Beruflich Dokumente
Kultur Dokumente
ROBROY L. MARTIN, PT, PhD • TODD E. DAVENPORT, DPT • STEPHEN F. REISCHL, DPT • THOMAS G. MCPOIL, PT, PhD
JAMES W. MATHESON, DPT • DANE K. WUKICH, MD • CHRISTINE M. MCDONOUGH, PT, PhD
SUMMARY OF RECOMMENDATIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A2
INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A3
Journal of Orthopaedic & Sports Physical Therapy®
METHODS.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A4
CLINICAL GUIDELINES:
Impairment/Function-Based Diagnosis. . . . . . . . . . . . . . . . . . . A7
CLINICAL GUIDELINES:
Examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A10
CLINICAL GUIDELINES:
Interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A11
REFERENCES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A21
REVIEWERS: Roy D. Altman, MD • Paul Beattie, PT, PhD • Mark Cornwall, PT, PhD
Irene Davis, PT, PhD • John DeWitt, DPT • James Elliott, PT, PhD • James J. Irrgang, PT, PhD
Sandra Kaplan, PT, PhD • Stephen Paulseth, DPT, MS • Leslie Torburn, DPT • James Zachazewski, DPT
For author, coordinator, contributor, and reviewer affiliations, see end of text. Copyright ©2014 Orthopaedic Section, American Physical Therapy Association (APTA), Inc,
and the Journal of Orthopaedic & Sports Physical Therapy ®. The Orthopaedic Section, APTA, Inc, and the Journal of Orthopaedic & Sports Physical Therapy consent to
the reproduction and distribution of this guideline for educational purposes. Address correspondence to: Joseph Godges, DPT, ICF-based Clinical Practice Guidelines
Coordinator, Orthopaedic Section, APTA, Inc, 2920 East Avenue South, Suite 200, La Crosse, WI 54601. E-mail: icf@orthopt.org
Summary of Recommendations*
and the associated International Classification of Functioning, riod of inactivity and pain with palpation of the proximal insertion of
Disability and Health (ICF) impairment-based category of heel pain the plantar fascia, and may include measures of active and passive
(b28015 Pain in lower limb, b2804 Radiating pain in a segment ankle dorsiflexion range of motion and body mass index in nonath-
or region) using the following history and physical examination letic individuals.
findings:
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
A
of motion nemius/soleus stretching to provide short-term (1 week to
• Abnormal Foot Posture Index score 4 months) pain relief for individuals with heel pain/plantar fasciitis.
• High body mass index in nonathletic individuals Heel pads may be used to increase the benefits of stretching.
a2 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
tion in conjunction with a foot orthosis, and (2) shoe rotation during
INTERVENTIONS – PHYSICAL AGENTS
the work week for those who stand for long periods.
Electrotherapy: clinicians should use manual therapy,
D
stretching, and foot orthoses instead of electrotherapeutic
modalities, to promote intermediate and long-term (1-6 months) INTERVENTIONS – EDUCATION AND
improvements in clinical outcomes for individuals with heel pain/ COUNSELING FOR WEIGHT LOSS
plantar fasciitis. Clinicians may or may not use iontophoresis with Clinicians may provide education and counseling on exercise
dexamethasone or acetic acid to provide short-term (2-4 weeks) E strategies to gain or maintain optimal lean body mass in
pain relief and improved function. individuals with heel pain/plantar fasciitis. Clinicians may also refer
individuals to an appropriate health care practitioner to address
Low-level laser: clinicians may use low-level laser therapy to nutrition issues.
C
reduce pain and activity limitations in individuals with heel
pain/plantar fasciitis.
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
List of Acronyms
Introduction
AIM OF THE GUIDELINES physical therapy management of patients with musculoskel-
The Orthopaedic Section of the American Physical Therapy etal impairments described in the World Health Organiza-
Association (APTA) has an ongoing effort to create evidence- tion’s International Classification of Functioning, Disability
based clinical practice guidelines (CPGs) for orthopaedic and Health (ICF).97
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a3
Introduction (continued)
The purposes of these clinical guidelines are to: • Create a reference publication for orthopaedic physical
• Describe evidence-based physical therapy practice, includ- therapy clinicians, academic instructors, clinical instruc-
ing diagnosis, prognosis, intervention, and assessment tors, students, interns, residents, and fellows regarding the
of outcome for musculoskeletal disorders commonly best current practice of orthopaedic physical therapy
managed by orthopaedic physical therapists
• Classify and define common musculoskeletal conditions STATEMENT OF INTENT
using the World Health Organization’s terminology relat- These guidelines are not intended to be construed or to serve as
ed to impairments of body function and body structure, a standard of medical care. Standards of care are determined on
activity limitations, and participation restrictions the basis of all clinical data available for an individual patient
• Identify interventions supported by current best evidence and are subject to change as scientific knowledge and technology
to address impairments of body function and structure, advance and patterns of care evolve. These parameters of prac-
activity limitations, and participation restrictions associ- tice should be considered guidelines only. Adherence to them
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
ated with common musculoskeletal conditions will not ensure a successful outcome in every patient, nor should
• Identify appropriate outcome measures to assess chang- they be construed as including all proper methods of care or
es resulting from physical therapy interventions in body excluding other acceptable methods of care aimed at the same
function and structure as well as in activity and participa- results. The ultimate judgment regarding a particular clinical
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
tion of the individual procedure or treatment plan must be made based on clinician
• Provide a description to policy makers, using internation- experience and expertise in light of the clinical presentation of
ally accepted terminology, of the practice of orthopaedic the patient; the available evidence; the available diagnostic and
physical therapists treatment options; and the patient’s values, expectations, and
• Provide information for payers and claims reviewers preferences. However, we suggest that significant departures
regarding the practice of orthopaedic physical therapy from accepted guidelines should be documented in the patient’s
for common musculoskeletal conditions medical records at the time the relevant clinical decision is made.
Journal of Orthopaedic & Sports Physical Therapy®
Methods
Content experts were appointed by the Orthopaedic Section, and ProQuest Nursing and Allied Health Source (2007 to
APTA to conduct a review of the literature and to develop date). See APPENDIX A (available online) for full search strate-
an updated heel pain/plantar fasciitis CPG as indicated by gies and APPENDIX B (available online) for search dates and
the current state of the evidence in the field. The aims of results.
the revision were to provide a concise summary of the evi-
dence since publication of the original guideline and to de- The authors declared relationships and developed a conflict
velop new recommendations or revise previously published management plan, which included submitting a conflict-of-
recommendations to support evidence-based practice. The interest form to the Orthopaedic Section, APTA. Articles
authors of this guideline revision worked with research li- that were authored by a reviewer were assigned to an al-
brarians with expertise in systematic review to perform a ternate reviewer. Funding was provided to the CPG devel-
systematic search for concepts associated with heel pain or opment team for travel and expenses for CPG development
plantar fasciitis in articles published since 2007 related to training. The CPG development team maintained editorial
classification, examination, and intervention strategies for independence.
heel pain or plantar fasciitis, consistent with previous guide-
line development methods related to ICF classification.91 Articles contributing to recommendations were reviewed
Briefly, the following databases were searched from 2007 to based on specified inclusion and exclusion criteria, with the
between December 13 and 19, 2012: MEDLINE (PubMed) goal of identifying evidence relevant to physical therapist clin-
(2007 to date), Cochrane Library (2007 to date), Web of Sci- ical decision making for adult persons with heel pain/plantar
ence (2007 to date), CINAHL (2007 to date), ProQuest Dis- fasciitis. The title and abstract of each article were reviewed
sertations and Theses (2007 to date), PEDro (2007 to date), independently by 2 members of the CPG development team
a4 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
Methods (continued)
for inclusion. See APPENDIX C (available online) for inclusion strength of evidence, including how directly the studies ad-
and exclusion criteria. Full-text review was then similarly dressed the question and heel pain/plantar fasciitis popu-
conducted to obtain the final set of articles for contribution lation. In developing their recommendations, the authors
to recommendations. The team leader (R.L.M.) provided the considered the strengths and limitations of the body of evi-
final decision for discrepancies that were not resolved by the dence and the health benefits, side effects, and risks of tests
review team. See APPENDIX D (available online) for a flow chart and interventions.
of articles and APPENDIX E (available online) for articles includ-
ed in recommendations by topic. For selected relevant topics GRADES OF RECOMMENDATION
that were not appropriate for the development of recommen- BASED ON STRENGTH OF EVIDENCE
dations, such as shockwave therapy, injection, and imaging, Strong evidence A preponderance of level I and/or level II
articles were not subject to the systematic review process A studies support the recommendation.
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
based Medicine, Oxford, UK for diagnostic, prospective, research supports this conclusion
and therapeutic studies.62 In 3 teams of 2, each reviewer Expert opinion Best practice based on the clinical
independently assigned a level of evidence and evaluated F experience of the guidelines-
the quality of each article using a critical appraisal tool. development team
See APPENDICES F and G (available online) for the evidence
REVIEW PROCESS
table and details on procedures used for assigning levels of
The Orthopaedic Section, APTA selected content experts and
evidence. An abbreviated version of the grading system is
stakeholders to serve as reviewers of the early drafts of these
provided below.
CPGs. The draft was posted for public comment on the web-
site of the Orthopaedic Section of the APTA. The authors
Evidence obtained from high-quality diagnostic studies,
I used the feedback from the reviewer and website comments
prospective studies, or randomized controlled trials
to inform final revisions.
