Outcomes of the Proprioception and Strengthening Exercise Program in Chronic Plantar Fasciitis
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 105
- 试验地点
- 1
- 主要终点
- Pain Intensity (First-Step Morning, Evening, and Overall Daily Pain)
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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) >
- •Voluntary agreement to participate, evidenced by signing the written informed consent form.
排除标准
- •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.
研究组 & 干预措施
Stretching and Proprioception
In addition to the standard stretching program, this group will receive supervised proprioception exercises three times per week for 6 weeks.
干预措施: Proprioception and Stretching Exercises (Other)
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.
干预措施: Knee Strengthening and Stretching Exercises (Other)
Stretching Only
This group will perform plantar fascia-gastrocnemius-soleus stretching exercises alone (twice daily, 7 days per week, for 6 weeks).
干预措施: Stretching (Other)
结局指标
主要结局
Pain Intensity (First-Step Morning, Evening, and Overall Daily Pain)
时间窗: 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.
Pressure Pain Threshold (PPT)
时间窗: 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.
Foot Function and Health Status (Revised Foot Function Index, FFI-R)
时间窗: 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.
Foot and Ankle Function (Foot and Ankle Outcome Score, FAOS)
时间窗: 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.
次要结局
- Myofascial Tissue Biomechanical Properties(Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).)
- Plantar Fascia Ultrasonographic Parameters(Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).)
- Ankle Dorsiflexion Range of Motion (ROM)(Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).)
- First Metatarsophalangeal (MTP) Joint Range of Motion(Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).)
- Joint Position Sense (JPS) (Ankle-Knee and Hip)(Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).)
- Isometric Muscle Strength of the Lower Extremity(Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).)
- Static Balance(Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).)
- Dynamic Balance(Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12).)
研究者
Sule Kosar
Resident, Physical Medicine and Rehabilitation
Karamanoğlu Mehmetbey University