Review Question - QID 3299

A plantar fascia-specific stretching program has the highest patient satisfaction at the 8 week follow-up interval. Symptoms of plantar fasciitis include “start-up” inferior heel pain with patients often preferring to walk on their toes for the first few steps when getting out of bed. The pain lessens with ambulation and then increases again with increased activity. Illustration A depicts a patient performing plantar fascia-specific stretching. Illustration B displays a patient performing an achilles tendon–stretching program.

The review article by Neufeld and Cerrato details that stretching programs have been the primary treatment therapy modality for patients with plantar fasciitis. The purpose of plantar fascia–specific stretching is to recreate the windlass mechanism and achieve tissue tension through a controlled stretch of the plantar fascia.

The Level 2 study by DiGiovanni et al compared these 2 protocols and showed that heel pain was eliminated or improved at 8 weeks in 52% of patients treated with the plantar fascia–specific stretching program versus only 22% of patients participating in the Achilles tendon–stretching program. At 2-year follow-up, the study reported no difference between the two groups with 92% of all patients reporting total satisfaction or satisfaction with minor reservations.

Corticosteroids (Answer 2) should be used rarely as they can cause fat atrophy and even plantar fascia rupture. The FDA has approved extracorporeal shock-wave therapy (Answer 3) for plantar fasciitis lasting greater than 6 months. AAOS Comprehensive Orthopaedic Review states surgical treatment( Answer 5) is indicated for symptoms lasting greater than 9 months despite conservative management.