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APTA Practice Guidelines for heel Pain-Plantar Fasciitis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Apr 17, 2008.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Practice Guidelines: Heel Pain-Plantar Fasciitis
    Thomas G. McPoil, RobRoy L. Martin, Mark W. Cornwall, Dane K. Wukich, James J. Irrgang, Joseph J. Godges
    J Orthop Sports Phys Ther. 2008;38(4):A1-A18.
    The full text of the guidelines can be accessed here.
  2. NewsBot

    NewsBot The Admin that posts the news.

    Summary of recommendations:

    Recommendations*Heel Pain—Plantar Fasciitis: A Clinical Practice Guideline

    Pathoanatomical Features: Clinicians should assess for impairments in muscles, tendons, and nerves, as well as the plantar fascia, when a patient presents with heel pain. (Recommendation based on expert opinion.)

    Risk Factors: Clinicians should consider limited ankle dorsiflexion
    range of motion and a high body mass index in nonathletic
    populations as predisposing factors for the development of heel pain/plantar fasciitis.
    (Recommendation based on moderate evidence.)

    Diagnosis/Classification: Pain in the plantar medial heel region; most noticeable with initial steps after a period of inactivity
    but also worse following prolonged weight bearing; and often precipitated by a recent increase in weight-bearing activity
    are useful clinical findings for classifying a patient with heel pain into the International Statistical Classification of Diseases and Related Health Problems (ICD) category of plantar fasciitis and the associated International Classification of Functioning, Disability, and Health (ICF) impairment-based category of heel pain (b28015, Pain in lower limb; b2804, Radiating pain in a segment or region).
    In addition, the following physical examination measures may be useful in classifying a patient with heel pain into the ICD category of plantar fasciitis and the associated ICF impairment-
    based category of heel pain. (Recommendation based on moderate evidence.)
    • Palpation of the proximal plantar fascia insertion
    • Active and passive talocrural joint dorsiflexion range
    of motion
    • The tarsal tunnel syndrome test
    • The windlass test
    • The longitudinal arch angle

    Differential Diagnosis: Clinicians should consider diagnostic classifications other than heel pain/plantar fasciitis when the patient’s reported activity limitations or impairments of body function and structure are not consistent with those presented in the diagnosis/classification section of this guideline, or, when the patient’s symptoms are not resolving with interventions aimed at normalization of the patient’s physical impairments.
    (Recommendation based on expert opinion.)

    Examination—Outcome Measures: Clinicians should use validated self-report questionnaires, such as the Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ), or the Foot and Ankle Ability Measure (FAAM), before and after interventions
    intended to alleviate the impairments of body function and structure, activity limitations, and participation restrictions associated with heel pain/plantar fasciitis. Physical therapists should consider measuring change over time using the FAAM as it has been validated in a physical therapy practice setting.
    (Recommendation based on strong evidence.)

    Examination—Activity Limitation Measures: Clinicians should utilize easily reproducible activity limitation and participation restriction measures associated with the patient’s heel pain/plantar fasciitis to assess the changes in level of function over the episode of care.
    (Recommendation based on expert opinion.)

    Interventions—Modalities: Dexamethasone 0.4% or acetic acid 5% delivered via iontophoresis can be used to provide short-term (2 to 4 weeks) pain relief and improved function. (Recommendation based on moderate evidence.)

    Interventions—Manual Therapy: There is minimal evidence to support the use of manual therapy and nerve mobilization procedures to provide short-term (1 to 3 months) pain relief and improved function. Suggested manual therapy procedures include
    talocrural joint posterior glide, subtalar joint lateral glide, anterior and posterior glides of the first tarsometatarsal joint, subtalar joint distraction manipulation, soft tissue mobilization
    near potential nerve entrapment sites, and passive neural mobilization procedures. (Recommendation based on theoretical/foundational evidence.)

    Interventions—Stretching: Calf muscle and/or plantar fascia- specific stretching can be used to provide short-term (2-4 months) pain relief and improvement in calf muscle flexibility. The dosage for calf stretching can be either 3 times a day or 2 times a day utilizing either a sustained (3 minutes) or intermittent (20 seconds) stretching time, as neither dosage produced a better effect. (Recommendation based on moderate evidence.)

    Interventions—Taping: Calcaneal or low-Dye taping can be used to provide short-term (7-10 days) pain relief. Studies indicate that taping does cause improvements in function.
    (Recommendation based on weak evidence.)

    Interventions—Orthotic Devices: Prefabricated or custom foot orthoses can be used to provide short-term (3 months) reduction in pain and improvement in function. There appear to be no differences in the amount of pain reduction or improved function created by custom foot orthoses in comparison to prefabricated orthoses. There is currently no evidence to support the use of prefabricated or custom foot orthoses for long-term (1 year) pain management or function improvement. (Recommendation based on strong evidence.)

    Interventions—Night Splints: Night splints should be considered as an intervention for patients with symptoms greater than 6 months in duration. The desired length of time for wearing the night splint is 1 to 3 months. The type of night splint used (ie, posterior, anterior, sock-type) does not appear to affect the outcome. (Recommendation based on moderate evidence.)
  3. bob

    bob Active Member

    Plantar fascia release?:santa2:
  4. NewsBot

    NewsBot The Admin that posts the news.

  5. Paul Bowles

    Paul Bowles Well-Known Member

    Great read many thanks - a lot of it needs to be questioned especially the stretching recommendations.

    Name me ONE pharma study which cites a 22% increase in symptoms and pain with the associated disease (Radford et al) yet still recommends the treatment.... Thats not a criticism of Joels/Hyltons or Karls study, more of a criticism of this papers recommendations.

    To me that is fairly bizarre. I do appreciate though that they have suggested "stretching" should be used with careful consideration based on the case. Im only a little way through reading the 36 or so pages of this - thanks to Craig for posting. Its a worthwhile read.

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