An Evaluation of Research Evidence for Selected Physical Therapy Interventions for Plantar Fasciitis

Abstract

To evaluate the strength of research evidence for selected interventions in the management of plantar fasciitis and compare the evidence with current clinical guidelines. A literature search of PubMed and CINAHL from 1995 to 2005 was conducted using articles that involve interventions that physical therapists would administer directly, are English-only, peer reviewed, prospective and retrospective studies, and whose interventions are supported at least two randomized controlled trials. Grouped by treatment category, these articles were evaluated using the American Academy of Cerebral Palsy and Development Medicine classification system. Each category was assessed using the Modified Canadian Task Force grading format, and compared with current clinical guidelines. Twenty-seven articles were reviewed: 6 for night splints, 9 for orthotics/inserts, 9 for extracorporeal shock wave therapy (ESWT), and 3 for stretching. Night splints and stretching received a C; orthotics/inserts received a B, and ESWY received an A. Comparisons between the results and the Brigham and Women's Clinical Guideline for Lower Extremity Musculoskeletal Disorders revealed similar recommendations, except for ESWT. Evidence exists for night splints, orthoses, extracorporeal shock wave, and stretching as interventions for plantar fasciitis. ESWT received the highest grade, although existing guidelines have not mentioned this as an intervention.

The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review

“…Previous reviewers [11] and authors of clinical guidelines [1], included just two of the studies in this review [14, 15], and concluded that there is some, scientific evidence described as moderate quality [1], and poor quality [11] to support the use of stretching for the treatment of plantar heel pain in terms of short term relief. Landorf and Menz [4] included two primary studies in their review [15, 26] only one of which [15] fulfilled the inclusion criteria for this current review.…”

“…The condition of Plantar Fasciitis is thought to arise from overuse or repetitive micro trauma of the tissue [9]. As the aetiology of plantar fasciitis is unclear, diagnosis is usually based on clinical signs including: plantar heel pain when weight‐bearing after a period on non‐weight‐bearing, pain that eases with initial activity, but then increases with further use as the day progresses, and pain on palpation [1, 10, 11].…”

“…Stretching is frequently utilised as a conservative treatment for plantar heel pain [1, 12]. Systematic reviews investigating the efficacy of conservative treatments for plantar fascia have been published [4, 11, 13]. However none of the reviews have focused specifically upon stretching.…”

The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

“…The following research was performed on 10 stroke patients diagnosed with plantar fasciitis, and the conditions for selecting the candidates were as follows7, 15,16,17,18 ) : patients diagnosed with hemiparalysis due to stroke who had been at the chronic stage for 6 months to 2 years but could walk on their own; patients who had been diagnosed by a rehabilitation expert as having plantar fasciitis on the paralyzed side based on an ultrasonic image diagnosis (ultrasonic image must have shown that the thickness of the plantar fascia was over 4 mm from the standard point of the calcaneus rim); patients with at least G1 plantar flexors of the ankle on the paralyzed side as, evaluated through the MAS; patients who did not have other foot injuries, tarsal tunnel syndrome, Achilles tendinitis, nerve entrapment syndrome, or any other symptoms in the foot that were causing pain; and patients who could understand the researchers commands and execute them. All subjects agreed voluntarily to participate in this research.…”

Conservative Treatment of Plantar Fasciitis and Posterior Heel Pain: A Review

“…Stretching is frequently utilized as a conservative treatment for plantar heel pain [14,15] and systematic reviews and studies investigating the efficacy of conservative treatments for plantar fascia published different findings [16][17][18]. Di Giovanni et al found that exercise program focused on distension of the plantar fascia resulted in less pain, better patient satisfaction, and a higher functional status than exercise focusing on distension of the Achilles tendon and plantar fascia [19,20].…”