Effect of foot core exercises vs ankle proprioceptive neuromuscular facilitation on pain, range of motion, and dynamic balance in individuals with plantar fasciitis: a comparative study

Manali Boob; Pratik Phansopkar

doi:10.12688/f1000research.136828.1

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Effect of foot core exercises vs ankle proprioceptive neuromuscular facilitation on pain, range of motion, and dynamic balance in individuals with plantar fasciitis: a comparative study

[version 1; peer review: 2 approved with reservations]

Manali Boob ¹, Pratik Phansopkar¹

PUBLISHED 30 Jun 2023

Author details Author details

¹ Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India

Manali Boob
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

Pratik Phansopkar
Roles: Supervision, Validation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Datta Meghe Institute of Higher Education and Research collection.

Abstract

Plantar fasciitis is generally described as an inflammation of the plantar fascia and adjacent tissues around calcaneus tuberosity. Plantar fasciitis onset has been proposed to have an internal mechanical cause, even though this is inadequately recognized. Studies related to alternation in lower-extremity biomechanics that leads to reduced domes of the foot are hypothesized to cause tension in the underlying fascia. Similarly, despite a wealth of anecdotal data suggesting a direct connection between foot mechanism and disability. This condition typically leads to calf muscular stiffness, soreness in the bottom of the feet, decreased range and foot function, strength, and balance impairment. These results in interference with the normal biomechanics of ambulation. A total of (n=66) individuals with plantar fasciitis will be selected for the trial. Subjects will be allocated to Groups A and B at equal allocation with randomization. Group A will undergo foot core exercises, while Group B will undergo ankle proprioceptive neuromuscular facilitation, with both groups receiving conventional treatment. The regimen lasts for 40 minutes, 5 days, for 6 weeks. The outcome measures will be assessed on Foot Functional Index, modified Star Excursion Balance Test (mSEBT), Visual Analogue Scale (VAS), and Weight Bearing Lunge Test (WBLT) be assessed at the initiation and completion of the entire treatment protocol. Prior and after therapeutic intervention results will be analyzed. Based on the comparison of the two treatments' effects on measuring outcomes in individuals with plantar fasciitis, an analysis will be conducted.

Keywords

Plantar fasciitis, foot core exercises, ankle proprioceptive neuromuscular facilitation, foot functional index, modified star excursion test.

Corresponding author: Manali Boob

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 Boob M and Phansopkar P. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Boob M and Phansopkar P. Effect of foot core exercises vs ankle proprioceptive neuromuscular facilitation on pain, range of motion, and dynamic balance in individuals with plantar fasciitis: a comparative study [version 1; peer review: 2 approved with reservations]. F1000Research 2023, 12:765 (https://doi.org/10.12688/f1000research.136828.1) First published: 30 Jun 2023, 12:765 (https://doi.org/10.12688/f1000research.136828.1) Latest published: 23 Apr 2024, 12:765 (https://doi.org/10.12688/f1000research.136828.2)

Introduction

The ankle and foot are constituted of twenty-six separate small bones as well as the major bones of the leg.¹ The ankle joint creates a connection that enables the lower extremity to connect with the foot.¹ Ankle and foot mobility is described in the following three categorical planes: longitudinal, coronal, and axial.² The sole of the foot comprises three main vaults: a transverse arch, and two longitudinal arches. The muscles, ligaments, tendons, and fascia in the foot support these domes.³ The gastrocnemius and soleus muscles work together to predominantly plantarflex the ankle.⁴ The plantar layers contain the intrinsic foot muscles in their anatomical alignment.⁴ The ends of extrinsic foot muscles are connected at the foot distally and the leg proximally, respectively.⁵ A broad, longitudinally oriented strand that are firmly linked to the sole of the foot is referred to as plantar fascia. The proximally plantar fascia is attached to the calcaneal tuberosity and distally split into five bands for each toe.⁶

A gradual degenerative irritation of the plantar fascia, which starts at the medial calcaneal tuberosity, as well as the nearby perifascial tissues, results in plantar fasciitis, an inflammatory disorder. The plantar fascia serves a crucial role in accurate foot mechanics.⁷ The main prevalent source of heel discomfort is plantar fasciitis. This is responsible for around 15% of all foot issues brought to the attention of healthcare practitioners.⁸ A mechanical model known as the “windlass mechanism” offers a complete justification for the biomechanical components of the foot. Such knowledge is crucial for clinical practice since it could give medical experts a comprehensive grasp of the connection between pathologies and biomechanical factors.⁹ A history of pain with the first steps in the morning, pain that becomes worse with loading activities and gets better over the day, and palpable soreness in the medial calcaneal tubercle are used to make the diagnosis of this illness. Achilles tendon tightness may cause patients to have decreased ankle dorsiflexion, which might lead to anticipatory overpronation of the ankle.¹⁰

