607619

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FAIXXX10.1177/1071100715607619Foot & Ankle InternationalÇelik et al

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Foot & Ankle International®

Joint Mobilization and Stretching Exercise

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DOI: 10.1177/1071100715607619

Plantar Fasciitis: A Randomized Controlled fai.sagepub.com

Study

Derya Celik, PhD1, Gamze Kuş, MSc, PT2, and Serkan Önder Sırma, MD3

Abstract
Background: This study compared the effectiveness of joint mobilization combined with stretching exercises (JM&Str) vs
steroid injection (SI) in the treatment of plantar fasciitis (PF).
Methods: A total of 43 patients (mean age, 45.5 ± 8.5 years; range, 30-60 years; 23 females) with PF were randomly
assigned to receive either JM&Str (n = 22) or SIs (n = 21). JM&Str was applied 3 times per week for 3 weeks for a total of 9
visits. The SI group received 1 injection at baseline. The patients’ functional scores were assessed using the Foot and Ankle
Ability Measure (FAAM), and pain was evaluated using the Visual Analog Scale (VAS). Outcomes of interest were captured
at baseline and at 3-week, 6-week, 12-week, and 1-year follow-ups. The primary aim was examined using a mixed-model
analysis of variance (ANOVA). Pairwise comparisons were performed to examine differences between the baseline and
follow-up periods using Bonferroni equality at an alpha level of 0.05.
Results: Age, sex, body mass index, and dorsiflexion range of motion did not significantly impact pain relief or functional
outcome (P > .05) at the 3-, 6- or 12-week follow-ups compared to baseline. Planned pairwise comparisons demonstrated
significant improvements in pain relief and functional outcomes in both groups (P < .05) at the 3-, 6-, and 12-week follow-
ups compared to baseline. However, at the 12-week and 1-year follow-ups, pain and functional outcomes were significantly
improved in only the JM&Str group (P = .002). The overall group-by-time interaction was statistically significant for both
FAAM (P = .001; F = 7.0) and VAS (P = .001; F = 8.3) scores. Between-group differences favored the SI group at the 3-week
(P = .001, P = .001), 6-week (P = .002, P = .001), and 12-week (P = .008, P = .001) follow-ups for pain relief and functional
outcomes. However, no significant differences (P = .62, P = .57) were detected in the measured outcomes at the 1-year
follow-up.
Conclusion: Our study demonstrated that while both groups achieved significant improvements at the 3-, 6-, and 12-
week follow-ups, the SI group exhibited better outcomes at all 3 time points. The noted improvements continued in only
the JM&Str group for a period of time ranging from 12 weeks to 1 year.
Level of Evidence: Level II, comparative study.

Keywords: exercise therapy, manual therapy, fascia, pain management, foot pain

Introduction and soft tissue mobilization, to treat deficits in lower

Plantar fasciitis (PF) is a common cause of heel pain in
adults. Many treatment options exist, including rest, elec-
trotherapy agents, stretching, strengthening, manual ther-
apy, proper footwear, arch supports, orthotics, night splints,
anti-inflammatory agents, steroid injections, and surgery.19
Manual therapy and stretching are commonly used by phys-
ical therapists as interventions for PF.4,31 Additionally, ste-
roid injections are frequently administered by physicians,
podiatrists, and other qualified medical professionals to
treat PF.
A recent systematic review provided strong evidence for
the use of manual therapy procedures, consisting of joint
extremity joint mobility and calf flexibility to decrease pain
and improve function in individuals with PF.19 That review
1
Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation,
Istanbul University, Istanbul, Turkey
2
Institute of Health Sciences, Department of Physiotherapy and
Rehabilitation, Istanbul University, Istanbul, Turkey
3
Department of Orthopedics and Traumatology, Bezmialem University,
Istanbul, Turkey
Corresponding Author:
Derya Celik, PhD, Faculty of Medicine, Department of Orthopedics and
Traumatology, Bezmialem University, Istanbul, Turkey.
Email: ptderya@hotmail.com

