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Year : 2019  |  Volume : 19  |  Issue : 1  |  Page : 13-16

Effect of cryostretch on plantar fasciitis in ramblers

Department of Physiotherapy, KG College of Physiotherapy (Affiliated to The TN Dr MGR Medical University, Chennai), Coimbatore, Tamil Nadu, India

Date of Submission14-May-2019
Date of Decision09-Apr-2020
Date of Acceptance13-Apr-2020
Date of Web Publication16-May-2020

Correspondence Address:
Dr. Arun Balasubramaniam
KG College of Physiotherapy, KGISL Campus, Saravanampatti, Coimbatore - 641 035, Tamil Nadu
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DOI: 10.4103/sjsm.sjsm_5_19

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Background: Plantar fasciitis is the most common cause of heel pain. It is characterized by pain in the heel, especially with the first walking in the morning or after a long period of rest. Cryotherapy was the common treatment method used for soft tissue injuries. There is poor literature on the application of cryotherapy on plantar fasciitis.
Aim of the Study: The aim of the study was to identify the effect of cryotherapy along with dynamic stretching on pain and foot function in plantar fasciitis individuals.
Study Design: This was a quasi-experimental study involving 34 ramblers; all were selected based on the selection criteria.
Methodology: The study was conducted for 8 weeks. Participants were divided into two groups. Experimental group underwent cryotherapy for 20 min followed by dynamic stretching to the calf muscles and the plantar fascia for 15 min. Control group received dynamic stretching for 15 min. Outcome variables in the study are pain and foot function. Pain was measured by numerical pain rating scale and foot function by foot function index.
Statistical Analysis: Student's t-test was used to analyze the data collected during the study. Statistical Package for the Social Sciences 20.0 was used with P < 0.05.
Results: Result of the study shows that pain was 7.72 ± 0.689 with P ≤ 0.05 and the foot function index was 10.6 ± 3.85.
Conclusion: This study concluded that there was a significant improvement in group who underwent cryotherapy and dynamic stretching.

Keywords: Cryotherapy, dynamic stretching, foot function index, numerical pain scale, plantar fasciitis, ramblers

How to cite this article:
Balasubramaniam A, Kumar R K. Effect of cryostretch on plantar fasciitis in ramblers. Saudi J Sports Med 2019;19:13-6

How to cite this URL:
Balasubramaniam A, Kumar R K. Effect of cryostretch on plantar fasciitis in ramblers. Saudi J Sports Med [serial online] 2019 [cited 2022 Jan 22];19:13-6. Available from: https://www.sjosm.org/text.asp?2019/19/1/13/284307

  Introduction Top

Plantar fasciitis is one of the common causative factors for heel pain in middle-aged individuals in India. It accounts to 15% of total foot-related pathologies. Many researchers stated that the use of plantar fasciosis rather than plantar fascitiis, since there will be no inflammation found where as it is degeneration.[1]

Patient often complains of pain in the sole or over the heel during weight-bearing, and it is relieved once it was discontinued. Pain was severe during the first step after rest or sleep.[2] Causative factor for the plantar fasciitis may be unclear and multifactorial. Plantar fasciitis becomes more common in long-distance runners and walkers. Individuals who walk for a longer distance for pleasure were called as ramblers. These are the people who are not doing exercises regularly, whereas they walk occasionally. They are the common people who encounter with various reasons for foot injuries. Factors such as training errors, unfit shoes, improper cushioning in the shoes, walking on uneven surfaces, prolonged standing, obesity, pregnancy, and foot types (high-arched or flat foot) could alter the biomechanics of the body and produce stress in the plantar fascia.[3]

Walking and long standing on the poor surfaces (hard), abnormal loads in the body, and people with foot deformities were at more risk of plantar fasciitis. Long-distance walkers with poor shoes or insole or poor platforms would cause excessive mobility of the foot result in over pronation which lead to increase stress to the musculofascial structures around the soft tissues and elongation of the plantar fascia.[4]

