Clinical Bottom Line: Research shows that plantar fasciitis is a syndrome resulting from a multitude of factors that cannot be addressed by any single treatment currently available. Rather, each contributing factor should be independently identified and addressed as part of a comprehensive treatment regimen that is individualized to each patient’s clinical presentation. That being said, the majority of our patients are likely to benefit from the inclusion of off-the-shelf orthotics, as well as Achilles and plantar fascia-specific stretches. Night splints, custom orthotics, manipulation and taping would be recommended only under circumstances where conditions such as aberrant foot/ankle joint mobility or biomechanical defects are present, or if there has been poor responsiveness to first-line treatments.
Clinical Scenario: Heel pain, particularly when associated with the plantar aponeurosis, is one of the most commonly reported foot problems in adults. Through our clinical experience it seems that there is little agreement on standardization of conservative therapy options in the treatment of chronic plantar fasciitis. Although many of these treatments have reputedly provided some level of relief, the final long-term outcomes, as well as the financial and personal burden imposed by each treatment, appear inconsistent throughout the literature. We plan to learn which conservative measures within the scope of physical therapy practice are efficacious in the treatment of chronic plantar fasciitis.
Our Clinically Answerable Question: P: Population is to include adult subjects aged 18-65 years old who present to an outpatient physical therapy clinic with chronic plantar fasciitis persisting for at least 6 months. I: Intervention of conservative physical therapy treatments including: night splints, Achilles stretching, plantar fascia stretching, customized orthotics, over-the-counter orthotics (heel lifts or cups, arch supports, padding), manual therapy mobilizations. Treatment options may be prescribed in combination or individually. C: Comparison group is a control group that received sham/placebo, or no treatment. O: Outcomes should demonstrate improvement of symptoms as measured by a decrease of pain score on the Visual Analog Scale (VAS), and/or increased functional outcomes as measured by functional outcome surveys and questionnaires that ideally address one or more of the following: 1) tolerance for general activity, 2) ability to participate in sports, 3) tolerance for prolonged standing/walking, and 4) satisfaction.
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