Theories of Proprioceptive Neuromuscular Facilitation (PNF) may be beneficial in enhancing postural balance and stability. In the development of a therapeutic relationship, PNF is characterized as a strategy to improve the neuromuscular stimulation of the proprioceptive sense response mechanism. This technique set contains methods that stimulate proprioceptive sense to improve the response of the neurological and muscular systems. PNF is a stretching method that is utilized in the realms of exercise and sports to increase muscular flexibility, strength, and balance as well as joint mobility.¹¹ The technique emphasis of timing in ankle proprioceptive neuromuscular facilitation (PNF) was enhanced to synchronise and strengthen the movement patterns of both the foot's intrinsic and exterior muscles.¹²

Exercises for the foot core were done to maintain proper foot alignment, manage the position of the arch, and activate the proprioceptors on the foot's sole to enhance balance. As a result, earlier gait retraining studies have started to include foot core exercise to lower the risk of injury in individuals when the striking pattern abruptly changes. The towel curls, foot doming, and toe spread, which have been shown to be efficient treatments to develop the arch muscles, might be used to strengthen the foot muscles in order to stabilise the form of the arch.¹³

Visual analogue scale (VAS) is used to assess the pain, rated from zero to ten. The foot functional index (FFI) questionnaire evaluates physical discomfort, impairments, as well as activity-restricting foot pathologies in everyday functioning.¹⁴ The 23 items on the questionnaire are categorized into three subdimensions: pain, activity limitations, and disabilities. It was created in English, and it has official translations for usage in Chinese, German, French, Italian, and Spanish. Because standardisation is crucial when utilising measures of assessment, checklists created in other languages must be translated and their parametric qualities assessed to promote comparability between research.¹⁵ Ankle dorsiflexion may be directly monitored with weight bearing lung test. The therapist measured the amount of dorsiflexion in affected limbs while the patient will be in a lunge position. The therapists either employed an inclinometer or a measuring tape to evaluate the numerical outcome. In several disorders, including patellofemoral pain syndrome and overpronation of the foot, which may result in plantar fasciitis, it is well-accepted that inadequate ankle dorsiflexion plays a vital role.¹⁶

The modified Star Excursion Balance Test is among the popular techniques for the clinical examination of dynamic balance (mSEBT). When assessing the likelihood of lower extremity injuries, clinicians frequently employ just one of these diagnostic techniques and one outcome factor. It is well-established that age, sex, and sport may affect dynamic balance scores.¹⁷

The purpose of the study is to compare the effects of foot core exercises and ankle proprioceptive neuromuscular facilitation on pain, range of motion, and dynamic balance in patients with plantar fasciitis. The plantar fascia is subjected to steadily increasing loading stress if these musculatures are weaker and the plantar fascia lacks flexibility, which flattens the longitudinal arch and causes foot eversion. This results in the hip of the afflicted side descending, which causes the hip to rotate inward, and a reduction in the medial joint space of the knee. This may result in plantar fascia overload, muscle imbalance, abnormal gait, and reduced functional performance. Foot core exercises and Proprioceptive neuromuscular facilitation have been shown to be helpful in the reduction of pain, restoring the motion, and regaining muscular strength. There is a lack of literature that emphasizes a comparison between foot core exercises and PNF that helps in improving dynamic state of balance, as well as functional status in patients suffering from plantar fasciitis. As a result, strong evidence is very important in this field.

Aim and objective

1) To assess and evaluate the effects of foot core exercises on pain (VAS and FFI), range of motion (WBLT), and dynamic balance (mSEBT) in patients with plantar fasciitis.
2) To assess and evaluate the effects of ankle proprioceptive neuromuscular facilitation on pain (VAS and FFI), range of motion (WBLT), and dynamic balance (mSEBT) in patients with plantar fasciitis.
3) To compare the effects of foot core exercises and ankle proprioceptive neuromuscular facilitation on pain (VAS and FFI), range of motion (WBLT), and dynamic balance (mSEBT) in patients with plantar fasciitis.

