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

RCTs published from January 2010 to June 2025 were identified using Scopus, Web of Science, PubMed, and Google Scholar. Random-effects meta-analyses were performed for pain, foot function, pressure pain threshold (PPT), and plantar fascia thickness, whereas range of motion (ROM) was synthesized narratively. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used for pooled effects, while heterogeneity was assessed with I2. 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

Twelve RCTs met inclusion criteria. Pain outcomes showed no statistically significant difference between stretching and comparator interventions overall (11 RCTs; SMD -0.54, 95% CI - 1.20 to 0.13; I2 = 92%) or foot function (7 RCTs; SMD 1.08, 95% CI - 0.25 to 2.40; I2 = 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.