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2 Foot & Ankle International 

also found strong evidence to support calf stretching and

plantar fascia–specific stretching. Other studies have spe-
cifically demonstrated that ankle dorsiflexion and stretch-
ing of the plantar fascia improves pain, activity, and patient
satisfaction.10,16,29 SI is widely practiced, but very few con-
trolled trials have examined its efficacy in treating PF. One
randomized controlled trial found no significant differences
between injections of steroid vs placebo.3 A more recent
trial of 106 patients reported that SI was superior to placebo
at 1 month but not at subsequent follow-up assessments.7
Another recent report detailing various treatments for PF
concluded that there was insufficient evidence to support
the use of SI and advised that steroids could be harmful in
the medium to long term.16 A recent report provided the first
strong evidence to support the administration of a single SI
into the plantar fascia to treat the inferior medial aspect of
calcaneus pain when it failed to respond to conservative
treatment at a 12-week follow-up.2
No studies have demonstrated the effectiveness of joint
mobilization combined with stretching exercises (JM&Str)
relative to SI for the treatment of PF. We hypothesized that
SI would be more effective at improving function and pain
than JM&Str in the short term but that this superiority
would not be maintained over the long term. This study
compared the effectiveness of JM&Str vs SI on pain and
function in PF.

Methods
Study Design
A prospective, single-blinded, randomized, controlled trial
was performed at the Orthopedics and Traumatology Clinic
between October 2012 and December 2013. All of the
patients who agreed to participate in the study signed a writ-
ten informed consent form, which was approved by the eth-
ics committee.
Participants
Forty-three (average age, 46 years; range, 30-60 years; 23
females) patients with PF were randomly assigned to either
the JM&Str (n = 22) group or the SI (n = 21) group (Figure 1).
The sample size was evaluated and power calculations were
performed using an Instat sample size calculator. The calcu-
lations were based on a standard deviation of 6.9 points
based on the FAAM-ADL score, with a between-group dif-
ference of 8 points20 (which represented the minimal clini-
cally important difference [MCID] in FAAM-ADL score),
an alpha level of 0.05, and a β level of 20% at a desired
power of 80%. These parameters generated a sample size of
at least 12 patients per group. We recruited 43 patients into
the study to allow for dropouts. Patients with unilateral PF
were screened for eligibility criteria. The inclusion criteria
Figure 1.  Flow chart of the study design.
required patients to have a point of maximal tenderness on
clinical examination over the medial tubercle of the calca-
neus, pain with palpation of the proximal insertion of the
plantar fascia, heel pain during weight-bearing activity, a
negative tarsal tunnel test, and a positive windlass test.
Patients with potential arthritis, fractures, tumors of the foot
or ankle, rheumatoid arthritis, generalized polyarthritis sero-
negative arthropathy, neurologic impairments, or extremity
nerve entrapment were excluded. Patients with prior surgery
to the distal tibia, fibula, ankle joint or rear foot region
(proximal to the base of the metatarsals) or with fractures or
other absolute contraindications to manual therapy that led
to the prior use of corticosteroids or other therapy were also
excluded.
None of the evaluated baseline characteristics, including
age, gender, duration of symptoms, body mass index (BMI),
and dorsiflexion range of motion, were significantly different
between the 2 groups (P > .05) (Table 1). Two patients dropped
out of the JM&Str group: one patient during the intervention
period and the other patient after the intervention period. Two