Trial Design: single centric two arm parallel, comparative open labelled superiority trial.

Protocol

The study will be conducted at Musculoskeletal Physiotherapy OPD of Acharya Vinoba Bhave Rural Hospital and Musculoskeletal Physiotherapy OPD of Ravi Nair Physiotherapy college, Sawangi (Meghe) Wardha, after receiving approval from ethical committee of Datta Meghe Institute of Higher Education and Research. The participants diagnosed as plantar fasciitis and follows the inclusion criteria will be randomly selected using simple random sampling and divided into Group A and Group B using computer generated list. After explaining the study protocol in detail, written consent will be signed by the participants. The duration of study will be one year. A total of 33 participants will be in each group. The outcome measures are foot functional index, modified star excursion balance test, weight bearing lunge test and visual analogue scale used to assessed pain, range of motion, dynamic balance, disability, and limitations in activities of daily living. Group A patients will be receiving foot core exercises and conventional therapy and group B patients will be receiving ankle proprioceptive neuromuscular facilitation. The outcome measure will be assessed at the base line and after six weeks of intervention Figure 1. Explains the study procedure.

Figure 1. Study procedure flow chart.

Inclusion criteria

1) A progressive onset of heel pain lasting three months or more, localized to the medial calcaneal tubercle.
2) Sharp and worsen pain with the first few steps out of bed in morning.
3) Positive windlass test.
4) Both male and female.
5) Age ranging between 40-60.

Exclusion criteria

1) Patients with type 1 or 2 Diabetes Mellitus, systemic inflammatory arthritis, cancer, active tuberculosis.
2) Arthrosis of the ankle, knee, and hip.
3) Pregnant women.
4) Patients with numbness or tingling with or without provocation in the lower extremity, undiagnosed pain.
5) Patients currently receiving treatment and using steroids within the last six months for the plantar fasciitis.

Intervention

Control group

Group A will be given foot core exercises which includes heel raise, toe curls, foot doming, toe spreading, balancing board, and tennis ball roll under foot along with conventional therapy which includes ultrasound, plantar fascia stretching and Achilles stretching. The foot core exercises mentioned in Table 1. which lasts for 30 mins with 10 mins of conventional therapy. The entire protocol lasts for 40 min, five days a week, for six weeks.

Table 1. Foot core exercises.

Foot core exercises	1-2 weeks	3-4 weeks	5-6 weeks
Double Leg Heel Raise	1 × 10 times	2 × 10 times	2 × 15 times
Single Leg Heel Raise	1 × 10 times	2 × 10 times	2 × 15 times
Towel curls	3 × 10 times	3 × 20 times	3 × 10 times (+0.25 kg)
Foot doming	2 × 10 times	2 × 15 times	2 × 20 times
Toe spread	2 × 10 times	2 × 15 times	2 × 20 times
Balance board	2 × 20 second	2 × 25 second	2 × 30 second
Foot relaxes	1 × 30 second	1 × 30 second	1 × 30 second

Experimental group

Group B will be given Ankle Proprioceptive Neuromuscular Facilitation (PNF) which includes techniques such as slow reversal (SR), and rhythmic stabilization (RS) along with conventional therapy. The PNF protocol mentioned in Table 2 which last for 30 mins with 10 mins of conventional therapy. The entire protocol lasts for 40 min, five days a week, for six weeks.

Table 2. Ankle PNF technique.

Muscles	PNF technique	Duration (sec) of technique	Repetition of each technique
Ankle Plantarflexors	Slow Reversal	35	3
Ankle Plantarflexors	Rhythmic Stabilization	90	3
Ankle Dorsiflexors	Slow Reversal	35	3
Ankle Dorsiflexors	Rhythmic Stabilization	90	3
Ankle Invertors	Slow Reversal	35	3
Ankle Invertors	Rhythmic Stabilization	90	3
Ankle Evertors	Slow Reversal	35	3
Ankle Evertors	Rhythmic Stabilization	90	3

Outcome measures

Primary outcomes

1. Foot Function Index (FFI)
the Foot Function Index (FFI) was designed to analyze the effect of foot abnormalities on performance in terms of pain, functional limitations, and activity restriction. The internal consistency was between 0.96 and 0.7.¹⁵
2. The Modified Star Excursion Balance Test (mSEBT)
The SEBT (Star Excursion Balance Test) is a multi-dimensional test that includes power, mobility, and postural control. This is a dynamic balancing measurement that poses a substantial challenge to players and healthy and active adults. The evaluation is used to measure functional ability as well as to screen for inadequacies in dynamic balance caused by musculoskeletal disorder. coefficients of variation ranging from 2.0 to 2.9 percent, the mSEBT has been shown to be a valid indicator of dynamic balance.¹⁷

