Manual stretching program may be an effective initial treatment for plantar fasciopathy

Rompe JD. J Bone Joint Surg. 2010;92:2514-2522. doi:10.2106/JBJS.I.01651.

For managing the acute symptoms of proximal plantar fasciopathy, investigators found that manual stretching exercises were better than repetitive low-energy radial shock wave therapy.

Jan D. Rompe, MD, from the OrthoTrauma Evaluation Center in Mainz, Germany, and colleagues randomized 102 patients with acute unilateral plantar fasciopathy into two groups. Fifty-four patients performed an 8-week plantar fascia-specific stretching program; the remaining 48 received repetitive low-energy radial shock wave therapy once a week for 3 weeks.

All patients completed the 7-item pain subscale of the Foot Function Index and a patient-relevant outcome questionnaire. The investigators assessed the patients at baseline and at 2, 4 and 15 months after baseline. For the primary outcome measures, they chose the following: the mean change in the Foot Function Index sum score at 2 months after baseline; the mean change in item two on the Foot Function Index — pain during the first few steps of walking in the morning — and satisfaction with treatment.

At baseline, both groups were similar in terms of mean age, sex, weight and symptom duration. Patients treated with plantar fascia-specific stretching had significantly greater changes in their Foot Function Index sum scores 2 months after baseline compared with patients treated with shock-wave energy. The stretching group also had significant individual changes. Thirty-five patients (65%) in the stretching group were satisfied with treatment compared with 14 (29%) in the shock wave therapy group. These results were maintained at 4 months. Fifteen months after baseline, there were no significant between-group differences.