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Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis: A Prospective Clinical Trial with Two-Year Follow-Up

Digiovanni, Benedict F., MD1; Nawoczenski, Deborah A., PhD, PT2; Malay, Daniel P., MSPT3; Graci, Petra A., DPT4; Williams, Taryn T., MSPT5; Wilding, Gregory E., PhD6; Baumhauer, Judith F., MD1

doi: 10.2106/JBJS.E.01281
Scientific Articles
Supplementary Content

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.

1 Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY 14620. E-mail address for B.F. DiGiovanni: E-mail address for J.F. Baumhauer:

2 Department of Physical Therapy, Ithaca College, University of Rochester Campus, 300 East River Road, Rochester, NY 14623. E-mail address:

3 Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, University Hospital, 750 East Adams Street, Syracuse, NY 13210. E-mail address:

4 Physical Medicine and Rehabilitation, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140. E-mail address:

5 Physical Therapy Department, Saint Joseph Regional Medical Center, 415 6th Street, P.O. Box 816, Lewiston, ID 83501. E-mail address:

6 Department of Biostatistics, University at Buffalo, State University of New York, 3435 Main Street, Building 26, Buffalo, NY 14214. E-mail address:

Copyright © 2006 by The Journal of Bone and Joint Surgery, Incorporated
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