Embedding pain neuroscience education in the physical therapy management of patients with chronic plantar fasciitis: a prospective case series

Abstract

Objectives: The purpose of this case series was to describe the effects of a biopsychosocial approach that embeds pain neuroscience education (PNE) within physical therapy for improving foot and ankle function, pain, and psychosocial factors in patients with chronic plantar fasciitis. Methods: Seven female patients (mean [SD] age = 49.0 [11.4] years) receiving physical therapy for chronic plantar fasciitis were enrolled. Along with formal physical therapy, patients received six 15-minute PNE sessions. Knowledge of pain neuroscience was assessed before and after PNE with the Revised Neurophysiology of Pain Questionnaire. Patients completed questionnaires for foot and ankle function (Activities of Daily Living subscale of the Foot and Ankle Ability Measure), pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and fear of movement (Tampa Scale for Kinesiophobia) at baseline (before treatment) and 6 and 12 weeks. Local and remote pain sensitivity was assessed using a pressure algometer at baseline and 6 weeks. Results: Patients attended a mean (range) of 8.7 (7 to 12) physical therapy sessions over a mean (range) of 46.7 (42 to 56) days. After PNE, six (86%) patients demonstrated increased knowledge of pain neuroscience. At 12 weeks, six (86%) patients met or exceeded minimally clinically important difference (MCID) for foot and ankle function and pain. Five (71%) patients met or exceeded MCID for pain catastrophizing and fear of movement. Local pain sensitivity was reduced in six (86%) patients. Conclusions: Physical therapy integrating PNE is potentially beneficial for patients with chronic plantar fasciitis. Future studies should examine the efficacy of PNE in randomized trials with larger representative samples.

Artificial Intelligence Technology Combined with Ultrasound-Guided Needle Knife Interventional Treatment of PF: Improvement of Pain, Fascia Thickness, and Ankle-Foot Function in Patients

“…When the metatarsophalangeal joint is flexion, the plantar fascia is pulled to increase the arch angle of the foot. Human long-term walking, standing, running, and jumping and other movements lead to strain at the starting point of plantar aponeurosis and then degeneration, resulting in tearing, degeneration, chronic fibrous tissue inflammation, edema, and thickening of plantar fascia [ 16 ]. Therefore, PF is a syndrome of coexistence and interaction of inflammation and degeneration [ 16 ].…”

“…Human long-term walking, standing, running, and jumping and other movements lead to strain at the starting point of plantar aponeurosis and then degeneration, resulting in tearing, degeneration, chronic fibrous tissue inflammation, edema, and thickening of plantar fascia [ 16 ]. Therefore, PF is a syndrome of coexistence and interaction of inflammation and degeneration [ 16 ]. PF is a kind of chronic aseptic inflammation, and the age of onset is mostly between 40 and 70 years old.…”

Soft-Tissue Mobilization and Pain Neuroscience Education for Chronic Nonspecific Low Back Pain with Central Sensitization: A Prospective Randomized Single-Blind Controlled Trial

“…Based on this information, pain and pain-related behaviors should be considered the results of interactions between biological, psychological, social, and contextual factors. Pain neuroscience education (PNE) is an example of a biopsychosocial approach in the field of physical therapy [5,6]. PNE is a top-down educational therapy that changes patients' beliefs based on a neurophysiological understanding of pain [7,8], and focuses on pain experience and cognition of chronic pain [9,10].…”

“…In a meta-analysis of the effects of PNE on kinesiophobia in patients with chronic pain, it was reported that a combined intervention of manual therapy and exercise therapy was effective in improving chronic pain and kinesiophobia [5,6,11]. Similarly, soft-tissue mobilization (STM) in CNLBP has been reported as a manual therapy that could help avoid short-term pain, disability, and fear [11].…”

Is There a Relationship Between Perceived Activity Performance-Satisfaction Level and Quality of Life in Activities of Daily Living in Adults with Plantar Fasciitis?

“…In addition to having negative effects on physical and social activities, it causes losses in terms of financial resources and workforce (23). The restriction of physical activities by plantar heel pain and the fact that individuals put barriers both socially and psychologically due to this problem negatively affect health-related quality of life (24,25). Many previous studies have shown that plantar heel pain has adverse effects on various aspects of the individual's life, including ADL, quality of life related to the foot and ankle, and functions in sports and recreational activities (26).…”