Foot and ankle mobilisations for plantar fasciitis
Heel pain affects approximately 10% of the population and plantar fasciitis (better referred to as fasciosis or fasciopathy) is the leading cause of heel pain. The current, well-designed RCT (8/10 PEDro score) aimed to assess the efficacy of adding midfoot and ankle joint mobilisations to calf stretches in order to address reduced dorsiflexion which is often associated with plantar fasciosis. The authors found no significant differences between the 2 of groups for any of the outcomes. Both groups showed reduced pain and improved dorsiflexion after 4 weeks of either stretching or stretching AND mobilisations.
50 patients between the ages of 23 and 73 participated in the study and were randomly assigned to the treatment (mobilisations PLUS stretching and ultrasound) or control group (stretching and ultrasound). To fit the criteria, patients had to have pain under the heel generated by direct pressure onto the fascial attachment and pain greater than 3/10 on inital weight-bearing. Exclusing criteria was exhaustive and included red flags, previous fractures, steroid use, neural signs etc. Outcome measures were dorsiflexion ROM (measured via weight-bearing lunge), pain intensity, lower extremity functional scale questionnaire and algometry (pressure pain threshold test). All participants were seen twice a week for 4 weeks with the treatment group receiving talocrural, subtalar and midfoot mobilsations aimed at improving dorsiflexion.
The results suggest that adding joint mobilisations to stretching and ultrasound for plantar fasciosis has no added benefit. Analysis revealed that increases in dorsiflexion ROM was as a result of stretching alone and mobilisations did not have any effect on ROM. Therefore the association between limited dorsiflexion and plantar fasciosis may be due to soft tissue shortening.
Is reduced dorsiflexion more of a symptom rather than a cause for plantar heel pain?
> From: Shashua et al., J Orthop Sports Phys There 45 (2015) 265-72(Epub ahead of print). All rights reserved to Journal of Orthopaedic and Sports Physical Therapy. Click here for the Pubmed summary.