Evidence obtained from lesser-quality diagnostic studies,
prospective studies, or randomized controlled trials (eg,
II CLASSIFICATION
weaker diagnostic criteria and reference standards, improper
randomization, no blinding, less than 80% follow-up) The primary International Classification of Diseases 10th re-
III Case-control studies or retrospective studies vision (ICD-10) code and condition associated with heel pain
IV Case series
is M72.2 Plantar fascial fibromatosis/Plantar fasciitis.96
Secondary ICD-10 codes and conditions associated with heel
V Expert opinion
pain are G57.5 Tarsal tunnel syndrome and G57.6 Lesion
GRADES OF EVIDENCE of plantar nerve/Morton’s metatarsalgia.96
The strength of the evidence supporting the recommenda-
tions was graded according to the previously established The primary ICF body function codes associated with plantar
methods for the original guideline and those provided be- fasciitis, tarsal tunnel syndrome, and plantar nerve lesions
low. Each team developed recommendations based on the are the sensory functions related to pain. These body function
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a5
Methods (continued)
codes are b28015 Pain in lower limb and b2804 Radiating A comprehensive list of codes was published in the previous
pain in a segment or region. guideline.56
The primary ICF body structure codes associated with plan- ORGANIZATION OF THE GUIDELINE
tar fasciitis are s75023 Ligaments and fasciae of ankle and For each topic, the summary recommendation and grade
foot and s75028 Structures of ankle and foot, neural. of evidence from the 2008 guideline are presented,
followed by a synthesis of the recent literature with the
The primary ICF activities and participation codes associated corresponding evidence levels. Each topic concludes with
with plantar fasciitis are d4500 Walking short distances, the 2014 summary recommendation and its updated grade
d4501 Walking long distances, and d4154 Maintaining a of evidence.
standing position.
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Journal of Orthopaedic & Sports Physical Therapy®
a6 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
CLINICAL GUIDELINES
Impairment/Function-Based
Diagnosis
PREVALENCE Plantar fasciitis accounted for 8% of the reported previ-
2008 Summary ous injuries, with the incidence being greater in female
Plantar fasciitis is the most common foot condition treated by runners.83
health care providers. It has been estimated that plantar fasciitis
occurs in approximately 2 million Americans each year and af- In a prospective assessment of nontraumatic foot
fects as much as 10% of the population over the course of a life- III and lower-limb injuries in 166 runners involved
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
time. In 2000, the Foot and Ankle Special Interest Group of the in various running specialties, 98 (59%) indicated
Orthopaedic Section, APTA surveyed over 500 members and they had developed an overuse injury, with 30 (31%) report-
received responses from 117 therapists. Of those responding, ing plantar fasciitis.19
100% indicated that plantar fasciitis was the most common foot
condition seen in their clinic. Rome et al68 reported that plantar 2014 Summary
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
fasciitis accounts for 15% of all adult foot complaints requir- The prevalence of pain in the hind foot or heel region is high
ing professional care and is prevalent in both nonathletic and in both nonathletic and athletic populations. In athletic pop-
athletic populations. Taunton et al82 conducted a retrospective ulations, plantar fasciitis is a common injury reported by high
case-control analysis of 2002 individuals with running-related school, competitive, and recreational distance runners.
injuries who were referred to the same sports medicine center.
They reported that plantar fasciitis was the most common con-
dition diagnosed in the foot and represented 8% of all injuries. PATHOANATOMICAL FEATURES
2008 Summary
Evidence Update Clinicians should assess for impairments in muscles, ten-
Journal of Orthopaedic & Sports Physical Therapy®
A systematic review of ankle and foot overuse in- dons, and nerves, as well as the plantar fascia, when a patient
II juries occurring in numerous sporting activities
(54 851 athletes in total) found that 50% of the
presents with heel pain.
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a7
a8 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
lower limb, b2804 Radiating pain in a segment or region) In a retrospective study of 100 pathology specimens
using the following history and physical examination findings: IV from 97 individuals diagnosed with recalcitrant
plantar fasciitis, 25% of the specimens had a histo-
• Plantar medial heel pain: most noticeable with initial logical appearance of plantar fibroma.30
steps after a period of inactivity but also worse following
prolonged weight bearing 2014 Recommendation
• Heel pain precipitated by a recent increase in weight- Clinicians should assess for diagnostic classifica-
bearing activity
• Pain with palpation of the proximal insertion of the plan-
C tions other than heel pain/plantar fasciitis, in-
cluding spondyloarthritis, fat-pad atrophy, and
tar fascia proximal plantar fibroma, when the individual’s reported
• Positive windlass test activity limitations or impairments of body function and
• Negative tarsal tunnel tests structure are not consistent with those presented in the Di-
• Limited active and passive talocrural joint dorsiflexion agnosis/Classification section of this guideline, or when the
range of motion individual’s symptoms are not resolving with interventions
• Abnormal FPI score aimed at normalization of the individual’s impairments of
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
DIFFERENTIAL DIAGNOSIS
2008 Recommendation IMAGING STUDIES
Clinicians should consider diagnostic classifica- 2008 Summary
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a9
CLINICAL GUIDELINES
Examination
OUTCOME MEASURES and after interventions intended to alleviate the physical im-
2008 Recommendation pairments, activity limitations, and participation restrictions
Clinicians should use validated self-report ques- associated with heel pain/plantar fasciitis.
A tionnaires, such as the Foot Function Index (FFI),
Foot Health Status Questionnaire (FHSQ), or the
Foot and Ankle Ability Measure (FAAM), before and after ACTIVITY LIMITATION MEASURES
interventions intended to alleviate the physical impairments, 2008 and 2014 Recommendations
functional limitations, and activity restrictions associated Clinicians should utilize easily reproducible per-
with heel pain/plantar fasciitis. Physical therapists should F formance-based measures of activity limitation
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
consider measuring change over time using the FAAM, as and participation restriction measures to assess
it has been validated in a physical therapy practice setting. changes in the patient’s level of function associated with heel
pain/plantar fasciitis over the episode of care.
Evidence Update
A computer-adaptive version of the Lower Extrem-
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
III values for the FHSQ and visual analog scale (VAS) Treatment directed to reducing plantar fascia strain
for pain levels were defined in 2 interventional
studies for patients with plantar fasciitis.44,45 The MCID val-
II has been shown to be effective in reducing pain
with initial steps and palpation of the proximal in-
ues for the FHSQ were as follows: pain subscale, 13 points45 sertion of the plantar fascia.21,43,78
and 14 points44; function subscale, 7 points44,45; and footwear
domain, 2 points.45 The general foot health domain was not High body mass index8,36,39 and decreased ankle
responsive to change in pain or function.45 The MCID on the
VAS was 8 mm45 and 9 mm44 for average pain and 19 mm45
IV dorsiflexion range of motion60 were found to
be risk factors for developing heel pain/plantar
for pain on first step. fasciitis.
A review found the FAAM and FHSQ to have evi- 2014 Recommendation
III dence for content validity, construct validity, reli- When evaluating a patient with heel pain/plantar
ability, and responsiveness for patients with plantar
fasciitis in orthopaedic physical therapy.54
B fasciitis over an episode of care, assessment of im-
pairment of body function should include measures
of pain with initial steps after a period of inactivity and pain
2014 Recommendation with palpation of the proximal insertion of the plantar fascia,
Clinicians should use the FAAM, FHSQ, or the FFI and may include measures of active and passive ankle dorsi-
A and may use the computer-adaptive version of the
LEFS as validated self-report questionnaires before
flexion range of motion and body mass index in nonathletic
individuals.
a10 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
CLINICAL GUIDELINES
Interventions
MANUAL THERAPY leus trigger points in addition to the self-stretching protocol.
2008 Recommendation All patients received intervention 4 times weekly for 4 weeks.
There is minimal evidence to support the use of Outcome measures were assessed before and immediately af-
E manual therapy and nerve mobilization procedures
in the short term (1 to 3 months) for pain and func-
ter intervention, including the Medical Outcomes Study 36-
Item Short-Form Health Survey (SF-36) physical function
tion improvement. Suggested manual therapy procedures and bodily pain subscales, and mechanical pressure algometry
include talocrural joint posterior glide, subtalar joint lateral over the gastrocnemius, soleus, and calcaneus of the affected
glide, anterior and posterior glides of the first tarsometatarsal foot. Both groups demonstrated significant improvement in
joint, subtalar joint distraction manipulation, soft tissue mo- SF-36 subscale scores and mechanical pressure algometry im-
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
bilization near potential nerve entrapment sites, and passive mediately following 4 weeks of intervention. Further analysis
neural mobilization procedures. found a significant group-by-time effect favoring the group
receiving self-stretching and trigger point manual therapy.
Evidence Update However, the 95% CI for change in disability measures in
Brantingham and colleagues7 conducted a system- each group included the MCID, so the clinical relevance of
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
apy (n = 30) underwent calf soft tissue mobilization, followed treat relevant lower extremity joint mobility and
by pragmatically applied manual therapy to the hip, knee, calf flexibility deficits and to decrease pain and improve func-
ankle, and/or foot combined with specific follow-up home tion in individuals with heel pain/plantar fasciitis.
exercises for self-mobilization. Numeric pain rating scale (0-
10), self-reported foot and ankle function measured using
the LEFS and the FAAM, and a self-reported global rating of STRETCHING
change were obtained before treatment, as well as 4 weeks 2008 Recommendation
and 6 months following enrollment. A small but significant Calf muscle and/or plantar fascia–specific stretch-
between-group difference favoring the manual therapy group
for changes in pain scores was found at 4 weeks (–1.5; 95%
B ing can be used to provide short-term (2-4 months)
pain relief and improvement in calf muscle flexibil-
confidence interval [CI]: –0.4, –2.5) but was not present at ity. The dosage for calf stretching can be either 3 times a day
6 months. However, clinically and statistically significant be- or 2 times a day, utilizing either a sustained (3 minutes) or
tween-group differences in self-reported function and global intermittent (20 seconds) stretching time, as neither dosage
patient self-rating that favored the manual therapy group produced a better effect.
were noted at both 4 weeks and 6 months.12
Evidence Update
A randomized clinical trial found that soft tissue Evidence from 2 systematic reviews suggests
I mobilization techniques directed to the muscula-
ture of the lower leg were associated with improved
I stretching of the ankle and foot provides short-term
clinical benefit for individuals with heel pain/plan-
disability and pressure pain threshold measurements in tar fasciitis.43,80 Landorf and Menz43 found no studies that
individuals with plantar heel pain. Renan-Ordine and col- compared the effect of stretching to no stretching in individu-
leagues66 randomized 60 individuals with plantar heel pain to als with plantar heel pain. The review by Landorf and Menz43
receive either a self-stretching protocol (n = 30) or soft tissue found that the addition of a heel pad to gastrocnemius/so-
mobilization pragmatically directed to gastrocnemius and so- leus and plantar aponeurosis stretching could improve clini-
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a11
cal outcomes,61 and that plantar fascia stretching may be of In patients with plantar fasciitis, antipronation
more benefit than Achilles stretching.20 A more recent sys-
tematic review by Sweeting and colleagues80 concluded that
II (low-Dye) taping was found to reduce pain and im-
prove function over a 3-week period. Taping was
the main pain-relieving benefits of stretching appear to occur not more effective than a medial longitudinal arch support.1
within the first 2 weeks to 4 months, but could not support Also, antipronation taping (augmented low-Dye) produced
one method of stretching over another as being more effec- an immediate decrease in mean walking plantar pressure and
tive for reducing pain or improving function. This review did pain when walking and jogging compared with the controls.88
include a study by Radford et al,64 who noted adverse effects,
which included increased pain in the heel, calf, and other Antipronation taping was found to reduce calcane-
areas of the lower limb, in 10 of 46 participants within the
calf stretching group.
