Li Z. et al. - Photobiomodulation and Plantar Fasciitis as a Complement to a Home Exercise Program: A Network Meta-Analysis

In a network meta-analysis of 24 randomized trials involving 1,240 patients with plantar fasciitis, photobiomodulation combined with a home exercise program reduced short-term pain by 1.54 points (95% CI -2.82 to -0.27). However, it is not among the interventions that significantly improve function.

What this study measured

Plantar fasciitis is the most common cause of heel pain in adults. The cornerstone of treatment remains a home exercise program combining stretches for the plantar fascia and the triceps surae. The question posed here is different from the usual one: what are the benefits of adding physical therapy to this program, rather than comparing it to no treatment at all?

The authors conducted a network meta-analysis, a method that allows for the indirect comparison of treatments that have never been tested against one another. Twenty-four randomized trials and 1,240 participants were included, with eight treatment nodes, including low-intensity laser therapy, dry needling, manual therapy, and taping. The certainty of the estimates was assessed using the CINeMA framework, and the risk of bias was assessed using the Cochrane tool.

Key Findings

Photobiomodulation ranks among the three interventions that provide clinically significant short-term pain relief.

• Short-term pain: low-intensity laser vs. exercise program alone: -1.54 points (95% CI -2.82 to -0.27)
• Quality of evidence for this result: moderate
• Other clinically significant short-term pain management interventions: dry needling and manual therapy
• Effectiveness: Photobiomodulation is not among the effective treatments; only dry needling and taping are effective
• Scope: 24 randomized trials, 1,240 participants, 8 treatment groups

The dissociation between pain and function is the most insightful finding of this study: reducing pain is not enough to restore walking and weight-bearing.

How photobiomodulation works for this indication

The plantar fascia is a superficial structure that can be treated with cutaneous radiation, which explains the interest in this indication. The mechanisms proposed in the literature involve both modulation of local inflammatory mediators and an analgesic effect resulting from action on nociceptive nerve endings.

The very name of the condition has evolved: today, it is more commonly referred to as fasciopathy, since tissue samples show tissue degeneration rather than overt inflammation. A treatment that primarily targets inflammation might therefore have a limited effect over time, as suggested by the lack of medium- and long-term benefits observed in this analysis.

Limits You Should Know

The benefit is limited to the short term. Photobiomodulation does not appear to be an effective intervention in the medium or long term, which significantly limits the clinical relevance of the findings for a condition whose course is often measured in months.

The lack of an effect on function is the second key point to note. A patient may therefore report less pain without walking any better. Finally, a network meta-analysis relies on partially indirect comparisons, the validity of which depends on the assumption that the populations in the various trials are comparable. The quality of evidence is rated as moderate, not high.

What This Means in Practice

The main message of this study is not that photobiomodulation replaces exercise, but that it can be used in conjunction with exercise to help patients get past an initial painful phase. The at-home exercise program remains the foundation upon which other interventions are built.

For persistent heel pain, a medical evaluation or a physical therapy assessment can help rule out other causes—such as a stress fracture or Baxter’s nerve injury—and tailor the treatment plan accordingly.

Frequently Asked Questions

Does photobiomodulation cure plantar fasciitis?

No. In this network meta-analysis, it is associated with a reduction in pain in the short term only, with no significant improvement in function or demonstrated long-term benefit.

Should we continue the exercises during the sessions?

Yes. In all of the included studies, photobiomodulation was added to a home exercise program; it was never used as a substitute for it. The control group followed the exercise program alone.

What other interventions have been tested?

A total of eight treatments, including dry needling and manual therapy, which also provide short-term pain relief, as well as taping, which improves function when combined with dry needling.

Reference

Li Z, He S, Wu J, Zhu Z, Chen L, Lu W. Efficacy of physical therapy interventions combined with home exercise programs for pain and function in plantar fasciitis: a systematic review and network meta-analysis of randomized controlled trials. Physical Therapy, 2026. PMID 42176209. PubMed link

This summary is provided for informational purposes only and does not constitute medical advice. Photobiomodulation is not a substitute for prescribed treatment. Consult a healthcare professional.