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

Karamanoğlu Mehmetbey University105 enrolled

Overview

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.

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.

Study Type

INTERVENTIONAL

Allocation

Interventions

StretchingOTHER

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 ExercisesOTHER

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 ExercisesOTHER

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.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

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.

Outcomes

Primary Outcomes

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

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.