Management of plantar heel pain: a best practice guide

NewsBot · Jul 11, 2026

Effectiveness of Sandals Combined with Physical Therapy Versus Physical Therapy Alone on Pain and Function in Plantar Fasciitis: A Randomised Controlled Trial
Thanwarat Lunsarn et al
Malays J Med Sci. 2025 Aug;32(4):189-202.

Background: Recent evidence suggests that appropriate footwear can facilitate recovery in individuals with plantar fasciitis. This study evaluated the effectiveness of combining arch-supportive, shock-absorbing flip-flop sandals with physical therapy (PT) compared to PT alone in treating plantar fasciitis.

Methods: Sixty-six participants aged 20-60 years with normal body mass index and plantar fasciitis (median symptom duration = 6 months) were randomised into either an intervention group (n = 33; PT plus sandals) or a control group (n = 33; PT alone). Both groups received eight weeks of PT and home exercises. Outcome measures were assessed at baseline, four weeks, and eight weeks and included pain-related parameters, pressure pain threshold, the Foot Function Index, and the Lower Extremity Functional Scale. The global rating of change was evaluated at weeks four and eight.

Results: Both groups demonstrated significant improvements across all outcome measures (P < 0.001). A significant time × group interaction was observed for first-step post-inactivity pain (F = 3.238, P = 0.042), with the intervention group showing greater improvement (mean reduction: 3.71 points, d = 2.01) compared to controls (mean reduction: 2.82 points, d = 1.30). Improvements in all other outcome measures were comparable between the groups.

Conclusion: While PT effectively improves plantar fasciitis symptoms, adding sandals provided significantly greater improvement in first-step post-inactivity pain. Further large-scale trials with extended follow-up are warranted to confirm these findings and assess long-term efficacy.
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NewsBot · Aug 12, 2026

Risk Factors and Treatment Effectiveness in the Recovery and Recurrence of Plantar Fasciitis: A Single-Center Study at King Saud Medical City, Riyadh, Saudi Arabia
Yasser S. Aljaied • Mohamed Alrubaiaan • Mazin Elsarrag • Bandar ALshehry • Rahaf Almutairi • Ghada F. AlSwaji • Abdulmlk A. Alqasem • Hamza Enabi
Cureus 18(7): e112265. doi:10.7759/cureus.112265

Background: Plantar fasciitis is a frequent cause of heel pain, and local evidence describing risk factors, recurrence patterns, and treatment outcomes in Saudi Arabia remains limited.

Objective: The objective of the study is to investigate the epidemiology, risk factors, treatment types and outcomes, recurrence rates, and recovery patterns of plantar fasciitis at King Saud Medical City in Riyadh, Saudi Arabia.

Methods: A retrospective cohort study was conducted at King Saud Medical City in Riyadh, Saudi Arabia, from May 1, 2023, to November 28, 2025. Due to limited follow-up documentation in routine hospital records, data were collected using structured telephone interviews, while the hospital electronic medical record system was used to confirm eligibility by verifying the diagnosis of plantar fasciitis and to obtain updated contact information; verbal consent was obtained prior to interviews. A total of 121 adult patients were identified; 10 were included in a pilot phase and excluded, leaving 111 eligible patients, of whom 93 completed interviews and were included in the final dataset. Responses were entered into a structured electronic form during interviews and exported for cleaning and verification prior to analysis. Categorical variables were summarized using frequencies and percentages, and ordinal outcomes were summarized using medians and interquartile ranges; associations were evaluated using the Chi-squared test, with statistical significance set at a probability value less than 0.05.

