGM strengthening alongside conventional therapy to obtain better clinical outcomes
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NewsBot · Jul 25, 2024

Effectiveness of Ankle Proprioceptive Neuromuscular Facilitation Techniques in Restoring the Biomechanical Integrity of the Ankle Following Plantar Fasciitis: An Experimental Study
Sasun et al.
10.7759/cureus.64371

Background Recent studies have highlighted the role of the central nervous system in modulating pain perception and the movement patterns associated with plantar fasciitis. Neurological changes, such as altered sensorimotor control and cortical reorganization, may contribute to the persistence of symptoms and the recurrence of the condition. Integrating neurorehabilitation techniques may enhance outcomes and reduce the risk of recurrence. Physiotherapy exercises such as ankle proprioceptive neuromuscular facilitation, foot doming exercises, balance exercises, towel curl exercises, and stretching exercises were given to check the impact of physiotherapy interventions on ankle muscle instability and dynamic balance following plantar fasciitis. Method An experimental investigation was carried out at the outpatient department of Acharya Vinoba Bhave Rural Hospital. A total of 71 participants were assigned arbitrarily, employing a straightforward random sampling procedure. Each participant received treatment for six weeks, with five weekly sessions. Result The results demonstrated significant findings. The pre- and post-test score results are as follows: visual analogue scale scores (t=1.619, p=0.0001), weight-bearing lunge test scores (t=24.36, p=0.0001*), and functional reach test scores (t=24.36, p=0.0001). Conclusion We conclude that physiotherapy exercises such as ankle proprioceptive neuromuscular facilitation (PNF), foot doming exercises, strengthening exercises, toe spreading exercises, towel curl exercises, and stretching exercises are effective in reducing pain and ascertaining dynamic balance in plantar fasciitis. The rehabilitation program significantly improved ankle biomechanical integrity and muscle strength, allowed functional recovery, and reduced pain. Future studies should focus on investigating the long-term effects of PNF therapies. For better patient outcomes, clinicians should consider incorporating ankle PNF exercises into their therapy regimens.
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NewsBot · Aug 16, 2024

Effectiveness of Ankle Proprioceptive Neuromuscular Facilitation Techniques in Restoring the Biomechanical Integrity of the Ankle Following Plantar Fasciitis: An Experimental Study
Anam R Sasun et al
Cureus. 2024 Jul 11;16(7):e64371

Background Recent studies have highlighted the role of the central nervous system in modulating pain perception and the movement patterns associated with plantar fasciitis. Neurological changes, such as altered sensorimotor control and cortical reorganization, may contribute to the persistence of symptoms and the recurrence of the condition. Integrating neurorehabilitation techniques may enhance outcomes and reduce the risk of recurrence. Physiotherapy exercises such as ankle proprioceptive neuromuscular facilitation, foot doming exercises, balance exercises, towel curl exercises, and stretching exercises were given to check the impact of physiotherapy interventions on ankle muscle instability and dynamic balance following plantar fasciitis. Method An experimental investigation was carried out at the outpatient department of Acharya Vinoba Bhave Rural Hospital. A total of 71 participants were assigned arbitrarily, employing a straightforward random sampling procedure. Each participant received treatment for six weeks, with five weekly sessions. Result The results demonstrated significant findings. The pre- and post-test score results are as follows: visual analogue scale scores (t=1.619, p=0.0001), weight-bearing lunge test scores (t=24.36, p=0.0001*), and functional reach test scores (t=24.36, p=0.0001). Conclusion We conclude that physiotherapy exercises such as ankle proprioceptive neuromuscular facilitation (PNF), foot doming exercises, strengthening exercises, toe spreading exercises, towel curl exercises, and stretching exercises are effective in reducing pain and ascertaining dynamic balance in plantar fasciitis. The rehabilitation program significantly improved ankle biomechanical integrity and muscle strength, allowed functional recovery, and reduced pain. Future studies should focus on investigating the long-term effects of PNF therapies. For better patient outcomes, clinicians should consider incorporating ankle PNF exercises into their therapy regimens.
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NewsBot · Jul 16, 2025

Comparative effectiveness of static stretching and deep kneading massage in the management of plantar fasciitis: a randomized controlled trial
Syed Muhammad Ghalman Jaffri et al
Source

Objective: To compare the efficacy of static stretching and deep kneading massage in patients with plantar fasciitis in enhancing pain relief and functional outcomes.

