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Stretching works. But it depends on how you do it.

Posted by Jan R. on 11/12/04 at 04:42 (163672)

Funny but I suffered symptoms of plantar fasciitis myself. Wait-and-see didn´t help too much. After 3 months (definitely too early for ESWT !!!) I ran over the following article. After changing my stretching program accordingly it took only 3 weeks until a 90% improvement. And I continue with the exercises to prevent recurrence:

Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study.

J Bone Joint Surg Am. 2003 Jul;85-A:1270-1277.

DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF.

Department of Physical Therapy, Ithaca College, University of Rochester Campus, New York 14623, USA. (email removed)

BACKGROUND: Approximately 10% of patients with plantar fasciitis have development of persistent and often disabling symptoms. A poor response to treatment may be due, in part, to inappropriate and nonspecific stretching techniques. We hypothesized that patients with chronic plantar fasciitis who are managed with the structure-specific plantar fascia-stretching program for eight weeks have a better functional outcome than do patients managed with a standard Achilles tendon-stretching protocol. METHODS: One hundred and one patients who had chronic proximal plantar fasciitis for a duration of at least ten months were randomized into one of two treatment groups. The mean age was forty-six years. All patients received prefabricated soft insoles and a three-week course of celecoxib, and they also viewed an educational video on plantar fasciitis. The patients received instructions for either a plantar fascia tissue-stretching program (Group A) or an Achilles tendon-stretching program (Group B). All patients completed the pain subscale of the Foot Function Index and a subject-relevant outcome survey that incorporated generic and condition-specific outcome measures related to pain, function, and satisfaction with treatment outcome. The patients were reevaluated after eight weeks. RESULTS: Eighty-two patients returned for follow-up evaluation. With the exception of the duration of symptoms (p < 0.01), covariates for baseline measures revealed no significant differences between the groups. The pain subscale scores of the Foot Function Index showed significantly better results for the patients managed with the plantar fascia-stretching program with respect to item 1 (worst pain; p = 0.02) and item 2 (first steps in the morning; p = 0.006). Analysis of the response rates to the outcome measures also revealed significant differences with respect to pain, activity limitations, and patient satisfaction, with greater improvement seen in the group managed with the plantar fascia-stretching program. CONCLUSIONS: A program of non-weight-bearing stretching exercises specific to the plantar fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of proximal plantar fasciitis. These findings provide an alternative option to the present standard of care in the nonoperative treatment of patients with chronic, disabling plantar heel pain.

Re: Stretching works. But it depends on how you do it.

Julie on 11/12/04 at 06:31 (163677)

Thank you for this, Dr Rompe. Having conducted a one-person anti-weight-bearing-achilles-stretching campaign here for the past four years, I'm heartened to see the abstract of this study. I hope the word gets out to all the podiatrists, and others, who continue to counsel the standard stretching programme.

Might you be able to (1) give us a link to the full study (assuming it is available to lay people) and (2) briefly describe the exercises that have helped you?

Thanks again.
.

Re: Stretching works. But it depends on how you do it.

Dr. Z on 11/12/04 at 07:34 (163681)

Dr. Rompe, Julie,

The is the original article that I first learned of the plantar fascia stretch I just described. I am not sure if they ever describe the actual stretch but I have only read the abstract.

Re: Stretching works. But it depends on how you do it.

Jan R. on 11/12/04 at 08:27 (163683)

Please mail me your e-mail address to: (email removed)

I will then mail you a PDF of the article.

Best wishes

Re: Stretching works. But it depends on how you do it.

Lynn F. on 11/12/04 at 11:10 (163710)

Dr. R, Julie, Dr. Z - Is this the same PF stretch previously posted here? If there are additional PF exercises that can help, I hope they will be made available here as well.

Dr. Z - I am doing all of your recommendations, hot contrast baths, moist heat wrap, and PF stretches religiously. It's amazing how beneficial having the right information can be.

Thanks to all for sharing your knowledge & experience!

Re: Stretching works. But it depends on how you do it.

Julie on 11/12/04 at 11:14 (163711)

Lynn, Dr Rompe has sent me a pdf of the article, which includes detailed instructions for the exercise. Yes, it is the same exercise that Dr Z has mentioned and posted. I am going to write it up and ask Scott to append it to the post that describes the yoga foot exercises, to which there exists a well-used link. It will then be available and accessible to all who want to use it.
.

Re: Stretching works. But it depends on how you do it.

Lynn F. on 11/12/04 at 12:09 (163721)

Thanks Julie. I'm also doing the yoga exercies you posted. I really like the fact that they are gentle yet seem highly effective. Thanks again!

Re: Stretching works. But it depends on how you do it.

Dr. Z on 11/12/04 at 21:52 (163775)

Julie,
Is there any different then my description. Would you send me a copy
thanks

Re: Stretching works. But it depends on how you do it.

Julie on 11/13/04 at 03:21 (163798)

Dr Z

Sure, but I can't find your email address. Can you post it again, please?
.

Re: Stretching works. But it depends on how you do it.

Dr. Z on 11/13/04 at 17:33 (163861)

(email removed)