OBJECTIVE: To investigate the effectiveness of a physiotherapy-based exercise program versus dexamethasone injection for chronic plantar fasciopathy in workers standing for prolonged periods of time. DESIGN: A parallel group nonblinded randomized controlled trial with 12-week follow-up. SETTING: An outpatient sports medicine clinic in Vancouver, British Columbia, Canada. PARTICIPANTS: Fifty-six workers required to stand for greater than 5 h/d with chronic plantar fasciopathy took part. Diagnosis from a physiotherapist must include signs of structural changes to the plantar fascia seen on ultrasound. INTERVENTIONS: The PHYSIO group included 7 physiotherapy-led exercises performed daily over a 12-week period. The INJECTION group received 1 palpation-guided dexamethasone injection followed by a daily routine of calf stretching. MAIN OUTCOME MEASURES: The Foot and Ankle Disability Index (FADI) scores 12-weeks postintervention and ultrasound-based measures of ligament appearance. RESULTS: At follow-up, both groups reported significant improvements in FADI and visual analog scales for pain at work and with activities of daily living at 6 and 12 weeks compared with baseline scores (p < 0.001). There were no significant between-group differences. There were no significant changes to plantar fascia thickness reported at the 6- and 12-week follow-up point. Both the number of cases with focal anechoic areas and the size of these anechoic areas improved significantly in the PHYSIO (p = 0.003) and INJECTION (p < 0.001) groups at 12-week follow-up. CONCLUSIONS: Workers standing for prolonged periods experienced the same short-term therapeutic effectiveness with a physiotherapy-led exercise program compared with an injection of corticosteroid with stretching.
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