Pain relief in plantar fasciitis within 6–8 weeks using (ortho)manual therapy of the foot joints: a prospective cohort study

Objectives What changes over time are measured on pain, activities, quality of life and thickness of the plantar fascia when (ortho)manual therapy of the foot joints is applied to patients with plantar fasciitis (PF). Methods In this observational single-arm cohort study, 50 patients with PF (31 females and 19 males, aged between 27 and 73 years) were recruited over a 22-month period. Of the 50 patients included, 32 completed the 26-week follow up. Eight patients were excluded after T2 because they needed additional spine treatments. 10 dropped out during the remainder of the study. The intervention protocol involved five visits in the first 6–8 weeks for assessments and treatments and one visit after 26 weeks for evaluation. The (ortho)manual therapy consisted of manual manipulations of the foot joints often preceded by the techniques with hammer and thrift. The (ortho)manual therapy was combined with a corrective insole. Primary outcomes were pain intensity numeric pain rating scale (NPRS), and plantar fascia thickness, assessed via ultrasound. Secondary outcomes included the Patient Specific Functional Scale (PSFS), Foot Function Index (FFI), Short Form 12 (SF-12), and EuroQoL 5D (EQ5D). Results Significant reductions in NPRS scores at rest (2.98 to 1.39, p = 0.004) during activity (6.64 to 2.66, p ≤ .001), and during the first step in the morning (6.79 to 2.69, p ≤ .001) were observed. Plantar fascia thickness in the unilateral group also decreased significantly over time (affected side 5.34 mm to 3.70 mm, p ≤ 0.001). PSFS scores improved significantly, indicating reduced difficulty in performing activities. The FFI showed significant improvements in pain, disability, and activity subscales. Quality of life showed significant improvement in the physical component scores. Discussion Dropout during follow-up, variability in therapist experience, missing data in patient-reported outcomes, and the lack of a standardized ultrasound examiner may have influenced reliability. Additionally, the intervention combined two treatments—(ortho)manual therapy and corrective insoles—making it difficult to isolate their individual effects. Despite these limitations, significant improvements in pain and plantar fascia thickness were observed as early as 1–2 weeks after the first treatment session, with clinically relevant changes sustained over 26 weeks. Due to the limitations, the results of this study should be interpreted with caution, but support (ortho)manual therapy as a promising treatment for PF. Further controlled studies are needed to confirm these findings. Conclusion The results show pain reduction within 6–8 weeks with further improvement at follow up. The treatment has lasting effects, potentially preventing PF recurrence and other lower extremity issues. Ultrasound findings may alter the understanding of PF and tendon problems.