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Is Stretching exercises Superior to Steroids for Sustained Relief in Plantar Fasciitis? Evidence from a Prospective
Divya Nand Pandey1, Harsh Pratap Singh1, Chetan Singh1
1Department of Orthopaedics, GSVM Medical College and Associated LLR Hospital, Kanpur, Uttar Pradesh, India.
Introduction:
Plantar fasciitis is a prevalent cause of heel pain, especially in middle-aged and older adults. This study compares the short-term and long-term effectiveness of plantar fascia stretching exercises versus corticosteroid injections in improving pain and function.
Materials And Methods:
This prospective clinical trial included 100 patients randomly assigned to two treatment groups: One undergoing plantar fascia-specific stretching exercises with anti-inflammatory medications, contrast bath and shoe insole and the other receiving a single corticosteroid injection (Triamcinolone acetonide 1 mL i.e., 40 mg with 1 mL 2% lignocaine with 20 gauze needle) on medial to the heel pad on most tender point after local sensitivity followed by anti-inflammatory medications, contrast bath and shoe insole .Outcome measures included the Visual Analog Scale (VAS) and the foot and ankle ability measure (FAAM), recorded at baseline, and at 2, 6, 12, and 16 weeks post-treatment.
Results:
While the steroid group showed superior pain relief and functional improvement at 2 and 6 weeks, the stretching group demonstrated significantly better outcomes at 12 and 16 weeks. VAS and FAAM scores favored stretching in long-term analysis (P < 0.0001).
Discussion:
The mean age was 42.8 ± 3.82 years in the conservative group and 40.5 ± 3.48 years in the steroid group, with 76% aged 30-50 years. Gender distribution was nearly equal, and 14% had bilateral involvement. Most participants (64%) were overweight (body mass index [BMI] 25-30), a known risk factor. VAS scores were similar at baseline (7.24 vs. 7.50; P = 0.2428). The steroid group showed faster pain relief at 2 and 6 weeks (VAS: 4.86 and 2.64 vs. 6.62 and 3.86; P < 0.0001), but the conservative group had better outcomes by 12 and 16 weeks (VAS: 2.65 and 2.26 vs. 2.98 and 3.12; P = 0.0113 and <0.0001). FAAM scores followed a similar pattern: Early gains favored steroids (60.13 vs. 54.82 at 2 weeks; P < 0.0001), but long-term improvement was greater in the conservative group (70.13 vs. 63.86 at 16 weeks; P < 0.0001).Thus, while corticosteroids offer quick relief, stretching exercises yield superior long-term outcomes, supporting a combined treatment approach.
Conclusion:
Structured stretching offers more durable relief and should be considered a primary intervention in plantar fasciitis.