Secondary outcome

1) The Visual Analogue Scale (VAS)
To determine the intensity of the pain this scale is used. The VAS is a 10 cm line that has two terminals marked with the numbers 0 (“no discomfort”) and 10 (“pain as horrific as it can be”). Ask the patient to rate their current level of discomfort and mark the line accordingly. Using a ruler determine the distance in centimetres between baseline and the current pain mark.¹⁸
2) Weight Bearing Lunge Test (WBLT)
Ankle dorsiflexion range is determined with this procedure. In this test with the help of inch tape distance will be measured. Inter-rater ICC values for angles were 0.97 and 0.99. The analysis shows evaluating a dorsiflexion range with this method have great reliability.¹⁹

Sample size calculation

Sample size calculation resulted at 5% level of significance considering Z (1-α) value = 1.96 and (1- β) at power of 80% = 0.84 measuring the expected mean difference for superiority (effect side) of (δ) = 2.602 and standard deviation (σ) = 3.24

Formula Using Mean difference

n 1 = n 2 = 2 \frac{{(Z_{α} + Z_{β})}^{2} σ^{2}}{{(δ)}^{2}}

Primary variable – (Foot Functional Index)

Mean. (Pre) result on Foot Functional Index for foot core exercises with conventional physiotherapy = 72.68

Mean. (Post)- result on Foot Functional Index for foot core exercises with conventional physiotherapy = 59.67 ± 10.69

Difference (mean ± SD) = 13.01 ± 3.24 (As per reference article)

Clinically relevant superiority = 20% = (13.01 *20)/100 = 2.602

N1 = 2^{*} [{(1.96 + 0.84)}^{2} {(3.24)}^{2}] / {(2.602)}^{2} = 25

Minimum samples required = 25 per group

Considering 30% drop out = 8

Total sample size required = 33 per group

Assumptions

Z_{α} = 1.96

α = Type I error at 5 %

Z_{β} = 0.84 (1 - β) = Power at 80 %

σ = std . dev

Ref Article: - Jadhav and Gurudut.²⁰

Analysis

All the results will be calculated using SPSS 27 version. Demographic variables (Confounding factors) as per quantitative assessment will be resulted for finding observational values on mean Standard deviation minimum and maximum. Quantitative assessment will be observed on frequency and percentage. The data for inferential statistics, with outcome variables will be tested for normality using Kolmogorov Smirnov Test. A parametric test will be used if the data follows normal distribution. Non-normal data will be attempted for transformation to normality by using mathematical algorithm such as log or exponential function or box cox method. For finding the significance over the mean pre- and post T-paired will be used for analysis if data still persist with non-normal distribution alternative Wilcoxon test will be used for finding the difference for mean significance between the two groups (Inter) un-paired t-test will be used while the Man-Whitney will be used as an alternative t-test for non-normal data Association and analysis for finding the significance of confounding parameters will be evaluated using Chi square test or Fischer Exact Test or using multi-variant analysis.

Primary outcome

The two groups will be compared using inferential statistics for their mean change in the primary variable (Foot functional index and modified star excursion test) between baseline and six weeks. For research participants, random effects will be generalised, treatment group and visit count will be taken into consideration while analysing fixed effects. At the conclusion of the intervention, the effect size over the mean change difference on the primary variable will be assessed and the matching 95% confidence interval (CI) given.

Primary endpoint

To predict the difference in effect size between the active and control groups, secondary outcomes (the visual analogue scale and the weight bearing lunge test) will be examined in accordance with the mixed model effect. If the data is distributed normally, the T-test (unpaired) will be performed to determine whether there is a significant difference between the means of the two groups. The data will be transformed into a normal distribution for non-normal distributions using mathematical techniques. If the primary variable's data still exhibits a non-normal distribution, an alternative non-parametric test will be used (Chi square, Mann Whitney, Wilcoxon test).

Dissemination

To present the research findings at conferences, seminars, community forums etc.

Study status

The study is yet to start.

