Plantar Heel Pain: Multisegment Foot Motion and Muscle Function, FFI Translation, and Evaluation of Treatments

NCT03161314 | Completed Results

• 1 other identifier: MU-CIRB 2016/182.0211
• Study Type: interventional
• Target: 84
• Locations: 1 country
• Sites: 2

Brief Summary

Plantar fasciitis (PF) is a prevalent musculoskeletal condition of plantar heel pain (PHP) that leads to pain, functional limitations, and reduced quality of life, especially among active adults aged 25 to 65. Understanding the biomechanical alterations in foot motion among individuals with PF is essential to inform targeted treatment strategies and prevent symptom chronicity. However, research exploring detailed multi-segment foot motion changes in this population remains limited. Assessing foot function is a key component in understanding symptom development and treatment outcomes. The Foot Function Index (FFI) is an internationally recognized, reliable, and valid questionnaire used to measure foot pain and disability. To facilitate its use in Thai populations and enable cross-cultural comparisons, it is crucial to translate and validate the FFI into Thai. Although exercise interventions such as strengthening and stretching are widely used to manage PHP, evidence regarding their relative effectiveness on pain reduction and gait improvement is inconclusive. Rigorous evaluation of these programs is needed to establish evidence-based guidelines for physical therapy in this population. Study 1: Comparative Study of Gait and Foot Segment Motion Between Individuals with Plantar Fasciitis and Healthy Controls This study aimed to compare multi-segment foot motion during walking between individuals with plantar fasciitis (PF) and healthy controls. A matched case-control design was used, with gait data collected via a 3D motion capture system and analyzed using the Oxford Foot Model. Study 2: Translation and Validation of the Thai Version of the Foot Function Index (FFI-Th) This study aimed to translate the Foot Function Index (FFI) into Thai (FFI-Th) and evaluate its psychometric properties individuals with plantar foot complaints. Study 3: Effects of Strengthening and Stretching Exercise Programs on Pain and Gait in Patients with Plantar Fasciitis: A Randomized Controlled Trial This study aimed to investigate the effects of physical therapy interventions-specifically strengthening versus stretching exercise programs-on pain and temporospatial gait parameters in patients with PF.

Conditions

Plantar Fasciitis

Keywords

plantar fasciitis; multisegment foot motion; gait; physical therapy; strengthening; stretching; exercise; translation; plantar heel pain

Outcome Measures

Primary Outcomes (2)

• Worst Pain

  Worst pain was assessed using the Visual analog scale (VAS), where 0 indicates "no pain" and 10 indicates "pain as bad as participants can imagine". Participants were asked to report their worst pain level over the past 24 hours. Higher scores indicate more severe pain. Unit of Measure: scores

  Baseline, 2 weeks after the intervention, 4 weeks after the intervention, 1-month follow-up, and 2-month follow-up

• Morning Pain

  Morning pain intensity upon waking was assessed using a 10 cm Visual Analog Scale (VAS), where participants mark a point along a continuous line anchored by "no pain" (0) and "worst imaginable pain" (10), with higher values indicating more severe morning pain. Unit of Measure: scores

  Baseline, 2 weeks after the intervention, 4 weeks after the intervention, 1-month follow-up, and 2-month follow-up

Secondary Outcomes (4)

• Cadence

  Baseline, 2 weeks after the intervention, 4 weeks after the intervention, 1-month follow-up, and 2-month follow-up

• Stride Length

  Baseline, 2 weeks after the intervention, 4 weeks after the intervention, 1-month follow-up, and 2-month follow-up

• Stride Time

  Baseline, 2 weeks after the intervention, 4 weeks after the intervention, 1-month follow-up, and 2-month follow-up

• Gait Speed

  Baseline, 2 weeks after the intervention, 4 weeks after the intervention, 1-month follow-up, and 2-month follow-up

Study Arms (2)

Strengthening group

EXPERIMENTAL

Individuals with PF who received strengthening exercises. (study 3)

Procedure: Strengthening exercises

Stretching group

ACTIVE COMPARATOR

Individuals with PF who received stretching exercises. (study 3)

Procedure: Stretching exercises

Interventions

Strengthening exercises PROCEDURE

Conservative physical therapy treatment with home-based strengthening exercises (study 3)

Strengthening group

Stretching exercises PROCEDURE

Conservative physical therapy treatment with home-based stretching exercises (study 3)

Stretching group

Eligibility Criteria

• Age: 20 Years - 80 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged 20-80 years
• Plantar fasciitis (PF) symptoms for at least one month
• Pain or tenderness at the medial calcaneal tubercle or proximal plantar fascia
• At least one of the following symptoms:
• Morning pain (first steps in the morning)
• Pain after prolonged sitting
• Pain during weight-bearing activities

You may not qualify if:

