Effects of combined myofascial release and fascia stretching therapy on pain and function in chronic plantar fasciopathy: a randomized controlled trial

Chronic plantar fasciopathy (CPF) is a common cause of heel pain associated with functional limitations. While myofascial release (MFR) and fascia stretching therapy (FST) are widely used, the added benefit of their combination remains unclear. This study aimed to compare the effects of combined MFR and FST versus MFR alone on pain intensity and functional disability in individuals with CPF. In this assessor-blinded, three-arm randomized controlled trial, 90 participants with CPF were randomly assigned to combined MFR + FST (N = 30), MFR alone (N = 30), or control (N = 30). Interventions were administered three times per week for 8 weeks. Pain intensity and functional outcomes were assessed using the Visual Analog Scale (VAS) and Foot Function Index (FFI). Between‑group differences in post‑intervention outcomes were analyzed using ANCOVA with baseline values as covariates, and MANCOVA was applied for the correlated FFI subscales. ANCOVA showed a significant effect of group on VAS scores ( p < 0.001, η 2 = 0.47), with greater pain reduction in the MFR + FST group compared with MFR alone and control, while MFR also outperformed control. Similarly, significant group effects were found for total FFI ( p < 0.001, η 2 = 0.45), with the greatest functional improvement in the MFR + FST group. Multivariate analysis demonstrated a significant overall group effect across FFI subscales (Pillai’s Trace = 0.56, p < 0.001), indicating superior improvements in pain, disability, and activity limitation for the combined MFR + FST intervention compared with the other groups. MFR combined with FST was associated with greater improvements in pain and function compared with MFR alone and a control group. These findings suggest a potential added benefit of multimodal fascial interventions, although interpretation should consider the lack of a sham control and subjective outcome measures.