IV al eversion,10 increase arch height,25,27,28,100 increase
plantar pressures in the lateral midfoot, decrease
pressure in the medial forefoot and rearfoot,91 reduce tibialis
In 102 patients with proximal plantar fasciopathy, posterior and tibialis anterior muscle activity,27-29 decrease
II Rompe et al69 reported significantly improved FFI
scores when comparing plantar fascia–specific
foot motion, and limit ankle abduction and plantar flexion.29
These changes were diminished 48 hours after application.100
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
stretching to shockwave therapy at 2- and 4-month follow- Also, low-Dye taping was less effective than the other taping
up (P<.002). However, at 15-month follow-up, no significant techniques, such as high-Dye and stirrups taping.10 These
between-group difference was found.69 findings were consistent with a review performed by Franet-
tovich et al.26
2014 Recommendation
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Evidence Update
A to provide short-term (3 months) reduction in
pain and improvement in function. There appear
The results of a systematic review looking at the to be no differences in the amount of pain reduction or im-
I efficacy of taping on plantar heel pain (fasciosis)
performed by van de Water and Speksnijder87
provement in function created by custom foot orthoses in
comparison to prefabricated orthoses. There is currently no
noted strong evidence for decreasing pain at 1-week follow- evidence to support the use of prefabricated or custom foot
up, inconclusive results for change in level of disability, and orthoses for long-term (1 year) pain management or function
evidence that taping can have an additional benefit when improvement.
added to a stretching program. Similar results were found in
the systematic review by Landorf and Menz,43 as they found Evidence Update
moderate evidence that taping was more effective than no The Cochrane review by Hawke et al32 found the fol-
taping at 1 week for reducing pain with first step and that tap-
ing was more effective than sham taping at improving pain
I lowing results regarding individuals diagnosed with
plantar fasciitis: custom foot orthoses were more
at 1 week. However, taping was not more effective than no effective than sham orthoses in improving function, but not
treatment at 1 week for improving function.43 for reducing pain after 3 and 12 months; custom foot ortho-
ses were not more effective than noncustom foot orthoses in
Tsai et al85 found that elastic therapeutic tape ap- reducing pain or improving function after 8 to 12 weeks or 12
I plied to the gastrocnemius and plantar fascia im-
proved pain scores and reduced plantar fascia
months; custom foot orthoses were not more effective than
night splints but increased the effectiveness of night splints in
thickness when compared to ultrasound and electrotherapy reducing pain and improving function after 6 to 12 weeks; cus-
alone at 1-week follow-up in patients with plantar fasciitis. tom foot orthoses did not increase the effectiveness of Achilles
a12 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
tendon and plantar fascia stretching or night-splint interven- fasciitis treated with a temporary custom foot orthosis used
tion in reducing pain after 6 to 8 weeks; and custom foot for 2 weeks, followed by a stretching program.
orthoses were less effective than a combined treatment of ma-
nipulation, mobilization, and/or stretching in reducing pain In patients with plantar fasciitis, Chia et al11 re-
after 2 weeks, but not after 4 to 8 weeks. Similar conclusions
were reported by others,43,46 including a meta-analysis that
III ported that both prefabricated and custom ortho-
ses were useful in distributing rearfoot pressure,
noted that short-, intermediate-, and long-term improvements whereas heel pads increased rearfoot pressure. Bonanno et
occur regardless of specific orthotic design,46 and findings that al6 found that prefabricated foot orthoses were more effective
custom foot orthoses may be no better than prefabricated foot at reducing pressure under the heel when compared to a sili-
orthoses in those with heel pain/plantar fasciitis.43 con heel cup, soft foam heel pad, and heel lift in older people
(greater than 65 years of age) with heel pain.
The review by Hume et al34 found prefabricated
I semi-rigid foot orthoses to have a moderately ben- Van Lunen et al88 noted that a heel pain orthosis
eficial effect compared to sham foot orthoses in re-
ducing pain and improving function over a 3- to 12-month
III (heel cup with rearfoot control) produced immedi-
ate decrease in walking mean plantar pressure and
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
period in individuals with plantar fasciitis. Customized rigid pain when walking and jogging compared with controls.
foot orthoses were found to have moderately beneficial ef-
fect compared with anti-inflammatories and when compared A systematic review and meta-analysis performed
with stretching for a positive final assessment and perceived
better outcome, respectively.34 Similar findings were noted in
IV by Collins et al13 supported the use of foot orthoses
in the prevention of overuse conditions but found
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
the systematic review by Uden et al,86 who concluded that a no difference between the use of custom and prefabricated
customized functional foot orthosis can lead to a decrease in foot orthoses. Cheung et al10 performed a meta-analysis and
pain and increase in functional ability in those with plantar found custom foot orthoses to be more effective than prefab-
fasciitis. ricated foot orthoses, but not as effective as taping, in control-
ling rearfoot motion.
In individuals with plantar fasciitis, Lee et al47
I found that an accommodative pressure-relieving Ferber and Benson23 studied healthy individuals
foot orthosis, when combined with night-splint in-
tervention, reduced pain and improved function at 2- and
IV and found that plantar fascia strain was reduced
by 34% when walking in either the molded or non-
Journal of Orthopaedic & Sports Physical Therapy®
8-week follow-up periods. molded semi-custom foot orthoses. However, they did not find
differences in peak rearfoot eversion, tibial internal rotation,
Al-Bluwi et al2 noted that a foot orthosis that sup- or medial longitudinal arch angles between no orthosis and
I ported the medial arch and cushioned the heel, when
combined with nonsteroidal anti-inflammatory
molded or nonmolded semi-custom orthoses.23 In those with
common foot symptoms, an insole created specifically for foot
drugs (NSAIDs), produced a decrease in pain at the 6-month symptoms and arch height did not produce any difference in
follow-up period when compared to NSAIDs and physical plantar pressure redistribution. Therefore, it was concluded
therapy and NSAIDs, physical therapy, and local injection. that basic insoles may be sufficient for all patient groups.77
Improvement in economy of gait was found with both prefab-
Marabha et al53 reported that a silicon heel pad ricated and custom foot orthoses. However, only the custom
II combined with plantar fascia stretching, intrinsic
foot muscle strengthening, and steroid injection re-
foot orthoses maintained this improvement over 4 weeks.84
duced pain at 1- and 3-month follow-up periods in patients A systematic review investigated evidence for the ki-
with plantar fasciitis. IV nematic, shock attenuation, and neuromotor control
paradigms for orthosis selection.58 Under the kine-
In patients with plantar fasciitis, Stratton et matic and shock absorption paradigms, this review found that
II al78 noted that the use of plantar fascia–specific
stretching and prefabricated foot orthoses provid-
posted nonmolded orthoses could decrease peak rearfoot ever-
sion and tibial internal rotation, whereas nonposted and posted
ed pain relief and improvement in function at the 3-month molded orthoses could reduce loading rate and vertical impact
follow-up. force compared to posted nonmolded orthoses. The neuromo-
tor control paradigm found that orthoses could increase tibialis
Drake et al21 found that first-step heel pain de- anterior and fibularis longus muscle activity. Overall, a great
II creased and function improved at 2-, 4-, and 12-
week follow-up periods in individuals with plantar
deal of variability in an individual’s response was noted, and
further research to guide orthosis selection is needed.58
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a13
Antipronation taping techniques have been used as splint had significantly better improvement compared to
IV a means to assess and determine the appropriate-
ness of foot orthoses.74,89,90 If the taping technique as
those who chose not to use a night splint.5
described by Vicenzino89 is effective, orthoses are fabricated Attard and Singh3 compared posterior versus ante-
according to the change in foot posture created by the tape.57
The results of a case series indicated that orthoses created
II rior night splints in 15 patients with heel pain. Each
patient used both devices for a 6-week period. Both
based on taping technique resulted in a substantial short- devices reduced pain via the VAS, but the posterior night splint
term (4-week) reduction in pain and an increase in function.57 was tolerated less, with more complaints of sleep disruption.3
NIGHT SPLINTS
A gram of night splints for individuals with heel pain/
plantar fasciitis who consistently have pain with the
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
a14 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
and global patient self-rating that favored the manual thera- and posttreatment plantar fascia thickness measurements
py group were noted at both 4 weeks and 6 months.12 were not significantly different between groups, although both
groups demonstrated significant improvement posttreatment.
