Lived experience and attitudes of people with plantar heel pain:a qualitative exploration

BACKGROUND: Plantar heel pain is a common source of pain and disability. Evidence-based treatment decisions for people with plantar heel pain should be guided by the best available evidence, expert clinical reasoning, and consider the needs of the patient. Education is a key component of care for any patient and needs to be tailored to the patient and their condition. However, no previous work has identified, far less evaluated, the approaches and content required for optimal education for people with plantar heel pain. The aim of this study was to gather the patients' perspective regarding their lived experience, attitudes and educational needs in order to inform the content and provision of meaningful education delivery approaches. METHODS: Using a qualitative descriptive design, semi-structured interviews were conducted with participants with a clinical diagnosis of plantar heel pain. A topic guide was utilised that focused on the experience of living with plantar heel pain and attitudes regarding treatment and educational needs. Interviews were audio recorded, transcribed verbatim and analysed using the Framework approach. Each transcription, and the initial findings, were reported back to participants to invite respondent validation. RESULTS: Eighteen people with plantar heel pain were interviewed. Descriptive analysis revealed eight themes including perceptions of plantar heel pain, impact on self, dealing with plantar heel pain, source of information, patient needs, patient unmet needs, advice to others and interest in online education. Participants revealed doubt about the cause, treatment and prognosis of plantar heel pain. They also expressed a desire to have their pain eliminated and education individually tailored to their condition and needs. Respondent validation revealed that the transcripts were accurate, and participants were able to recognise their own experiences in the synthesised themes. CONCLUSION: Plantar heel pain has a negative impact on health-related quality of life. Participants wanted their pain eliminated and reported that their expectations and needs were frequently unmet. Health professionals have an important role to be responsive to the needs of the patient to improve their knowledge and influence pain and behaviour. Our study informs the content needed to help educate people with plantar heel pain

Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Plantar heel pain (plantar fasciitis) is a common and disabling condition, which has a detrimental impact on health-related quality of life. Despite the high prevalence of plantar heel pain, the optimal treatment for this disorder remains unclear. Consequently, an alternative therapy such as dry needling is increasingly being used as an adjunctive treatment by health practitioners. Only two trials have investigated the effectiveness of dry needling for plantar heel pain, however both trials were of a low methodological quality. This manuscript describes the design of a randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain.</p> <p>Methods</p> <p>Eighty community-dwelling men and woman aged over 18 years with plantar heel pain (who satisfy the inclusion and exclusion criteria) will be recruited. Eligible participants with plantar heel pain will be randomised to receive either one of two interventions, (i) real dry needling or (ii) sham dry needling. The protocol (including needling details and treatment regimen) was formulated by general consensus (using the Delphi research method) using 30 experts worldwide that commonly use dry needling for plantar heel pain. Primary outcome measures will be the pain subscale of the Foot Health Status Questionnaire and "first step" pain as measured on a visual analogue scale. The secondary outcome measures will be health related quality of life (assessed using the Short Form-36 questionnaire - Version Two) and depression, anxiety and stress (assessed using the Depression, Anxiety and Stress Scale - short version). Primary outcome measures will be performed at baseline, 2, 4, 6 and 12 weeks and secondary outcome measures will be performed at baseline, 6 and 12 weeks. Data will be analysed using the intention to treat principle.</p> <p>Conclusion</p> <p>This study is the first randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain. The trial will be reported in accordance with the Consolidated Standards of Reporting Trials and the Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines. The findings from this trial will provide evidence for the effectiveness of trigger point dry needling for plantar heel pain.</p> <p>Trial registration</p> <p>Australian New Zealand 'Clinical Trials Registry'. <a href="http://www.anzctr.org.au/ACTRN12610000611022.aspx">ACTRN12610000611022</a>.</p

A Comparitive study between Myofascial Trigger Point Release and Self Stretching with Intermittent Icing in Improving the Foot and Ankle Function of Hockey Players with Plantar Heel Pain

