Efficacy of physical therapy interventions delivered with home exercise programs for pain and function in plantar fasciitis: a systematic review and network meta-analysis of randomized controlled trials.

Plantar fasciitis, pain under the heel linked to the thick tissue band on the sole of the foot, is often first treated with a home exercise program, but it's unclear whether adding other physical therapy approaches improves outcomes further. This review pooled 24 randomized trials, comparing seven add-on interventions, including dry needling, shockwave therapy, ultrasound, manual therapy, taping, laser therapy, and orthoses, against home exercises alone, using a method that lets multiple treatments be compared indirectly within one analysis. Adding dry needling, low-level laser therapy, or manual therapy to home exercises was linked to clinically significant short-term pain reductions, and dry needling or taping improved short-term function, compared to home exercises alone. Dry needling stood out as the only approach with benefits lasting into the medium term.

Certainty ranged from moderate to high for these specific results, but since many individual comparisons relied on only a handful of trials, the overall evidence base for most interventions remains limited.

If you've dealt with plantar fasciitis, the stabbing heel pain that often worsens with the first steps in the morning, you may already know that home stretching and strengthening exercises are a common starting point. This review looked at whether adding other treatments, like dry needling, laser therapy, manual therapy, taping, shockwave therapy, ultrasound, or orthotic inserts, works better than home exercises alone, by combining results from 24 clinical trials. The findings suggest that adding dry needling, laser therapy, or manual therapy to home exercises was linked to meaningful short-term pain relief, and dry needling or taping were linked to short-term improvements in function.

Dry needling was the only option that kept showing benefits for both pain and function several weeks later. These results come from pooling multiple trials, which strengthens confidence somewhat, but many individual comparisons were based on only a small number of studies, so these patterns should be seen as encouraging rather than definitive for any one person's recovery.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This network meta-analysis addresses a common clinical decision: whether adding a specific physical therapy modality to a home exercise program offers measurable benefit over home exercise alone for plantar fasciitis. Pooling 24 randomized controlled trials (1240 participants) across eight treatment nodes, it found that dry needling, low-level laser therapy, and manual therapy delivered alongside home exercise produced clinically significant short-term pain reductions compared with home exercise alone, each supported by moderate-quality evidence, while dry needling and taping showed short-term functional gains.

Dry needling was distinct in sustaining both pain (SMD -1.14, medium term, high-quality evidence) and function (SMD 1.06, moderate-quality evidence) benefits into the 6-12 week window. For practice, this informs expectations about which adjuncts have trial-level support for short-term symptom relief, though the analysis does not establish that one active intervention outperforms another directly, since comparisons were made against home exercise rather than head-to-head between active treatments. Ultrasound, taping, orthoses, and shockwave therapy did not demonstrate the same consistent pattern of significant findings across outcomes and timeframes reported.

The review does not report on long-term outcomes beyond 12 weeks for most interventions, nor does it detail adverse events, and since home exercise alone served as the comparator without a sham condition, attention or expectation effects from added therapist contact cannot be ruled out for the add-on treatments.