Multiple treatment options available for the managing plantar fasciitis include physiotherapeutic modalities, exercises, foot wear modification, steroid injections, and surgeries. However, there are no optimal treatment modalities available for managing plantar fasciitis. Many studies say that combination of these modalities would be beneficial.[5]

Cold therapy was identified as one of the best treatments in reducing inflammations, and many studies support on the application of cryotherapy in acute inflammations, although very poor evidence was found on the application of cryotherapy in plantar fasciitis.[6]

Stretching is an integral part of plantar fasciitis management, it plays a major role in reducing the symptoms of plantar heel pain, and it reduces the strain in the plantar fascia as well as over the calf.[7] Dynamic stretching to the calf and the plantar fascia would produce long-term benefit of pain and function.[8] Although there is many evidence produced, still there is a strong dilemma on which is the best treatment for plantar fasciitis. Hence, this study aim is to identify the role of cryostretch (cryotherapy with stretching) on plantar fasciitis in ramblers.

  Methodology Top

This study is a quasi-experimental study with involving ramblers. After obtaining approval from the KG Hospital Institutional Ethical Committee, the study was conducted in various runners' associations. Information about the study was displayed in the runner's associations; volunteers were evaluated based on the selection criteria. Volunteers who are willing to participate can be registered in a separate note. Those who fall in the criteria were selected for the study: individuals with 30–60 years, running at least 3–5 years, long-distance walkers, nonprofessional walkers, without any other injuries in the lower limb, walkers who volunteer for the study, and walkers with proper footwear. All the volunteers selected through purposive sampling method, and a total of 40 volunteers were selected for the study. All are randomly assigned into two groups by computer-assisted randomization process. Twenty ramblers in the experimental group underwent cryotherapy along with dynamic calf and plantar fascia stretching, named cryostretch group (CSG), cryotherapy was applied for 20 min followed by dynamic stretching for 15 min, and the control group underwent only dynamic calf and plantar fascia stretch for 15 min, named stretch group (SG). Cryotherapy massage was given using cold wrap method described by Laymon et al., 2013[6] for alternative days for 4 weeks. Dynamic stretching was given based on Vaghela and Parmar, 2015.[9] The study was conducted for 8 weeks. Initial 4 weeks, all volunteers were instructed to come to the association for the treatment on alternate days (3 days in a week); home program was given to the volunteers and advised them to do exercises at home for another 4 weeks. A log book was given to every individual to mark their exercise schedule at home. WhatsApp group was created and motivated the volunteers to do exercises and advised them to post photographs and videos of exercises. No withdrawal was noted in the study. The outcome measures used in the study are pain using numerical pain scale and foot function by foot function index.

  Results Top

The data were analyzed using statistical software, the Statistical Package for the Social Sciences (SPSS 20.0), with P < 0.05 being considered statistically significant. [Table 1] and [Table 2] show the difference of the values and their mean. Paired t-test used to analyze for within the group, while unpaired t-test was used to analyze between the groups.
Table 1: Numerical pain scale

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Table 2: Foot functional index

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[Table 1] shows the difference of the values for the pain scales; based on these values, it was found that CSG (cryotherapy with dynamic stretching) would produce significant reduction in foot disability compared with SG (dynamic stretching).

[Table 2] shows the difference of the values for the foot function index; based on these values, it was found that CSG (cryotherapy with dynamic stretching) would produce significant reduction in foot disability compared with SG (dynamic stretching).

  Discussion Top

Plantar fasciitis is a common disorder secondary to an inflammatory caused by repetitive trauma. It may cause inability to walk in the first few steps soon after the rest. Various managements applied for the plantar fasciitis have been found to be effective temporarily. Application of the cryotherapy was found to be effective in relieving pain by reducing the inflammation around the plantar fascia.[10] Cryotherapy helps in reducing local hypothermia, induces vasoconstriction, and lowers microcirculations. It also reduces extravasation of blood into surrounding tissues, local inflammation, and edema production; it also decreases motor and sensory nerve conduction,[11] although there is no strong evidence supporting to it. However, this study identifies much effective in plantar fasciitis.

