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.