To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Specific Stretching Exercises Can Relieve Chronic Heel Pain Symptoms URL: http://www.pslgroup.com/dg/23619E.htm Doctor's Guide July 2, 2003
ROSEMONT, IL -- July 2, 2003 -- Exercises that specifically stretch the plantar fascia can relieve heel pain caused by an inflammation of the sole (plantar surface) of the foot following an injury of the tough, ligament-like sheet of tissue (fascia) that extends from the heel bone to the base of the toes. These findings are the result of an investigation performed by Benedict F. DiGiovanni, MD; Deborah A. Nawoczenski, PhD, PT; Marc E. Lintal, MSPT; Elizabeth A. Moore, MSPT; Joseph C. Murray, MSPT; Gregory E. Wilding, PhD; and Judith F. Baumhauer, MD, of the Department of Orthopaedics, University of Rochester, and the Department of Physical Therapy, Ithaca College - University of Rochester campus, Rochester, New York, and published in the July 2003 issue of The Journal of Bone and Joint Surgery. The investigators monitored a group of patients who had experienced persistent and often disabling heel pain for at least ten months. The patients first completed a survey that provided an account of their heel pain and background information that was then matched to the selection criteria of similar age, weight, and time spent standing on their feet. This was followed by an examination by an orthopaedic surgeon to confirm the diagnosis of plantar fascitis. All of the selected patients received prefabricated soft insoles and a three-week course of non-steroidal pain medication and were shown an educational video about plantar fascitis. The researchers then split the patients into two groups: Group A received instructions for a non-weight-bearing plantar fascia-stretching program, and Group B were taught a weight-bearing Achilles tendon-stretching regimen. After eight weeks of performing their respective exercises, the patients again evaluated their pain, function, and satisfaction with treatment outcome. The two groups showed significant differences with regard to pain, activity limitations, and satisfaction with results: the members of Group A (plantar fascia stretch) reported greater improvement and satisfaction than those in Group B (Achilles tendon stretch). The researchers, therefore, concluded that plantar fascia-stretching exercises are superior to the previously standard Achilles tendon-stretching exercises for relieving chronic heel pain. While the Achilles tendon- stretching exercise does have a beneficial result, as shown by improvement in the patients in Group B, it does not work directly on the plantar fascia and is normally performed after putting weight on the affected heel, which may increase inflammation. The plantar fascia-stretching exercise, on the other hand, "directly isolates the plantar fascia by recreating the windlass mechanism, or the tensioning of the plantar fascia by pulling the toes and ankle toward the shin," says Dr. DiGiovanni, an Orthopaedic Surgeon, and foot and ankle specialist. "The timing of the stretching exercises, before taking the first step in the morning and prior to standing after prolonged sitting, is also very important since it is felt to limit the cycle of repetitive micro-tearing and inflammation occurring with those first painful steps." Dr. DiGiovanni also notes, "the plantar fascia stretching program which has been created is especially promising since it is highly effective, straight- forward, and inexpensive." For these reasons, the researchers think the plantar fascia stretching program should be the stretching exercise emphasized during treatment, rather than the traditional Achilles tendon stretch. Dr. DiGiovanni and his colleagues recommend that patients with heel pain caused by plantar fascitis learn how to perform plantar fascia-stretching exercises. Patients are instructed to perform these exercises before getting out of bed in the morning by sitting on the side of the bed and crossing the affected leg over the other leg, resting the ankle on top of the thigh. Using the hand on the affected side, the patient places the fingers across the base of the toes on the bottom of the foot and pulls the toes toward the shin until he or she feels a stretch in the arch of the foot. The patient places the other hand on the sole of the foot to feel the tension and confirm that it is being stretched. Patients are also instructed to perform the stretch prior to standing after prolonged sitting or inactivity, such as after sitting for a meal. Patients who perform the Achilles tendon-stretching exercise do their first stretch immediately after getting out of bed in the morning. Standing facing a wall, the patient positions the affected foot behind the other leg and leans into the wall. Before stretching, the patient places a shoe insert under the affected foot to minimize excessive midfoot rotation and points the toes of the affected foot toward the heel of the front foot. The patient bends the front knee while keeping the back knee straight and the affected heel firmly on the floor. Both groups were told to hold each stretch for a count of ten and to repeat ten times, three times a day. Dr. DiGiovanni and his colleagues are just completing a two-year follow-up study on the effect of plantar fascia-stretching exercises on chronic heel pain. He also plans to explore the possibility that beginning such an exercise program earlier after the onset of heel pain can shorten the duration of symptoms. His goal is to provide a breakthrough in treatment for those who suffer ongoing heel pain. SOURCE: American Academy of Orthopaedic Surgeons --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.