Effect of gait retraining with visual biofeedback on chronic pain, function and biomechanics parameters in runners with plantar fasciitis: a clinical trial

Plantar fasciitis (PF) affects approximately 2 million individuals per year, affecting approximately 10–25% of runners around the world. It is considered to have a great impact on health, especially due to the pain and functional limitations of the feet and lower limbs. Thus, the objective of this randomized clinical trial was to verify the effect of gait retraining with real-time visual feedback on pain, function, and biomechanical parameters of plantar loading in runners with and without PF. Controlled, clinical trial with blinded evaluators. Participants: 24 runners were evaluated and divided into two groups: 12 runners with plantar fasciitis (39.3 years, 78.3 kg, 1.73 cm, 58% male and 42% female) and 12 control runners (40.4 years, 75,1 kg, 1.70 cm, 59% male and 41% female). The assessments were performed pre-intervention and post-intervention. The intervention protocol consisted of gait retraining during treadmill running, for 5 consecutive weeks, over two months (2 sessions/week, 40 min/session, total of 10 sessions). During treadmill running at self-selected and progressively increased speeds (3–12 km/h), participants received real-time visual feedback on vertical ground reaction force and foot support via a front-facing monitor. They were instructed to “run as softly as possible,” encouraging midfoot strike and reducing rearfoot impact. Primary outcomes were: feet pain by visual analogue scale and plantar pressure during gait on the pressure platform. Secondary outcomes were: functionality of the feet and lower limbs, evaluated through the questionnaires: Foot Function Index, Foot and Ankle Ability Measure and Lower Extremity Functional Scale, and the Foot Posture Index. Data were analyzed according to intention-to-treat. Runners with PF presented improvement in pain (p = 0.001, d = 0.92).and physical-functional performance (FFI p = 0.001 d = 0.80; FAAM p = 0.003 d = 0.59; LEFS p = 0.023 d = 0.47), as well as a reduction in plantar overload on the rearfoot (medial p = 0.035 d = 0.57; lateral p = 0.020 d = 0.50) after the intervention protocol when compared to the initial assessment and control, but without difference to FPI (p > 0.005). In relation to the control group, there were no significant differences after intervention in physical-functional performance, but there was a reduction in the loading rate on the rearfoot (medial p = 0.027 d = 0.35; lateral p = 0.024 d = 0.36). Gait retraining program using real-time visual biofeedback, 10 sessions over five weeks across two consecutive months, effectively reduced rearfoot plantar pressure and pain, while improving foot and lower limb function in runners with plantar fasciitis. RBR-5m6msq7; registration date: 21/03/2024.