NEED FOR THE STUDY: Plantar heel pain not only cause pain and discomfort but also affects the physical foot and ankle functions of the hockey players and their results in deconditioning. Previous studies have reported that stretching of the calf musculature and the plantar fascia are effective management strategies for plantar heel pain. Few studies are available to analyse the effect of soft tissue therapy for plantar heel pain in athletic population. So this study was conducted in order to compare either Myofascial trigger point release or self-stretching with intermittent icing as a useful intervention in the management to improve foot and ankle function for plantar heel pain in hockey players. OBJECTIVES: 1. To determine the efficacy of physiotherapeutic techniques in improving foot and ankle function of hockey players with plantar heel pain. 2. To systematically compare the efficacy of myofascial trigger point and self stretching with intermittent icing in improving foot and ankle functions of hockey players with plantar heel pain. 3. To systematically assess the literature and present the best available evidence for improving the foot and ankle function in hockey players with plantar heel pain. METHODOLOGY: STUDY DESIGN: Pre test-post test study comparative in nature. STUDY SETTING: Study was conducted at Nehru stadium - Hockey team Coimbatore, Tamilnadu, under the guidance of Shasti Sports Institute. STUDY DURATION: Total duration was six months. Individuals received the treatment for duration of one week. SUBJECTS: 30 hockey players with clinical diagnosis of plantar heel pain, who fulfill the predetermined inclusive and exclusive criteria were selected and divided into 2 groups by simple random sampling method. Each group consists of 15 patients. Groups are named as group A, and B. CRITERIA FOR SELECTION: INCLUSIVE CRITERIA: Male hockey players, Age group between 18 and 25 years, Minimum one years of continuous performance, Clinical diagnosis of unilateral plantar heel pain, Specific controls for subjects included the time of testing, activities of daily living, nutritional factors, and psychological status can be controlled during the study. EXCLUSIVE CRITERIA: Subjects with Neurological problems, Any recent injuries to lower limbs, Any recent surgery in lower limbs, Psychologically unstable players. Red flags to manual therapies; Tumour in lower limb, Fractures in lower limb, Rheumatoid arthritis, Osteoporosis, Severe vascular disease, Calcanial spur, TA calcification. Previous manual therapy interventions for the foot region. RESULTS: In the table I & IV the pre test and post value of Visual Analogue Scale and Foot and Ankle Ability Measures were assessed for the stretching group. The results show that there was significant decrease in reduction of pain and increase in the physical performance for plantar heel pain hockey players. In the table II & V the pre test and post value of Visual Analogue Scale and Foot and Ankle Ability Measures were assessed for the myofascial trigger point release and self-stretching with intermittent icing group. The results showed that there was significant decrease in reduction of pain and increase in the physical performance for plantar heel pain hockey players. In the table III & VI the post test value of both Visual Analogue Scale and Foot and Ankle Ability Measures show that there is significant difference in between self-stretching with intermittent icing and myofascial trigger point release The analysis of the post test values shows that there is decrease in reduction of pain and increase in the foot and ankle function between the groups for plantar heel pain in hockey players. Post test values of Group A and Group B is analysed by Unpaired ‘t’ test. In table III and Figure III he calculated ‘t’ value is 3.0880 which is greater than table ‘t’ value 1.7011 at 5% level of significance. SUMMARY AND CONCLUSION: The aim of the study is to compare myofascial trigger point release and selfstretching with intermittent icing for plantar heel pain in hockey players. 30 hockey players with a minimum of five year experience in playing hockey were selected in the age group between 18 and 25 years and the subjects were allotted into two groups, according to inclusion criteria. Group A received self-stretching & intermittent icing ; Group B received Myofascial trigger point release. The pre-test and post-test were taken before and at the end of the treatment. Statistical analysis was done by using paired and unpaired ‘t’ test. Paired ‘t’ test was used to find out the improvement within the group. Unpaired ‘t’ test was used to find out the difference between two groups. The results of the study showed that there is a reduction of pain and increasing foot and ankle function in hockey players with plantar heel pain in both the Group A and Group B When comparing both Group A and Group B it was concluded that myofacial trigger point release showed better improvement in hockey players with plantar heel pain. CONCLUSION: It as concluded that myofascial trigger point treatment programme showed better improvement in the reduction of pain in hockey players with plantar heel pain than Group A. It is concluded that the myofascial trigger point treatment programme showed better improvement in foot and ankle function among hockey players with plantar heel pain than Group A

