Effect of Selected Rehabilitation Program in Patients With Plantar Fasciitis

Effect of Selected Rehabilitation Program on Pain, Function, and Plantar Fascia Thickness in Patients With Plantar Fasciitis

This study will be done to investigate the effect of the selected rehabilitation program for PF on plantar fascia thickness, clinical outcomes such as pain, foot function, dorsiflexion ROM and pressure pain threshold and alignment such as rearfoot eversion angle and foot posture index in patients with PF.

Study Overview

• Status: Completed
• Conditions: Plantar Fascitis; Heel Pain Syndrome; Plantar Fasciitis, Chronic
• Intervention / Treatment: Other: stretching exercises; Other: rigid tape; Other: mobilization; Other: strengthening exercise; Device: ultrasound; Other: myofascial release

Detailed Description

Plantar fasciitis (PF), which constitutes approximately 15% of all foot disorders, is the most prevalent cause of heel pain. It is a long-term degenerative process that is impacted by subtalar pronation and pes planus. One million US patients saw primary care physicians with PF between 1995 and 2000. There is not enough data to determine the best physical therapy management techniques for individuals with heel pain, despite the existence of multiple successful treatment approaches. this study investigated at how a mechanically based rehabilitation program affected patients with PF in terms of foot alignment, plantar fascia thickness, pain, pressure pain threshold, ROM and foot function. The approach included strengthening the plantar intrinsic muscles of the foot, plantar fascia specific stretching and Achilles tendon stretching, and passively correcting the pathomechanics of the foot by low dye tapping and high load resistance exercise for Achilles tendon and windlass mechanism

• Study Type: Interventional
• Enrollment (Actual): 48
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Damietta, Egypt, 34518
    • Outpatient clinic, Faculty of Physical Therapy, Horus University, Egypt
  • Damietta, Egypt
    • out-patient clinic, faculty of physical therapy, Horus university

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Plantar medial heel pain: most noticeable with initial steps after a period of inactivity, but also worse following prolonged weight-bearing
• Pain with palpation of the proximal insertion of the plantar fascia
• Positive windlass test
• flat foot posture utilizing the foot posture index
• age range from 40 to 60 years

Exclusion Criteria:

• tarsal tunnel syndrome
• atrophy of the fat pad.
• diabetic patients or patients with rheumatoid arthritis
• corticosteroid injection over the last sex months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: selected rehabilitation program; involves 24 patients and will be given the selected rehabilitation program involving (self-stretching exercise, mobilization of the ankle and subtalar, rigid tape and unilateral heel raising exercise 3 times per week for 8 weeks.	Other: stretching exercises; stretching exercises of the plantar fascia, gastrocnemius and soleus; Other: rigid tape; low-dye tapping will be done to provide mechanical correction to plantar fascia and medial longitudinal arch; Other: mobilization; mobilization techniques for the talocrural joint in weight bearing and non-bearing positions and subtalar joint; Other: strengthening exercise; strengthening exercise of the plantar intrinsic muscles using short foot exercise and strengthening of the Achilles tendon and windlass mechanism using unilateral heel raise exercises
Experimental: traditional program; involves 24 patients and will be given the traditional program involving (self-stretching exercise, mobilization of the ankle and subtalar, plantar fascial release and ultrasonic therapy 3 times per week for 8 weeks.	Other: stretching exercises; stretching exercises of the plantar fascia, gastrocnemius and soleus; Other: mobilization; mobilization techniques for the talocrural joint in weight bearing and non-bearing positions and subtalar joint; Device: ultrasound; therapeutic ultrasound upon the most painful point on the medial calcaneal tubercle. The parameters involved a pulsed mode (duty cycle 50%) using an intensity of 1.5 W/cm2 and a 1 MHz of frequency for 5 minutes; Other: myofascial release; deep tissue release of the plantar fascia and flexor hallucis longus in a stretched position of the plantar fascia

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessing the change in pain intensity	VAS is typically composed of a 100 mm horizontal line attached to two opposed labels, the left end marked "no pain" and the right end marked "worst possible pain. Patients were marked a score on the scale by a vertical line that exactly refer to their pain	At baseline and following 8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessing the change in foot posture	using the foot posture index. It is a clinical measure of foot posture, either supinated or pronated, using 6 items for assessment of foot and scoring of each item from -2 to +2	At baseline and following 8 weeks
Assessing the change in foot function	The Arabic version of the foot function index (FFI) is a widely used self-reporting measure used to assess the impact of foot pathology on pain, disability, and activity limitation. It is a reliable and sensitive outcome measure for patients with foot and ankle disorders. The FFI's subscale scores range from 0% to 100%, with higher scores indicating lower function and a poorer quality of life.	At baseline and following 8 weeks
Assessing the change in plantar fascia thickness	using the ultrasound, participants were positioned in a prone position with relaxed arms and legs, and measurements were taken with the ankle joint in neutral or slightly dorsi-flexion. Electro-conductive gel was applied to the US transducer and plantar surface of foot before imaging. The transducer was placed longitudinally on the calcaneus surface to obtain a clear image of the plantar fascia.	At baseline and following 8 weeks
Assessing the change in rear foot angle	using kinovea motion analysis software, the rearfoot (calcaneus) angle is measured as the angle between the bisection of the lower one-third of the leg and the bisection of the calcaneus. The MLA is classified as: normal arch 2-8°, low arch ≥ 8.1° and high arch ≤ 1.9.	At baseline and following 8 weeks
Assessing the change in range of motion	The bubble inclinometer is used to measure the angle of the tibia relative to the floor during active ankle dorsiflexion, while the patient lunges forward with their heel on the ground and knee in line with the second toe.	At baseline and following 8 weeks
Assessing the change in pressure pain threshold	the pressure algometer is utilized to measure the pressure pain threshold (PPT), The patient lay supine, in a relaxed position, with his feet hanging over the edge of the bed with no pressure on the heel. PPT is measured by laying the patient supine with feet hanging over the bed, without pressure on the heel. PPT is determined by applying pressure to the skin until the patient experiences pain.	At baseline and following 8 weeks

Collaborators and Investigators

• Sponsor: Horus University
• Investigators: Principal Investigator: Mohamed Ramadan Ibraheem, Assistant lecturer, Horus University

Study record dates

Study Major Dates

• Study Start (Actual): June 15, 2024
• Primary Completion (Actual): March 15, 2025
• Study Completion (Actual): April 15, 2025

Study Registration Dates

• First Submitted: June 8, 2024
• First Submitted That Met QC Criteria: June 8, 2024
• First Posted (Actual): June 13, 2024

Study Record Updates

• Last Update Posted (Actual): July 22, 2025
• Last Update Submitted That Met QC Criteria: July 19, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Foot Diseases; Fasciitis; Fasciitis, Plantar
• Other Study ID Numbers: Mohamed PHD

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No