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

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

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.

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.

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