Results: Among 93 participants, the largest age group was 51 to 60 years (29 (31.18%)), and women comprised 51 (54.84%). Sedentary occupation (73 (78.49%)) and physical inactivity based on World Health Organization recommendations (69 (74.19%)) were common. Most participants reported a single episode over the previous two years (76 (81.72%)), while recurrence occurred in 17 (18.28%). Symptom duration in the first episode was predominantly acute (72 (77.40%)), with fewer subacute (17 (18.30%)) and chronic (4 (4.30%)) presentations; recurrent episodes showed a shift toward longer subacute courses without chronicity. Management remained predominantly conservative across episodes, with rest or activity modification and non-steroidal anti-inflammatory drugs used in every reported episode; during the first episode, stretching exercises (68 (73.10%)), avoidance of non-supportive footwear (63 (67.70%)), and external support (58 (62.40%)) were commonly reported. Pain severity improved after treatment across episodes, with median pain scores decreasing from 5.00 to 2.00 in the first episode, 5.00 to 1.00 in the second episode, 5.00 to 1.00 in the third episode, and 4.00 to 3.00 in the fourth episode. Satisfaction was high, with 52 (55.91%) very satisfied and 25 (26.88%) satisfied. Recurrence was significantly associated with obesity, with a Chi-squared value of 4.25 and a probability value of 0.039; recurrence was more frequent among obese than non-obese participants, 28.57% versus 9.80%.

Conclusion: In our cohort from King Saud Medical City, plantar fasciitis was managed mainly with conservative measures and was associated with meaningful patient-reported pain improvement and high satisfaction; however, recurrence was not uncommon and was significantly associated with obesity, supporting the importance of addressing weight-related risk alongside conservative management to reduce recurrence.
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NewsBot · Aug 29, 2026

Randomized controlled trials evaluating exercise interventions for plantar fasciopathy pain: a systematic review and meta-analysis
Irenilde F. Gonçalves et al
Musculoskeletal Science and Practice Volume 86, November 2026, 103644

Highlights

•
Exercise may make small benefits of uncertain relevance for plantar fasciitis pain.
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Studies were susceptible to bias and the certainty of evidence was low.
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Few studies comparing exercise with no treatment compromised the analysis.
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Testing ways to improve the effect or obtaining more data can alter the result.
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Future well-conducted randomized controlled studies are necessary on this topic.

Abstract
Background
Plantar fasciitis is characterized by mechanical degeneration of the plantar fascia with a possible tear at the calcaneal origin. Clinical findings are heel pain when taking the first step in the morning, local sensitivity and decreased functional capacity. Exercise, such as stretching and strength training are potential effective interventions for plantar fasciitis pain management.
Objectives
This systematic review aimed to assess the effectiveness of exercise on pain intensity (primary outcome) in patients with plantar fasciitis.
Method
We searched six databases (last updated October 10, 2025). Eligible were randomized controlled studies in adults diagnosed with plantar fasciitis, evaluating exercise interventions compared to a control group in which the subjects did not experience any type of exercise. Pain scores from unidimensional pain scales were extracted and the standard mean deviation (SMD) and 95% confidence interval (CI) were calculated. The risk of bias was assessed by Risk of Bias 2. The validation of quality and reporting of exercise training studies were assessed, and the certainty of evidence was rated using grading of recommendations assessment, development, and evaluation.
Results
Three studies met the inclusion criteria (n = 146). The risk of bias was moderate-to-high and the study quality and reporting in exercise showed moderate quality. There was an overall effect favoring the exercise interventions relative to no intervention on plantar fasciitis pain intensity reduction (SMD of −1.10, 95% CI: −2.01 to −0.19, 3 studies, n = 146 participants, I2 = 0.74, low certainty), indicating a benefit of uncertain relevance.
Conclusion
In conclusion, we found uncertain benefit of exercise interventions for plantar fasciitis pain intensity reduction, especially in short-term exercise protocols (≤3 months).
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scotfoot · Aug 29, 2026

NewsBot said: ↑

Randomized controlled trials evaluating exercise interventions for plantar fasciopathy pain: a systematic review and meta-analysis
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Skeletal muscle is highly adaptable and will get stronger if it is subjected to increased demand, particularly in younger people.

