Effect of aquatic exercises on pain and functional performance in plantar fasciitis

Objectives: Plantar fasciitis (PF) is a prevalent cause of heel pain, especially in middle-aged and older adults. Non-invasive treatments such as physiotherapy and exercise are essential for relief. Aquatic exercises (AQEs), with their low-impact nature, may offer functional and analgesic benefits. This study evaluated the impact of a structured AQE program on pain and function in PF. Methods: A total of 116 participants with chronic PF, bilateral heel pain lasting over a month, normal or overweight body mass index, morning pain, and a positive windlass test were included in the study. Exclusion criteria included lower limb fractures, recent surgery, malignancy, skin disorders, pregnancy, or aquaphobia. Participants were randomly assigned to Group A (land-based) or Group B (AQEs). Pre- and post-intervention assessments included the visual analog scale (VAS), range of motion, manual muscle testing (MMT), ultrasonographic evaluation, and the foot function index (FFI). Results: Both groups showed significant improvements across all outcomes; however, the group subjected to aquatic training demonstrated superior results ( P < 0.0001) compared to the land-based group. The reduction in pain during activity surpassed the minimal clinically important difference (MCID) of 2.0 on the VAS with a mean difference of 4.37. Improvements in dorsiflexion, MMT, FFI scores, and plantar fascia thickness also exceeded those of Group A. The AQE group exceeded established MCID thresholds across all the outcome measures. Conclusion: Although both exercise approaches effectively alleviate symptoms, AQEs produced more notable improvements in pain relief and functional performance in patients with PF.