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Çelik et al 3
Table 1.  Patient Demographics.a
JM&Str Group SI Group
(n = 19) (n = 20) P Value
Age (y) 45.4 ± 9.3 45.6 ± 7.9
Gender (male/female) 6/14 5/14
Duration of symptoms (mo) 11.2 ± 3.2 13.1 ± 2.6
BMI 29.4 ± 3.6 30.6 ± 4.8
Dorsiflexion range of motion 9.4 ± 3.1 10.8 ± 5.1
Abbreviations: JM&Str, Joint Mobilization & Stretching; SD, standard
deviation.
a
Values are expressed as mean ± SD.
*Independent t test for between-group comparison.
†
Chi-square test for between-group comparison.
patients also dropped out of the SI group: one patient before
the intervention period and the other patient after the interven-
tion period. Consequently, there were 20 patients in the
JM&Str group and 19 patients in the SI group, all of whom
were followed up for 1 year.
Randomization
Randomization was performed using a computer-generated
random numbers (www.randomization.com) table and pre-
labeled sealed envelopes. The participants were assigned to
one of the 2 interventions based on their corresponding ran-
dom number tables. An individual who was blinded to the
patients’ information performed the randomization and pro-
vided the group assignments to the treating physical thera-
pist or surgeon. Randomization was performed after the
first assessment.
Outcome Measures
The FAAM is a region-specific, self-reported questionnaire
with 2 subscales. The ADL subscale consisted of 21 ques-
tions, each with a Likert-type response scale ranging from 4
(no difficulty) to 0 (unable to do the activity). Individuals
could also mark “N/A” in response to any of the activities
listed. Items marked N/A were not scored. The scores for
each of the items were added together. The number of ques-
tions with a response was multiplied by 4 to obtain the high-
est potential score. The highest possible score was 84 if all
of the questions were answered. Higher scores indicated
higher levels of function. The sports subscale was scored
separately (highest possible number of points is 28) using
the same method as the ADL subscale.20
For the visual analog scale (VAS), a patient was asked to
indicate his/her perceived pain during daily living activi-
ties. Pain intensity was measured from 0 (indicating no
pain), which appeared on the left, to 100 (indicating severe
pain), which appeared on the right.11
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.98*
.88†
.58*
.45*
.28*
Figure 2.  (A) Subtalar distraction. (B) Talocrural dorsal
(posterior) glide.
The outcomes of interest were captured at baseline and
at 3-, 6-, and 12-week and 1-year follow-ups.
Interventions
JM&Str Group.  Joint mobilization is one treatment option
for improving tissue extensibility, increasing range of
motion (ROM), modulating pain, and reducing soft tissue
swelling, inflammation, and restriction. Grade I (small-
amplitude rhythmic oscillations applied at the beginning of
a range of motion) and Grade II (large-amplitude rhythmic
oscillations applied within the midrange of a movement)
rhythmic oscillations were used in this study to control
pain. Such oscillations may have an inhibitory effect on
pain perception, and stretching motions are not considered
to help move synovial fluid to improve nutritional access to
cartilage.12,26
Subtalar traction.  For this intervention, a therapist used
a distal hand grasp around the calcaneus from the posterior
aspect of the foot while the patient was supine, and the other
hand fixed the talus and malleoli against the table. The ther-
apist pulled the calcaneus distally with respect to the long
axis of the leg. This maneuver was applied to control pain
and to increase general mobility for inversion and eversion
(Figure 2A).12,26
Talocrural dorsal (posterior) glide. For this intervention,
a therapist wrapped his/her fingers and thumb around a
patient’s foot to maintain the ankle in a resting position
while the patient was supine. Grades I and II rhythmic oscil-
lations were applied in a caudal direction (Figure 2B).12,26
Subtalar lateral glide. For this intervention, while the
patient was supine and his/her leg was supported with
a towel roll, the therapist placed the base of his/her dis-
tal hand on the side of the calcaneus medially to provide
a lateral glide. Distraction force was applied in a caudal
4 Foot & Ankle International 
Figure 3.  (A) Subtalar lateral glide. (B) First tarsometatarsal
joint dorsal glide.
Figure 4.  (a) Gastrocnemius stretching. (B) Plantar fascia–
specific stretching.
direction. This maneuver was applied to increase inversion
(Figure 3A).12,26
First tarsometatarsal joint dorsal glide.  For this interven-
