The short-term effects of treating plantar fasciitis with a temporary custom foot orthosis and stretching

Comparison between customised foot orthoses and insole combined with the use of extracorporeal shock wave therapy in plantar fasciitis, medium-term follow-up results: A randomised controlled trial

OBJECTIVE

To determine the clinical results of custom-made foot orthoses versus placebo flat cushioning insoles combined with an extracorporeal shock wave therapy on pain and foot functionality in patients with plantar fasciitis.

DESIGN AND SETTING

A randomised controlled clinical trial with follow-up at six months. Faculty of Podiatry and Centre Clinical private of Physiotherapy, Seville, Spain.

SUBJECTS AND INTERVENTIONS

Patients with plantar fasciitis were randomly assigned to either group A (n = 42), which received custom-made foot orthoses, or group B (n = 41), which received placebo insoles. All the participants received active extracorporeal shock wave therapy including stretching exercises. Recruitment period was from Mach 2019 to July 2020.

MAIN MEASUREMENTS

The main outcome was foot pain, measured by visual analogue scale and the secondary outcome measures were recorded by Roles and Maudsley scores respectively, at the beginning and at one week, one month and six months.

RESULTS

Eighty-eight patients were assessed for eligibility. Eighty-three patients were recruited and randomised. This study showed significant differences between both groups according to the visual analogue scale. In control group, the difference was at baseline (P 0.01) and, in the experimental group was at the one- and six-month follow-up (P 0.001). The mean (SD) visual analogue scale at baseline were Control group 6.31 (1.69) and Experimental group 5.27 (1.64); and at six months were 7.52 (3.40) and 3.29 (4.26), respectively. The custom-made foot orthosis was perceived as 'good' (85%) and 'excellent' (97.5%) at medium-long term.

CONCLUSION

Wearing a custom-made foot orthosis leads to a improvement in patients with plantar fasciitis; it reduced foot pain and improved foot functionality.

Effectiveness of Foot Biomechanical Orthoses to Relieve Patients Suffering from Plantar Fasciitis: Is the Reduction of Pain Related to Change in Neural Strategy?

Plantar fasciitis is a cause of chronic pain under the heel and bottom of the foot. One of the treatments to reduce pain consists of using plantar orthoses to address specific imbalances during foot placement or gait. The aim of the present study was to determine if reduction of pain with a treatment based on plantar orthoses is related to changes in reflexes and muscle activity of the muscles of the lower limbs. Ten patients (51.0±3.5 years, 76.0±2.38 kg, 171.9±1.8 cm, 3 women and 7 men) with plantar fasciitis for less than 1 year were followed up during nine weeks. Soleus M, H, and V waves recorded at rest and during voluntary contraction and Root Mean Square-Electromyogram from four leg muscles recorded during walking and static position were analyzed in patients before and 3, 6, and 9 weeks after wearing orthoses. Pain level and gait and posture parameters were also analyzed. Results were compared to five healthy participants exhibiting no pain (30.6±2.1 years, 60.0±3.5 kg, 167.0±3.4 cm, 3 women and 2 men). Results indicated that pain was significantly reduced after 3 weeks. H_max/M_max and H_sup/M_sup ratios were significantly higher and M_Hmax/M_max and M_Hsup/M_sup were significantly lower in healthy participants compared to patients with plantar fasciitis. No difference in the V/M_sup ratio was found between groups. Furthermore, all other measured locomotor, stabilometric, and electromyographic parameters remained unchanged throughout the entire protocol. The reduction of pain is not related to change in neural activity suggesting that, after 9 weeks of wearing plantar orthoses, patients are not yet cured and return to physical activity should be delayed.

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

Study Design

Randomized, single-blinded, multi-center, parallel-group trial.

Objectives

To compare the effects of adding electrical dry needling into a program of manual therapy, exercise and ultrasound on pain, function and related-disability in individuals with plantar fasciitis (PF).