A randomized trial by Stratton et al78 found that
I the addition of low-frequency electrical stimulation
did not provide any benefit to the effectiveness of
2014 Recommendation
Clinicians may use low-level laser therapy to reduce
plantar fascia–specific stretching and prefabricated foot or-
thoses over a 3-month period. Stratton and colleagues78 pro-
C pain and activity limitations in individuals with
heel pain/plantar fasciitis.
vided prefabricated foot orthoses and plantar fascia–specific
stretching to patients with plantar fasciitis (n = 26). These Supplemental Note Regarding Low-Level Laser Therapy
interventions were to be used daily in the context of a home- Data from 1 randomized study that was published
based program. In addition, the authors randomized patients
with plantar fasciitis to receive either low-frequency electrical
I outside the review time frame for this guideline re-
vision failed to support the clinical effectiveness of
stimulation (10-Hz frequency for 20 minutes) in the context low-level laser therapy to address symptoms in individuals
of a home-based program (n = 13) or no additional treatment with plantar fasciitis. Basford and colleagues4 analyzed data
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
(n = 13). Outcome measurements consisted of VAS pain rat- from 31 patients with plantar heel pain who were random-
ings and the FAAM activities of daily living subscale, which ized to receive either gallium-arsenide infrared diode laser or
were collected before intervention, after 4 weeks of interven- placebo irradiation 3 times weekly for 4 weeks. Dependent
tion, and at the 3-month follow-up. Both treatment groups measures included morning pain, pain with toe walking, ten-
demonstrated significant reductions in pain based on the VAS derness to palpation, windlass test response, medication con-
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
and significant improvements in function measurements over sumption, and foot orthosis use. All dependent measures were
time. There were no significant between-group differences in obtained before the study, at the treatment midpoint, at the
either pain reduction or function improvement.78 end of treatment, as well as 1 month following the last study
treatment. In addition, data regarding potential adverse effects
2014 Recommendation were collected. No significant difference between treatment
Clinicians should use manual therapy, stretching, groups was documented for any measures at any study time
D and foot orthoses instead of electrotherapeutic
modalities to promote intermediate and long-term
point. The active low-level laser therapy treatment was well
tolerated, with 96% of patients reporting no adverse effects.
(1-6 months) improvements in clinical outcomes for individ-
Journal of Orthopaedic & Sports Physical Therapy®
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a15
intensity, which was small but statistically significant (mean Werner et al94 reported that shoe rotation during
difference, 2.1; 95% CI: 1.4, 2.8) in favor of phonophoresis. III the work week was found to reduce the risk of plan-
tar fasciitis.
2014 Recommendation
Clinicians may use phonophoresis with ketoprofen Cheung and colleagues,10 in their systematic re-
C gel to reduce pain in individuals with heel pain/
plantar fasciitis.
IV view of motion-control interventions, found that
foot orthoses, motion-control footwear, and taping
all controlled rearfoot eversion, with taping being the most
effective. In healthy individuals, plantar heel pressures are
PHYSICAL AGENTS – ULTRASOUND positively associated with shoe heel height.14 In addition,
2008 Recommendation rocker shoes reduced loading of the plantar aponeurosis.49
No recommendation.
2014 Recommendation
Evidence Update To reduce pain in individuals with heel pain/plan-
A review by Shanks et al72 concluded that there C tar fasciitis, clinicians may prescribe (1) a rocker-
III
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
cycle) delivered for eight 8-minute sessions at a frequency EDUCATION AND COUNSELING
of twice weekly for 4 weeks no more effective than a sham FOR WEIGHT LOSS
treatment in treating those with heel pain. 2008 Recommendation
No recommendation.
2014 Recommendation
The use of ultrasound cannot be recommended for Evidence Update
C individuals with heel pain/plantar fasciitis. In a systematic review by Butterworth et al8 focus-
IV ing on the relationship between body mass index
and foot disorders, 12 of the 25 articles in their
Journal of Orthopaedic & Sports Physical Therapy®
a16 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
DRY NEEDLING health) to 100 (best foot health), and FHSQ score, which were
2008 Recommendation assessed at baseline and 2, 4, 6, and 12 weeks after enrollment
No recommendation. into the study. There was a significant effect of decreased pain
and improved FHSQ score over time in the study, and the dif-
Evidence Update ference between groups was significant at 6-week follow-up
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
A systematic review indicates there is limited but at no other time point. The clinical relevance of the ob-
III evidence to support the clinical benefit of trigger
point dry needling for patients with plantar heel
served statistically significant mean difference in FHSQ score
between groups remains questionable, because the mean dif-
pain to reduce treatment duration.16 Included in the system- ference did not meet the MCID. Overall, the observed number
atic review, Imamura and colleagues35 conducted a nonran- needed to treat to achieve the MCID on VAS first-step pain
domized study in which they compared a group receiving rating and FHSQ score was 4 (95% CI: 2, 12). Adverse events
trigger point dry needling with a group receiving a standard- were noted in approximately one third of patients in the dry
ized program of physical agents and home exercises. Trigger needling group. Harms were minor and transient in nature,
point dry needling consisted of repetitive insertion of 22- to including immediate needle insertion pain, increased plan-
Journal of Orthopaedic & Sports Physical Therapy®
25-gauge needles into the medial head of the gastrocnemius, tar heel pain symptoms, and delayed bruising. The observed
soleus, tibialis posterior, popliteus, abductor hallucis, fibu- number needed to harm for immediate and delayed adverse
laris longus, and flexor digitorum brevis, followed by 0.1% events was 3 (95% CI: 1, 3).17
lidocaine injection into the identified trigger points. Out-
come measurements included pain rating on the VAS (0-10)
and pressure pain threshold by way of algometry, which were INTERVENTIONS – OTHER
obtained at discharge, 6 months after discharge, and 2 years Patients may seek advice from clinicians regarding the poten-
after discharge. Duration of treatment was significantly less tial efficacy of extracorporeal shockwave therapy (ESWT) and
in the trigger point dry needling group (3.2 2.2 weeks) medications as part of a comprehensive nonsurgical man-
compared to the physical agents and exercise group (21.1 agement plan for heel pain/plantar fasciitis. In particular,
19.5 weeks). At discharge, significant improvement in rela- intralesional corticosteroid injection (ICSI) is a widespread
tive pain intensity was documented in both groups (trigger practice for the management of heel pain/plantar fasciitis.
point dry needling group, 58.4% improvement; physical This section is intended to assist physical therapists, patients,
agents/exercise group, 54.9% improvement). However, be- and other stakeholders in effective multidisciplinary manage-
tween-group differences were not substantially different for ment of heel pain/plantar fasciitis.
discharge pain ratings and were unreported at the 6-month
and 2-year time points. Between-group differences for pres-
sure pain algometry were unreported at all measurement EXTRACORPOREAL
time points.35 SHOCKWAVE THERAPY
Evidence Update
2014 Recommendation Extracorporeal shockwave therapy does not appear
The use of trigger point dry needling cannot be rec- I to be more effective in reducing pain than stretch-
F ommended for individuals with heel pain/plantar
fasciitis.
ing and therapeutic ultrasound. The systematic re-
view by Landorf and Menz43 found 6 randomized controlled
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a17
trials and noted that the better-quality studies did not favor The results of 2 systematic reviews failed to yield evidence
ESWT and identified the potential for adverse effects as a favoring any substantive clinical benefit of ICSI for pa-
result of treatment. tients with heel pain/plantar fasciitis.43,86 Potential harms
associated with ICSI may include injection-site pain, infec-
tion, subcutaneous fat atrophy, skin pigmentation changes,
CORTICOSTEROID INJECTIONS plantar fascia rupture, peripheral nerve injury, and muscle
Evidence Update damage.43,86
There is limited evidence supporting the effective-
I ness of ICSI as a first-tier intervention for heel
pain/plantar fasciitis, because the benefits do not
A model to guide clinical decisions regarding evaluation,
diagnosis, and treatment planning for individuals with heel
offset the risk for harms, including long-term disablement. pain/plantar fasciitis is depicted in the FIGURE.
lumbar and pelvic girdle structures, lower-limb nerve tension, and neurological status examination (F)
Measures to Assess Level of Functioning, Presence of Associated Physical Impairments to Address With Treatment, and Response to Treatment
• A self-report outcome measure, such as the Foot and Ankle Ability Measure (A)
• Visual analog scale to assess pain with initial steps after a period of inactivity (B)
• Active and passive talocrural dorsiflexion range of motion (B)
• Foot Posture Index-6 score (C)
• Body mass index in nonathletic individuals (B)
Journal of Orthopaedic & Sports Physical Therapy®
• Lower-quarter musculoskeletal and biomechanical assessment, to include the following required elements of gait (F):
– First metatarsophalangeal joint range of motion and accessory mobility to attain 65° of extension at preswing
– Rearfoot/talocalcaneal range of motion and accessory mobility to attain 4° to 6° of eversion at loading response
– Tibialis posterior strength and movement coordination to control mid-tarsal joint motion at loading response
– Fibularis longus strength and movement coordination to control mid-tarsal joint motion at terminal stance
– Talocrural dorsiflexion range of motion, accessory mobility, and gastrocnemius/soleus muscle length and tissue mobility to attain 10° of
dorsiflexion at terminal stance
– Gastrocnemius/soleus strength and movement coordination to control tibial advancement at midstance and propulsion at terminal stance
– Knee joint and thigh muscle flexibility to attain 0° of extension at terminal stance and 60° of flexion at initial swing
– Quadriceps femoris strength and movement coordination to control knee flexion at loading response
– Hip joint mobility and muscle flexibility to attain 10° of extension at terminal stance
– Trunk, buttock, and thigh strength and movement coordination to control lower-limb internal rotation at loading response and hip
abduction at loading response and midstance
FIGURE. Heel pain/plantar fasciitis evaluation/intervention decision-making model. A, guidelines based on strong evidence; B, guidelines based on moderate evidence; C,
guidelines based on weak evidence; E, guidelines based on theoretical/foundational evidence; F, guidelines based on expert opinion.
a18 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
indicates excessive supination and/or coexisting lower-quarter strength and movement coordination deficits
• Night splints (A)
– As appropriate, depending on the response to other interventions, utilization of night splints for a 1- to 3-month period
• Physical agents (C)
– Application of iontophoresis, low-level laser, or phonophoresis for individuals who present with acute pain, proceeding with the
interventions noted above as the pain diminishes and those other interventions are tolerated
Interventions – Targeted to Directly Address Lower-Limb Physical Impairments Potentially Associated With the Individual's Heel Pain/Plantar
Journal of Orthopaedic & Sports Physical Therapy®
Fasciitis, With the Primary Focus of Reducing Walking and Running Gait Abnormalities, as Well as Relevant and Lower-Quarter Musculoskele-
tal/Biomechanical Assessment Findings
• Manual therapy (F)
– Joint mobilization and manual stretching procedures to restore normal first metatarsophalangeal joint, tarsometatarsal joints,
talocalcaneal, talocrural, knee, and hip mobility
– Soft tissue mobilization and manual stretching procedures to restore normal muscle length to the calf, thigh, and hip myofascia,
primarily required at terminal stance
• Therapeutic exercises and neuromuscular re-education (F)
– Strengthening and training of the muscles that work eccentrically to control mid-tarsal pronation (tibialis posterior and fibularis longus),
ankle plantar flexion (tibialis anterior), knee flexion (quadriceps femoris), hip adduction (gluteus medius), and lower-limb internal
rotation (hip external rotators) at loading response, to lessen the individual's pronatory tendencies and improve the individual's ability to
attenuate and absorb weight-bearing forces
FIGURE (CONTINUED). Heel pain/plantar fasciitis evaluation/intervention decision-making model. A, guidelines based on strong evidence; B, guidelines based on moderate
evidence; C, guidelines based on weak evidence; E, guidelines based on theoretical/foundational evidence; F, guidelines based on expert opinion.
