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Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial

PainSci » bibliography » Radford et al 2007
Tags: stretch, plantar fasciitis, exercise, self-treatment, treatment, muscle, foot, leg, limbs, pain problems, overuse injury, injury, tendinosis

Two articles on PainSci cite Radford 2007: 1. Quite a Stretch2. Complete Guide to Plantar Fasciitis

PainSci commentary on Radford 2007: ?This page is one of thousands in the 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 wherever possible.

This trial of stretching for plantar fasciitis made an effort to blind the participants. That is, the 92 study subjects didn’t know what treatment was being tested, reducing the likelihood of bias in reporting on the results. This was achieved by adding sham ultrasound to both the treatment and control groups, a good strategy. After two weeks, unfortunately there was no difference between the groups: “a two-week stretching program provides no statistically significant benefit in ‘first-step’ pain, foot pain, foot function or general foot health compared to not stretching.”

It could have been a larger, longer study, sure, but 92 feet is quite a decent sample size for studies of this kind of thing. And although stretching benefits might ramp up over time, that’s probably wishful thinking, and you’d certainly hope to see clearer signs of progress after two weeks of diligent stretching.

~ Paul Ingraham

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: Plantar heel pain is one of the most common musculoskeletal disorders of the foot and ankle. Treatment of the condition is usually conservative, however the effectiveness of many treatments frequently used in clinical practice, including stretching, has not been established. We performed a participant-blinded randomised trial to assess the effectiveness of calf muscle stretching, a commonly used short-term treatment for plantar heel pain.

METHODS: Ninety-two participants with plantar heel pain were recruited from the general public between April and June 2005. Participants were randomly allocated to an intervention group that were prescribed calf muscle stretches and sham ultrasound (n = 46) or a control group who received sham ultrasound alone (n = 46). The intervention period was two weeks. No participants were lost to follow-up. Primary outcome measures were ‘first-step’ pain (measured on a 100 mm Visual Analogue Scale) and the Foot Health Status Questionnaire domains of foot pain, foot function and general foot health.

RESULTS: Both treatment groups improved over the two week period of follow-up but there were no statistically significant differences in improvement between groups for any of the measured outcomes. For example, the mean improvement for ‘first-step’ pain (0-100 mm) was -19.8 mm in the stretching group and -13.2 mm in the control group (adjusted mean difference between groups -7.9 mm; 95% CI -18.3 to 2.6). For foot function (0-100 scale), the stretching group improved 16.2 points and the control group improved 8.3 points (adjusted mean difference between groups 7.3; 95% CI -0.1 to 14.8). Ten participants in the stretching group experienced an adverse event, however most events were mild to moderate and short-lived.

CONCLUSION: When used for the short-term treatment of plantar heel pain, a two-week stretching program provides no statistically significant benefit in ‘first-step’ pain, foot pain, foot function or general foot health compared to not stretching.

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