Plantar fasciitis, affecting many athletes and active individuals, can be challenging to manage. New research in 2024 highlights effective treatments and downplays those with limited benefits. Here are five key pillars of evidence-based treatment for plantar fasciitis, including a look at joint mobilization and manipulation.
1. Stretching and Strengthening: The Core of Treatment (1)
Evidence-Based Approaches:
• Stretching: Studies support stretching the plantar fascia and calf muscles to reduce pain and improve mobility.
• Strengthening Exercises: Both eccentric and concentric strengthening exercises targeting the foot and lower leg muscles show significant results in reducing pain. Isometric exercises also aid in stability.
• Dynamic vs. Static: Dynamic stretching, especially when combined with strengthening, tends to yield better functional outcomes than static stretching alone.
2. Shockwave Therapy: Overrated for Plantar Fasciitis? (2)
Evidence-Based Perspective:
• Limited Efficacy: Although popular, shockwave therapy (SWT) generally shows only temporary effects, similar to a structured stretching and strengthening program.
• Recommendation: Stretching and strengthening exercises are cost-effective alternatives to SWT, often with comparable results.
3. Activity Modification: Adjusting Physical Demands (3)
Importance of Rest and Low-Impact Exercise:
• Reduce High-Impact Activities: Limiting high-impact sports prevents further strain on the plantar fascia.
• Alternative Exercises: Swimming and cycling maintain fitness without aggravating the fascia, supporting a gradual return to activity.
4. Footwear and Orthotics: Importance of Support and Structure (4)
Evidence on Footwear:
• Proper Footwear: Supportive shoes with good arch support distribute pressure across the foot, reducing strain on the plantar fascia.
• Custom Orthotics: Patients with specific foot issues, like flat feet, benefit from custom orthotics, which provide support and improve alignment.
5. Joint Mobilization and Manipulation: An Emerging Approach
• Recent Findings: Joint mobilization, particularly at the ankle and subtalar joints, has shown potential benefits for plantar fasciitis. A systematic review in recent literature suggests that joint mobilization, when combined with traditional treatments, can enhance overall outcomes for pain reduction and foot function (5).
• Mechanism of Action: Mobilization techniques likely improve range of motion and reduce muscle stiffness, which can relieve stress on the plantar fascia. This approach is especially relevant for patients with limited ankle dorsiflexion, which contributes to plantar strain.
• Manual Therapy Techniques: Manipulation, specifically targeting restricted midfoot and subtalar joints, can complement other therapies, such as stretching and strengthening. However, high-velocity manipulations are not always essential; low-velocity mobilizations seem to provide comparable results.
• Comparison to Other Treatments: While not as primary as stretching and strengthening, mobilization can be a valuable adjunct, especially for patients with restricted joint mobility. The latest evidence supports using mobilization alongside exercises rather than as a standalone treatment.
Conclusion
Managing plantar fasciitis effectively in 2024 relies on a well-rounded, evidence-based approach. Stretching and strengthening remain core treatments, while activity modification, proper footwear, and joint mobilization provide supportive roles. Shockwave therapy, though still used, may be reconsidered in favor of more accessible, scientifically supported interventions.
References:
Thong-On S, Bovonsunthonchai S, Vachalathiti R, Intiravoranont W, Suwannarat S, Smith R. Effects of Strengthening and Stretching Exercises on the Temporospatial Gait Parameters in Patients With Plantar Fasciitis: A Randomized Controlled Trial. Ann Rehabil Med. 2019 Dec;43(6):662-676. doi: 10.5535/arm.2019.43.6.662. Epub 2019 Dec 31. PMID: 31918529; PMCID: PMC6960082.
Sun J, Gao F, Wang Y, Sun W, Jiang B, Li Z. Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs. Medicine (Baltimore). 2017 Apr;96(15):e6621. doi: 10.1097/MD.0000000000006621. PMID: 28403111; PMCID: PMC5403108.
Lim AT, How CH, Tan B. Management of plantar fasciitis in the outpatient setting. Singapore Med J. 2016 Apr;57(4):168-70; quiz 171. doi: 10.11622/smedj.2016069. PMID: 27075037; PMCID: PMC4853481.
Whittaker GA, Munteanu SE, Menz HB, Tan JM, Rabusin CL, Landorf KB. Foot orthoses for plantar heel pain: a systematic review and meta-analysis. Br J Sports Med. 2018 Mar;52(5):322-328. doi: 10.1136/bjsports-2016-097355. Epub 2017 Sep 21. PMID: 28935689.
Kashif M, Albalwi A, Alharbi A, Iram H, Manzoor N. Comparison of subtalar mobilisation with conventional physiotherapy treatment for the management of plantar fasciitis. J Pak Med Assoc. 2021 Dec;71(12):2705-2709. doi: 10.47391/JPMA.1049. PMID: 35150524.
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