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a19
Department of Physical Boston, Massachusetts John DeWitt, DPT Leslie Torburn, DPT
Therapy cmm@bu.edu Director of Physical Therapy Sports Principal and Consultant
University of the Pacific and and Orthopaedic Residencies Silhouette Consulting, Inc
Stockton, California Adjunct Clinical Assistant The Ohio State University Sacramento, California
tdavenport@pacific.edu Professor Columbus, Ohio torburn@yahoo.com
Department of Orthopaedic Surgery john.dewitt@osumc.edu
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
ACKNOWLEDGEMENTS: The authors would like to acknowledge the contributions of Dartmouth Biomedical Libraries Research and Education
Librarians Karen V. Odato and Pamela Bagley, for their guidance and assistance in the design and implementation of the literature search.
The authors would also like to acknowledge the assistance in developing the evidence tables provided by the following University of the Pacific
Doctor of Physical Therapy students: Pete Charukesnant, Dinah Compton, Rachel Eng, Megan Jackson, Steven Jew, Meiying Lam, and
Katherine Samstag.
a20 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
er extremity conditions: update of a literature review. J Manipulative Physi- prescription of rocker sole shoes and custom-made foot orthoses for the
ol Ther. 2012;35:127-166. http://dx.doi.org/10.1016/j.jmpt.2012.01.001 treatment of plantar fasciitis. Clin Biomech (Bristol, Avon). 2012;27:1072-
8. B
utterworth PA, Landorf KB, Smith SE, Menz HB. The associa- 1077. http://dx.doi.org/10.1016/j.clinbiomech.2012.08.003
tion between body mass index and musculoskeletal foot disorders: 25. F ranettovich M, Chapman A, Blanch P, Vicenzino B. Continual use of
a systematic review. Obes Rev. 2012;13:630-642. http://dx.doi. augmented low-Dye taping increases arch height in standing but does
org/10.1111/j.1467-789X.2012.00996.x not influence neuromotor control of gait. Gait Posture. 2010;31:247-250.
9. C
hang R, Kent-Braun JA, Hamill J. Use of MRI for volume estimation of http://dx.doi.org/10.1016/j.gaitpost.2009.10.015
tibialis posterior and plantar intrinsic foot muscles in healthy and chronic 26. F ranettovich M, Chapman A, Blanch P, Vicenzino B. A physiological and
plantar fasciitis limbs. Clin Biomech (Bristol, Avon). 2012;27:500-505. psychological basis for anti-pronation taping from a critical review of the
http://dx.doi.org/10.1016/j.clinbiomech.2011.11.007 literature. Sports Med. 2008;38:617-631.
Journal of Orthopaedic & Sports Physical Therapy®
10. C
heung RT, Chung RC, Ng GY. Efficacies of different external controls for 27. F ranettovich M, Chapman A, Vicenzino B. Tape that increases medial
excessive foot pronation: a meta-analysis. Br J Sports Med. 2011;45:743- longitudinal arch height also reduces leg muscle activity: a preliminary
751. http://dx.doi.org/10.1136/bjsm.2010.079780 study. Med Sci Sports Exerc. 2008;40:593-600. http://dx.doi.org/10.1249/
11. C
hia KK, Suresh S, Kuah A, Ong JL, Phua JM, Seah AL. Comparative trial MSS.0b013e318162134f
of the foot pressure patterns between corrective orthotics, formthotics, 28. F ranettovich M, Chapman AR, Blanch P, Vicenzino B. Augmented low-Dye
bone spur pads and flat insoles in patients with chronic plantar fasciitis. tape alters foot mobility and neuromotor control of gait in individuals with
Ann Acad Med Singapore. 2009;38:869-875. and without exercise related leg pain. J Foot Ankle Res. 2010;3:5. http://
12. C
leland JA, Abbott JH, Kidd MO, et al. Manual physical therapy and ex- dx.doi.org/10.1186/1757-1146-3-5
ercise versus electrophysical agents and exercise in the management of 29. F ranettovich MM, Murley GS, David BS, Bird AR. A comparison of aug-
plantar heel pain: a multicenter randomized clinical trial. J Orthop Sports mented low-Dye taping and ankle bracing on lower limb muscle activity
Phys Ther. 2009;39:573-585. http://dx.doi.org/10.2519/jospt.2009.3036 during walking in adults with flat-arched foot posture. J Sci Med Sport.
13. C
ollins N, Bisset L, McPoil T, Vicenzino B. Foot orthoses in lower limb 2012;15:8-13. http://dx.doi.org/10.1016/j.jsams.2011.05.009
overuse conditions: a systematic review and meta-analysis. Foot Ankle Int. 30. H
afner S, Han N, Pressman MM, Wallace C. Proximal plantar fibroma
2007;28:396-412. http://dx.doi.org/10.3113/FAI.2007.0396 as an etiology of recalcitrant plantar heel pain. J Foot Ankle Surg.
14. C
ong Y, Cheung JT, Leung AK, Zhang M. Effect of heel height on in-shoe 2011;50:153-157. http://dx.doi.org/10.1053/j.jfas.2010.12.016
localized triaxial stresses. J Biomech. 2011;44:2267-2272. http://dx.doi. 31. H
art DL, Wang YC, Stratford PW, Mioduski JE. Computerized adaptive test
org/10.1016/j.jbiomech.2011.05.036 for patients with foot or ankle impairments produced valid and responsive
15. C
ornwall MW, McPoil TG, Lebec M, Vicenzino B, Wilson J. Reliability of measures of function. Qual Life Res. 2008;17:1081-1091. http://dx.doi.
the modified Foot Posture Index. J Am Podiatr Med Assoc. 2008;98:7-13. org/10.1007/s11136-008-9381-y
http://dx.doi.org/10.7547/0980007 32. H
awke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for
16. C
otchett MP, Landorf KB, Munteanu SE. Effectiveness of dry needling the treatment of foot pain. Cochrane Database Syst Rev. 2008:CD006801.
http://dx.doi.org/10.1002/14651858.CD006801.pub2
and injections of myofascial trigger points associated with plantar heel
pain: a systematic review. J Foot Ankle Res. 2010;3:18. http://dx.doi. 33. H
ill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain
org/10.1186/1757-1146-3-18 in a population-based study: the North West Adelaide health study. J Foot
Ankle Res. 2008;1:2. http://dx.doi.org/10.1186/1757-1146-1-2
17. C
otchett MP, Munteanu SE, Landorf KB. Effectiveness of trigger point dry
needling for plantar heel pain: a randomized controlled trial. Phys Ther. 34. Hume P, Hopkins W, Rome K, Maulder P, Coyle G, Nigg B. Effectiveness of
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a21
foot orthoses for treatment and prevention of lower limb injuries: a review. of plantar fasciitis. J Am Podiatr Med Assoc. 2010;100:452-455. http://
Sports Med. 2008;38:759-779. dx.doi.org/10.7547/1000452
35. Imamura M, Fischer AA, Imamura ST, Kaziyama HS, Carvalho AE, Sa- 52. M
ahowald S, Legge BS, Grady JF. The correlation between plantar fascia
lomao O. Treatment of myofascial pain components in plantar fasciitis thickness and symptoms of plantar fasciitis. J Am Podiatr Med Assoc.
speeds up recovery: documentation by algometry. J Musculoskelet Pain. 2011;101:385-389. http://dx.doi.org/10.7547/1010385
1998;6:91-110.
53. M
arabha T, Al-Anani M, Dahmashe Z, Rashdan K, Hadid A. The relation
36. Irving DB, Cook JL, Young MA, Menz HB. Obesity and pronated foot between conservative treatment and heel pain duration in plantar fasciitis.
type may increase the risk of chronic plantar heel pain: a matched Kuwait Med J. 2008;40:130-132.
case-control study. BMC Musculoskelet Disord. 2007;8:41. http://dx.doi.
54. M
artin RL, Irrgang JJ. A survey of self-reported outcome instruments for
org/10.1186/1471-2474-8-41
the foot and ankle. J Orthop Sports Phys Ther. 2007;37:72-84. http://
37. J asiak-Tyrkalska B, Jaworek J, Frańczuk B. Efficacy of two different phys- dx.doi.org/10.2519/jospt.2007.2403
iotherapeutic procedures in comprehensive therapy of plantar calcaneal
55. M
artin RL, Irrgang JJ, Conti SF. Outcome study of subjects with insertional
spur. Fizjoter Polska. 2007;7:145-154.
plantar fasciitis. Foot Ankle Int. 1998;19:803-811.
38. K
iritsi O, Tsitas K, Malliaropoulos N, Mikroulis G. Ultrasonographic
56. M
cPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ.
evaluation of plantar fasciitis after low-level laser therapy: results of
Heel pain—plantar fasciitis: clinical practice guidelines linked to the
a double-blind, randomized, placebo-controlled trial. Lasers Med Sci.
International Classification of Function, Disability, and Health from the
2010;25:275-281. http://dx.doi.org/10.1007/s10103-009-0737-5
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
2008;2008:1111.
61. P
feffer G, Bacchetti P, Deland J, et al. Comparison of custom and prefab-
44. L andorf KB, Radford JA. Minimal important difference: values for the Foot ricated orthoses in the initial treatment of proximal plantar fasciitis. Foot
Health Status Questionnaire, Foot Function Index and Visual Analogue Ankle Int. 1999;20:214-221.
