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

Abstract

findings revealed that none of the samples exhibited any evidence of inflammation but, rather, degenerative changes in the fascia. 22 Perhaps this is the reason why corticosteroid injections have been found to be ineffective and, in fact, often result in serious side effects, including plantar fascia ruptures. 1,34 Considering the ongoing debate regarding proper nomenclature, for the purpose of this study we will use the term "plantar heel pain" to refer to the presentation of our clinical population.It has been reported that approximately 1 in 10 individuals will develop chronic P lantar heel pain is commonly referred to as "plantar fasciitis"; however, recent research suggests that the condition manifests itself as a noninflammatory degenerative process, thus the term "fasciosis" may be more appropriate. To compare the effectiveness of 2 different conservative management approaches in the treatment of plantar heel pain.There is insufficient evidence to establish the optimal physical therapy management strategies for patients with heel pain, and little evidence of long-term effects.Patients with a primary report of plantar heel pain underwent a standard evaluation and completed a number of patient self-report questionnaires, including the Lower Extremity Functional Scale (LEFS), the Foot and Ankle Ability Measure (FAAM), and the Numeric Pain Rating Scale (NPRS). Patients were randomly assigned to be treated with either an electrophysical agents and exercise (EPAX) or a manual physical therapy and exercise (MTEX) approach. Outcomes of interest were captured at baseline and at 4-week and 6-month follow-ups. The primary aim (effects of treatment on pain and disability) was examined with a mixed-model analysis of variance (ANOVA). The hypothesis of interest was the 2-way interaction (group by time).Sixty subjects (mean [SD] age, 48.4 [8.7] years) satisfied the eligibility criteria, agreed to participate, and were randomized into the EPAX (n = 30) or MTEX group (n = 30). The overall group-by-time interaction for the ANOVA was statistically significant for the LEFS (P = .002), FAAM (P = .005), and pain (P = .043). Between-group differences favored the MTEX group at both 4-week (difference in LEFS, 13.5; 95% CI: 6.3, 20.8) and 6-month (9.9; 95% CI: 1.2, 18.6) follow-ups.The results of this study provide evidence that MTEX is a superior management approach over an EPAX approach in the management of individuals with plantar heel pain at both the short-and long-term follow-ups. Future studies should examine the contribution of the different components of the exercise and manual physical therapy programs. Therapy, level 1b.

Combination of Hip Strengthening and Manipulative Therapy for the Treatment of Plantar Fasciitis: A Case Report

“…A comprehensive functional assessment at the beginning of the treatment and at all follow-up time points may improve the management of the activity limitation and participation restriction in patients with PF. Other measures, such as decreased extremity function 8 and quality of life, 7 should be investigated in future studies.…”

“…Manipulative therapy (MT) has been used as a treatment option for PF in several previous studies, [5][6][7][8][9][10][11] and randomized clinical trials have recommended MT for improving the pain and function in PF patients. 7,8 The techniques for PF treatment include passive joint manipulation of the ankle and foot; myofascial maneuvers of the gastrocnemius, soleus muscles, and plantar fascia; neural mobilization of the tibial nerve; and stretching of the plantar fascia and triceps surae.…”

“…7,8 The techniques for PF treatment include passive joint manipulation of the ankle and foot; myofascial maneuvers of the gastrocnemius, soleus muscles, and plantar fascia; neural mobilization of the tibial nerve; and stretching of the plantar fascia and triceps surae. 1 A recent study reported that strengthening the hip abductors and external rotators is effective for reducing pain in fasciitis.…”

Light-Emitting Diode Versus Sham in the Treatment of Plantar Fasciitis: A Randomized Trial

“…The stretching program consisted of four commonly used fascia stretching activities that were derived from the literature. [1][2][3][4]6 Subjects performed 3 repetitions of each exercise, holding each repetition for 30 seconds. During the first stretch, the subjects passively extended their great toe while applying pressure to fascia (Fig 1).…”

“…[1][2][3][4][5][6][7] Clinicians commonly apply local modalities, manual treatments and stretching exercises in spite of a general lack of clinical evidence to prove the effectiveness of some of these methods. Authors performing a systematic review cited, "26 conservative treatments that have been recommended for the treatment of plantar heel pain."…”