title: Joint Mobilization and Stretching Exercise vs Steroid Injection in the Treatment of Plantar Fasciitis: A Randomized Controlled Study.
abstract: BACKGROUND
  This study compared the effectiveness of joint mobilization combined with stretching exercises (JM&Str) vs steroid injection (SI) in the treatment of plantar fasciitis (PF).
  
  
  METHODS
  A total of 43 patients (mean age, 45.5 ± 8.5 years; range, 30-60 years; 23 females) with PF were randomly assigned to receive either JM&Str (n = 22) or SIs (n = 21). JM&Str was applied 3 times per week for 3 weeks for a total of 9 visits. The SI group received 1 injection at baseline. The patients' functional scores were assessed using the Foot and Ankle Ability Measure (FAAM), and pain was evaluated using the Visual Analog Scale (VAS). Outcomes of interest were captured at baseline and at 3-week, 6-week, 12-week, and 1-year follow-ups. The primary aim was examined using a mixed-model analysis of variance (ANOVA). Pairwise comparisons were performed to examine differences between the baseline and follow-up periods using Bonferroni equality at an alpha level of 0.05.
  
  
  RESULTS
  Age, sex, body mass index, and dorsiflexion range of motion did not significantly impact pain relief or functional outcome (P > .05) at the 3-, 6- or 12-week follow-ups compared to baseline. Planned pairwise comparisons demonstrated significant improvements in pain relief and functional outcomes in both groups (P < .05) at the 3-, 6-, and 12-week follow-ups compared to baseline. However, at the 12-week and 1-year follow-ups, pain and functional outcomes were significantly improved in only the JM&Str group (P = .002). The overall group-by-time interaction was statistically significant for both FAAM (P = .001; F = 7.0) and VAS (P = .001; F = 8.3) scores. Between-group differences favored the SI group at the 3-week (P = .001, P = .001), 6-week (P = .002, P = .001), and 12-week (P = .008, P = .001) follow-ups for pain relief and functional outcomes. However, no significant differences (P = .62, P = .57) were detected in the measured outcomes at the 1-year follow-up.
  
  
  CONCLUSIONS
  Our study demonstrated that while both groups achieved significant improvements at the 3-, 6-, and 12-week follow-ups, the SI group exhibited better outcomes at all 3 time points. The noted improvements continued in only the JM&Str group for a period of time ranging from 12 weeks to 1 year.
  
  
  METHODS
  Level II, comparative study.
authors.affiliation: Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey ptderya@hotmail.com.
authors.forename: Derya
authors.initials: D
authors.lastname: Celik
authors.affiliation: Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey.
authors.forename: Gamze
authors.initials: G
authors.lastname: Kuş
authors.affiliation: Department of Orthopedics and Traumatology, Bezmialem University, Istanbul, Turkey.
authors.forename: Serkan Önder
authors.initials: SÖ
authors.lastname: Sırma
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D005081:Exercise Therapy / Q000379:methods*; D036981:Fasciitis, Plantar / Q000628:therapy*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008775:Methylprednisolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D011318:Prilocaine / Q000627:therapeutic use; D011446:Prospective Studies; D016037:Single-Blind Method; D064232:Visual Analog Scale
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D011318:Prilocaine; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone
keywords: exercise therapy; fascia; foot pain; manual therapy; pain management