Methods: This open-label randomized controlled trial was conducted involving 69 patients diagnosed with plantar fasciitis, aged 20–60 years. Participants were randomized into two groups: Control group received conservative treatment with static stretching, and experimental Group received conservative treatment with deep kneading massage. Stretching was administered in 3–5 repetitions of 45 seconds, while massage lasted 5–15 minutes, adjusted for tolerance and severity. Both groups received two sessions per week for two weeks. Outcome measures included the Visual Analog Scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM). Statistical analysis was performed using SPSS v21.

Results: Both interventions showed significant within-group improvements in pain and functional ability (p = .000). The static stretching group showed a mean VAS reduction of 5.80 (SD = 0.96) and FAAM improvement of 39.00 (SD = 8.88). The deep kneading massage group showed a VAS reduction of 4.91 (SD = 1.05) and FAAM improvement of 36.61 (SD = 6.67). Between-group comparisons indicated that deep kneading massage resulted in greater overall improvements.

Conclusion: Both static stretching and deep kneading massage are effective adjuncts in managing plantar fasciitis, with deep kneading massage showing superior pain relief and functional recovery. Further research with larger, more diverse populations is needed to confirm these findings and optimize treatment strategies.
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NewsBot · Jul 19, 2025

Long-Term Relief: Sustained Benefits and Strategies of PNF Techniques for
Plantar Fasciitis with Restricted Dorsiflexion: A Kinovea – Software Based GaitPlantar Fasciitis with Restricted Dorsiflexion: A Kinovea – Software Based Gait
Analysis
Source

Objective:Objective: This prospective longitudinal study aimed to investigate the long-term effectiveness and
maintenance strategies following proprioceptive neuromuscular facilitation (PNF) technique interventions
in individuals with plantar fasciitis and limited dorsiflexion which is one of the conditions affecting the
community. The primary objectives included quantitatively comparing pain levels, functional mobility, and
patient adherence to prescribed strategies over an extended follow-up period. Methods:Methods: A cohort of 120
participants with plantar fasciitis and limited dorsiflexion, previously treated with PNF interventions, were
enrolled in the study. Follow-up assessments were conducted at three-month intervals over a one-year
period. Pain levels were measured using a Visual Analog Scale (VAS), functional mobility was assessed
using the Foot and Ankle Ability Measure (FAAM), and patient-reported outcomes were recorded.
Qualitative insights into maintenance strategies were obtained through in-depth interviews, covering
aspects such as home exercise programs, lifestyle modifications, and adherence to recommendations.
Also Kinovea software was used for analysing the dorsiflexion of the foot during gait. Results:Results: Statistical
analysis revealed a statistically significant (p < 0.05) reduction in pain levels and improved functional
mobility over the study period. Recurrence rates were found lower than baseline, with only 15% of
recurrence. Logistic regression analysis identified factors contributing to sustained outcomes, including
consistent adherence to prescribed home exercises (p = 0.021) and proactive lifestyle modifications (p =
0.035). Conclusion:Conclusion: This study provides the sustained effectiveness of PNF technique in plantar fasciitis
individuals with limited dorsiflexion. The identified maintenance strategies, supported by statistically
significant findings, offer practical implications for clinicians and patients, enhancing long-term
maintenance strategies for outcomes in this specific patient population.
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NewsBot · Jun 14, 2026

Effect of Stretching Exercises on Pain and Function in Patients with Plantar Fasciitis
Abdelrhman Shafiq Alsayyed
The Egyptian Journal of Hospital Medicine (April 2026) Vol. 103, Page 2375-2379

