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Arch stretching beats calf stretching for plantar fasciitis, slightly, short-term

PainSci » bibliography » Digiovanni et al 2006
Tags: treatment, stretch, plantar fasciitis, running, foot, exercise, self-treatment, muscle, leg, limbs, pain problems, overuse injury, injury, tendinosis

Two articles on PainSci cite Digiovanni 2006: 1. Complete Guide to Plantar Fasciitis2. The Unstretchables

PainSci notes on Digiovanni 2006:

This is a two-year follow-up on a previous study (DiGiovanni 2003). The original was inspired by the idea that chronic plantar fasciitis may respond better to stretching only the arch of the foot, and not just the calf (a very common treatment recommendation). Eighty-two middle-aged patients with chronic plantar fasciitis spent eight weeks doing one kind of stretching or the other, and were then re-evaluated, and the arch-stretchers had modestly better results: their worst pain wasn’t as bad, and the pain of morning steps wasn’t as bad. It was technically a good result, but not a dramatic one.

Two years later, for this paper, those patients were sent a follow-up questionnaire, and 66 responded. The original differences between the two kinds of stretching were lost over time, and no other significant differences emerged.

Based on these results, the authors seem to enthusiastically endorse a tissue-specific plantar fascia-stretching protocol, and that optimism has been echoed by many scientific papers ever since. But my conclusion is different: I don’t think this data shows any important difference! The original short-term results were minor, and the long-term results were nonexistent. Faced with the lack of difference over the long term, the authors emphasized the generally positive results for both groups … but that can’t support the hypothesis that arch-stretching beats calf-stretching, and without a control group we can’t know if any kind of stretching beats nothing — not from this research, anyway.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: In a previous investigation [DiGiovanni 2003], 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.

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