tion, tarsometatarsal joint dorsal glides were initially per-
formed by stabilizing the first cuneiform between the thumb
and index finger of the proximal hand, while the distal hand
grasped the base of the first metatarsal between the thumb
and index finger to produce a plantar-dorsal movement and
assess joint mobility (Figure 3B).12,26
Gastrocnemius stretching.  For this intervention, a patient
was seated on a firm surface while holding one leg straight
in front of him/her and a towel was looped around the ball
of his/her foot. The patient then pulled the towel towards
himself/herself. This position was held for 30 seconds
(Figure 4A).
Plantar fascia–specific stretching.  For this intervention, a
patient grabbed the base of her/his toes while in a seated
position and pulled them toward the shin (Figure 4B).
A physical therapist delivered the manual physical ther-
apy interventions at each session. The same physiotherapist
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provided follow-up and patient guidance in all of the ses-
sions. In addition, the therapist, who had 3 years of experi-
ence in joint mobilization techniques, aided the patients in
performing all joint mobilization exercises. The physical
therapist supervised patient performance of stretching exer-
cises of the gastrocnemius and plantar fascia in the clinic.
The patients were instructed to hold each stretching exercise
for a count of 30 and to repeat it a total of 10 times. The
supervised stretching exercises were performed at the clinic
for 9 visits and twice at home. The patients were also advised
to repeat the same stretching exercises on their own.
Steroid Injection Group.  Each patient was placed in a supine
position. A medial approach was used for injection adminis-
tration. The injection was usually applied at the point of max-
imal tenderness on palpation.14 The most painful site of the
medial aspect of the heel was identified by palpation. Proper
preparation was performed by applying an antiseptic solution
to the skin overlying the injection point. Subsequently, either
1 mL of corticosteroid (40 mg methylprednisolone acetate)
or 4 mL of 2% prilocaine hydrochloride was injected using a
22-gauge needle. Each injection was administered into the
heel around the plantar fascia. The same physician adminis-
tered all of the injections. Each injection was administered
once at baseline. No calf stretching was performed.
Statistical Analyses.  The data were evaluated using the Sta-
tistical Package for the Social Sciences 15.0 program for
Windows® and via descriptive statistics analysis (frequency,
mean, and standard deviation). The Shapiro-Wilk test was
used to assess the data distribution prior to statistical analy-
ses. Our data were normally distributed, and parametric tests
were used for statistical analyses. Demographic compari-
sons of the 2 groups were conducted using chi-square analy-
ses for categorical variables and independent sample t tests
for continuous variables. Changes in dependent variables
before and after treatment (3 weeks) and at the 6-week,
12-week, and 1-year follow-ups were analyzed using a
2-by-4 mixed-model analysis of variance (ANOVA) to
assess overall differences in group, time, and time-and-
group interaction effects. Independent t tests were used to
determine between-group differences at follow-ups. An
intention-to-treat analysis was performed using the multiple-
imputation method to impute values for missing data.27 An
alpha level of 0.05 was established for all statistical tests.
Results
The results of the intention-to-treat analyses were consistent.
The planned pairwise comparisons showed that in both
groups, the patients demonstrated significant improvements
in pain relief and functional outcomes (P < .05) at the 3-, 6-
and 12-week follow-ups compared to baseline. However,
improvements at the 12-week and 1-year follow-ups were
Çelik et al 5
Table 2.  A Comparison of Repeated Measures of FAAM and VAS Between Groups.
Baseline Mean 3-wk Mean
Assessments Group ± SD ± SD
VAS JM&Str 7.8 ± 1.6 5.4 ± 2.8
SI 7.7 ± 1.5 1.8 ± 2.1
P value* .84 .001
FAAM JM&Str 55.2 ± 18.4 60.6 ± 14.4
SI 45.5 ± 17.6 80.7 ± 19.4
P value* .09 .001
ANOVA, analysis of variance; FAAM, Foot and Ankle Ability Measure; JM&Str, Joint Mobilization & Stretching; SD, standard deviation; VAS, visual
analog scale.
*Independent sample t test.
only significant in the JM&Str group (P = .002). The overall
group-by-time interaction was statically significant based on
both FAAM (P = .001; F = 7.0) and VAS (P = .001; F = 8.3)
scores. The between-group differences favored the SI group at