Background: Plantar fasciitis (PF) results in significant functional disabilities, including discomfort and rigidity in the
feet. Patients with plantar fasciitis have significantly lower foot-specific and generic quality of life (QoL) than healthy
individuals.
Objective: To evaluate the effect of a structured stretching exercise program on pain intensity and functional
performance in patients with PF.
Patients and Methods: This quasi-experimental pre–post intervention study included 20 patients attending the
Physiotherapy Clinic in Khobar, Saudi Arabia and clinically diagnosed with PF. Participants completed a 4-week
structured stretching program focusing on the plantar fascia and the gastrocnemius–soleus complex, performed twice
daily. Pain intensity was assessed using the Visual Analog Scale (VAS), and functional disability was evaluated using
the Foot Function Index (FFI). Functional performance parameters included walking tolerance and duration of first-step
pain. Physical examination assessed ankle dorsiflexion range of motion (ROM) and calf muscle tightness.
Results: Significant improvements were observed after the intervention. Mean VAS pain scores decreased from 7.2 ±
1.1 to 3.1 ± 1.0 (p < 0.001), and FFI scores improved from 58.4 ± 9.6 to 32.7 ± 8.1 (p < 0.001). Walking tolerance
increased significantly, while first-step pain duration markedly decreased (p < 0.001). Ankle dorsiflexion ROM
improved and calf muscle tightness significantly decreased (p < 0.001). Clinical improvement was observed in the
majority of patients.
Conclusion: A structured stretching exercise program is an effective conservative intervention for reducing pain and
improving functional performance in patients with plantar fasciitis.
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NewsBot · Aug 29, 2026

Randomized controlled trials evaluating exercise interventions for plantar fasciopathy pain: a systematic review and meta-analysis
Irenilde F. Gonçalves et al
Musculoskeletal Science and Practice Volume 86, November 2026, 103644

Highlights

•
Exercise may make small benefits of uncertain relevance for plantar fasciitis pain.
•
Studies were susceptible to bias and the certainty of evidence was low.
•
Few studies comparing exercise with no treatment compromised the analysis.
•
Testing ways to improve the effect or obtaining more data can alter the result.
•
Future well-conducted randomized controlled studies are necessary on this topic.

Abstract
Background
Plantar fasciitis is characterized by mechanical degeneration of the plantar fascia with a possible tear at the calcaneal origin. Clinical findings are heel pain when taking the first step in the morning, local sensitivity and decreased functional capacity. Exercise, such as stretching and strength training are potential effective interventions for plantar fasciitis pain management.
Objectives
This systematic review aimed to assess the effectiveness of exercise on pain intensity (primary outcome) in patients with plantar fasciitis.
Method
We searched six databases (last updated October 10, 2025). Eligible were randomized controlled studies in adults diagnosed with plantar fasciitis, evaluating exercise interventions compared to a control group in which the subjects did not experience any type of exercise. Pain scores from unidimensional pain scales were extracted and the standard mean deviation (SMD) and 95% confidence interval (CI) were calculated. The risk of bias was assessed by Risk of Bias 2. The validation of quality and reporting of exercise training studies were assessed, and the certainty of evidence was rated using grading of recommendations assessment, development, and evaluation.
Results
Three studies met the inclusion criteria (n = 146). The risk of bias was moderate-to-high and the study quality and reporting in exercise showed moderate quality. There was an overall effect favoring the exercise interventions relative to no intervention on plantar fasciitis pain intensity reduction (SMD of −1.10, 95% CI: −2.01 to −0.19, 3 studies, n = 146 participants, I2 = 0.74, low certainty), indicating a benefit of uncertain relevance.
Conclusion
In conclusion, we found uncertain benefit of exercise interventions for plantar fasciitis pain intensity reduction, especially in short-term exercise protocols (≤3 months).
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NewsBot · Sep 4, 2026

Effectiveness of Windlass-Mechanism Based Exercises on Plantar Fasciitis and Intrinsic Foot Muscle Activation Among Teaching Professionals: A Randomized Controlled Trial.
Sasidharan, Shwetha; Dharmapalan, Biju
Journal of Chemical Health Risks, 2026, v. 16, n. 4, p. 152

