Background: In a previous investigation, eighty-two patients with
chronic proximal plantar fasciitis for a duration of more than ten months
completed a randomized, prospective clinical trial. The patients received
instructions for either a plantar fascia-stretching protocol or an Achilles
tendon-stretching protocol and were evaluated after eight weeks. Substantial
differences were noted in favor of the group managed with the plantar
fascia-stretching program. The goal of this two-year follow-up study was to
evaluate the long-term outcomes of the plantar fascia-stretching protocol in
patients with chronic plantar fasciitis.
Methods: Phase one of the clinical trial concluded at eight weeks.
At the eight-week follow-up evaluation, all patients were instructed in the
plantar fascia-stretching protocol. At the two-year follow-up evaluation, a
questionnaire consisting of the pain subscale of the Foot Function Index and
an outcome survey related to pain, function, and satisfaction with treatment
was mailed to the eighty-two subjects who had completed the initial clinical
trial. Data were analyzed with use of a mixed-model analysis of covariance for
each outcome of interest.
Results: Complete data sets were obtained from sixty-six patients.
The two-year follow-up results showed marked improvement for all patients
after implementation of the plantar fascia-stretching exercises, with an
especially high rate of improvement for those in the original group treated
with the Achilles tendon-stretching program. In contrast to the eight-week
results, the two-year results showed no significant differences between the
groups with regard to the worst pain or pain with first steps in the morning.
Descriptive analysis of the data showed that 92% (sixty-one) of the sixty-six
patients reported total satisfaction or satisfaction with minor reservations.
Fifty-one patients (77%) reported no limitation in recreational activities,
and sixty-two (94%) reported a decrease in pain. Only sixteen of the sixty-six
patients reported the need to seek treatment by a clinician.
Conclusions: This study supports the use of the tissue-specific
plantar fascia-stretching protocol as the key component of treatment for
chronic plantar fasciitis. Long-term benefits of the stretch include a marked
decrease in pain and functional limitations and a high rate of satisfaction.
This approach can provide the health-care practitioner with an effective,
inexpensive, and straightforward treatment protocol.
Level of Evidence: Therapeutic Level II. See Instructions
to Authors for a complete description of levels of evidence.