the 3-week (P = .001, P = .001), 6-week (P = .002, P = .001),
and 12-week (P = .008, P = .001) follow-ups for pain and
function; however, no significant differences (P = .62, P =
.57) were detected in these outcomes at the 1-year follow-up.
Discussion
The results of our study demonstrated that both groups
achieved significant improvements at 3, 6, and 12 weeks of
follow-up. However, these improvements continued in only
the JM&Str group for a period of 12 weeks to 1 year. The
results also suggest that the treatment approach in the SI
group provided greater clinical benefits in terms of function
and pain than those experienced by the JM&Str group at the
follow-up periods ranging from 3 weeks to 12 weeks.
However, the superiority of SI was not maintained at the
1-year follow-up, as a significant difference was no longer
found for this effect (Table 2). These results support that SI
provides remarkable short-term pain relief and functional
improvement. Although not significant, the results also sug-
gest that JM&Str is a promising treatment method of
achieving longer-term improvements in pain and function,
as evidenced by the 1-year follow-up data. A set of clinical
practice guidelines published in 2008 that focused on the
management of patients with PF concluded that only mini-
mal evidence suggested that manual therapy was effective
for managing PF.22 However, these guidelines were revised
in 2014 to recommend that clinicians use manual therapy
consisting of soft tissue and joint mobilization to decrease
pain and improve function in patients with plantar heel
pain.19 However, “manual therapy” includes many tech-
niques, such as joint mobilization and manipulation, neu-
ral mobilization, myofascial trigger point manipulation,
and soft tissue mobilization.5,6,15,23,25 A case series by Yong
et al reported that patients experienced rapid improvements
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Repeated
6-wk Mean 12-wk Mean 12-mo Mean Measures
± SD ± SD ± SD F ANOVA
5.0 ± 2.3 4.9 ± 2.4 2.7 ± 3.2 .001
1.2 ± 1.4 1.5 ± 1.9 3.3 ± 3.2 8.30
.001 .001 .57  
70.2 ± 17.5 69.4 ± 16.8 86.7 ± 21.9 .001
85.7 ± 11.2 83.5 ± 14.6 83.4 ± 17.3 7.00
.002 .008 .62  
in pain and function after a single session of joint mobiliza-
tion combined with stretching exercises.31 The most com-
prehensive study to date was performed by Cleland et al,4
who applied soft tissue mobilization and joint mobilization,
including high-velocity, low-amplitude thrust and manipu-
lation and mobilization techniques to the ankle, foot, inter-
tarsal joint and upper joint. The authors reported that manual
physical therapy and exercise were superior to electrophysi-
cal agents and exercise in managing patients with PF in
terms of pain and function.4 Our study did not use soft tis-
sue mobilization or thrust and manipulation techniques. We
primarily focused on pain rather than dorsiflexion restric-
tion, which was not significantly different between groups.
We only applied Grade I and II talocrural, subtalar and tar-
sometatarsal joint mobilization and stretching exercises.
Our short-term results revealed that the JM&Str group was
not superior to the SI group based on FAAM and VAS scor-
ing and that the 2 groups were not significantly different at
1-year follow-up. However, the JM&Str group exhibited
continued improvements between 12 weeks and 1 year,
although these improvements did not lead to between-group
differences in pain or function.
Several studies have recommended the use of calf
stretching for the treatment of PF.9,24,31 Calf muscle and/or
plantar fascia–specific stretching may provide short-term
pain relief and improvements in calf-muscle flexibility.
Evidence from 2 systematic reviews suggests that stretch-
ing the soft tissue around the ankle and foot provides short-
term clinical benefits to individuals with PF.16,29 Many
studies have attempted to delineate how and what to stretch
for the treatment of PF.9,19,24,29 It appears that there are no dif-
ferences between the results obtained from sustained vs inter-
mittent stretching techniques9 and that calf stretching may be
more effective than plantar fascia–specific stretching24 in
improving plantar fascia flexibility. The present study used
a method of sustained stretching in which patients were
instructed to hold each stretch for a count of 30, to repeat
the stretch 10 times, and to perform these stretching exer-
cises 3 times daily for 3 weeks (9 visits). We also used
6 Foot & Ankle International 
plantar fascia–specific stretching because the Achilles ten-
don and plantar fascia are continuous connective tissue.
Steroid injection is commonly used to treat PF. There is