Introduction: Teaching professionals are prone to plantar fasciitis (PF) due to prolonged occupational standing, which leads to chronic loading of the plantar fascia and subsequent degeneration. The Windlass mechanism, a critical biomechanical feature of the foot, provides a foundation for therapeutic interventions aimed at restoring arch stability and reducing pain. Objective: This study aimed to evaluate the comparative effectiveness of a 6-week Windlass- mechanism-based exercise program versus conventional stretching on pressure pain threshold (PPT) and abductor hallucis (AbdH) electromyographic (EMG) activity in teaching professionals with PF. Methods: A randomized controlled trial was conducted with 40 teaching professionals (aged 30-60 years) diagnosed with unilateral or bilateral PF. Participants were randomly assigned to either the Windlass Group (n=20), which performed plantar fascia-specific stretching and high- load heel raises, or the Control Group (n=20), which performed conventional calf and fascia stretching. Primary outcomes included PPT at the medial calcaneal tubercle measured via digital algometry and normalized AbdH EMG activity (%MVIC) during the toe-off phase of gait. Assessments were performed at baseline and after 6 weeks. Results Both groups showed significant improvements; however, the Windlass Group demonstrated superior outcomes. PPT increased by 1.44 ± 0.66 kg/cm² in the Windlass Group compared to 0.50 ± 0.75 kg/cm² in the Control Group (p < 0.001, Hedges' g = 1.30). AbdH EMG activation increased by 20.63 ± 11.73% in the Windlass Group versus 7.45 ± 13.88% in the Control Group (p = 0.002, Hedges' g = 1.01). Conclusion: A Windlass-mechanism-focused exercise protocol is more effective than conventional stretching in modulating mechanical pain sensitivity and enhancing intrinsic foot muscle recruitment in teachers with PF. These findings support the integration of high-load Windlass exercises into occupational rehabilitation programs.
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NewsBot · Sep 7, 2026

Effectiveness of Lower Limb Exercise in Chronic Heel Pain: A Critical Narrative Review of Stretching, Progressive Loading and Regional Strengthening
Aishwarya Gandhi et al
Asian Journal of Medicine and Health Year

Chronic heel pain is among the most frequent musculoskeletal complaints presenting to primary care, podiatry and physiotherapy services, and a substantial minority of those affected remain symptomatic for years. Exercise directed at the lower limb is recommended almost universally, yet the term covers interventions that differ in target tissue, contraction type, load magnitude, dose and degree of supervision. Whether those differences matter for clinical outcome remains contested. This critical narrative review examines the effectiveness of the principal categories of lower limb exercise used for chronic heel pain: tissue-specific plantar fascia stretching, calf stretching, progressive and heavy-slow resistance training, isometric loading, intrinsic foot muscle training and proximally directed strengthening. Literature was identified through structured searching of open scholarly indexes, supplemented by backward and forward citation searching and targeted author searching. Appraisal concentrated on case definition, dose reporting, outcome selection, interpretation against minimal important differences and the behaviour of comparison groups. Several patterns emerge from the synthesis. Tissue-specific plantar fascia stretching shows the most consistent short-term advantage over generic calf stretching, although the advantage attenuates and is no longer detectable at two years. High-load resistance training produced a large advantage at three months in one trial that was not sustained and has not been independently replicated; subsequent trials of standing heel-raise loading show improvement in all arms without between-group separation, and only a small minority of participants reach an acceptable symptom state. Isometric loading did not produce immediate analgesia in plantar fasciopathy, which contrasts with observations in tendinopathy of the knee. Evidence for intrinsic foot and hip-directed exercise remains preliminary. The dominant methodological constraints are inconsistent eligibility criteria, undocumented achieved dose, follow-up that is short relative to the natural history of the disorder, and substantial improvement within comparison arms. Confidence that any specific exercise formulation outperforms another is therefore low. Confidence that structured loading combined with education represents a defensible, low-cost first-line strategy is comparatively higher.
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NewsBot · Sep 13, 2026

Therapeutic efficacy of stretching exercises as a conservative treatment for plantar fasciitis: a systematic review with meta-analysis
Swapna Sugat Jawade , Sugat Ambadas Jawade
J Man Manip Ther. 2026 Sep 12:1-15.