Discussion

The purpose of this study to analyse the efficacy of ankle pnf vs standard foot core exercises in enhancing functional capacities, enhancing dynamic balance, increasing joint mobility, and reducing discomfort in individuals who are suffering from plantar fasciitis. Poor foot posture can lead to structural abnormalities throughout the body because it places enormous strain on the lower extremity’s joints and muscles. If this abnormal pressure is not alleviated, it will continue to cause discomfort, fatigue, and musculoskeletal injury. When a person has plantar fasciitis, the fascia becomes inflamed because of excessive intense activity, which causes pain and discomfort when doing weight-bearing activities like walking. When engaging in weight-bearing activities, dynamic balance control can be impacted by pain.²¹

Numerous studies demonstrate the impact on the reduction of pain, improve joint mobility and foot function, etc. According to Ranbhor et al., foam rolling and calf and plantar fascia stretching both aided with pain relief and joint motion. However, the outcome measure shows boosting effects in the foam rolling than the traditional stretching exercises.²² According to Kaur and Koyal's study, stretching the Achilles tendon produced a significant improvement in the patient's outcome variables, but stretching the calves reduced discomfort and foot function deficit but did not have the same impact.²³ According to Kumar et al., low dye taping combined with stretching of the plantar fascia and strengthening of the intrinsic muscles was an effective method for reducing pain and enhancing functional activities. Both groups showed a substantial improvement in all categories, however the people who had low dye taping saw a considerably superior overall improvement. Consequently, low dye tape is an effective intervention method for the treatment of plantar fasciitis patients.²⁴

By analysing the outcome, we will be evaluating the impact of foot core exercises and ankle pnf on dynamic balance and compare both the intervention in this study. Muscle strength in the fundamental body parts is crucial for maintaining balance. Accurate and efficient exercise of these muscles appears to be of utmost importance since they play a significant function secondary to that of the foot, as well as in relation to the complete kinematic chain.

Ethical considerations

Institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research (Deemed to be University) approved this study.

DMIHER (DU)/IEC/2023/804 is the reference number.

Data availability

Not applicable as this is a protocol.

Reporting guidelines

Zenodo: SPIRIT Checklist DOI: 10.5281/zenodo.7990088.²⁵

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

I would like to thank my institution, colleague, and my guide Dr. Pratik Phansopkar.