Scale. Foot. 2008;18:15-19. http://dx.doi.org/10.1016/j.foot.2007.06.006
62. P
hillips B, Ball C, Sackett D, et al. Oxford Centre for Evidence-based Medi-
45. L andorf KB, Radford JA, Hudson S. Minimal Important Difference (MID) of cine - Levels of Evidence (March 2009). Available at: http://www.cebm.
two commonly used outcome measures for foot problems. J Foot Ankle net/index.aspx?o=1025. Accessed August 4, 2009.
Res. 2010;3:7. http://dx.doi.org/10.1186/1757-1146-3-7
63. P
ohl MB, Hamill J, Davis IS. Biomechanical and anatomic factors associ-
46. L ee SY, McKeon P, Hertel J. Does the use of orthoses improve self-reported ated with a history of plantar fasciitis in female runners. Clin J Sport Med.
pain and function measures in patients with plantar fasciitis? A meta- 2009;19:372-376. http://dx.doi.org/10.1097/JSM.0b013e3181b8c270
analysis. Phys Ther Sport. 2009;10:12-18. http://dx.doi.org/10.1016/j.
ptsp.2008.09.002 64. R
adford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf
muscle stretching for the short-term treatment of plantar heel pain: a
47. L ee WC, Wong WY, Kung E, Leung AK. Effectiveness of adjustable dorsi- randomised trial. BMC Musculoskelet Disord. 2007;8:36. http://dx.doi.
flexion night splint in combination with accommodative foot orthosis on org/10.1186/1471-2474-8-36
plantar fasciitis. J Rehabil Res Dev. 2012;49:1557-1564.
65. R
edmond AC, Crosbie J, Ouvrier RA. Development and validation of a nov-
48. L entz TA, Sutton Z, Greenberg S, Bishop MD. Pain-related fear contrib- el rating system for scoring standing foot posture: the Foot Posture Index.
utes to self-reported disability in patients with foot and ankle pathology. Clin Biomech (Bristol, Avon). 2006;21:89-98. http://dx.doi.org/10.1016/j.
Arch Phys Med Rehabil. 2010;91:557-561. http://dx.doi.org/10.1016/j. clinbiomech.2005.08.002
apmr.2009.12.010
66. R
enan-Ordine R, Alburquerque-Sendín F, de Souza DP, Cleland JA, Fernán-
49. L in SC, Chen CP, Tang SF, Wong AM, Hsieh JH, Chen WP. Changes in dez-de-las-Peñas C. Effectiveness of myofascial trigger point manual
windlass effect in response to different shoe and insole designs dur- therapy combined with a self-stretching protocol for the management
ing walking. Gait Posture. 2013;37:235-241. http://dx.doi.org/10.1016/j. of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys
gaitpost.2012.07.010 Ther. 2011;41:43-50. http://dx.doi.org/10.2519/jospt.2011.3504
50. L opes AD, Hespanhol Junior LC, Yeung SS, Costa LO. What are the main
67. R
ibeiro AP, Trombini-Souza F, Tessutti V, Lima FR, de Camargo Neves
running-related musculoskeletal injuries? A systematic review. Sports Med.
Sacco I, João SM. Rearfoot alignment and medial longitudinal arch
2012;42:891-905. http://dx.doi.org/10.1007/BF03262301
configurations of runners with symptoms and histories of plantar fasci-
51. M
ahmood S, Huffman LK, Harris JG. Limb-length discrepancy as a cause itis. Clinics (São Paulo). 2011;66:1027-1033. http://dx.doi.org/10.1590/
a22 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
74. S
mith M, Brooker S, Vicenzino B, McPoil T. Use of anti-pronation taping to 91. V
icenzino B, McPoil T, Buckland S. Plantar foot pressures after the aug-
assess suitability of orthotic prescription: case report. Aust J Physiother. mented low Dye taping technique. J Athl Train. 2007;42:374-380.
2004;50:111-113.
92. W
earing SC, Smeathers JE, Sullivan PM, Yates B, Urry SR, Dubois P.
75. S
nyder KR, Earl JE, O’Connor KM, Ebersole KT. Resistance training is ac- Plantar fasciitis: are pain and fascial thickness associated with arch shape
companied by increases in hip strength and changes in lower extremity and loading? Phys Ther. 2007;87:1002-1008. http://dx.doi.org/10.2522/
biomechanics during running. Clin Biomech (Bristol, Avon). 2009;24:26- ptj.20060136
34. http://dx.doi.org/10.1016/j.clinbiomech.2008.09.009
93. W
earing SC, Smeathers JE, Yates B, Urry SR, Dubois P. Bulk compres-
76. S
obhani S, Dekker R, Postema K, Dijkstra PU. Epidemiol- sive properties of the heel fat pad during walking: a pilot investigation in
ogy of ankle and foot overuse injuries in sports: a system- plantar heel pain. Clin Biomech (Bristol, Avon). 2009;24:397-402. http://
atic review. Scand J Med Sci Sports. 2013;23:669-686. http://dx.doi. dx.doi.org/10.1016/j.clinbiomech.2009.01.002
Journal of Orthopaedic & Sports Physical Therapy®
org/10.1111/j.1600-0838.2012.01509.x
94. W
erner RA, Gell N, Hartigan A, Wiggerman N, Keyserling WM. Risk factors
77. S
tolwijk NM, Louwerens JW, Nienhuis B, Duysens J, Keijsers NL. Plantar for plantar fasciitis among assembly plant workers. PM R. 2010;2:110-116.
pressure with and without custom insoles in patients with common foot http://dx.doi.org/10.1016/j.pmrj.2009.11.012
complaints. Foot Ankle Int. 2011;32:57-65. http://dx.doi.org/10.3113/
FAI.2011.0057 95. W
olgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plan-
tar heel pain: long-term follow-up. Foot Ankle Int. 1994;15:97-102.
78. S
tratton M, McPoil TG, Cornwall MW, Patrick K. Use of low-frequency elec-
trical stimulation for the treatment of plantar fasciitis. J Am Podiatr Med 96. W
orld Health Organization. ICD-10: International Statistical Classification
Assoc. 2009;99:481-488. of Diseases and Related Health Problems: Tenth Revision. Geneva, Swit-
zerland: World Health Organization; 2005.
79. S
utton Z, Greenburg S, Bishop M. Association of pain related beliefs with
disability and pain in patients with foot and/or ankle pain: a case series. 97. W
orld Health Organization. International Classification of Functioning, Dis-
Orthop Phys Ther Pract. 2008;20:200-207. ability and Health: ICF. Geneva, Switzerland: World Health Organization;
2009.
80. S
weeting D, Parish B, Hooper L, Chester R. The effectiveness of manual
stretching in the treatment of plantar heel pain: a systematic review. J Foot 98. W
u CH, Chang KV, Mio S, Chen WS, Wang TG. Sonoelastography of the
Ankle Res. 2011;4:19. http://dx.doi.org/10.1186/1757-1146-4-19 plantar fascia. Radiology. 2011;259:502-507. http://dx.doi.org/10.1148/
radiol.11101665
81. T anamas SK, Wluka AE, Berry P, et al. Relationship between obesity and
foot pain and its association with fat mass, fat distribution, and muscle 99. Y i TI, Lee GE, Seo IS, Huh WS, Yoon TH, Kim BR. Clinical characteristics of
mass. Arthritis Care Res (Hoboken). 2012;64:262-268. http://dx.doi. the causes of plantar heel pain. Ann Rehabil Med. 2011;35:507-513. http://
org/10.1002/acr.20663 dx.doi.org/10.5535/arm.2011.35.4.507
82. T aunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo 100. Y oho R, Rivera JJ, Renschler R, Vardaxis VG, Dikis J. A biomechanical
BD. A retrospective case-control analysis of 2002 running injuries. Br J analysis of the effects of low-Dye taping on arch deformation dur-
Sports Med. 2002;36:95-101. ing gait. Foot (Edinb). 2012;22:283-286. http://dx.doi.org/10.1016/j.
foot.2012.08.006
83. T enforde AS, Sayres LC, McCurdy ML, Collado H, Sainani KL, Freder-
icson M. Overuse injuries in high school runners: lifetime prevalence
and prevention strategies. PM R. 2011;3:125-131; quiz 131. http://dx.doi.