Background: Plantar fasciitis (PF) is a prevalent source of plantar heel pain, and stretching is a recommended conservative treatment. However, comparative effectiveness of plantar fascia-specific stretching (PFSS), gastrocnemius-soleus (GS) stretching, and Achilles tendon stretching (ATS) remains uncertain because of heterogeneity in intervention protocols, comparator interventions, and outcome reporting across randomized controlled trials (RCTs).

Objective: To quantitatively synthesize the effectiveness of stretching-based interventions on clinical and structural outcomes in PF.

Methods: RCTs published from January 2010 to June 2025 were identified using Scopus, Web of Science, PubMed, and Google Scholar. Random-effects meta-analyses were performed for pain, foot function, pressure pain threshold (PPT), and plantar fascia thickness, whereas range of motion (ROM) was synthesized narratively. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used for pooled effects, while heterogeneity was assessed with I2. Predefined comparator-based subgroup analyses were undertaken. The Cochrane Risk of Bias 2 (ROB 2) tool evaluated risk of bias, while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework assessed certainty of evidence across all pooled outcomes.

Results: Twelve RCTs met inclusion criteria. Pain outcomes showed no statistically significant difference between stretching and comparator interventions overall (11 RCTs; SMD -0.54, 95% CI - 1.20 to 0.13; I2 = 92%) or foot function (7 RCTs; SMD 1.08, 95% CI - 0.25 to 2.40; I2 = 94%). Subgroup analyses showed no significant differences between comparator categories. Evidence for PPT and plantar fascia thickness remained uncertain, while ROM findings were inconsistent. ROB 2 assessment identified some concerns in eleven studies, and certainty of evidence was very low across all pooled outcomes.

Conclusion: Current evidence does not establish the superiority of stretching-based interventions across outcomes compared with alternative conservative interventions for PF. Further robust RCTs using standardized stretching protocols, clinically relevant comparators, and longer follow-up are required to strengthen the evidence base.
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scotfoot · Sep 19, 2026

What about stretching the foot transversely, that is, across the ball of the foot to improve the ability of the metatarsal heads to move relative to each other from heel off through push off.
The human foot in habitually unshod individuals is wider across the forefoot than in habitually shod people. In fact, during the covid period, when people stayed at home and wore constrictive shoes less, individuals found that their feet had broadened out and they had difficulty getting them back into their old, narrow shoes.

What if feet that are forced to become narrower in the metatarsal head region are mechanically deficient compared to a broader foot ? Is there a way of stretching the foot across the forefoot and can it help improve mechanics?

scotfoot · Sep 21, 2026

Below is an illustration from Venkandesen et al . It shows the medial transverse arch of the foot ,blue line ,and the bones of the foot including the metatarsals .

Imagine the met heads are tightly held together by a ligament so that adjacent heads are in contact. Since the met heads are advanced distally to varying degrees , when the heel lifts as it does through toe off, it can be visualized that eventually only the 2nd met head will be " in contact" with the substrate. However, if the met heads are connected by a ligament that allows the forefoot to be wider and also allows the met heads to move relative to each other , then the mechanics will alter and more closely resemble those seen in the video clip, below. Hence I would argue a narrow foot likely spreads load less evenly than a broader foot .

Increased load on the 2nd met head may caused more concentrated forces on the associated slip of the plantar fascia.

Transverse arch of the foot ( hand as analogy )

YouTube · Gerrard Farrell
1.1k+ views · 6 years ago

0:10
Tips of fingers represent met heads of foot and area under elastic band repr

Brian A. Rothbart · Sep 21, 2026

I agree that a broader foot has intrinsically more stability than a narrower foot. However, plantar fasciitis is just one, of many symptoms, associated with gravity-driven pronation. Stabilize/control the etiology of gravity-driven pronation and the symptoms automatically abate.

