# The effect of multimodal rehabilitation program on pain, functional outcomes, and plantar fascia thickness in patients with plantar fasciitis: a randomized controlled trial

## TL;DR

A new multimodal rehabilitation program improved foot posture more than a conventional one in patients with plantar fasciitis.

## Contribution

The study introduces a multimodal rehabilitation approach combining active and passive correction for plantar fasciitis.

## Key findings

- Both groups improved in pain, function, and plantar fascia thickness, but the experimental group showed better foot posture outcomes.
- The multimodal program included low-dye tape, short foot exercises, and heel raising, leading to significant differences in foot posture measures.
- The trial highlights the importance of addressing biomechanical aspects in plantar fasciitis rehabilitation.

## Abstract

Plantar fasciitis (PF) is characterized by heel pain and functional limitations, with hyperpronation identified as a primary risk factor. Mechanical correction of malalignment is one of several therapeutic options, but no one has settled on a single, comprehensive treatment protocol. The aim of this study was to examine the effect of a multimodal rehabilitation program that incorporates both active and passive correction of the foot’s pathomechanics on pain intensity, function, plantar fascia thickness, foot posture, and ankle dorsiflexion range of motion in patients with PF, in comparison to a conventional rehabilitation protocol.

A randomized controlled trial involving 48 patients (21 males and 27 females) aged 40 to 60 years and clinically diagnosed with PF. They were randomly assigned to either the experimental or control groups. The control group received a conventional rehabilitation program (self-stretching, mobilization of the ankle and subtalar joint, myofascial release, and ultrasound), while the experimental group received the multimodal rehabilitation program that included low-dye tape, short foot exercise, and unilateral heel raising, in addition to the same self-stretching and mobilization given to the control group. Both groups were given 3 sessions per week for 8 consecutive weeks (2 months). Outcome measures included pain intensity (using visual analogue scale and pressure pain threshold) and foot posture (via the foot posture index and rear foot angle. Functional impairment (using the foot function index). Dorsiflexion range of motion (assessed with a bubble inclinometer), and plantar fascia thickness (measured via ultrasonography).

Post-treatment, both groups showed significant improvements in all outcomes (p < 0.001), except for the foot posture index, which wasn’t significant in the control group (p = 0.097). However, the rear foot angle and foot posture index showed significant differences between groups, favoring the experimental group (p = 0.046 and p = 0.027, respectively).

Both programs effectively improved clinical outcomes and reduced plantar fascia thickness in patients with PF. However, the multimodal rehabilitation program demonstrated greater improvement in foot posture measures. Thorough rehabilitation targeting clinical outcomes and biomechanical aspects may yield superior results in the management of PF.

The trial was registered on June 8, 2024, on clinicaltrials.gov (NCT06456944). https://clinicaltrials.gov/study/NCT06456944.