org/10.1016/j.pmrj.2010.09.009
84. T rotter LC, Pierrynowski MR. Changes in gait economy between full- @ MORE INFORMATION
WWW.JOSPT.ORG
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a23
ONLINE APPENDIX A
SEARCH STRATEGIES FOR ALL indices OR score OR scores) NEAR/8 (pain OR function OR functional
DATABASES SEARCHED OR dysfunction OR impaired OR impairment OR impairments OR dis-
ability) NEAR/8 (foot OR feet OR heel OR heels OR “lower limb” OR
MEDLINE plantar OR calcaneal OR calcaneus OR midfoot)) OR TS=(“abductor
((“foot”[mesh] AND “pain”[mesh] AND arch[tiab]) OR “abduc- halluces” OR (arch AND (shoe OR midfoot OR foot OR plantar OR
tor hallucis”[tiab] OR (arch[tiab] AND (shoe[tiab] OR midfoot[tiab] heel) AND pain)) OR TS=(“heel pain” OR “painful heel” OR “painful
OR foot[tiab] OR plantar[tiab] OR heel[tiab]) AND pain[tiab])) OR heels” OR (heel AND pain) OR “calcaneal spur” OR “calcaneal spurs”
(“heel spur”[mesh] OR “fasciitis, plantar”[mesh] OR ((“heel”[mesh] OR (calcaneus AND spurs) OR “plantar fasciitis” OR “plantar fascitis”
OR “calcaneus”[mesh]) AND “pain”[mesh]) OR “heel pain”[tiab] OR “plantar foot pain” OR “plantar pain” OR (heel AND spurs))
OR “painful heel”[tiab] OR “painful heels”[tiab] OR (heel[tiab] AND
pain[tiab]) OR “calcaneal spur”[tiab] OR “calcaneal spurs”[tiab] OR
(calcaneus[tiab] AND spur[tiab]) OR (calcaneus[tiab] AND spurs[tiab]) ProQuest Nursing and Allied Health Source
OR “plantar fasciitis”[tiab] OR “plantar fascitis”[tiab] OR “plantar foot ab(“Heel pain” OR “painful heel” OR “painful heels” OR (heel AND
pain”[tiab] OR “plantar pain”[tiab] OR (heel[tiab] AND spur[tiab]) OR pain) OR “Calcaneal spur” OR “calcaneal spurs” OR (Calcaneus AND
spur) OR (calcaneus AND spurs) OR “Plantar fasciitis” OR “Plantar
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
OR “lower limb”[tiab] OR “lower limbs”[tiab] OR plantar[tiab] OR OR foot OR plantar OR heel) AND pain) OR ((questionnaire OR
calcaneal[tiab] OR calcaneus[tiab] OR midfoot[tiab]) AND (Pain[tiab] questionnaires OR instrument OR instruments OR scale OR scales
OR function[tiab] OR functional[tiab] OR dysfunction[tiab] OR OR measurement OR measurements OR index OR indices OR score
dysfunctional[tiab] OR impaired[tiab] OR impairment[tiab] OR OR scores) AND (pain OR function OR functional OR dysfunction
impairments[tiab] OR disability[tiab])) NOT medline[sb]) OR dysfunctional OR impaired OR impairment OR impairments OR
disability) AND (foot OR feet OR heel OR heels OR “lower limb” OR
plantar OR calcaneal OR calcaneus OR midfoot)))
Cochrane Library
((questionnaire OR questionnaires OR instrument OR instruments CINAHL
OR scale OR scales OR measurement OR measurements OR index (MH “Heel Spur” OR MH “Heel Pain” OR MH “Plantar Fasciitis”) OR
OR indices OR score OR scores) AND (pain OR function OR func- ((MH “Heel” OR MH “Calcaneus”) AND MH “Pain”) OR TI ((“Heel
tional OR dysfunction OR dysfunctional OR impaired OR impair- pain” OR “painful heel” OR “painful heels” OR (heel AND pain) OR
ment OR impairments OR disability) AND (foot OR feet OR heel OR “calcaneal spur*” OR (calcaneus AND spur*) OR “plantar fasciitis”
heels OR “lower limb” OR plantar OR calcaneal OR calcaneus OR OR “plantar fascitis” OR “plantar foot pain” OR “plantar pain” OR
midfoot)):ti,ab,kw OR (“abductor hallucis” OR (arch AND (shoe OR (heel AND spur*))) OR AB ((“Heel pain” OR “painful heel” OR “pain-
midfoot OR foot OR plantar OR heel) AND pain)):ti,ab,kw OR (“heel ful heels” OR (heel AND pain) OR “calcaneal spur*” OR (calcaneus
pain” OR “painful heel” OR “painful heels” OR (heel and pain) OR AND spur*) OR “plantar fasciitis” OR “plantar fascitis” OR “plantar
“calcaneal spur” OR “calcaneal spurs” OR (calcaneus and spur) OR foot pain” OR “plantar pain” OR (heel AND spur*))) OR MH “Foot”
(calcaneus and spurs) OR “plantar fasciitis” OR “plantar fascitis” OR AND MH “Pain” AND (TI arch OR AB arch) OR TI “Abductor hallucis”
“plantar foot pain” OR “plantar pain” OR (heel and spur) OR (heel OR AB “Abductor hallucis” OR AB ( (arch AND pain AND (shoe OR
and spurs)):ti,ab,kw (Word variations have been searched) midfoot OR foot OR plantar OR heel)) ) OR TI ( (arch AND pain AND
(shoe OR midfoot OR foot OR plantar OR heel)))
Web of Science (Science Citation Index Expanded, Social
Sciences Citation Index, Arts and Humanities Citation Index) ProQuest Dissertations and Theses
TS=((questionnaire OR questionnaires OR instrument OR instruments ab(“Heel pain” OR “painful heel” OR “painful heels” OR (heel AND
OR scale OR scales OR measurement OR measurements OR index OR pain) OR “Calcaneal spur” OR “calcaneal spurs” OR (Calcaneus AND
a24 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
ONLINE APPENDIX A
spur) OR (calcaneus AND spurs) OR “Plantar fasciitis” OR “Plantar OR scores) AND (pain OR function OR functional OR dysfunction
fascitis” OR “plantar foot pain” OR “plantar pain” OR (heel AND spur) OR dysfunctional OR impaired OR impairment OR impairments OR
OR (heel AND spurs) OR “Abductor hallucis” OR (arch AND (shoe disability) AND (foot OR feet OR heel OR heels OR “lower limb” OR
OR midfoot OR foot OR plantar OR heel) AND pain) OR ((Question- plantar OR calcaneal OR calcaneus OR midfoot)))
naire OR questionnaires OR instrument OR instruments OR scale OR
scales OR measurement OR measurements OR index OR indices OR
score OR scores) AND (pain OR function OR functional OR dysfunc-
PEDro (Physiotherapy Evidence Database)
“heel pain” OR “painful heel” OR “painful heels” OR (heel AND pain)
tion OR dysfunctional OR impaired OR impairment OR impairments
OR “calcaneal spur” OR “calcaneal spurs” OR (calcaneus AND spur)
OR disability) AND (foot OR feet OR heel OR heels OR “lower limb”
OR (calcaneus AND spurs) OR “plantar fasciitis” OR “plantar fascitis”
OR plantar OR calcaneal OR calcaneus OR midfoot))) OR ti(“heel
OR “plantar foot pain” OR “plantar pain” OR (heel AND spur) OR
pain” OR “painful heel” OR “painful heels” OR (heel AND pain) OR (heel AND spurs) OR “abductor hallucis” OR (arch AND (shoe OR
“calcaneal spur” OR “calcaneal spurs” OR (Calcaneus AND spur) OR midfoot OR foot OR plantar OR heel) AND pain) OR ((questionnaire
(calcaneus AND spurs) OR “plantar fasciitis” OR “plantar fascitis” OR OR questionnaires OR instrument OR instruments OR scale OR
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
“plantar foot pain” OR “plantar pain” OR (heel AND spur) OR (heel scales OR measurement OR measurements OR index OR indices OR
AND spurs) OR “abductor hallucis” OR (arch AND (shoe OR midfoot score OR scores) AND (pain OR function OR functional OR dysfunc-
OR foot OR plantar OR heel) AND pain) OR ((questionnaire OR tion OR dysfunctional OR impaired OR impairment OR impairments
questionnaires OR instrument OR instruments OR scale OR scales OR disability) AND (foot OR feet OR heel OR heels OR “lower limb”
OR measurement OR measurements OR index OR indices OR score OR plantar OR calcaneal OR calcaneus OR midfoot))
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
ONLINE APPENDIX B
SEARCH RESULTS
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a25
ONLINE APPENDIX C
ARTICLE INCLUSION AND EXCLUSION CRITERIA – Diagnostic characteristics of heel pain/plantar fasciitis,
Inclusion Criteria including but not limited to pain location, duration, and
We included articles providing evidence of the following types: quality, and related impairments and functional limitations
systematic reviews, meta-analyses, experimental and quasi- – Interventions within the scope of practice of physical
experimental, cohort, case series, and cross-sectional studies therapists, to include modalities (including but not limited
reporting on: to iontophoresis, manual therapy, stretching exercises,
• The functional anatomy (abductor hallucis, longitudinal arch, taping, orthotic devices, dry needling, and splints)
muscles, tendons, and nerves, as well as the plantar fascia)
of the heel and foot relevant to plantar fasciitis All outcomes were included.
OR
• Tests and measures for diagnosis and/or differential diagnosis
of heel pain/plantar fasciitis within the scope of physical therapist
Exclusion Criteria
practice, including but not limited to tarsal tunnel syndrome test, We excluded nonsystematic review articles and reports,
windlass test, longitudinal arch angle, Foot Posture Index and articles reporting on:
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
OR – Tumors
• Measurement properties of instruments that are not specific – Postoperative heel pain from foot surgery
to heel pain/plantar fasciitis BUT are specific to lower extremity – Posterior or lateral heel pain related to Achilles
outcomes or peroneal tendinitis
OR – Nonmusculoskeletal heel pain:
• Measurement properties of instruments using data from
• Diabetes
a sample of patients with heel pain/plantar fasciitis
• Ulcers
OR
• Primary peripheral nerve entrapment
• Primarily adults (16 years old or greater)
– Studies reporting on persons less than 16 years old IF • Topics outside the scope of physical therapist
Journal of Orthopaedic & Sports Physical Therapy®
a26 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
ONLINE APPENDIX D
n = 238
• Redundant, n = 14
• Not English, n = 12
• Could not locate, n = 4
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a27
ONLINE APPENDIX E
ARTICLES INCLUDED IN RECOMMENDATIONS BA. Clinical presentation and self-reported patterns of pain
BY TOPIC and function in patients with plantar heel pain. Foot Ankle Int.
Impairment/Function-Based Diagnosis 2012;33:693-698. http://dx.doi.org/10.3113/FAI.2012.0693
Prevalence Yi TI, Lee GE, Seo IS, Huh WS, Yoon TH, Kim BR. Clinical charac-
Di Caprio F, Buda R, Mosca M, Calabrò A, Giannini S. Foot and lower teristics of the causes of plantar heel pain. Ann Rehabil Med.
limb diseases in runners: assessment of risk factors. J Sports Sci 2011;35:507-513. http://dx.doi.org/10.5535/arm.2011.35.4.507
Med. 2010;9:587-596.
Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates Risk Factors
of foot pain in a population-based study: the North West Ad- Butterworth PA, Landorf KB, Smith SE, Menz HB. The association
elaide health study. J Foot Ankle Res. 2008;1:2. http://dx.doi. between body mass index and musculoskeletal foot disorders:
org/10.1186/1757-1146-1-2 a systematic review. Obes Rev. 2012;13:630-642. http://dx.doi.
Lopes AD, Hespanhol Junior LC, Yeung SS, Costa LO. What are the org/10.1111/j.1467-789X.2012.00996.x
main running-related musculoskeletal injuries? A systematic Chang R, Kent-Braun JA, Hamill J. Use of MRI for volume estima-
tion of tibialis posterior and plantar intrinsic foot muscles
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
org/10.1111/j.1600-0838.2012.01509.x
Tenforde AS, Sayres LC, McCurdy ML, Collado H, Sainani KL, Freder- Med. 2010;9:587-596.
icson M. Overuse injuries in high school runners: lifetime preva- Irving DB, Cook JL, Young MA, Menz HB. Obesity and pronated
lence and prevention strategies. PM R. 2011;3:125-131; quiz 131. foot type may increase the risk of chronic plantar heel pain:
http://dx.doi.org/10.1016/j.pmrj.2010.09.009 a matched case-control study. BMC Musculoskelet Disord.
