Hamstring Stretching in Plantar Fasciitis
Condition: Plantar Fasciitis of Both Feet
MeSH terms: Fasciitis; Fasciitis, Plantar
Study type: Interventional

Summary: 
      The purpose of the study is to compare the effects of Hamstring stretching versus
      conventional treatment for plantar fasciitis. A randomized control trial was conducted at
      Cena Medical Center Rawalpindi and Midland Doctors Institute Muzaffarabaad. The sample size
      was 64 calculated through open-epi tool. The participants were divided into two groups,
      interventional and control group each having 32 participants. The study duration was 1 year.
      Sampling technique applied was Purposive sampling for recruitment and group randomization
      using flip coin method. Only 25to 45 years participants with plantar fasciitis along with
      hamstring tightness were included in the study. Tools used in this study are Goniometer,
      Visual Analogue Scale(VAS) for pain, and Functional Foot Index (FFI) for pain and disability.
      Data was collected before treatment at baseline and after 1st and 2nd week of the application
      of interventions. Data analyzed through SPSS version 25.
    

Detailed description: 
      Plantar fasciitis is one of the main causes of heel pain. it is caused by the micro trauma to
      the site of attachment of plantar fascia at its origin on the medial tubercle of calcaneus
      resulting in inflammation. Plantar fascia is a fibrous band present at the bottom of foot
      which attaches heel to each of the toes.plantar fascia has a windlass mechanism which
      continuously stretches and shortens facilitating foot movements during walk.

      During the standing phase all the tension forces are gathered at calcaneal tuberosity, which
      is a site of attachment for plantar fascia on heel. Pain is generally present at the medial
      side of heel to the medial arch of the foot.

      Plantar fasciitis is often caused in people who have long periods of standing, involved in
      activities like running, jumping or other repeated activities. After knowing the exact
      mechanism it is suggested that it should be termed as planter fasciosis.Plantar fasciitis
      accounts for almost 80% of the total heel pain experienced by the people.

      Planter fasciitis is treated with various treatment options. Initially it is treated by
      conservative treatments such as, rest, ice massage, foot ware modification, oral analgesics,
      stretching techniques, physical therapy modalities, and night splinting. If pain do not
      resolve with conservative treatment then further treatment options will be extracorporeal
      shock wave therapy, cortisone injections and surgery.

      Diana et al concluded that addition of manual techniques for trigger point release along with
      stretching of plantar fascia is more effective than stretching alone. In a randomized control
      trial with a follow up of 12 months high load strength training was found to be quicker and
      more efficient treatment for plantar fasciitis. another RCT conducted in 2017 reported that
      stretching of Achilles tendon along with plantar fascia is twice effective than only plantar
      fascia stretching.

      Immobilization done by using splints at night is one of the best treatments to avoid
      contracture in plantar fascia during night. But they are also related to sleep disturbances
      and discomfort during night. By using night splint there has been a pain relief for shorter
      period of time. Night splints used alongside custom foot orthotics have better results than
      used alone. Controlled Ankle Movement is very effective in reducing pain in heel. It can be
      done by using walking boots and casts. These boots and casts will help to reduce over
      stretching of plantar fascia with unloading mechanism over heel. The reported reduction of
      pain by this mechanism of controlled ankle movement is in up to 40% of individuals.

      Jonathan et al reported that there is a role of hamstring tightness in plantar fasciitis. A
      correlation study found a strong relationship between hamstring tightness and plantar
      fasciitis. patients having hamstring tightness are 8.7% more prone towards developing planter
      fasciitis.

      Hamstring is found to be affected in patients with plantar fasciitis. Many studies found
      relationship of hamstring tightness with plantar fasciitis. Hamstring tightness affects the
      posterior muscles increasing load on plantar fascia. There is scarce evidence about the
      hamstring stretching in patients having plantar fasciitis. So this study will focus on
      hamstring stretching along with plantar fascia stretching and strengthening to improve pain,
      range of motion and disability.
    

Intervention name(s): Experimental Group; Control Group
Intervention type(s): Other; Other
Intervention description(s): Hamstring stretching is the main intervention which is being used along with convention protocol for plantar fasciitis.; Control group included Cold pack for 7 to 10 mins. Followed by stretching of plantar fascia .
Other intervention name(s): Hamstring Streching; cold pack, calf and plantar fascia stretchings and strenthening exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Planter Faciatis