You can effectively attenuate the inflammation associated with plantar fasciitis by working with the intrinsic muscles, stretching and strengthening. But it does not address the underlying pathology. Thus symptoms will exacerbate, intermittently.

scotfoot · Sep 22, 2026

Brian A. Rothbart said: ↑

I agree that a broader foot has intrinsically more stability than a narrower foot. However, plantar fasciitis is just one, of many symptoms, associated with gravity-driven pronation. Stabilize/control the etiology of gravity-driven pronation and the symptoms automatically abate.

You can effectively attenuate the inflammation associated with plantar fasciitis by working with the intrinsic muscles, stretching and strengthening. But it does not address the underlying pathology. Thus symptoms will exacerbate, intermittently.
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I am not sure a "broader foot has intrinsically more stability than a narrow foot" and I am not talking here about pronation causing plantar fasciitis. Instead, I am focusing on relative movement of the met heads during gait and the effect this movement, or lack thereof ,might have on stress distribution within the plantar fascia.

Some time ago I proposed that the metatarsal parabola, acting in concert with the transverse metatarsal ligament ,produces an effect that stiffness the foot by amplifying and projecting the transverse arch of the foot into the forefoot area. Here is a link to a youtube clip of effect . The pencils are the metatarsals and the wire represents the ligament . Note how the ends of the pencils move relative to each other during "toe off " ( hand being lifted ) .

https://youtube.com/shorts/MPTYdPIit_4?si=tshhzhM2AXqbCJQY

NewsBot · Sep 23, 2026

Chronic plantar fasciitis: Effectiveness of stretching, ultrasound, and phonophoresis. A randomized clinical trial
Alma Yolanda Otero-Varela et
Source

Background: Plantar fasciitis (PF) is the main cause of heel pain. Conservative management is broad, but there is no consensus on the most effective adjuvant physical therapy.

Objective: To compare the clinical effectiveness of phonophoresis plus stretching, therapeutic ultrasound plus stretching, and isolated stretching in reducing pain in patients with chronic PF.

Material and methods: A randomized, single-blind clinical trial conducted in a rehabilitation unit. 60 patients with chronic PF were included, randomly assigned to 3 groups (n = 20 in each group): G1 (phonophoresis + stretching), G2 (ultrasound + stretching), and G3 (stretching only). Pain was assessed using the Visual Analog Scale (VAS) at baseline and after 15 sessions. Paired Student's t test was used for intragroup comparison, and ANOVA with Tukey's post-hoc test was used for intergroup comparison.

Results: All 60 participants (76.7% women) completed the study. All groups showed a statistically significant reduction in pain (p < 0.01). The mean VAS reduction was: G1 (4.9 points), G2 (4.3 points), and G3 (6.7 points). The G3 (stretching only) group achieved the lowest final VAS score (0.9 ± 0.5). The intergroup comparison showed a statistically significant difference (p < 0.05) favoring the G3 group over G1 and G2.

Conclusion: Isolated stretching demonstrated superior efficacy in pain reduction compared to the addition of ultrasound or phonophoresis in the treatment of chronic PF.
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Stretching or Strengthening for Plantar Fasciitis

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Foot and hip stretching and strengthening for plantar fasciitis

Effects of strengthening, stretching and functional training on foot function in patients with diabe

"New" stretching method for plantar fasciitis.

Can stretching the ball of the foot transversely improve mechanics ?

Foot sole stretching and foam rolling and shoulder range of motion

Cool-down stretching

Stretching Typology and Stretching Duration

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Stretching or Strengthening for Plantar Fasciitis

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Foot and hip stretching and strengthening for plantar fasciitis

Effects of strengthening, stretching and functional training on foot function in patients with diabe

"New" stretching method for plantar fasciitis.

Can stretching the ball of the foot transversely improve mechanics ?

Foot sole stretching and foam rolling and shoulder range of motion

Cool-down stretching

Stretching Typology and Stretching Duration

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