A Combined Treatment Approach Emphasizing Impairment-Based Manual Physical Therapy for Plantar Heel Pain: A Case Series

Abstract

Study Design: Case series. Objective: To describe an impairment-based physical therapy treatment approach for 4 patients with plantar heel pain. Background: There is limited evidence from clinical trials on which to base treatment decision making for plantar heel pain. Methods and Measures: Four patients completed a course of physical therapy based on an impairment-based model. All patients received manual physical therapy and stretching. Two patients were also treated with custom orthoses, and 1 patient received an additional strengthening program. Outcome measures included a numeric pain rating scale (NPRS) and self-reported functional status. Results: Symptom duration ranged from 6 to 52 weeks (mean duration ± SD, 33 ± 19 weeks). Treatment duration ranged from 8 to 49 days (mean duration ± SD, 23 ± 18 days), with number of treatment sessions ranging from 2 to 7 (mode, 3). All 4 patients reported a decrease in NPRS scores from an average (±SD) of 5.8 ± 2.2 to 0 (out of 10) during previously painful activities. Additionally, all patients returned to prior activity levels. Conclusion: In this case series, patients with plantar heel pain treated with an impairment-based physical therapy approach emphasizing manual therapy demonstrated complete pain relief and full return to activities. Further research is necessary to determine the effectiveness of impairmentbased physical therapy interventions for patients with plantar heel pain/plantar fasciitis. J Orthop Sports Phys Ther 2004;34:725-733.

Manual Physical Therapy and Exercise Versus Electrophysical Agents and Exercise in the Management of Plantar Heel Pain: A Multicenter Randomized Clinical Trial

“…[9][10][11]15 Only weak evidence exists to support the use of manual therapy interventions and therapeutic exercise in the patient population with plantar heel pain. 27,41 No randomized trials of manual therapy interventions have been reported. Young et al 41 reported the outcomes of a series of 4 patients with heel pain who were managed with manual physical therapy, which was augmented by therapeutic exercise.…”

“…27,41 No randomized trials of manual therapy interventions have been reported. Young et al 41 reported the outcomes of a series of 4 patients with heel pain who were managed with manual physical therapy, which was augmented by therapeutic exercise. Although all patients received 7 or fewer treatments in physical therapy, they all reported a clinically meaningful reduction in pain and improvement in function.…”

“…The MTEX approach also included an impairmentsbased manual therapy approach directed at the hip, knee, ankle, and foot. 41 Appropriate technique selection was determined through the clinical decision making of the treating therapists: for example, if restricted ankle dorsiflexion was noted at the clinical examination, anteroposterior talocrural joint mobilization or distraction manipulation was indicated; if restricted hip joint rotation was noted at the clinical examination, mobilization of the hip joint was indicated; and so forth, as indicated in . 41 Specific techniques that clinicians were instructed to use are outlined in .…”

“…Approach (MTEX) All patients in this group were treated with 5 minutes of aggressive soft tissue mobilization directed at the triceps surae and the insertion of the plantar fascia at the medial calcaneal tubercle 12,41 and rearfoot eversion mobilization 41 ( ). The MTEX approach also included an impairmentsbased manual therapy approach directed at the hip, knee, ankle, and foot.…”

Heel Pain—Plantar Fasciitis

“…Young et al 61 reported on 4 patients referred to physical therapy for plantar fasciitis or unilateral -rating scale and a self-reported function scale to assess out--scribed foot orthoses and another patient received additional --a rapid improvement in pain and function as a result of the 38 reported on 1 patient referred to physical therapy for plantar fasciitis with an 8-month history of subcalcaneal heel pain that limited standing the straight-leg raising (SLR) test in combination with ankle dorsiflexion and eversion to sensitize the tibial nerve, suggesting that there was a neurogenic component to this paappear consistent with the findings of Coppieters and associates 11 who reported significant strain and excursion of the tibial nerve in 8 embalmed cadavers when ankle dorsiflexion 38 received passive and active mobilization aimed at restoring pain-free soft tissue mobility along -tion procedures were performed with the patient in the slump sitting position. Because restricted ankle dorsiflexion, excessive pronation, and posterior tibialis weakness were also found, low-Dye taping and therapeutic exercises were utilized to control excessive pronation and reduce stress on the plantar fascia.…”