Original ArticleIntensive physiotherapy versus home-based exercise and custom-made orthotic insoles in patients with plantar fasciitis: Pilot study☆
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.
References (29)
- et al.
Translation, cross-cultural adaptation, reliability, and validity of Turkish version of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale
J Foot Ankle Surg
(2016) - et al.
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
Man Ther
(2016) - et al.
AORN Ergonomic Tool 4: solutions for prolonged standing in perioperative settings
AORN J
(2011) - et al.
Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes
Foot Ankle Int
(2020) - et al.
Impact of demographic and impairment-related variables on disability associated with plantar fasciitis
Foot Ankle Int
(2004) - et al.
Heel pain--plantar fasciitis: clinical practice guidelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association
J Orthop Sports Phys Ther
(2008) - et al.
Testbook of pain
(1984) - et al.
Factors associated with chronic plantar heel pain: a systematic review
J Sci Med Sport
(2016) - et al.
Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up
J Bone Joint Surg Am
(2006) Analysis of ankle and subtalar motion during human locomotion
Plantar heel pain and plantar fasciitis
BMJ Clin Evid
Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice
J Athl Train
Joint mobilization and stretching exercise vs steroid injection in the treatment of plantar fasciitis: a randomized controlled study
Foot Ankle Int
Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes
Foot Ankle Int
Cited by (5)
The effect of a home-based stretching exercise on the ground reaction force generation and absorption during walking in individuals with plantar fasciitis
2022, Physical Therapy in SportCitation Excerpt :The first group received manual treatment, exercises, and insoles, the second group received exercises and insoles, and the last group received insoles only. The findings showed moderate improvement in pain and function when compared to baseline in all the three groups but no inter-group difference was found (Yildiz, Sumer, Zengin, & Bek, 2022). The efficacy of home-based exercise was further supported by a prospective randomized controlled study of Kaiser et al. (Kaiser et al., 2022).
Effects of therapeutic interventions on pain due to plantar fasciitis: A systematic review and meta-analysis
2023, Clinical RehabilitationManual Therapy versus Kinesio Taping and Stretching to Enhance Plantar Mobility and the Quality of Life of Patients with Plantar Fasciitis
2022, Journal of Exercise Physiology Online
- ☆
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.