Background

The isolated application of electrical dry needling, manual therapy, exercise, and ultrasound has been found to be effective for PF. However, no previous study has investigated the combined effect of these interventions in this population.

Methods

One hundred and eleven participants (n = 111) with plantar fasciitis were randomized to receive electrical dry needling, manual therapy, exercise and ultrasound (n = 58) or manual therapy, exercise and ultrasound (n = 53). The primary outcome was first-step pain in the morning as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included resting foot pain (NPRS), pain during activity (NPRS), the Lower Extremity Functional Scale (LEFS), the Foot Functional Index (FFI), medication intake, and the Global Rating of Change (GROC). The treatment period was 4 weeks with follow-up assessments at 1 week, 4 weeks, and 3 months after the first treatment session. Both groups received 6 sessions of impairment-based manual therapy directed to the lower limb, self-stretching of the plantar fascia and the Achilles tendon, strengthening exercises for the intrinsic muscles of the foot, and therapeutic ultrasound. In addition, the dry needling group also received 6 sessions of electrical dry needling using a standardized 8-point protocol for 20 minutes. The primary aim was examined with a 2-way mixed-model analysis of covariance (ANCOVA) with treatment group as the between-subjects variable and time as the within-subjects variable after adjusting for baseline outcomes.

Results

The 2X4 ANCOVA revealed that individuals with PF who received electrical dry needling, manual therapy, exercise and ultrasound experienced significantly greater improvements in first-step morning pain (F = 22.021; P<0.001), resting foot pain (F = 23.931; P<0.001), pain during activity (F = 7.629; P = 0.007), LEFS (F = 13.081; P<0.001), FFI Pain Subscale (F = 13.547; P<0.001), FFI Disability Subscale (F = 8.746; P = 0.004), and FFI Total Score (F = 10.65; P<0.001) than those who received manual therapy, exercise and ultrasound at 3 months. No differences in FFI Activity Limitation Subscale (F = 2.687; P = 0.104) were observed. Significantly (X² = 9.512; P = 0.023) more patients in the electrical dry needling group completely stopped taking medication for their pain compared to the manual therapy, exercise and ultrasound group at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X² = 45.582; P<0.001) more patients within the electrical dry needling group (n = 45, 78%) achieved a successful outcome compared to the manual therapy, exercise and ultrasound group (n = 11, 21%). Effect sizes ranged from medium to large (0.53<SMD<0.85) at 3 months in favor of the electrical dry needling group.

Conclusion

The inclusion of electrical dry needling into a program of manual therapy, exercise and ultrasound was more effective for improving pain, function and related-disability than the application of manual therapy, exercise and ultrasound alone in individuals with PF at mid-term (3 months).

Level of evidence

Therapy, Level 1b.

Multidimensional impact of low-Dye taping on low-load hopping in individuals with and without plantar fasciitis

OBJECTIVES

Evaluate the acute effect of low-Dye, placebo and no tape on motor behaviour in individuals with plantar fasciitis (PF).

DESIGN

Prospective, experimental.

SETTING

Motion analysis laboratory.

PARTICIPANTS

Ten participants with PF and ten matched controls.

MAIN OUTCOME MEASURES

Hopping behaviour (lower-limb stiffness and ankle angle at peak loading) were evaluated during low-load sleigh hopping, during three taping conditions. Stiffness and ankle angle were determined using three-dimensional motion analysis. Pain during submaximal loading was assessed with a numeric pain rating scale.

RESULTS

The lower-limb stiffness response to therapeutic taping was modulated by the presence of PF (interaction, F = 4.48, p = 0.018). Matched controls demonstrated a significant increase in stiffness post application of low-Dye taping (p = 0.001), stiffness was unchanged in the PF group. In the PF group, low-Dye taping decreased hopping pain in comparison to placebo (p = 0.037) and no-tape (p = 0.024). There was no difference in ankle angle at peak loading between the groups or across taping conditions.