Certain characteristics of modern shoes seem to make our feet weaker and so, presumably, place less demand on the toe flexor muscles during gait than would be the case in the natural, unshod condition.

Potentially, lack of tension in the toe flexor muscles could mean less "load sharing" support for the plantar fascia. Making these muscles stronger using progressive strengthening, then walking around in the same shoes as before, may give the same level of muscle activation as before, regardless of increased strength, meaning that the strengthening efforts are redundant.

It seems to me that if you want to offload the plantar fascia during gait, using strengthening techniques, you need to increase tension in these muscles during the activity ( achieve higher levels of activation) . To do that you need to address the shoe features that reduce activation levels/tension.

IMO, the shoe features that are most likely to reduce activation in the toe flexor muscles are toe springs and relatively inflexible soles.

The authors of the referenced research paper have concluded-
"In conclusion, we found uncertain benefit of exercise interventions for plantar fasciitis pain intensity reduction, especially in short-term exercise protocols (≤3 months)."

My question would be, why expect strengthening to bring benefits if the increase in strength is not being used?

IMO research is urgently needed regarding the relationship between plantar fasciitis, foot strengthening and footwear features .

NewsBot · Sep 2, 2026 at 8:22 PM

Home-based digital exercise versus hospital physiotherapy for plantar fasciitis: a propensity-score-matched retrospective cohort study with dual-perspective cost-utility evaluation
Wenbo Xu et al
J Rehabil Med. 2026 Sep 2:58:jrm45974.

Objective: To compare the clinical effectiveness and cost-effectiveness of a 12-week home-based digital exercise programme with 12-week hospital-supervised physiotherapy for plantar fasciitis in routine Chinese tertiary-hospital care.

Design: Single-centre retrospective cohort study with 1:2 propensity-score matching on 13 baseline covariates.

Subjects/patients: 587 adults with a clinician-confirmed diagnosis of plantar fasciitis treated in 2022-2024 were matched.

Methods: The primary outcome was first-step morning pain at 3 months on a 0-10 numeric rating scale (non-inferiority margin 1.3 points; sensitivity margins 0.9 and 1.9). A 12-month cost-utility analysis took payer and societal perspectives.

Results: The adjusted mean difference was -0.63 points (95% confidence interval -0.92 to -0.35; p < 0.001), non-inferior against all 3 margins (E-value 2.84). Incremental payer cost was -¥4,920 (-US$684), incremental societal cost -¥7,008 (-US$974), and incremental quality-adjusted life-years +0.011, with dominance in 96.7% of bootstrap replications.

Conclusion: Home-based digital exercise was non-inferior for 3-month first-step pain and less costly from both perspectives. Matching left 12 of 13 covariates imbalanced and only 6.3% of screened patients were eligible, so residual confounding and selection bias are likely. These observational findings are provisional and require confirmation in a pragmatic multicentre randomized controlled trial before informing reimbursement.
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Management of plantar heel pain: a best practice guide

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

scotfoot Well-Known Member

NewsBot The Admin that posts the news.

Management of plantar heel pain: a best practice guide informed by a systematic review, expert clini

Podiatrist vs GP management of plantar heel pain

Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel

TECAR Therapy for the Management of Plantar Fasciitis

Chiropractors and Podiatrists views on the management of plantar fasciitis

Embedding pain neuroscience education in the management of plantar fasciitis

Topical sevoflurane: analgesic management in a marathon runner with plantar fasciitis

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Management of plantar heel pain: a best practice guide

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

scotfoot Well-Known Member

NewsBot The Admin that posts the news.

Management of plantar heel pain: a best practice guide informed by a systematic review, expert clini

Podiatrist vs GP management of plantar heel pain

Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel

TECAR Therapy for the Management of Plantar Fasciitis

Chiropractors and Podiatrists views on the management of plantar fasciitis

Embedding pain neuroscience education in the management of plantar fasciitis

Topical sevoflurane: analgesic management in a marathon runner with plantar fasciitis

Share This Page

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