Background: Plantar fasciitis could be described as a heel pain syndrome
characterised by pain, significantly when arising from rest. Most research describes
plantar fasciitis as an inflammatory condition, but researchers question if inflammation
is present in the disease. Patients' pain is described as a "first-step pain" that is sharp
on the inner aspect of the plantar part of the foot. Ten per cent of the general
population will experience plantar fasciitis at least once in their lifetime. Chiropractors
and Podiatrists are professional practitioners that are involved in the management of
plantar fasciitis. Both these practitioners report that plantar fasciitis is one of the most
complicated musculoskeletal conditions to treat. As plantar fasciitis's natural history is
not yet fully understood, it can be difficult to distinguish between a patient who recovers
spontaneously and responds to treatment. Clinical practice guidelines suggest that
various conservative treatment methods could be used for the treatment of plantar
fasciitis. These guidelines indicate that 27 different treatment methods could be used
for the management of plantar fasciitis.
Aim: The study aimed to explore the similarities and differences in the perception of
and the most common treatment methods for plantar fasciitis between chiropractors
and podiatrists.
Method: A questionnaire was a self-administered and adapted version based on a
similar study done by Ferdinand et al (2014) which compared the perception of
physiotherapists and podiatrists in the management of plantar fasciitis. Questions
were adapted by the researcher with assistance from STATKON to ensure the
questions and structure aligned with Ferdinand et al's (2014) study.
Procedure: The study sample consisted of the registered chiropractors of CASA and
all the registered podiatrists of PASA. The total number of registered chiropractors at
CASA stood at 575, and the total number registered podiatrists at PASA stood at 117.
CASA and PASA were sought for assistance in the distribution of the survey link.
CASA sent out the email link for all the registered chiropractors and PASA for
podiatrists. Since the respective associations distributed the questionnaire on the
researcher's behalf, no personal information was disclosed. All participants who
completed the questionnaire were anonymous. No identifying data was asked to
ensure anonymity. A total of 100 completed responses shared between chiropractors
and podiatrists was necessary for the research to be valid and reliable.
The response rate was 23.84%. Only 105 questionnaires were valid and reliable for
data analysis. 60 of the 165 Questionnaires were discarded due to incorrect answering
of questions. A low response rate was due to the survey's anonymity since it was not
possible to follow up with participants telephonically or encourage participants to
complete it. Another contributing factor that could have affected the response rate was
the accuracy of the databases used to distribute the survey. Participants did not
update their contact details with their respective associations. The low response rate
could also have been because of electronic filters that place the survey link in the
participants' spam box.
Results: It was established that podiatrists see more plantar fasciitis patients
compared to chiropractors. Podiatrists used fewer sessions to treat plantar fasciitis
than chiropractors. Chiropractors and podiatrists agreed on treatment methods they
both perceive to work for plantar fasciitis. Each of these two professions established
their treatment methods of choice. Chiropractors and podiatrists, more or less, agreed
on their limitations to treat the condition, but there was a distinguishable difference in
service limitation. The perception of treatment roles showed prospective input but still
need further evidence and investigation.
Conclusion: Chiropractors and podiatrists agreed on the following treatment methods
to treat plantar fasciitis: activity modification advice, rest, calf-stretching,
taping/strapping and ball-rolling. Both these professions agree on these treatment
methods. Each of the occupations had their opinions on which methods they
specifically use for treating plantar fasciitis. Chiropractors decided to use cross friction
massage, instrumental-assisted soft tissue mobilisation (fascial release), manipulation
of the ankle joint, joint mobilisation, and soft tissue mobilisation. At the same time,
podiatrists preferred to use custom orthotics, arch support orthoses, heel cups/pads,
night splints, and compression. Most chiropractors and podiatrists agreed that they did
not have personal limitations or service limitations to treat. Still, a significant number
of chiropractors who reported their personal limits to treatment were due to factors that
alter the foot and ankle's biomechanics.
In contrast, fewer podiatrists reported the same factors as causing their limitations.
One can conclude that podiatrists have more extensive knowledge of the foot and
ankle's biomechanics.
The perception of treatment roles could not be well established, as chiropractors and
podiatrists disagreed on numerous treatment methods. There is quite a conflict in the
over-lapping of the boundaries for each profession's treatment role. It is anticipated
that this could negatively affect the effectiveness of the management of plantar
fasciitis. Until further evidence reveals the most effective treatment for plantar fasciitis,
and which discipline is best responsible for providing the most effective treatment
method.
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