CONCLUSIONS

Low-Dye taping reduces nociceptive inputs more than placebo in the presence of PF pain. Low-Dye tape alters stiffness in the control group but not the PF group. The motor behavioural outputs such as stiffness, during low-load hopping is modulated by both pathology and therapeutic taping.

A comparison of different over-the-counter foot orthotic devices on multi-segment foot biomechanics

BACKGROUND

Over-the-counter foot orthoses are a cost-effective alternative to custom-made devices. However, few studies have compared over-the-counter devices and most biomechanical research involving orthoses has focused on rearfoot biomechanics.

OBJECTIVES

To determine changes in multi-segment foot biomechanics during shod walking in three commercially available over-the-counter devices: SOLE, SuperFeet and Powerstep when compared to no orthotic.

STUDY DESIGN

Repeated measures, cross-sectional study.

METHODS

Retroreflective markers were placed on the right limb of 18 participants representing forefoot, midfoot, rearfoot and shank segments. Three-dimensional kinematics were recorded using an eight-camera motion capture system while participants walked on a treadmill and the order of condition was randomized between four conditions: SOLE, SuperFeet, Powerstep and no orthotic.

RESULTS

All over-the-counter devices exhibited significant decreases in plantar fascia strain compared to no orthotic and only Powerstep exhibited significant decreases in peak rearfoot eversion. Medial longitudinal arch deformation was not reduced for any over-the-counter device.

CONCLUSION

Different over-the-counter devices exhibited specific alterations in rearfoot kinematics and all reduced plantar fascia strain by varying amounts. These over-the-counter-specific kinematic changes should be taken into consideration when recommending these devices as a treatment option.

CLINICAL RELEVANCE

Over-the-counter orthoses are a cost-effective alternative to custom-made devices. We demonstrated that three commonly used over-the-counter devices influence foot kinematics and plantar fascia strain differently. Clinicians can use these results to provide more tailored treatment options for their patients.

Analysis of Pressure Pain Hypersensitivity, Ultrasound Image, and Quality of Life in Patients with Chronic Plantar Pain: A Preliminary Study

OBJECTIVES

To evaluate widespread pressure pain in patients with chronic plantar heel pain compared with that in healthy controls and to investigate the differences in ultrasound imaging and quality of life between these two groups.

METHODS

A total of 22 patients (11 female) with chronic plantar heel pain and the same number of healthy patients, matched according to age and gender, were included in this pilot study. Pressure pain thresholds (PPTs) were bilaterally assessed over the calcaneus bone, the plantar fascia, the first and fifth metatarsals, the soleus muscle, the second metacarpal, and the zygapophyseal joint of C5-C6. Plantar fascia thickness was measured via ultrasound imaging. In addition, quality of life and physical function were assessed using the Short-Form 36 (SF-36) questionnaire and the Foot and Ankle Ability Measure (FAAM) questionnaire, respectively.

RESULTS

Analysis of covariance (ANCOVA) results showed significant differences in the PPTs at all points between the groups (P < 0.001), but not between sides. The PPTs were significantly lower in the patients than in the controls at all sites (P < 0.05). The results showed significant increases in fascia thickness at the calcaneus insertion (group: F = 74.172, P ≤ 0.001; side: F = 8.920, P ≤ 0.001) and the middle fascia point (group: F = 133.685, P = <0.001; side: F = 11.414, P = <0.001) on ultrasound in the patient group compared with the matched control group. The analysis also revealed that the patient group had a significantly lower score on every subscale of the SF-36 and FAAM questionnaires (all P < 0.001), except for the mental component, compared with the matched control group.

DISCUSSION

Patients suffering from chronic plantar heel pain showed widespread and bilateral hypersensitivity, increased thickness of the plantar fascia in the affected foot, and deterioration in quality of life and physical functioning compared with matched controls.

Effect of stretching with and without muscle strengthening exercises for the foot and hip in patients with plantar fasciitis: A randomized controlled single-blind clinical trial

OBJECTIVE

To compare the effect of stretching with and without muscle strengthening of the foot alone or foot and hip on pain and function in patients with plantar fasciitis.