some evidence that injected corticosteroids are effective in
providing temporary pain relief.8 The rapid effects of SI on
pain encourages its frequent use by clinicians in treating PF,
particularly in professional athletes who must quickly
return to their livelihood. However, current scientific evi-
dence indicates that SI should not be used to treat PF in
athletes because of its greater risk of causing spontaneous
rupture.18 Previous studies have shown that SI is most ben-
eficial in treating PF-associated pain and swelling between
4 and 12 weeks.2,21 Similar to the aforementioned studies,
we found that SI was superior to JM&Str in the short term,
but no differences were observed in the long-term effects of
the 2 treatment modalities. Although we confirmed our
hypothesis that SI is more effective than JM&Str in the
short term, pain was increased by more than 2-fold, and
functional outcomes did not change between 12 weeks and
12 months. Clinicians offering this treatment should also
note that significant pain relief did not continue at the 1-year
follow-up. In addition, SI may lead to complications, such
as site pain, plantar fascia rupture, fat pad atrophy, lateral
plantar nerve injury, skin changes and/or infection, and cal-
caneal osteomyelitis, although the SI group did not show
any of these complications in our study.1,13,16,17,28,30 The
results of 2 systematic reviews also failed to provide evi-
dence indicating that any substantive clinical benefit is
obtained from using SI to treat patients with PF.16,30
This study has several limitations. We did not examine
dorsiflexion ROM at follow-up because we did not find any
significant differences at baseline. Joint mobilization was
not used to increase dorsiflexion ROM, although the stretch-
ing exercises would naturally aid in increasing dorsiflexion
ROM, which may explain the improvements in pain and
function between 12 weeks and 1 year. The patients were
encouraged to perform stretching exercises at home to
maintain their gains in ROM, and we do not know how this
affected the results. Although joint mobilization also pro-
duced effective results at 1 year, this intervention requires a
skilled therapist and is a time-consuming procedure.
Conclusion
In conclusion, the results of this study provide evidence that
patients with PF exhibit short-term relief with SI followed
by an increase in symptoms that equal the final results pro-
duced by manual therapy. The manual therapy group expe-
rienced a slow but steady decline in symptoms and showed
functional improvement at 1-year follow-up.
Editor’s Note
The authors are to be congratulated for completing this prospec-
tive randomized study on 2 treatment methods for plantar fasciitis.
Downloaded from fai.sagepub.com at UNIV NEBRASKA LIBRARIES on October 15, 2015
It reinforced what many clinicians have found in their clinics; ste-
roid injections can lead to good temporary relief of plantar heel
pain. It would have been more helpful to recommend that steroid
injection group perform calf stretching exercises but the study
nicely documented the time course of relief following these injec-
tions. It also demonstrated the effectiveness of stretching com-
bined with a joint mobilization program. It would have been
interesting to compare the effectiveness of stretching vs stretching
and joint mobilization to assess the added effect of the joint mobi-
lization. Perhaps this can be the subject of a future study.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
References
1. Acevedo JI, Beskin JL. Complications of plantar fascia rup-
ture associated with corticosteroid injection. Foot Ankle Int.
1998;19(2):91-97.
2. Ball EM, McKeeman HM, Patterson C, et al. Steroid injec-
tion for inferior heel pain: a randomised controlled trial. Ann
Rheum Dis. 2013;72:996-1002.
3. Blockey NJ. The painful heel; a controlled trial of the value of
hydrocortisone. BMJ. 1956;1:1277-1278.
4. Cleland JA, Abbott JH, Kidd MO, et al. Manual physical ther-
apy and exercise versus electrophysical agents and exercise in
the management of plantarheel pain: a multicenter random-
ized clinical trial. J Orthop Sports Phys Ther. 2009;39:573-
585. doi:10.2519/jospt.2009.3036.
5. Cornwall MW, McPoil TG, Lebec M, Vicenzino B, Wilson J.
Reliability of the modified Foot Posture Index. J Am Podiatr
Med Assoc. 2008;98:7-13. doi:10.7547/0980007
6. Cotchett MP, Landorf KB, Munteanu SE. Effectiveness of
dry needling and injections of myofascial trigger points asso-
ciated with plantar heel pain: a systematic review. J Foot
Ankle Res. 2010;3:18. doi:10.1186/1757-1146-3-18.
7. Crawford F, Atkins D, Young P, Edwards J. Steroid injection
