The symptomatic and functional effects of manual physical therapy on plantar heel pain: a systematic review

Abstract

Objectives: Plantar heel pain is common and can be severely disabling. Unfortunately, a gap in the literature exists regarding the optimal intervention for this painful condition. Consequently, a systematic review of the current literature regarding manual therapy for the treatment of plantar heel pain was performed. Methods: A computer-assisted literature search for randomized controlled trials in MEDLINE, EMBASE, Cochrane, CINAHL, and Rehabilitation & Sports Medicine Source, was concluded on 7 January 2014. After identification of titles, three independent reviewers selected abstracts and then full-text articles for review. Results: Eight articles were selected for the final review and underwent PEDro scale assessment for quality. Heterogeneity of the articles did not allow for quantitative analysis. Only two studies scored ≥7/10 on the PEDro scale and included joint, soft tissue, and neural mobilization techniques. These two studies showed statistically greater symptomatic and functional outcomes in the manual therapy group. Discussion: This review suggests that manual therapy is effective in the treatment of plantar heel pain; however, further research is needed to validate these findings given the preponderance of low quality studies.

Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial

“…All participants received up to eight treatment sessions at a frequency of once or twice per week over a 4-week period. Both groups received an impairment-based manual therapy approach directed to the lower limb,[ 6 , 13 , 26 , 28 , 58 ] an exercise program[ 7 , 12 , 13 , 29 , 42 , 43 ] including self-stretching of the plantar fascia and the Achilles tendon and strengthening exercises for the intrinsic muscles of the foot, and therapeutic ultrasound[ 6 , 30 , 50 ] (Sonicator, Mettler Electronics, Anaheim, CA; 3 MHz, 1.5 W/cm 2 , 20% duty cycle for 5 minutes to the most tender region of the proximal portion of the plantar fascia). Details regarding the manual therapies and exercise program are provided in S2 Table .…”

“…frequency, intensity, duration) of manual therapy remains unclear. [ 28 ] Strength training of the intrinsic foot musculature may be effective for improving pain and function in PF. [ 29 ] Although the APTA clinical practice guidelines do not recommend ultrasound therapy for PF,[ 22 ] a recent systematic review concluded that “the available higher-quality evidence suggests that patients with persistant PF may benefit from therapeutic ultrasound.”[ 30 ]…”

“…Although the 2014 APTA clinical practice guidelines[ 22 ] concluded that “the use trigger point dry needling cannot be recommended for individuauls with PF,” a recent meta-analysis of seven trials concluded that trigger point dry needling is effective in patients with PF with a pooled estimate effect size of -15.5 points for pain reduction. [ 39 ] Needling therapies[ 11 , 39 – 41 ] may be a reasonable non-pharmacologic adjunct therapy for the reduction of pain in individuals with PF who are already receiving manual therapy,[ 6 , 28 , 40 , 42 ] exercise,[ 29 , 43 ] and/or electrophysical agents. [ 30 ] Needling therapy refers to the insertion of thin monofilament needles without the use of injectate.…”

“…In the absence of high quality evidence for any one treatment modality,[ 23 ] it may still be possible to achieve a high success rate with a combination of the treatments for PF. [ 8 , 19 ] Electrical dry needling,[ 11 , 39 – 41 ] manual therapy,[ 6 , 28 , 42 ] exercise[ 29 , 43 ] and ultrasound,[ 30 , 50 ] when applied separately, have each been found to be effective for PF. However, no previous study has investigated the combination of the effectiveness of electrical dry needling in addition to manual therapy, exercise and ultrasound in patients with PF.…”

Authors' Reply to Letter to the Editor

“…However, when defining the scope of the CCS, we ultimately chose to restrict its content and recommendations to primarily those aspects that most foot and ankle surgeons have direct control over. Several excellent reviews have been reported on the topic of physical therapy and plantar fasciitis, and we would refer interested readers to the original sources for more information (5,6).…”