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Outcomes of the Proprioception and Strengthening Exercise Program in Chronic Plantar Fasciitis

2026年8月19日 更新者：Sule Kosar、Karamanoğlu Mehmetbey University
Plantar fasciitis is a common cause of heel pain, and although stretching exercises are a standard first-line treatment, current evidence on adding proprioception or knee-strengthening exercises remains limited. This study investigates whether adding knee strengthening or proprioception exercises to a standard stretching program improves pain, function, and disability in patients with chronic plantar fasciitis, and whether these interventions produce measurable changes in the biomechanical and kinesiological properties of the foot, ankle, and knee.

調査の概要

状態

募集

条件

介入・治療

詳細な説明

Plantar fasciitis is a degenerative condition of the plantar fascia and one of the most common musculoskeletal disorders affecting the foot, with an estimated prevalence of approximately 10% in the general population. It is diagnosed clinically based on history and physical examination, typically presenting as sharp heel pain during the first steps in the morning or after rest, tenderness on palpation of the medial calcaneal tuberosity, and a positive Windlass test. Risk factors include reduced ankle and first metatarsophalangeal joint range of motion, obesity, prolonged weight-bearing, and inappropriate footwear.

Stretching of the plantar fascia and gastrocnemius-soleus complex is a well-established, evidence-based treatment for plantar fasciitis. However, the underlying mechanism of the condition cannot be fully explained by tissue shortening and mechanical loading alone; impaired neuromuscular control and balance also appear to play a contributory role. Prior research has found that adding hip- and ankle-directed strengthening exercises to a stretching program provides no additional benefit over stretching alone in patients with plantar fasciitis, while other studies have reported reduced hamstring and quadriceps muscle strength in this population. Individuals with plantar fasciitis have also been shown to exhibit impaired postural balance and an increased risk of falls. While proprioception exercises have demonstrated benefit in the rehabilitation of ankle injuries, their effectiveness has not yet been established in plantar fasciitis. Given these gaps, this study aims to evaluate whether knee-strengthening and proprioception exercises, when added to a standard stretching program, provide additional benefit in reducing pain and disability and improving the biomechanical and kinesiological properties of the foot, ankle, and knee in patients with plantar fasciitis.

研究の種類

介入

入学 (推定)

105

段階

  • 適用できない

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

研究連絡先のバックアップ

研究場所

  • トルコ（Türkiye）
    • Karaman
      • Karaman、Karaman、トルコ（Türkiye）、70100
        • 募集
        • Karaman Training and Research Hospital
        • コンタクト：
        • コンタクト：
        • 主任研究者：
          • Aynur Basaran, MD, Prof.
        • 副調査官：
          • Ummahani Kus, MSc, PT

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

  • 大人
  • 高齢者

健康ボランティアの受け入れ

いいえ

説明

Inclusion Criteria:

  • Age between 18 and 65 years.
  • Formal diagnosis of plantar fasciitis, characterized by sharp pain during the first steps in the morning, pain that increases with prolonged activity, localized tenderness on palpation of the medial calcaneal tubercle or proximal fascia, and a positive Windlass test.
  • Symptom duration of at least 3 months.
  • Heel pain intensity score of Visual Analog Scale (VAS) > 3.
  • Voluntary agreement to participate, evidenced by signing the written informed consent form.

Exclusion Criteria:

  • History of acute lower-extremity trauma.
  • History of prior foot or ankle surgery.
  • Corticosteroid injection to the affected heel within the preceding 6 months.
  • Presence of systemic inflammatory or rheumatologic disease.
  • Uncontrolled systemic disease (e.g., uncontrolled hypertension, uncontrolled diabetes mellitus).
  • Current or past history of malignancy.
  • Current pregnancy.
  • Body mass index (BMI) ≥ 30 kg/m².
  • Any musculoskeletal, neuromuscular, ocular, or vestibular disorder that could impair balance or limit the ability to stand unsupported.
  • Neurocognitive or psychiatric conditions precluding adherence to the exercise protocols or outcome assessments.

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：独身

武器と介入

参加者グループ / アーム
介入・治療
アクティブコンパレータ：Stretching Only
This group will perform plantar fascia-gastrocnemius-soleus stretching exercises alone (twice daily, 7 days per week, for 6 weeks).
他の：Stretching
Participants will perform standardized plantar fascia and gastrocnemius-soleus stretching exercises. The protocol consists of stretching twice daily, 7 days per week, for 6 weeks.
実験的：Stretching and Proprioception
In addition to the standard stretching program, this group will receive supervised proprioception exercises three times per week for 6 weeks.
他の：Proprioception and Stretching Exercises
In addition to the standard stretching protocol, participants in this group will perform a supervised, 6-week progressive proprioception exercise program administered by a physiotherapist three times per week. Exercises will be performed under both eyes-open and eyes-closed conditions on progressively less stable surfaces with task difficulty advanced on a weekly basis.
実験的：Stretching and Knee Strengthening
In addition to the standard stretching program, this group will receive supervised knee strengthening exercises three times per week for 6 weeks.
他の：Knee Strengthening and Stretching Exercises
In addition to the standard stretching protocol, participants in this group will perform a supervised, 6-week progressive knee-strengthening program administered by a physiotherapist three times per week.