References

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2. Hertel J: Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability. J. Athl. Train. 2002; 37(4): 364–375. PubMed Abstract
3. Gray’s Anatomy - 42nd ed.[cited 2023 Feb 27]. Reference Source
4. McKeon PO, Hertel J, Bramble D, et al.: The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br. J. Sports Med. 2015 Mar; 49(5): 290–290. PubMed Abstract | Publisher Full Text
5. Orthotics MF: Intrinsic and Extrinsic Foot Musculature. MASS4D® Foot Orthotics; [cited 2023 Feb 27]. Reference Source
6. Plantar fasciitis: [cited 2023 Jan 23]. Reference Source
7. Buchanan BK, Kushner D: Plantar Fasciitis. StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2023 Jan 15]. Reference Source
8. Menon NA, Jain J: Plantar fasciitis: A review. Indian J. Pain. 2018 Jan 1; 32(1): 24. Publisher Full Text
9. Bolgla LA, Malone TR: Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice. J. Athl. Train. 2004; 39(1): 77–82. PubMed Abstract
10. The epidemiology of plantar fasciitis|Lower Extremity Review Magazine: 2010 [cited 2023 Jan 23]. Reference Source
11. Voss DE, Ionta MK, Myers BJ, et al.: Proprioceptive Neuromuscular Facilitation: Patterns and Techniques. Harper & Row; 1985; 370.
12. Park DJ, Lee KS, Park SY: Effects of Two Foot-Ankle Interventions on Foot Structure, Function, and Balance Ability in Obese People with Pes Planus. Healthcare. 2021 Jun 3; 9(6): 667. PubMed Abstract | Publisher Full Text | Free Full Text
13. Kim HJ, Cho J, Lee S: Talonavicular joint mobilization and foot core strengthening in patellofemoral pain syndrome: a single-blind, three-armed randomized controlled trial. BMC Musculoskelet. Disord. 2022 Feb 15; 23: 150. PubMed Abstract | Publisher Full Text | Free Full Text
14. Whole R, Chitale N, Phansopkar P: A Case Report of Plantar Fasciitis in Diabetic Female Successfully Treated with Physical Therapy. Biosci. Biotechnol. Res. Commun. 2021; 14: 113–115.
15. Martinez BR, Staboli IM, Kamonseki DH, et al.: Validity and reliability of the Foot Function Index (FFI) questionnaire Brazilian-Portuguese version. Springerplus. 2016 Oct 18; 5(1): 1810. PubMed Abstract | Publisher Full Text | Free Full Text
16. Cejudo A, Sainz de Baranda P, Ayala F, et al.: A simplified version of the weight-bearing ankle lunge test: Description and test–retest reliability. Man. Ther. 2014 Aug 1; 19(4): 355–359. PubMed Abstract | Publisher Full Text
17. Bulow A, Anderson JE, Leiter JR, et al.: THE MODIFIED STAR EXCURSION BALANCE AND Y-BALANCE TEST RESULTS DIFFER WHEN ASSESSING PHYSICALLY ACTIVE HEALTHY ADOLESCENT FEMALES. Int. J. Sports Phys. Ther. 2019 Apr; 14(2): 192–203. PubMed Abstract | Publisher Full Text | Free Full Text
18. Ratna S: EFFECT OF KINESIO TAPING IN ADJUNCT TO CONVENTIONAL THERAPY IN REDUCING PAIN AND IMPROVING FUNCTIONAL ABILITY IN INDIVIDUALS WITH PLANTAR FASCIITIS A RANDOMIZED CONTROLLED TRIAL. Int. J. Theor. Phys. 2015 Aug 17; 2. Publisher Full Text
19. Bennell K, Talbot R, Wajswelner H, et al.: Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust. J. Physiother. 1998 Jan 1; 44(3): 175–180. PubMed Abstract | Publisher Full Text
20. Jadhav A, Gurudut P: Comparative Effectiveness of Gua Sha, Cryostretch, and Positional Release Technique on Tenderness and Function in Subjects with Plantar Fasciitis: a Randomized Clinical Trial. Int. J. Ther. Massage Bodyw. 2023 Mar 1; 16(1): 13–23. Publisher Full Text
21. Lakhwani M, Phansopkar P: Efficacy of Percussive massage Versus Calf Stretching on Pain, Range of Motion, Muscle Strength and Functional Outcomes in Patients with Plantar Fasciitis – A Randomized Control Trial.2021.
22. Ranbhor AR, Prabhakar AJ, Eapen C: Immediate effect of foam roller on pain and ankle range of motion in patients with plantar fasciitis: A randomized controlled trial. Hong Kong Physiother. J. 2021 Jun; 41(01): 25–33. PubMed Abstract | Publisher Full Text | Free Full Text
23. Kaur S, Koley S: Efficacy of Calf Stretching and Achilles Tendon Stretching in Reducing Pain and Improving Foot Function Disability in Patients with Plantar Fasciitis.2020; 2.
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25. Boob MA: SPIRIT checklist. doc (Version v1). Zenodo. 2023. Publisher Full Text

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Version 2

VERSION 2 PUBLISHED 30 Jun 2023

Author details Author details

¹ Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India

Manali Boob
Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing

Pratik Phansopkar
Roles: Supervision, Validation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

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Published: 23 Apr 2024, 12:765

https://doi.org/10.12688/f1000research.136828.2

version 1

Published: 30 Jun 2023, 12:765

https://doi.org/10.12688/f1000research.136828.1

Copyright

© 2023 Boob M and Phansopkar P. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Boob M and Phansopkar P. Effect of foot core exercises vs ankle proprioceptive neuromuscular facilitation on pain, range of motion, and dynamic balance in individuals with plantar fasciitis: a comparative study [version 1; peer review: 2 approved with reservations]. F1000Research 2023, 12:765 (https://doi.org/10.12688/f1000research.136828.1)

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Reviewer Report 20 Feb 2024

Elif Tuğçe Çil, Department of Physiotherapy and Rehabilitation, Yeditepe University, Istanbul, Turkey

Approved with Reservations

https://doi.org/10.5256/f1000research.149973.r234132

Thanks to the authors for their efforts.
-The terminology of plantar fasciitis should be explained in an up-to-date manner. Because this condition is not only associated with inflammation.
-The discussion section should be written by discussing and interpreting ... Continue reading

Thanks to the authors for their efforts.
-The terminology of plantar fasciitis should be explained in an up-to-date manner. Because this condition is not only associated with inflammation.
-The discussion section should be written by discussing and interpreting the current literature in comparison with your results.
-The language of the article contains many grammatical errors and should be corrected.
-I did not see any table of your result.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Physiotehrapy