• Other painful conditions in the lower extremity or back
• History of rheumatoid arthritis
• Neurological or vascular diseases
• Leg length discrepancy \>1 cm
• Severe pain preventing walking
• No current or previous history of PF symptoms
• No foot pain
• Same as those listed for the PF group
• Aged 20-80 years
• Experienced plantar foot pain or tenderness for at least one month (at rest or during weight-bearing activities)
• Able to read and communicate in Thai
• Pain in other areas of the lower extremities
• History of systemic inflammatory diseases
• History of neurological diseases
• Received any treatment during the study period

Sponsors & Collaborators

• Mahidol University: lead
• Thailand Research Fund: collaborator

Study Sites (2)

Motion analysis laboratory

Salaya, Nakhonpathom, Thailand

Location

Physical therapy center, Physical therapy faculty, Mahidol University

Bangkok, 10700, Thailand

Location

Related Publications (12)

• Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK, McDonough CM; American Physical Therapy Association. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014 Nov;44(11):A1-33. doi: 10.2519/jospt.2014.0303.

  PMID: 25361863 BACKGROUND

• Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. 2005 Dec 1;72(11):2237-42.

  PMID: 16342847 BACKGROUND

• Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7. doi: 10.7547/87507315-93-3-234.

  PMID: 12756315 BACKGROUND

• Chang R, Rodrigues PA, Van Emmerik RE, Hamill J. Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis. J Biomech. 2014 Aug 22;47(11):2571-7. doi: 10.1016/j.jbiomech.2014.06.003. Epub 2014 Jun 11.

  PMID: 24992816 BACKGROUND

• Wearing SC, Smeathers JE, Yates B, Sullivan PM, Urry SR, Dubois P. Sagittal movement of the medial longitudinal arch is unchanged in plantar fasciitis. Med Sci Sports Exerc. 2004 Oct;36(10):1761-7. doi: 10.1249/01.mss.0000142297.10881.11.

  PMID: 15595298 BACKGROUND

• Budiman-Mak E, Conrad KJ, Mazza J, Stuck RM. A review of the foot function index and the foot function index - revised. J Foot Ankle Res. 2013 Feb 1;6(1):5. doi: 10.1186/1757-1146-6-5.

  PMID: 23369667 BACKGROUND

• Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study. J Foot Ankle Res. 2008 Jul 28;1(1):2. doi: 10.1186/1757-1146-1-2.

  PMID: 18822153 RESULT

• Sullivan J, Burns J, Adams R, Pappas E, Crosbie J. Musculoskeletal and activity-related factors associated with plantar heel pain. Foot Ankle Int. 2015 Jan;36(1):37-45. doi: 10.1177/1071100714551021. Epub 2014 Sep 18.

  PMID: 25237175 RESULT

• Rathleff MS, Moelgaard C, Lykkegaard Olesen J. Intra- and interobserver reliability of quantitative ultrasound measurement of the plantar fascia. J Clin Ultrasound. 2011 Mar-Apr;39(3):128-34. doi: 10.1002/jcu.20787. Epub 2011 Jan 10.

  PMID: 21387326 RESULT

• Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2006 Aug;88(8):1775-81. doi: 10.2106/JBJS.E.01281.

  PMID: 16882901 RESULT

• Rathleff MS, Molgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015 Jun;25(3):e292-300. doi: 10.1111/sms.12313. Epub 2014 Aug 21.

  PMID: 25145882 RESULT

• Bovonsunthonchai S, Thong-On S, Vachalathiti R, Intiravoranont W, Suwannarat S, Smith R. Thai version of the foot function index: a cross-cultural adaptation with reliability and validity evaluation. BMC Sports Sci Med Rehabil. 2020 Sep 10;12:56. doi: 10.1186/s13102-020-00206-8. eCollection 2020.

  PMID: 32944253 DERIVED

MeSH Terms

Conditions

Fasciitis, Plantar; Motor Activity

Interventions

Muscle Stretching Exercises

Condition Hierarchy (Ancestors)

Fasciitis; Musculoskeletal Diseases; Foot Diseases; Behavior

Intervention Hierarchy (Ancestors)

Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Limitations and Caveats

This study did not compare to the pure conservative physical therapy treatment, which may provide more information about the effectiveness of strengthening and stretching exercises that may superior to the conservative treatment alone.

Results Point of Contact

• Title: Asst.Prof.Dr. Sunee Bovonsunthonchai
• Organization: Physical Therapy Faculty, Mahidol University

sunee.bov@mahidol.edu

024415450

Study Officials

• Sunee Bovonsunthonchai, PhD

  Mahidol University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Masking Details: Conservative physical therapy intervention was launched by the same physical therapist who blind to participant group allocation.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: A stratified randomization table according to age (less or more than 50 years) and pain score (less or more than 5 out of 10 scores) was used.

Study Record Dates

• First Submitted: May 8, 2017
• First Posted: May 19, 2017
• Study Start: August 1, 2017
• Primary Completion: February 1, 2019
• Study Completion: March 1, 2019
• Last Updated: July 4, 2025
• Results First Posted: July 4, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will not share

Locations

TH (2)