PainSci summary of Digiovanni 2006?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★☆☆☆2-star ratings are for studies with flaws, bias, and/or conflict of interest; published in lesser journals. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
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.
- “Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study,” Benedict F DiGiovanni, Deborah A Nawoczenski, Marc E Lintal, Elizabeth A Moore, Joseph C Murray, Gregory E Wilding, and Judith F Baumhauer, Journal of Bone & Joint Surgery, 2003.
- “Conservative treatment of plantar heel pain: long-term follow-up,” M Wolgin, C Cook, C Graham, and D Mauldin, Foot & Ankle International, 1994.
- “Plantar fasciitis: a prospective randomized clinical trial of the tension night splint,” ME Batt, JL Tanji, and N Skattum, Clinical Journal of Sports Medicine, 1996.
- “A retrospective study of standing gastrocnemius-soleus stretching versus night splinting in the treatment of plantar fasciitis,” LD Barry, AN Barry, and Y Chen, Journal of Foot & Ankle Surgery, 2002.
- “Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study,” M Powell, WR Post, J Keener, and S Wearden, Foot & Ankle International, 1998.
- “The influence of foot position on stretching of the plantar fascia,” Ryan M Flanigan, Deborah A Nawoczenski, Linlin Chen, Hulin Wu, and Benedict F DiGiovanni, Foot & Ankle International, 2007.
These two articles on PainScience.com cite Digiovanni 2006 as a source:
- PS Save Yourself from Plantar Fasciitis! — Plantar fasciitis explained in great detail, including every possible treatment option, and all supported by recent scientific research
- PS The Unstretchables — Eleven muscles you can’t actually stretch hard (but wish you could)
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.