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 02 Oct 2023

Pornpimol Muanjai, Burapha University, Chonburi, Thailand

Approved with Reservations

https://doi.org/10.5256/f1000research.149973.r209275

Introduction

The rational in term of using these two intervention is still weak. Please provide more the beneficial effects to plantar fasciitis condition.
"PNF is a stretching method.." It sounds a

Introduction

The rational in term of using these two intervention is still weak. Please provide more the beneficial effects to plantar fasciitis condition.
"PNF is a stretching method.." It sounds a bit wrong. Please kindly check or rephrase as it is a kind of neuromuscular facilitation acts as muscle contracting or stretched.
Fifth paragraph can be shortened regrading available languages.
Please explain more why plantar fasciitis affects to balance deficit.
The study hypothesis should be given.
References needs for "foot core exercises and PNF have been shown to be helpful in..."

Methods

Please provide the ethical approve number for this study.
Please specify in case bilateral foot involved, which side will be trained and tested.
Please specify the treatment detail where those received and will be excluded from the study.
Why those 2 PNF technique were selected in this study? It would be useful to know for the other.
Please reconsider the foot core exercise program as in the review it was suggested that those 3 exercises were effective treatment for arch correction. Personally, I would suggest to remove the double leg heel raise as single one would be more loading and also the tennis ball rolls which it should be as a part of the conventional treatment for plantar fascia stretching for both groups.
What activity VAS will be examined? at rest or walking?

Discussion

It would be better if the evidence regarding the using these 2 interventions in plantar fasciitis or on those parameters will be more available.

There was no data to report yet.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Exercise, aging, physical therapy

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Version 1 30 Jun 23	read	read

Pornpimol Muanjai, Burapha University, Chonburi, Thailand
Elif Tuğçe Çil, Yeditepe University, Istanbul, Turkey
Karen Julie Mickle, The University of Newcastle, Callaghan, Australia
Sharath H V, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe, Wardha, India

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Reviewer Report

1 Views

13 Feb 2025 | for Version 2

Sharath H V, Paedaitrics Physiotherapy, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe, Wardha, India

1 Views Cite this report Responses(0)

Approved

In this study, the effects of ankle proprioceptive neuromuscular facilitation (PNF) and foot core exercises on pain, range of motion (ROM), and dynamic balance in people with plantar fasciitis are compared. Two groups of sixty individuals were randomly assigned to practice foot core exercises and ankle PNF, respectively. Assessments were conducted at baseline, three weeks into the intervention, and after the six-week duration of both programs.

Strength

Well-defined Participant Criteria: The study's inclusion and exclusion criteria are well-defined, guaranteeing a particular participant profile that increases the findings' applicability to people with plantar fasciitis.
One advantage of using a randomized controlled trial (RCT) design is that it reduces bias and makes it possible to compare interventions more accurately.
Comprehensive Outcome Measures: The study evaluates several aspects of recovering from plantar fasciitis, offering a comprehensive perspective on how well the therapies worked.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Neonates, Paediatrics, Orthopaedics, Neurology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

3 Views

28 Oct 2024 | for Version 2

Karen Julie Mickle, The University of Newcastle, Callaghan, New South Wales, Australia

3 Views Cite this report Responses(0)

Not Approved

General comments: This paper aimed outlines a protocol to compare the effects of two different exercise programs on pain, range of motion and balance in adults with plantar fasciitis. The quality of the paper needs improving to be suitable for indexing. There is a lot of incorrect terminology related to foot biomechanics and many statements are made without appropriate referencing or justification. There is not a clear link/justification of the exercise programs and why they may be beneficial for people with plantar fasciitis. Without the inclusion of a control group that receives conventional treatment, the findings of the study will lack validity. There are several mentions through the paper of comparing the active and control groups, however both are receiving exercise intervention. I am confused as to why pain is a secondary, not a primary outcome variable if studying a clinical population.
Specific Comments:
Title: Remove “a comparative study” and replace with “a protocol paper” or “a trial protocol”.
Abstract: 2^nd, 3^rd and 4^th sentences do not make sense. How can a “proposed” cause be “adequately recognized”? And recognized by whom? What is meant by domes of the foot? Not sure you can quantify anecdotal data, there should be scientific data linking “foot mechanisms” (whatever this means) to disability, but the sentence isn’t finished. Please rewrite.
Abstract: The aims of the study are not provided.
Introduction:
1^st paragraph-There is a lot of biomechanical/anatomical terminology errors. Confusion between planes and axes of motion. Longitudinal and axial is the same, mention of the sagittal plane is missing. Mention of ankle plantarflexion is out of place. What is meant by “intrinsic foot muscles in their anatomic alignment”? “The ends of extrinsic muscles” are called attachments, but the relevance of this sentence is not apparent.
3^rd and 4^th paragraphs: There needs to be a clearer link between PNF and foot core exercises and plantar fasciitis. The 4^th paragraph needs more references; “exercises for the foot core were done….” And “earlier gait retraining studies”.
5^th and 6^th paragraphs: Details on the VAS and mSEBT are not needed in an introduction.
7^th paragraph: This whole paragraph contains many unsupported statements (particularly around the plantar fascia and balance) as there are no references provided.
8^th paragraph: This information should come in earlier in the introduction to justify the choice of interventions, however again it contains many unsupported statements that need references.
Trial design: should be “single centre” not centric.
Protocol:

