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

Dear Editor,

We read with great interest the recently published article by Aphale and Shinde, titled “Effect of aquatic exercises on pain and functional performance in plantar fasciitis.” The study contributes valuable insight into the use of aquatic exercise as a rehabilitative strategy for plantar fasciitis (PF), highlighting clinically meaningful improvements in pain, range of motion, and foot function.^[1] The exploration of aquatic-based rehabilitation in PF management is both timely and relevant, given the increasing emphasis on non-invasive, patient-centered physiotherapy interventions that minimize mechanical loading on the plantar fascia.

While acknowledging these strengths, a few methodological and interpretative aspects merit consideration to strengthen future research and clinical applicability. The inclusion of both male and female participants across a broad age and body mass index range enhances generalizability; however, as the authors have noted, the study focused only on short-term outcomes, which limits understanding of sustained benefits and the prevention of recurrence. As PF often exhibits a chronic, recurrent pattern, reassessment of the outcome after 3–6 months would have provided valuable information on the durability of intervention effects and the long-term maintenance of functional gains. Furthermore, the study excluded individuals with diabetes and systemic disorders, which may restrict applicability to real-world clinical populations where such comorbidities are common.

Moreover, although allocation concealment and randomization procedures were well described, blinding was limited to participants only. The absence of assessor blinding may have introduced performance or detection bias, particularly for subjective measures such as the Visual Analog Scale (VAS) and foot function index (FFI). Future studies could enhance internal validity by incorporating independent assessors or automated digital tools for outcome measurement. Including objective, performance-based outcomes such as plantar pressure mapping, gait analysis, or electromyography could further strengthen the evidence for functional recovery.^[2]

Clinically, the study demonstrates that aquatic exercises can significantly reduce plantar fascia stress while enhancing patient adherence in a comfortable, low-impact environment. However, practical challenges remain regarding the accessibility of hydrotherapy facilities in routine outpatient physiotherapy settings. Evaluating the cost-effectiveness, feasibility, and patient satisfaction of such programs could help determine their broader clinical utility.^[3,4] In addition, comparative analysis of aquatic versus hybrid (land and water) exercise protocols could reveal optimal rehabilitation strategies tailored to different stages of PF recovery.

Overall, Aphale and Shinde’s study provides a meaningful foundation supporting the integration of aquatic therapy into musculoskeletal rehabilitation. Their findings reinforce the potential of water-based interventions to complement conventional physiotherapy approaches, particularly for patients with pain-limited mobility. Continued research with larger sample sizes, long-term follow-up, and inclusion of functional biomechanical measures will further strengthen the translational impact of these results in physiotherapy practice.