Plantar fasciitis: the effects of manual therapy
Plantar fasciitis can be a a real heel. Pun intended. Defined as inflammation of the connective tissue that supports the arch of the foot, it can be very debilitating if not addressed properly.
The study:
A systematic review performed by Mischke et al looks at the importance of manual physical therapy in the treatment of plantar fasciitis. Given the association between plantar fasciitis and limited ankle dorsiflexion range of motion, manual therapy is thought to play a key role in the improvement of symptoms and cause.
A comprehensive search was performed on online medical libraries, including MEDLINE, EMBASE, Cochrane, CINAHL and Rehabilitation & Sports Medicine Source. Quality assessment was performed using the PEDro scale to ensure all articles were randomized controlled trials discussing manual interventions for plantar fasciitis. Out of 1745 studies, 8 studies were included.
The results:
Of the 8 studies included, only 2 studies scored at least 7/10 points using the PEDro scale, underscoring the overall lack of quality studies. The two studies, however, depicted results favoring the use of manual therapy:
Study 1: Cleland et al (8/10 PEDro rating)
Electrophysical agents and exercise vs. manual therapy and exercise (impairment-based STM and joint mobilization)
The manual therapy group showed better pain levels (NPRS) at Week 4 and better functional levels (LEFS) at 6 months follow-up.
Study 2: Saban et al (7/10 PEDro rating)
STM, neural mobilization and self-stretching vs. US and self-stretching
The manual therapy group showed better pain levels (VAS) and better functional levels (FAA) at 6 weeks follow-up.
What it means:
Limitations of this study include 1.) the lack of quality studies used; 2.) questionable internal reliability of quality assessors; 3.) lack of detail on specific manual therapy techniques utilized, and 4.) lack of long-term follow-up, as most included studies were only for short-term results.
Nonetheless, the two randomized controlled trials with higher PEDro ratings showed favor towards manual therapy interventions in patients with plantar fasciitis. It is an area that warrants further research for finding specific manual therapy techniques and parameters with supportive, favorable long-term results.
Other than manual therapy, see below for examples of exercises that will also help treat this all-too-common problem.
REFERENCES:
Mischke JJ, Jayaseelan DJ, Sault JD, Emerson Kavchak AJ. The symptomatic and functional effects of manual physical therapy on plantar heel pain: a systematic review. J Man Manip Ther. 2017 Feb;25(1):3-10. doi: 10.1080/10669817.2015.1106818. Epub 2016 Apr 26. PMID: 28855787; PMCID: PMC5539575.