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

Condition(s) studied

Investigational drug(s) / intervention(s)

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.

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.

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.

Study summary

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.

Eligibility

Primary outcome measure(s)

• Pain Intensity (First-Step Morning, Evening, and Overall Daily Pain) — 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) — 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) — 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) — 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.

Trial sites (1)

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