Medical imaging for plantar heel pain:a systematic review and meta-analysis

BACKGROUND: Medical imaging can be used to assist with the diagnosis of plantar heel pain. The aim of this study was to synthesise medical imaging features associated with plantar heel pain. METHODS: This systematic review and meta-analysis conducted searches in MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to 12th February 2021. Peer-reviewed articles of cross-sectional observational studies written in English that compared medical imaging findings in adult participants with plantar heel pain to control participants without plantar heel pain were included. Study quality and risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Sensitivity analyses were conducted where appropriate to account for studies that used unblinded assessors. RESULTS: Forty-two studies (2928 participants) were identified and included in analyses. Only 21% of studies were rated ‘good’ on quality assessment. Imaging features associated with plantar heel pain included a thickened plantar fascia (on ultrasound and MRI), abnormalities of the plantar fascia (on ultrasound and MRI), abnormalities of adjacent tissue such as a thickened loaded plantar heel fat pad (on ultrasound), and a plantar calcaneal spur (on x-ray). In addition, there is some evidence from more than one study that there is increased hyperaemia within the fascia (on power Doppler ultrasound) and abnormalities of bone in the calcaneus (increased uptake on technetium-99 m bone scan and bone marrow oedema on MRI). CONCLUSIONS: People with plantar heel pain are more likely to have a thickened plantar fascia, abnormal plantar fascia tissue, a thicker loaded plantar heel fat pad, and a plantar calcaneal spur. In addition, there is some evidence of hyperaemia within the plantar fascia and abnormalities of the calcaneus. Whilst these medical imaging features may aid with diagnosis, additional high-quality studies investigating medical imaging findings for some of these imaging features would be worthwhile to improve the precision of these findings and determine their clinical relevance. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13047-021-00507-2

Effectiveness of myofascial trigger point release with self-stretching in improving physical performance for plantar heel pain in athletes.

INTRODUCTION : The heel bone is the largest of the 26 bones in the human foot, which has 33 joints, more than 100 tendons, muscles, and ligaments. Like all bones, it is also subjected to outside influences that can affect its integrity and its ability to keep us on our feet. Plantar heel pain is a common orthopaedic problem that can cause discomfort and a limp because of the difficulty in bearing weight. Plantar heel pain among athletes is usually due to overuse and poor biomechanics. However, muscle strength imbalance and muscle tightness have also been indicated as causes of plantar heel pain. Other possible contributing factors to plantar heel pain include loss of plantar fat pad with advancing age, increased body-weight. AIM OF THE STUDY : To compare the effect of myofascial trigger point release with self-stretching in improving physical performance for plantar heel pain in athletes OBJECTIVES : To study the effect of myofascial trigger point release in improving physical performance for plantar heel pain in athletes. • To study the effect of self-stretching in improving physical performance for plantar heel pain in athletes. • To study the combined effect of myofascial trigger point release with self-stretching in improving physical performance for plantar heel pain in athletes. METHODOLOGY : A randomised experimental pre-test, post-test control group design. Study was conducted at OPD Dept Maruthi College of Physical Education, Coimbatore. Total duration was six months. Individuals received the treatment for duration of one week. 30 athletic individuals with clinical diagnosis of plantar heel pain, who fulfill the predetermined inclusive and exclusive criteria were selected and divided into 2 groups by simple random sampling method. Each group consists of 15 patients. Groups are named as group A, and B. Inclusive Criteria: Male athletes, Age group between 18 to 25 years, Clinical diagnosis of unilateral plantar heel pain, Specific controls for subjects included the time of testing, activities of daily living, nutritional factors, and psychological status could be controlled during the study. Exclusive Criteria: Subjects with - Neurological problems, Any recent injuries to lower limbs, Any recent surgery, Psychologically unstable players. Red flags to manual therapies: Tumour, Fractures, Rheumatoid arthritis, Osteoporosis, Severe vascular disease. Diagnosis of fibromyalgia, Previous manual therapy interventions for the foot region. CONCLUSION : The aim of the study is to assess the effect of myofascial trigger point release with self-stretching for plantar heel pain in athletes. 30 athletes were selected in the age group between 18 to 25 years and the subjects were allotted into two groups, according to inclusion criteria. Group A received self-stretching only; Group B received Myofascial trigger point release with self-stretching. The pre-test and post-test were taken before and at the end of the treatment. Statistical analysis was done by using paired and unpaired’t’ test. Paired‘t’ test was used to find out the improvement within the group. Unpaired‘t’ test was used to find out the difference between two groups. The results showed that there is a reduction of pain and increasing physical performance for plantar heel pain in athletes, in group B Thus study conclude that myofascial trigger point release with self-stretching improve physical performance in plantar heel pain in athletes

Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review

<p>Abstract</p> <p>Background</p> <p>Plantar heel pain (plantar fasciitis) is one of the most common musculoskeletal pathologies of the foot. Plantar heel pain can be managed with dry needling and/or injection of myofascial trigger points (MTrPs) however the evidence for its effectiveness is uncertain. Therefore, we aimed to systematically review the current evidence for the effectiveness of dry needling and/or injections of MTrPs associated with plantar heel pain.</p> <p>Methods</p> <p>We searched specific electronic databases (MEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus and AMI) in April 2010 to identify randomised and non-randomised trials. We included trials where participants diagnosed with plantar heel pain were treated with dry needling and/or injections (local anaesthetics, steroids, Botulinum toxin A and saline) alone or in combination with acupuncture. Outcome measures that focussed on pain and function were extracted from the data. Trials were assessed for quality using the Quality Index tool.</p> <p>Results</p> <p>Three quasi-experimental trials matched the inclusion criteria<it>: </it>two trials found a reduction in pain for the use of trigger point dry needling when combined with acupuncture and the third found a reduction in pain using 1% lidocaine injections when combined with physical therapy. However, the methodological quality of the three trials was poor, with Quality Index scores ranging form 7 to 12 out of a possible score of 27. A meta-analysis was not conducted because substantial heterogeneity was present between trials.</p> <p>Conclusions</p> <p>There is limited evidence for the effectiveness of dry needling and/or injections of MTrPs associated with plantar heel pain. However, the poor quality and heterogeneous nature of the included studies precludes definitive conclusions being made. Importantly, this review highlights the need for future trials to use rigorous randomised controlled methodology with measures such as blinding to reduce bias. We also recommend that such trials adhere to the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) to ensure transparency.</p

Plantar heel pain in middle-aged and older adults: population prevalence, associations with health status and lifestyle factors, and frequency of healthcare use

Background The objectives of this study were to estimate the population prevalence and distribution of plantar heel pain in mid-to-older age groups, examine associations with selected health status and lifestyle factors, and report the frequency of healthcare use. Methods Adults aged ≥50 years registered with four general practices were mailed a health survey (n = 5109 responders). Plantar heel pain in the last month was defined by self-reported shading on a foot manikin, and was defined as disabling if at least one of the function items of the Manchester Foot Pain and Disability Index were also reported. Population prevalence estimates and associations between plantar heel pain and demographic characteristics, health status measures and lifestyle factors were estimated using multiple imputation and weighted logistic regression. Healthcare professional consultation was summarised as the 12-month period prevalence of foot pain-related consultation. Results The population prevalence of plantar heel pain was 9.6% (95% CI: 8.8, 10.5) and 7.9% (7.1, 8.7) for disabling plantar heel pain. Occurrence was slightly higher in females, comparable across age-groups, and significantly higher in those with intermediate/routine and manual occupations. Plantar heel pain was associated with physical and mental impairment, more anxiety and depression, being overweight, a low previous use of high-heeled footwear, and lower levels of physical activity and participation. The 12-month period prevalence of foot pain-related consultation with a general practitioner, physiotherapist or podiatrist/chiropodist was 43.0, 15.1 and 32.8%, respectively. Conclusions Plantar heel pain is a common, disabling symptom among adults aged 50 years and over. Observed patterns of association indicate that in addition to focused foot-specific management, primary care interventions should also target more general physical and psychological factors that could potentially act as barriers to treatment adherence and recovery

Cost-effectiveness of two dry needling interventions for plantar heel pain: A secondary analysis of an rct