DESIGN

Single blind randomized controlled trial.

METHOD

Eighty-three patients with plantar fasciitis were allocated to one of three treatment options for an eight-week period: Foot Exercise Group (FEG - extrinsic and intrinsic foot muscles), Foot and Hip Exercise Group (FHEG - abductor and lateral rotator muscles) and Stretching Alone Exercise Group (SAEG).

MAIN MEASURES

A visual analog scale for pain, the Foot and Ankle Outcome Score and the Star Excursion Balance Test. All evaluations were performed before treatment and after the last treatment session.

RESULTS

Improvements were found in all groups regarding the visual analog scale, the pain, activities of daily living, sports and recreation, quality of life (p < 0.001) and other symptoms (p < 0.01) subscales of the Foot and Ankle Outcome Score as well as posterolateral movement, posteromedial movement and composite score (p < 0.001) on the Star Excursion Balance Test. No time-group interactions were found for any of the variables (p > 0.05).

CONCLUSIONS

All three exercise protocols analyzed led to improvements at eight-week follow-up in pain, function and dynamic lower limb stability in patients with plantar fasciitis.

Predictors of response to physical therapy intervention for plantar heel pain

BACKGROUND

Age, weight, and duration of symptoms have been associated with a poor response to treatment for plantar heel pain (PHP), but no studies were identified that examined predictors of response to physical therapy intervention. The purpose of this investigation was to examine the influence of age, body mass index (BMI), and symptom duration on treatment response to physical therapy intervention.

METHODS

Sixty participants received 6 visits over 4 weeks of physical therapy intervention that included manual therapy and exercise or electrophysiological agents and exercise. Outcomes were assessed using the Foot and Ankle Ability Measure (FAAM), Numeric Pain Rating Scale (NPRS), and Global Rating of Change Scale (GRC). Logistic regression (P < .05) was used to analyze age, BMI, and symptom duration as potential predictors of a successful response based on the minimal clinically important difference of the outcome measures. Sensitivity analysis was used to assess the influence of success based on minimal clinically important changes in the FAAM, NPRS, and GRC or only the FAAM and NPRS. Receiver operating curves were used to determine the cut point for the significant predictor.

RESULTS

At the 6-month follow-up to physical therapy intervention, NPRS was improved by 3 points (95% CI, 2.4-3.6) and FAAM improved by 22.5 points (95% CI, 16.8-28.2). Individuals with symptoms less than 7.2 months were 4.2 (95% CI, 1.3-13.8; P = .016) and 8.5 (95% CI, 2.5-28.9; P = .001) times more likely to respond to treatment based on the NPRS/FAAM/GRC and NPRS/FAAM success criteria, respectively. Age and BMI were not significant predictors (P ≥ .455 and P ≥ .450, respectively).

CONCLUSION

Age and BMI were not associated with outcomes and obese individuals did achieve a successful outcome with the physical therapy intervention used in the clinical trial. Individuals with PHP symptoms longer than 7 months require additional consideration and further investigation of effective strategies to improve treatment response.

LEVEL OF EVIDENCE

Prognosis, level 2b comparative study.

The effect of additional ankle and midfoot mobilizations on plantar fasciitis: a randomized controlled trial

STUDY DESIGN

A single-blind randomized controlled trial.

OBJECTIVE

To evaluate the efficacy of ankle and midfoot mobilization on pain and function of patients with plantar fasciitis (PF).

BACKGROUND

Plantar fasciitis is a degenerative process of the plantar fascia, with a lifetime prevalence of approximately 10%. Limited ankle dorsiflexion is a common finding and apparently acts as a contributing factor to the development of PF.

METHODS

Fifty patients with PF, aged 23 to 73 years, were randomly assigned to either the intervention or control group. Both groups received 8 treatments, twice a week, consisting of stretching exercises and ultrasound. In addition, the intervention group received mobilization of the ankle and midfoot joints. Dorsiflexion range of motion was measured at the beginning and at the end of treatment. The results were evaluated by 3 outcomes: the numeric pain-rating scale, Lower Extremity Functional Scale, and algometry.