How will participants be diagnosed with PF?
It states that the study duration is 1 year, but flow chart says 6 weeks. Or do you mean data will be collected over a one year period?
Have you considered a control group that gets the conventional treatment? If both groups improve, it could just be a placebo.
Why 40- 60 years?

Intervention:

The naming of control and experimental groups is not appropriate. Both groups are receiving an exercise intervention. This study really needs a control group.
Details of the ultrasound treatment needs to be provided.
Are the exercises supervised? How will compliance be recorded?

Outcome measures

Is the FFI self-administered? Why are you using the Brazilian version (ref 15)?
If these interventions are for patients with PF, why is pain not a primary outcome variable?

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

foot biomechanics

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report

9 Views

20 Feb 2024 | for Version 1

Elif Tuğçe Çil, Department of Physiotherapy and Rehabilitation, Yeditepe University, Istanbul, Turkey

9 Views Cite this report Responses(0)

Approved With Reservations

Thanks to the authors for their efforts.
-The terminology of plantar fasciitis should be explained in an up-to-date manner. Because this condition is not only associated with inflammation.
-The discussion section should be written by discussing and interpreting the current literature in comparison with your results.
-The language of the article contains many grammatical errors and should be corrected.
-I did not see any table of your result.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Physiotehrapy

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report

14 Views

02 Oct 2023 | for Version 1

Pornpimol Muanjai, Burapha University, Chonburi, Thailand

14 Views Cite this report Responses(0)

Approved With Reservations

Introduction

The rational in term of using these two intervention is still weak. Please provide more the beneficial effects to plantar fasciitis condition.
"PNF is a stretching method.." It sounds a bit wrong. Please kindly check or rephrase as it is a kind of neuromuscular facilitation acts as muscle contracting or stretched.
Fifth paragraph can be shortened regrading available languages.
Please explain more why plantar fasciitis affects to balance deficit.
The study hypothesis should be given.
References needs for "foot core exercises and PNF have been shown to be helpful in..."

Methods

Please provide the ethical approve number for this study.
Please specify in case bilateral foot involved, which side will be trained and tested.
Please specify the treatment detail where those received and will be excluded from the study.
Why those 2 PNF technique were selected in this study? It would be useful to know for the other.
Please reconsider the foot core exercise program as in the review it was suggested that those 3 exercises were effective treatment for arch correction. Personally, I would suggest to remove the double leg heel raise as single one would be more loading and also the tennis ball rolls which it should be as a part of the conventional treatment for plantar fascia stretching for both groups.
What activity VAS will be examined? at rest or walking?

Discussion

It would be better if the evidence regarding the using these 2 interventions in plantar fasciitis or on those parameters will be more available.

There was no data to report yet.

Is the rationale for, and objectives of, the study clearly described?

Partly
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Exercise, aging, physical therapy

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Effect of foot core exercises vs ankle proprioceptive neuromuscular facilitation on pain, range of motion, and dynamic balance in individuals with plantar fasciitis: a comparative study

Abstract

Keywords

Introduction

Aim and objective

Protocol

Figure 1. Study procedure flow chart.

Inclusion criteria

Exclusion criteria

Intervention

Table 1. Foot core exercises.

Table 2. Ankle PNF technique.

Outcome measures

Sample size calculation

Analysis

Primary outcome

Primary endpoint

Dissemination

Study status

Discussion

Ethical considerations

Data availability

Reporting guidelines

Acknowledgements

References

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