Plantar heel pain is a common cause of foot pain that affects patients’ quality of life and represents a significant cost for the healthcare system. Dry needling and percutaneous needle electrolysis are two minimally invasive treatments that were shown to be effective for the management of plantar heel pain. The aim of our study was to compare these two treatments in terms of health and economic consequences based on the results of a published randomized controlled trial. For this, we evaluated the costs from the point of view of the hospital and we carried out a cost-effectiveness study using quality of life as the main variable according to the Eq-5D-5L questionnaire. The cost of the complete treatment with dry needling (DN) was €178.86, while the percutaneous needle electrolysis (PNE) was €200.90. The quality of life of patients improved and was translated into +0.615 quality-adjusted life years (QALYs) for DN and +0.669 for PNE. PNE presented an average incremental cost-effectiveness ratio (ICER) of €411.34/QALY against DN. These results indicate that PNE had a better cost-effectiveness ratio for the treatment of plantar heel pain than DN

Effectiveness of low-Dye taping for the short-term treatment of plantar heel pain: a randomised trial

BACKGROUND: Plantar heel pain is one of the most common musculoskeletal disorders of the foot and ankle. Treatment of the condition is usually conservative, however the effectiveness of many treatments frequently used in clinical practice, including supportive taping of the foot, has not been established. We performed a participant-blinded randomised trial to assess the effectiveness of low-Dye taping, a commonly used short-term treatment for plantar heel pain. METHODS: Ninety-two participants with plantar heel pain (mean age 50 ± 14 years; mean body mass index 30 ± 6; and median self-reported duration of symptoms 10 months, range of 2 to 240 months) were recruited from the general public between February and June 2005. Participants were randomly allocated to (i) low-Dye taping and sham ultrasound or (ii) sham ultrasound alone. The duration of follow-up for each participant was one week. No participants were lost to follow-up. Outcome measures included 'first-step' pain (measured on a 100 mm Visual Analogue Scale) and the Foot Health Status Questionnaire domains of foot pain, foot function and general foot health. RESULTS: Participants treated with low-Dye taping reported a small improvement in 'first-step' pain after one week of treatment compared to those who did not receive taping. The estimate of effect on 'first-step' pain favoured the low-Dye tape (ANCOVA adjusted mean difference -12.3 mm; 95% CI -22.4 to -2.2; P = 0.017). There were no other statistically significant differences between groups. Thirteen participants in the taping group experienced an adverse event however most were mild to moderate and short-lived. CONCLUSION: When used for the short-term treatment of plantar heel pain, low-Dye taping provides a small improvement in 'first-step' pain compared with a sham intervention after a one-week period

Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial

BACKGROUND: Plantar heel pain is one of the most common musculoskeletal disorders of the foot and ankle. Treatment of the condition is usually conservative, however the effectiveness of many treatments frequently used in clinical practice, including stretching, has not been established. We performed a participant-blinded randomised trial to assess the effectiveness of calf muscle stretching, a commonly used short-term treatment for plantar heel pain. METHODS: Ninety-two participants with plantar heel pain were recruited from the general public between April and June 2005. Participants were randomly allocated to an intervention group that were prescribed calf muscle stretches and sham ultrasound (n = 46) or a control group who received sham ultrasound alone (n = 46). The intervention period was two weeks. No participants were lost to follow-up. Primary outcome measures were 'first-step' pain (measured on a 100 mm Visual Analogue Scale) and the Foot Health Status Questionnaire domains of foot pain, foot function and general foot health. RESULTS: Both treatment groups improved over the two week period of follow-up but there were no statistically significant differences in improvement between groups for any of the measured outcomes. For example, the mean improvement for 'first-step' pain (0–100 mm) was -19.8 mm in the stretching group and -13.2 mm in the control group (adjusted mean difference between groups -7.9 mm; 95% CI -18.3 to 2.6). For foot function (0–100 scale), the stretching group improved 16.2 points and the control group improved 8.3 points (adjusted mean difference between groups 7.3; 95% CI -0.1 to 14.8). Ten participants in the stretching group experienced an adverse event, however most events were mild to moderate and short-lived. CONCLUSION: When used for the short-term treatment of plantar heel pain, a two-week stretching program provides no statistically significant benefit in 'first-step' pain, foot pain, foot function or general foot health compared to not stretching