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Pain Intensity (First-Step Morning, Evening, and Overall Daily Pain)
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Pain intensity during the first steps in the morning, before going to bed, and overall daily pain will be assessed using the Visual Analog Scale (VAS). The scale consists of a 10-cm horizontal line ranging from 0 (no pain) to 10 (worst imaginable pain), on which participants mark the point corresponding to their perceived pain level.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Pressure Pain Threshold (PPT)
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
PPT will be assessed using a Baseline® 12-1442 dolorimeter (22-lb sensitivity range; Fabrication Enterprises Inc., USA) to evaluate deep-tissue mechanical sensitivity. With the participant positioned prone and the feet hanging off the table, gradually increasing pressure will be applied to the midpoint of the plantar fascia insertion at the calcaneus. The pressure at which the participant first perceives pain will be recorded. Three measurements will be taken at 30-second intervals, and the mean value will be used for analysis.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Foot Function and Health Status (Revised Foot Function Index, FFI-R)
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
The FFI-R is a self-reported, multidimensional questionnaire comprising 68 items across four subscales: pain and stiffness, social and emotional consequences, dysfunction, and activity limitation. Each item is scored from 1 to 4, with higher scores indicating poorer foot health and greater functional limitation.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Foot and Ankle Function (Foot and Ankle Outcome Score, FAOS)
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
The FAOS is a 42-item self-reported questionnaire assessing five subscales: pain, other symptoms, activities of daily living, sports and recreation, and foot-and-ankle-related quality of life. Each item is scored from 0 to 4.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).

二次結果の測定

結果測定
メジャーの説明
時間枠
Myofascial Tissue Biomechanical Properties
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
The biomechanical and viscoelastic properties of the plantar fascia, Achilles tendon, gastrocnemius medialis, soleus, biceps femoris, semitendinosus, tibialis anterior, vastus lateralis, vastus medialis, and rectus femoris will be assessed non-invasively using the MyotonPRO device (Myoton AS, Tallinn, Estonia). The device will be positioned perpendicular to the anatomical landmark of each muscle; upon delivery of a mechanical impulse, it automatically calculates muscle tone (Hz), stiffness (N/m), and elasticity (logarithmic decrement). The mean of three consecutive measurements will be recorded.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Plantar Fascia Ultrasonographic Parameters
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Musculoskeletal ultrasonography (GE Logiq® P5 system; GE Healthcare, USA) will be used to evaluate structural changes. Plantar fascia thickness will be measured longitudinally at 0.5 cm, 1 cm, and 3 cm distal to the calcaneal insertion. Qualitative parameters, including tissue echogenicity, perifascial fluid accumulation, and calcifications, will also be recorded.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Ankle Dorsiflexion Range of Motion (ROM)
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Weight-bearing ankle dorsiflexion ROM will be measured in degrees using a Baseline® 12-1057 digital inclinometer (0.1° resolution; Fabrication Enterprises Inc., USA), positioned parallel to the long axis of the tibia over the tibial tuberosity during a weight-bearing lunge test. The mean of three measurements will be recorded.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
First Metatarsophalangeal (MTP) Joint Range of Motion
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Maximum active dorsiflexion and flexion angles of the first MTP joint will be measured in degrees using a finger goniometer with the participant in a supine position. The mean of three measurements will be recorded.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Joint Position Sense (JPS) (Ankle-Knee and Hip)
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Proprioceptive accuracy will be assessed at the ankle, knee, and hip joints via active joint position reproduction testing using a Baseline® 12-1057 digital inclinometer. For the ankle, participants will actively reproduce target dorsiflexion/plantarflexion angles. For the knee, participants will actively reproduce a target angle starting from 90° of flexion, with the inclinometer fixed to the middle third of the leg. For the hip, participants will actively reproduce target angles for flexion (assessed in supine position) and abduction (assessed in side-lying position), with the inclinometer fixed to the lateral aspect of the thigh. For each joint, the absolute error angle (the difference between the target angle and the actively reproduced angle) will be recorded across three trials, and the mean absolute error angle will be calculated as the outcome value. Lower values indicate better proprioceptive accuracy.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Isometric Muscle Strength of the Lower Extremity
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Isometric muscle strength for ankle (dorsiflexion, plantarflexion) and knee (extension, flexion) movements will be measured using a Lafayette® Hand-Held Dynamometer (Model 01165; Lafayette Instrument Company, USA), with standardized testing positions and stabilization protocols. Peak force will be recorded in Newtons (N) as the mean of three maximal isometric contractions.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Static Balance
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Static postural control will be assessed using the Single-Leg Stance Test (SLST) under eyes-open and eyes-closed conditions. The duration (in seconds) for which the participant maintains single-leg balance without touching the ground or the supporting leg will be recorded. Mean durations of three trials will be analyzed.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Dynamic Balance
時間枠：Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).
Dynamic balance and lower-extremity postural control will be evaluated using the Y-Balance Test (YBT). Maximum reach distances in the anterior, posteromedial, and posterolateral directions will be measured in centimeters and normalized to lower-limb length (LL). The composite score (%) will be calculated as: [(Anterior + Posteromedial + Posterolateral) / (3 × LL)] × 100.
Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Karamanoğlu Mehmetbey University

捜査官

  • 主任研究者：Aynur Basaran, MD, Prof.、Karamanoğlu Mehmetbey University

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (実際)

2026年8月1日

一次修了 (推定)

2026年12月31日

研究の完了 (推定)

2026年12月31日

試験登録日

最初に提出

2026年8月4日

QC基準を満たした最初の提出物

2026年8月4日

最初の投稿 (実際)

2026年8月10日

学習記録の更新

投稿された最後の更新 (実際)

2026年8月20日

QC基準を満たした最後の更新が送信されました

2026年8月19日

最終確認日

2026年8月1日

詳しくは

本研究に関する用語

キーワード

追加の関連 MeSH 用語

その他の研究ID番号

  • 05-2026/01

医薬品およびデバイス情報、研究文書

米国FDA規制医薬品の研究

いいえ

米国FDA規制機器製品の研究

いいえ

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