RESULTS

No significant difference was found between groups in any of the outcomes. Both groups showed a significant difference in the numeric pain-rating scale and Lower Extremity Functional Scale. Both groups significantly improved in dorsiflexion range of motion, with no difference between groups.

CONCLUSION

The addition of ankle and foot joint mobilization aimed at improving dorsiflexion range of motion is not more effective than stretching and ultrasound alone in treating PF. The association between limited ankle dorsiflexion and PF is most probably due to soft tissue limitations, not the joints. Trial registered at ClinicalTrials.gov (registration number NCT01439932).

LEVEL OF EVIDENCE

Therapy, level 1b.

Effectiveness of total contact insoles in patients with plantar fasciitis

OBJECTIVE

To assess the effectiveness of total contact insoles (TCI) in patients with plantar fasciitis (PF).

METHODS

A double-blind randomized controlled trial was carried out with intention-to-treat analysis. Seventy-four patients were randomly allocated to use a TCI made of ethylene vinyl acetate (study group, n = 37) or a flat insole (control group, n = 37). The following assessment tools were used: visual analog scale for pain while walking and at rest, Medical Outcomes Study Short Form-36 (SF-36) for quality of life, Foot Function Index and Foot Health Status Questionnaire for foot function, 6-min walk test (6MWT), and baropodometer FootWalk Pro for plantar pressure analysis. The groups were evaluated by a blinded assessor at baseline and after 45, 90, and 180 days.

RESULTS

The groups were homogeneous for the majority of variables at baseline. The over-time comparisons show a statistical difference between the groups for pain while walking (p = 0.008) and the 6MWT (p = 0.010). Both groups showed significant improvements in pain at rest, foot function, and some quality of life variables (physical functioning, bodily pain, vitality, and social functioning), with no significant statistical differences between them. The baropodometer recorded no changes from the use of the insoles.

CONCLUSION

A TCI can be used to reduce pain while walking and to increase walking distance in individuals with PF.

The gastrocnemius: a new paradigm for the human foot and ankle

A silent gastrocnemius contracture can gradually do so much harm when left undetected and unattended. The calf is a common source of a majority of acquired, nontraumatic adult foot and ankle problems. When it comes to surgical lengthening procedures, whether at the Achilles, at the musculotendinous junction, or more proximal, the search must move on to find the safest, most accurate, and quickest recovery method possible. Addressing the calf contracture as definitive treatment and, better yet, as prevention will no doubt become a mainstay of the treatment of many foot and ankle problems.

Heel pain-plantar fasciitis: revision 2014

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain.

Evidence of validity for the Japanese version of the foot and ankle ability measure

CONTEXT

The Foot and Ankle Ability Measure (FAAM) is a valid, reliable, and self-reported outcome instrument for the foot and ankle region.

OBJECTIVE

To provide evidence for translation, cross-cultural adaptation, validity, and reliability of the Japanese version of the FAAM (FAAM-J).

DESIGN

Cross-sectional study.

SETTING

Collegiate athletic training/sports medicine clinical setting.

PATIENTS OR OTHER PARTICIPANTS

Eighty-three collegiate athletes.

MAIN OUTCOME MEASURE(S)

All participants completed the Activities of Daily Living and Sports subscales of the FAAM-J and the Physical Functioning and Mental Health subscales of the Japanese version of the Short Form-36v2 (SF-36). Also, 19 participants (23%) whose conditions were expected to be stable completed another FAAM-J 2 to 6 days later for test-retest reliability. We analyzed the scores of those subscales for convergent and divergent validity, internal consistency, and test-retest reliability.