Stretching for the plantar fascia and the Achilles tendon is becoming frequent in the management of plantar fasciitis.[12] Stretching improves circulation of the blood that brings nutrients to cells and removes waste products.[13] The increase of blood flow opens up the connective tissues, which helps alleviate pain.[14] Researches show that tight calf muscle and Achilles tendon are stretched aggressively which aids in reducing the pain. This method is applied clinically and self-administered by the patient.[8] Many studies about stretching show much effective in plantar fasciitis; however, the stretching efficacy is short term.[15] The long-term effect of stretching is not identified yet.[16]

The study results showed that there was a significant difference obtained between the groups. The group that underwent cryotherapy with dynamic stretching would produce a significant reduction of pain and improvement of the foot function when compared with dynamic stretching alone. There are few limitations in the study: (1) the long-term follow-up on cryotherapy is not studied, (2) the foot wear used by the ramblers is not controlled, (3) daily activities were not controlled, and their (4) home program was not monitored by the researcher.

  Conclusion Top

This study concluded that there was a significant difference within the group of interventions. Cryotherapy with dynamic stretching produces more significant improvement in reducing pain as well as improving the foot function when compared to the dynamic stretching only.


We would like to thank Dr. G. Bakthavathsalam, Chairman, Mrs. Vasathi Ragu, Vice Chairman, Mrs. Vaijeyanthi M. Das, CEO, Prof. Mohan Gandhi, CEO, and Mr. Prabhukumar CEO, KG Hospital, Coimbatore, India, for their logistic support and technical support in conducting this study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Schwartz EN, Su J. Plantar fasciitis: A concise review. Perm J 2014;18:e105-7.  Back to cited text no. 1
Gautham P, Nuhmani S, Kachanathu SJ. Plantar fasciitis: A review of literature. Saudi J Sports Med 2014;14:69-73.  Back to cited text no. 2
  [Full text]  
Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: A matched case-control study. J Bone Joint Surg Am 2003;85:872-7.  Back to cited text no. 3
Backstrom KM, Moore A. Plantar fasciitis. Phys Ther Case Rep 2000;3:154-62.  Back to cited text no. 4
Menon NA, Jain J. Plantar fasciitis: A review. Indian J Pain 2018;32:24-9.  Back to cited text no. 5
  [Full text]  
Laymon MS, Petrofsky JS, Alshammari F, Fisher S. Evidence-based use of cold for plantar fasciitis. Phys Ther Rehabil Sci 2013;2:75-80.  Back to cited text no. 6
Carlson RE, Fleming LL, Hutton WC. The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle. Foot Ankle Int 2000;21:18-25.  Back to cited text no. 7
Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am 2006;88:1775-81.  Back to cited text no. 8
Vaghela V, Parmar D. Effects of static and dynamic stretching on agility performance in tennis players. Int J Sci Res 2015;4:581-4.  Back to cited text no. 9
Block JE. Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: A narrative review. Open Access J Sports Med 2010;1:105-13.  Back to cited text no. 10
Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: A systematic review of randomized controlled trials. Am J Sports Med 2004;32:251-61.  Back to cited text no. 11
Irving DB, Cook JL, Young MA, Menz HB. Obesity and pronated foot type may increase the risk of chronic plantar heel pain: A matched case-control study. BMC Musculoskelet Disord 2007;8:41.  Back to cited text no. 12
Mohamed HA. Effectiveness of Achilles tendon stretching for the treatment of chronic plantar fasciitis. Egypt Orthop J 2015;50: 215-22.  Back to cited text no. 13
  [Full text]  
Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: A randomized trial. BMC Musculoskeletal Disord 2007;8:36-40.  Back to cited text no. 14
De Vera Barredo R, Menna D, Farris J. An evaluation of research evidence for selected physical therapy interventions for plantar fasciitis. J Phys Ther Sci 2007;19:41-56.  Back to cited text no. 15
Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2003;3:CD000416.  Back to cited text no. 16


  [Table 1], [Table 2]


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