Therapeutic efficacy of stretching exercises as a conservative treatment for plantar fasciitis: a systematic review with meta-analysis

BACKGROUND: Plantar fasciitis (PF) is a prevalent source of plantar heel pain, and stretching is a recommended conservative treatment. However, comparative effectiveness of plantar fascia-specific stretching (PFSS), gastrocnemius-soleus (GS) stretching, and Achilles tendon stretching (ATS) remains uncertain because of heterogeneity in intervention protocols, comparator interventions, and outcome reporting across randomized controlled trials (RCTs). OBJECTIVE: To quantitatively synthesize the effectiveness of stretching-based interventions on clinical and structural outcomes in PF. METHODS: . Predefined comparator-based subgroup analyses were undertaken. The Cochrane Risk of Bias 2 (ROB 2) tool evaluated risk of bias, while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework assessed certainty of evidence across all pooled outcomes. RESULTS: = 94%). Subgroup analyses showed no significant differences between comparator categories. Evidence for PPT and plantar fascia thickness remained uncertain, while ROM findings were inconsistent. ROB 2 assessment identified some concerns in eleven studies, and certainty of evidence was very low across all pooled outcomes. CONCLUSION: Current evidence does not establish the superiority of stretching-based interventions across outcomes compared with alternative conservative interventions for PF. Further robust RCTs using standardized stretching protocols, clinically relevant comparators, and longer follow-up are required to strengthen the evidence base.