Elsevier

The Foot

Volume 51, May 2022, 101906
The Foot

Original Article
Intensive physiotherapy versus home-based exercise and custom-made orthotic insoles in patients with plantar fasciitis: Pilot study

https://doi.org/10.1016/j.foot.2022.101906Get rights and content

Highlights

  • Plantar fasciitis is debilitating foot problem in wide range of populations.

  • Treatment options include: stretching, strengthening, manual techniques, and insoles.

  • Intensive physiotherapy, home exercises, and insoles were effective for pain relief.

  • Manual techniques are effective for patients with ankle dorsiflexion limitation.

Abstract

Background

This prospective pilot study assessed the feasibility of comparing intensive physiotherapy group (IPG), home-based exercise (HBEG) group, and insole group (IG) to find the most effective treatment program for plantar fasciitis.

Methods

Thirty-nine individuals with plantar fasciitis were selected to participate in this pilot study. The patients were randomly divided into 3 groups, as IPG (manual interventions, exercise, insoles), HBEG (exercise, insoles), and IG (insoles). The feasibility details including percentage of the enrollment and adherence to the groups were recorded. Pain was measured with a visual analog scale, and dorsiflexion range of motion (DROM), foot function, and health-related quality of life were evaluated at the baseline and week 6. One-way ANOVA analysis and Kruskal Wallis test were used to determine the differences of the percentage change of the parameters.

Results

Pain and functional evaluation results showed improvements clinically in all of groups and quality of life results were similar for all groups. There was no difference between the groups after 6 weeks of treatment (P > 0.05).

Conclusions

The 3 treatment programs were found clinically applicable with high patient adherence. According to the data all intervention types were found moderately effective for pain and function. Insoles could be an option applied alone or with other treatments, and manual techniques gave better results in patients with limited ankle dorsiflexion. Although the results should be interpreted with caution because of the small sample size, these results were found promising and feasible to conduct a future RCT.

Clinical trial registration number

RCT 06144834.

Introduction

Plantar fasciitis is responsible for 11%–15% of foot problems in adults and it is one of the most common reasons for heel pain in the literature [1,2]. Pain, which begins from the medial calcaneal tubercle and spreads through the plantar aspect of the foot, is mostly seen with the first steps in the morning, upon palpation, or after standing for a long time [3].

Alterations in foot biomechanics, such as increased foot pronation or supination, obesity, intrinsic muscle weakness, improper footwear, and triceps surae muscle tightness are some of the risk factors that cause repetitive tensile stresses on the fascia, thus resulting in microtraumas at its origin, pain, and functional disability [4].

Most patients with plantar fasciitis-related pain find relief within 1 year of the onset of symptoms with conservative treatment methods [5]. Home-based exercise programs, which include stretching and strengthening exercises or shoe inserts, are the most preferred type of treatment in this population, but these methods do not provide satisfactory results for each patient [6]. Plantar fascia specific and triceps surae stretching have been the most common types of stretching for plantar fasciitis [7,8]. Systemic reviews have stated that stretching is effective for improving function and providing pain relief, although the statistical significance level of the results was not high [[9], [10], [11], [12]].

Manual techniques have also been shown to be effective for increasing lower extremity mobility, while decreasing pain [13,14]. Celik et al. reported that joint mobilization with stretching exercises was effective for up to one year when compared to steroid injections in patients with plantar fasciitis [10]. Insoles with medial arch support were reported to be effective in alleviating symptoms by preventing increased pronation or supination of the foot and correcting the foot posture, and they were especially useful in association with stretching exercises [15].

The role of extrinsic and intrinsic foot muscles in maintaining the height of the medial longitudinal arch and decreasing tension on the plantar fascia are well-known, and the presence of intrinsic muscle atrophy was reported in runners with plantar fasciitis [3,16,17]. In this context, strengthening exercises may be taught as a part of treatment programs. Rathleff et al. reported that strength training with custom-made insoles was more effective in reducing pain and improving function than plantar fascia stretching with custom-made insoles (medial arch support with and without a medial wedge) over a 3-month period [18]. Moreover, Kamonseki et al. stated that daily stretching exercises provided the same results as a combined program of stretching and foot strengthening exercises [19].

A combination of the treatment methods stated above was utilized by Irving et al. [5]. Although, conservative treatment methods like stretching, strengthening, manual techniques, orthotics, etc., have been advised as the first choices of treatment, there has been no consensus about the best treatment protocol or combination of treatments, and the superiority of these techniques for plantar fasciitis treatment in the literature until recently [5].

The purpose of this study was to assess the feasibility of using intensive physiotherapy, home-based exercise, and insole interventions, and to determine the most effective conservative treatment program for plantar fasciitis for use in a future randomized controlled trial.

Section snippets

Participants

This prospective pilot study was performed between July and December 2018. The participants were recruited from X. Participants were included if they were between 18 and 65 years of age, had been diagnosed with plantar fasciitis by a physician, prescribed custom-made orthotic insoles with medial longitudinal arch support, had pain in the plantar aspects of the heel or the central band of the plantar fascia, mostly during their first steps in the morning, volunteered to be part of the study, and

Results

A total of 42 patients (28 females, 14 males) were invited to participate in the pilot study. Of these, 3 patients (2 females, 1 male) could not complete the study (change of the city of residence); hence, 39 patients were taken into consideration for the study.

The percentage of the enrollment was 93 % (39 of 42 patients) and adherence to the groups were high. All patients attended to the all measurements and procedures with caution.

All of the patients were diagnosed with bilaterally plantar

Discussion

Plantar fasciitis is a functionally debilitating pain-related foot problem in a wide range of populations; thus, the importance of finding the best treatment methods is critical. Recent studies have suggested multimodal treatment approaches instead of using just one treatment modality [5,10]. In this context, the effects of intensive physiotherapy, home-based exercise, and custom-made orthotic insoles for a 6-week period were investigated and compared in this pilot study to assess the

Conclusions

All interventions were determined to have been helpful to reduce in pain, and increase clinical foot status, and function clinically over the 6-week period in patients with plantar fasciitis with high patient adherence in this pilot study. Custom-made orthotic insoles could be applied alone or with other techniques, such as stretching and strengthening exercises. Moreover, manual techniques could be the preferred choice for patients with limited ankle dorsiflexion over the short term. Although

Ethical approval

This study was approved by The Clinical Researches Ethics Boards of Hacettepe University (protocol number KA-17033).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgments

None.

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  • Cited by (5)

    This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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