for heel pain: evidence of short-term effectiveness. A ran-
domized controlled trial. Rheumatology (Oxford, England).
1999;38:974-977.
8. Crawford F, Thomson C. Interventions for treating plantar
heel pain. Cochrane Database Syst Rev. 2003;3:CD000416.
9. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-
specific plantar fascia-stretching exercise enhances outcomes
in patients with chronic heel pain. A prospective, randomized
study. J Bone Joint Surg Am. 2003;85-A:1270-1277.
10. Digiovanni BF, Nawoczenski DA, Malay DP, et al. Plantar
fascia-specific stretching exercise improves outcomes in
patients with chronic plantar fasciitis. A prospective clini-
cal trial with two-year followup. J Bone Joint Surg Am.
2006;88:1775-1781.
11. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA,
Anderson JA. Studies with pain rating scales. Ann Rheum Dis.
1978;37:378-381.
Çelik et al 7
12. Edmond SL. Joint Mobilization/Maniplation: Extremity and
Spinal Techniques. Philadelphia: Mosby; 2006:3-17.
13. Gidumal R, Evanski P. Calcaneal osteomyelitis following ste-
roid injection: a case report. Foot Ankle. 1985;6(1):44-46.
14. Kane D, Greaney T, Bresnihan B, Gibney R, FitzGerald O.
Ultrasound guided injection of recalcitrant plantar fasciitis.
Ann Rheum Dis. 1998;57:383-384.
15. Kiritsi O, Tsitas K, Malliaropoulos N, Mikroulis G.
Ultrasonographic evaluation of plantar fasciitis after low-
level laser therapy: results of a double-blind, randomized,
placebo-controlled trial. Lasers Med Sci. 2010;25:275-281.
http://dx.doi.org/10.1007/s10103-009-0737-5
16. Landorf KB, Menz HB. Plantar heel pain and fasciitis. Clin
Evid. 2008;2008:1111.
17. Leach R, Jones R, Silva T. Rupture of the plantar fascia in
athletes. Bone Joint Surg Am 1978;60:537-539.
18. Lee HS, Choi YR, Kim SW, Lee JY, Seo JH, Jeong JJ. Risk fac-
tors affecting chronic rupture of the plantar fascia. Foot Ankle
Int. 2014;35(3):258-263. doi:10.1177/1071100713514564.
19. Martin RL, Davenport TE, Reischl SF, et al. Heel pain—
plantar fasciitis: revision 2014. J Orthop Sports Phys Ther.
2014;44:A1-33. doi:10.2519/jospt.2014.0303.
20. Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen
JM. Evidence of validity for the Foot and Ankle Ability
Measure (FAAM). Foot Ankle Int. 2005;26(11):968-983.
21. McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow
AD, Menz HB. Ultrasound guided corticosteroid injec-
tion for plantar fasciitis: randomised controlled trial. BMJ.
2012;344:e3260. doi:10.1136/bmj.e3260.
22. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang
JJ, Godges JJ. Heel pain—plantar fasciitis: clinical practice
guildelines linked to the international classification of func-
tion, disability, and health from the orthopaedic section of
Downloaded from fai.sagepub.com at UNIV NEBRASKA LIBRARIES on October 15, 2015
the American Physical Therapy Association. J Orthop Sports
Phys Ther. 2008;38:A1-A18. doi:10.2519/jospt.2008.0302.
23. Pfeffer G, Bacchetti P, Deland J, et al. Comparison of custom
and prefabricated orthoses in the initial treatment of proximal
plantar fasciitis. Foot Ankle Int. 1999;20(4):214-221.
24. Porter D, Barrill E, Oneacre K, May BD. The effects of
duration and frequency of Achilles tendon stretching
on dorsiflexion and outcome in painful heel syndrome:
a randomized, blinded, control study. Foot Ankle Int.
2002;23(7):619-624.
25. Renan-Ordine R, Alburquerque-Sendín F, de Souza DP,
Cleland JA, Fernández-de-Las-Peñas C. Effectiveness of
myofascial trigger point manual therapy combined with a
self-stretching protocol for the management of plantar heel
pain: a randomized controlled trial. J Orthop Sports Phys
Ther. 2011;41:43-50. doi:10.2519/jospt.2011.3504.
26. Saunders DG, Walker JR, Levine D. Joint mobilization. Vet
Clin North Am Small Anim Pract. 2005;35:1287-1316.
27. Schafer JL, Graham JW. Missing data: our view of the state of
the art. Psychol Methods. 2002;7:147-177.
28. Sellman JR. Plantar fascia rupture associated with corticoste-
roid injection. Foot Ankle Int. 1994;15(7):376-381.
29. Sweeting D, Parish B, Hooper L, Chester R. The effectiveness
of manual stretching in the treatment of plantar heel pain: a
systematic review. J Foot Ankle Res. 2011;4:19.
30. Uden H, Boesch E, Kumar S. Plantar fasciitis—to jab or to
support? A systematic review of the current best evidence.
J Multidiscip Healthc. 2011;4:155-164.
31. Young B, Walker MJ, Strunce J, Boyles R. A combined treat-
ment approach emphasizing impairment-based manual physi-
cal therapy for plantar heel pain: a case series. J Orthop Sports
Phys Ther. 2004;34:725-733. doi:http://dx.doi.org/10.2519/
jospt.2004.1506.