Nov. 4, 2010 According to a new study from the Journal of Bone and Joint Surgery (JBJS), patients with acute plantar fasciitis who perform manual plantar fasciitis stretching exercises, as opposed to shockwave therapy, had superior results and higher patient satisfaction.
Study details and findings: A total of 102 patients who had acute plantar fasciitis pain, were randomly assigned to two groups. Acute is defined as any patient that experiences pain for less than six weeks. 54 people performed an eight-week stretching program, while 48 people received repetitive low-energy radial shock-wave therapy once a week for three weeks. Each group was asked to refrain from any other forms of physical therapy.
Patients in the stretching group, were told to perform stretching exercises three times a day, for eight weeks. All patients were contacted by phone every two weeks to check on training compliance. After four weeks, the patients were told to slowly return to their previous sport and/or recreational activity. Patients in group two received three sessions of radial shock-wave therapy, three times a week.
Patients were given follow-up evaluations at two, four and fifteen months. At both the two and fourth month evaluation, 65 percent of patients who performed the plantar fascia-specific stretch reported total satisfaction with treatment or satisfaction with treatment with minor reservations. Only 29 percent did so after shockwave therapy.
John Furia, MD, an orthopaedic surgeon in Pennsylvania and one of the study authors added that those who develop plantar fascia pain should begin non-operative treatment promptly. "The earlier you understand how stretching fits in, and the earlier you learn how frequently to perform the simple plantar stretch, the less likely you will require a more invasive treatment method," stated Dr. Furia. "Shockwave therapy has been shown to be a very effective treatment for patients with chronic plantar fasciitis (pain for more than six to eight weeks), however acute cases are probably best treated with more simple measures," he added.
How to do the stretch: According to the American Academy of Orthopaedic Surgeons (AAOS), this stretch should be performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and bring your ankle up and your toes up. Place your thumb along the plantar fascia and rub it to stretch it. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 10-20 times for each foot. Dr. Furia and Dr. Judy Baumhauer, orthopaedic surgeon and president-elect of the American Orthopaedic Foot and Ankle Society (AOFAS) recommend that this exercise be performed initially in the morning, before getting out of bed and after any long periods of sitting. If there is a sharp pain in your heel when getting up, a stretch should have been done before standing or walking. Dr. Baumhauer gives her patients a visual as a reference for this exercise.
Dr. Baumhauer, who was not involved in this study, has been counseling patients on the plantar fascia stretch for 15 years. "I am a firm believer in this type of stretch and nearly 80 percent of my patients have shown improvement in just eight weeks of stretching therapy."
- Plantar fasciitis is the most common cause of pain on the bottom of the heel, and approximately two million patients are treated for plantar fasciitis each year.
- More than 80 percent of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.
- Dr. Furia suggests that approximately 20 percent of patients with plantar fasciitis develop a chronic condition.
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- J. D. Rompe, A. Cacchio, L. Weil, J. P. Furia, J. Haist, V. Reiners, C. Schmitz, N. Maffulli. Plantar Fascia-Specific Stretching Versus Radial Shock-Wave Therapy as Initial Treatment of Plantar Fasciopathy. The Journal of Bone and Joint Surgery, 2010; 92 (15): 2514 DOI: 10.2106/JBJS.I.01651
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