Video-Based Versus Physician-Led Exercise Training for Plantar Fasciitis

Official title

Clinical Effectiveness of Video-Based Exercise Training Compared With Physician-Led Face-to-Face Exercise Instruction in Patients With Plantar Fasciitis: A Randomized Non-Inferiority Trial

Overview

This prospective, single-center, two-arm, parallel-group randomized non-inferiority trial will compare physician-led face-to-face exercise instruction with standardized video-based exercise instruction in adults with plantar fasciitis. Participants will be randomized in a 1:1 ratio to receive either face-to-face exercise training by an orthopedic physician or access to a standardized exercise video via QR code/web link. The exercise content will be identical in both groups; only the method of instruction will differ. The primary outcome will be the change in the Foot Function Index total/index score from baseline to 3 months. Secondary outcomes will include pain score, Foot Function Index subscales, exercise knowledge, exercise adherence, education time, video viewing status, additional treatment requirement, and patient satisfaction.

Detailed description

Plantar fasciitis is a common cause of chronic plantar heel pain and may lead to functional limitation and reduced quality of life. Exercise education is an important component of conservative treatment; however, in busy outpatient settings, the time available for detailed face-to-face instruction may be limited. Standardized video-based education may provide a practical alternative by delivering the same exercise content in a reproducible format.

This study will evaluate whether video-based exercise instruction is non-inferior to physician-led face-to-face instruction in patients with plantar fasciitis. All participants will receive standard information about plantar fasciitis, load management, footwear recommendations, weight control, short-term analgesic or anti-inflammatory use when needed, and heel pad or insole support. The home exercise program will be identical in both groups and will include plantar fascia-specific stretching, gastrocnemius/soleus stretching, plantar fascia self-massage, gradual toe raises, and towel pull exercises.

Assessments will be performed at baseline, 1 month, and 3 months after randomization. Functional status will be assessed using the Foot Function Index, and pain will be measured using a 0-10 numerical rating scale. Exercise knowledge, adherence, education duration, video viewing behavior, additional treatment use, and satisfaction will also be recorded.

Interventions

• Behavioral Physician-Led Face-to-Face Exercise Instruction
  Face-to-face instruction and demonstration of a standardized home exercise program by an orthopedic physician. The program includes plantar fascia-specific stretching, gastrocnemius/soleus stretching, plantar fascia self-massage, gradual toe raises, and towel pull exercises.
• Behavioral Video-Based Exercise Instruction
  Access to a standardized home exercise video prepared by the study team via QR code or web link. Participants will be instructed to watch the video at home and perform the same exercise program used in the physician-led group.

Primary outcome measures

• Change in Foot Function Index Total/Index Score From Baseline to 3 Months [Time frame: Baseline and 3 months after randomization]

Secondary outcome measures (3)

• Change in Numeric Rating Scale Pain Score From Baseline to 1 and 3 Months [Time frame: Baseline, 1 month, and 3 months after randomization]
• Change in Foot Function Index Pain Subscale Score From Baseline to 1 and 3 Months [Time frame: Baseline, 1 month, and 3 months after randomization]
• Change in Foot Function Index Disability Subscale Score From Baseline to 1 and 3 Months [Time frame: Baseline, 1 month, and 3 months after randomization]

Eligibility criteria

Inclusion criteria

• Adults aged 18 to 70 years
• Clinical diagnosis of plantar fasciitis
• Plantar heel pain lasting for at least 3 months
• Heel pain that is most prominent with the first steps in the morning or after rest
• Tenderness on palpation of the medial calcaneal tubercle
• Baseline heel pain score of 4 or higher on a 0-10 numerical rating scale
• Functional capacity to perform the prescribed exercises
• Access to a smartphone, tablet, or computer to view the exercise video
• Ability to provide written informed consent

Exclusion criteria

• Previous foot or ankle surgery on the affected side
• History of foot fracture, foot tumor, advanced neuropathy, Charcot arthropathy, or tarsal tunnel syndrome
• Corticosteroid injection, extracorporeal shock wave therapy, platelet-rich plasma injection, or other interventional treatment for plantar fasciitis within the last 6 months
• Inflammatory arthritis or systemic rheumatologic disease affecting the foot
• Severe knee or hip osteoarthritis limiting exercise performance
• Severe cognitive impairment preventing participation or completion of questionnaires
• Pregnancy
• Inability or unwillingness to comply with the study protocol

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Balikesir Ataturk City Hospital — Balıkesir

Identifiers

NCT: NCT07628218 · PF-RCT-NI-2026-001 · 2025/12/147

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