RESULTS

The Activities of Daily Living and Sports subscales of the FAAM-J had correlation coefficients of 0.86 and 0.75, respectively, with the Physical Functioning section of the SF-36 for convergent validity. For divergent validity, the correlation coefficients with Mental Health of the SF-36 were 0.29 and 0.27 for each subscale, respectively. Cronbach α for internal consistency was 0.99 for the Activities of Daily Living and 0.98 for the Sports subscale. A 95% confidence interval with a single measure was ±8.1 and ±14.0 points for each subscale. The test-retest reliability measures revealed intraclass correlation coefficient values of 0.87 for the Activities of Daily Living and 0.91 for the Sports subscales with minimal detectable changes of ±6.8 and ±13.7 for the respective subscales.

CONCLUSIONS

The FAAM was successfully translated for a Japanese version, and the FAAM-J was adapted cross-culturally. Thus, the FAAM-J can be used as a self-reported outcome measure for Japanese-speaking individuals; however, the scores must be interpreted with caution, especially when applied to different populations and other types of injury than those included in this study.

Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis

BACKGROUND

The aim of this study was to determine whether tightness of the posterior muscles of the lower extremity was associated with plantar fasciitis.

METHODS

A total of 100 lower limbs of 100 subjects, 50 with plantar fasciitis and 50 matching controls were recruited. Hamstring and calf muscles were evaluated through the straight leg elevation test, popliteal angle test, and ankle dorsiflexion (knee extended and with the knee flexed). All variables were compared between the 2 groups. In addition, ROC curves, sensitivity, and specificity of the muscle contraction tests were also calculated to determine their potential predictive powers.

RESULTS

Differences between the 2 groups for the tests used to assess muscular shortening were significant (P < .001) in all cases. The straight leg elevation test and ankle dorsiflexion with the knee extended presented respective sensitivities of 94% and 100% and specificities of 82% and 96% as diagnostic tests for the participants in this study.

CONCLUSION

Tightness of the posterior muscles of the lower limb was present in the plantar fasciitis patients, but not in the unaffected participants.

CLINICAL RELEVANCE

The results of this study suggest that therapists who are going to employ a stretching protocol for treatment of plantar fasciitis should look for both hamstring as well as triceps surae tightness. Stretching exercise programs could be recommended for treatment of plantar fasciitis, focusing on stretching the triceps surae and hamstrings, apart from an adequate tissue-specific plantar fascia-stretching protocol.

LEVEL OF EVIDENCE

Level III, case control study.

Changes in multi-segment foot biomechanics with a heat-mouldable semi-custom foot orthotic device

Background

Semi-custom foot orthoses (SCO) are thought to be a cost-effective alternative to custom-made devices. However, previous biomechanical research involving either custom or SCO has only focused on rearfoot biomechanics. The purpose of this study was therefore to determine changes in multi-segment foot biomechanics during shod walking with and without an SCO. We chose to investigate an SCO device that incorporates a heat-moulding process, to further understand if the moulding process would significantly alter rearfoot, midfoot, or shank kinematics as compared to a no-orthotic condition. We hypothesized the SCO, whether moulded or non-moulded, would reduce peak rearfoot eversion, tibial internal rotation, arch deformation, and plantar fascia strain as compared to the no-orthoses condition.

Methods

Twenty participants had retroreflective markers placed on the right limb to represent forefoot, midfoot, rearfoot and shank segments. 3D kinematics were recorded using an 8-camera motion capture system while participants walked on a treadmill.

Results

Plantar fascia strain was reduced by 34% when participants walked in either the moulded or non-moulded SCO condition compared to no-orthoses. However, there were no significant differences in peak rearfoot eversion, tibial internal rotation, or medial longitudinal arch angles between any conditions.

Conclusions

A semi-custom moulded orthotic does not control rearfoot, shank, or arch deformation but does, however, reduce plantar fascia strain compared to walking without an orthoses. Heat-moulding the orthotic device does not have a measurable effect on any biomechanical variables compared to the non-moulded condition. These data may, in part, help explain the clinical efficacy of orthotic devices.