2007;8:41. http://dx.doi.org/10.1186/1471-2474-8-41
Pathoanatomical Features Klein SE, Dale AM, Hayes MH, Johnson JE, McCormick JJ, Racette
Fabrikant JM, Park TS. Plantar fasciitis (fasciosis) treatment outcome BA. Clinical presentation and self-reported patterns of pain
study: plantar fascia thickness measured by ultrasound and and function in patients with plantar heel pain. Foot Ankle Int.
correlated with patient self-reported improvement. Foot (Edinb). 2012;33:693-698. http://dx.doi.org/10.3113/FAI.2012.0693
Journal of Orthopaedic & Sports Physical Therapy®
2011;21:79-83. http://dx.doi.org/10.1016/j.foot.2011.01.015 Labovitz JM, Yu J, Kim C. The role of hamstring tightness in plan-
Lentz TA, Sutton Z, Greenberg S, Bishop MD. Pain-related fear con- tar fasciitis. Foot Ankle Spec. 2011;4:141-144. http://dx.doi.
tributes to self-reported disability in patients with foot and ankle org/10.1177/1938640010397341
pathology. Arch Phys Med Rehabil. 2010;91:557-561. http://dx.doi. Lopes AD, Hespanhol Junior LC, Yeung SS, Costa LO. What are the
org/10.1016/j.apmr.2009.12.010 main running-related musculoskeletal injuries? A systematic
Mahowald S, Legge BS, Grady JF. The correlation between plantar review. Sports Med. 2012;42:891-905. http://dx.doi.org/10.1007/
fascia thickness and symptoms of plantar fasciitis. J Am Podiatr BF03262301
Med Assoc. 2011;101:385-389. http://dx.doi.org/10.7547/1010385 Mahmood S, Huffman LK, Harris JG. Limb-length discrepancy as a
Sutton Z, Greenburg S, Bishop M. Association of pain related beliefs cause of plantar fasciitis. J Am Podiatr Med Assoc. 2010;100:452-
with disability and pain in patients with foot and/or ankle pain: a 455. http://dx.doi.org/10.7547/1000452
case series. Orthop Phys Ther Pract. 2008;20:200-207. Patel A, DiGiovanni B. Association between plantar fasciitis and iso-
Wearing SC, Smeathers JE, Sullivan PM, Yates B, Urry SR, Dubois P. lated contracture of the gastrocnemius. Foot Ankle Int. 2011;32:5-
Plantar fasciitis: are pain and fascial thickness associated with 8. http://dx.doi.org/10.3113/FAI.2011.0005
arch shape and loading? Phys Ther. 2007;87:1002-1008. http:// Pohl MB, Hamill J, Davis IS. Biomechanical and anatomic factors
dx.doi.org/10.2522/ptj.20060136 associated with a history of plantar fasciitis in female runners.
Wearing SC, Smeathers JE, Yates B, Urry SR, Dubois P. Bulk Clin J Sport Med. 2009;19:372-376. http://dx.doi.org/10.1097/
compressive properties of the heel fat pad during walking: a JSM.0b013e3181b8c270
pilot investigation in plantar heel pain. Clin Biomech (Bris- Ribeiro AP, Trombini-Souza F, Tessutti V, Lima FR, de Camargo Neves
tol, Avon). 2009;24:397-402. http://dx.doi.org/10.1016/j. Sacco I, João SM. Rearfoot alignment and medial longitudinal
clinbiomech.2009.01.002 arch configurations of runners with symptoms and histories of
Wu CH, Chang KV, Mio S, Chen WS, Wang TG. Sonoelastography of plantar fasciitis. Clinics (São Paulo). 2011;66:1027-1033. http://
the plantar fascia. Radiology. 2011;259:502-507. http://dx.doi. dx.doi.org/10.1590/S1807-59322011000600018
org/10.1148/radiol.11101665 Sahin N, Öztürk A, Atici T. Foot mobility and plantar fascia elastic-
ity in patients with plantar fasciitis. Acta Orthop Traumatol Turc.
Clinical Course 2010;44:385-391. http://dx.doi.org/10.3944/AOTT.2010.2348
Klein SE, Dale AM, Hayes MH, Johnson JE, McCormick JJ, Racette Sobhani S, Dekker R, Postema K, Dijkstra PU. Epidemiology of
a28 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
ONLINE APPENDIX E
ankle and foot overuse injuries in sports: a systematic review. Analogue Scale. Foot. 2008;18:15-19. http://dx.doi.org/10.1016/j.
Scand J Med Sci Sports. 2013;23:669-686. http://dx.doi. foot.2007.06.006
org/10.1111/j.1600-0838.2012.01509.x Landorf KB, Radford JA, Hudson S. Minimal Important Differ-
Tenforde AS, Sayres LC, McCurdy ML, Collado H, Sainani KL, Freder- ence (MID) of two commonly used outcome measures for
icson M. Overuse injuries in high school runners: lifetime preva- foot problems. J Foot Ankle Res. 2010;3:7. http://dx.doi.
lence and prevention strategies. PM R. 2011;3:125-131; quiz 131. org/10.1186/1757-1146-3-7
http://dx.doi.org/10.1016/j.pmrj.2010.09.009 Martin RL, Irrgang JJ. A survey of self-reported outcome instruments
Werner RA, Gell N, Hartigan A, Wiggerman N, Keyserling WM. Risk for the foot and ankle. J Orthop Sports Phys Ther. 2007;37:72-84.
factors for plantar fasciitis among assembly plant workers. PM R. http://dx.doi.org/10.2519/jospt.2007.2403
2010;2:110-116. http://dx.doi.org/10.1016/j.pmrj.2009.11.012
Intervention
Diagnosis/Classification Manual Therapy
Cornwall MW, McPoil TG, Lebec M, Vicenzino B, Wilson J. Reliability Brantingham JW, Bonnefin D, Perle SM, et al. Manipulative therapy
of the modified Foot Posture Index. J Am Podiatr Med Assoc. for lower extremity conditions: update of a literature review.
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
Labovitz JM, Yu J, Kim C. The role of hamstring tightness in plan- trial. J Orthop Sports Phys Ther. 2009;39:573-585. http://dx.doi.
tar fasciitis. Foot Ankle Spec. 2011;4:141-144. http://dx.doi. org/10.2519/jospt.2009.3036
org/10.1177/1938640010397341 Renan-Ordine R, Alburquerque-Sendín F, de Souza DP, Cleland JA,
Mahmood S, Huffman LK, Harris JG. Limb-length discrepancy as a Fernández-de-las-Peñas C. Effectiveness of myofascial trigger
cause of plantar fasciitis. J Am Podiatr Med Assoc. 2010;100:452- point manual therapy combined with a self-stretching protocol for
455. http://dx.doi.org/10.7547/1000452 the management of plantar heel pain: a randomized controlled
Redmond AC, Crosbie J, Ouvrier RA. Development and validation trial. J Orthop Sports Phys Ther. 2011;41:43-50. http://dx.doi.
of a novel rating system for scoring standing foot posture: the org/10.2519/jospt.2011.3504
Foot Posture Index. Clin Biomech (Bristol, Avon). 2006;21:89-98.
Journal of Orthopaedic & Sports Physical Therapy®
http://dx.doi.org/10.1016/j.clinbiomech.2005.08.002 Stretching
Landorf KB, Menz HB. Plantar heel pain and fasciitis. Clin Evid
Differential Diagnosis (Online). 2008;2008:1111.
Hafner S, Han N, Pressman MM, Wallace C. Proximal plantar fibroma Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf
as an etiology of recalcitrant plantar heel pain. J Foot Ankle Surg. muscle stretching for the short-term treatment of plantar heel
2011;50:153-157. http://dx.doi.org/10.1053/j.jfas.2010.12.016 pain: a randomised trial. BMC Musculoskelet Disord. 2007;8:36.
Koumakis E, Gossec L, Elhai M, et al. Heel pain in spondyloarthritis: http://dx.doi.org/10.1186/1471-2474-8-36
results of a cross-sectional study of 275 patients. Clin Exp Rheu- Rompe JD, Cacchio A, Weil L, Jr., et al. Plantar fascia-specific stretch-
matol. 2012;30:487-491. ing versus radial shock-wave therapy as initial treatment of plan-
Wearing SC, Smeathers JE, Yates B, Urry SR, Dubois P. Bulk tar fasciopathy. J Bone Joint Surg Am. 2010;92:2514-2522. http://
compressive properties of the heel fat pad during walking: a dx.doi.org/10.2106/JBJS.I.01651
pilot investigation in plantar heel pain. Clin Biomech (Bris- Sweeting D, Parish B, Hooper L, Chester R. The effectiveness of
tol, Avon). 2009;24:397-402. http://dx.doi.org/10.1016/j. manual stretching in the treatment of plantar heel pain: a
clinbiomech.2009.01.002 systematic review. J Foot Ankle Res. 2011;4:19. http://dx.doi.
Yi TI, Lee GE, Seo IS, Huh WS, Yoon TH, Kim BR. Clinical charac- org/10.1186/1757-1146-4-19
teristics of the causes of plantar heel pain. Ann Rehabil Med.
2011;35:507-513. http://dx.doi.org/10.5535/arm.2011.35.4.507 Taping
Abd El Salam MS, Abd Elhafz YN. Low-Dye taping versus medial arch
Examination support in managing pain and pain-related disability in patients
Outcome Measures with plantar fasciitis. Foot Ankle Spec. 2011;4:86-91. http://dx.doi.
Hart DL, Wang YC, Stratford PW, Mioduski JE. Computerized adap- org/10.1177/1938640010387416
tive test for patients with foot or ankle impairments produced Cheung RT, Chung RC, Ng GY. Efficacies of different external controls
valid and responsive measures of function. Qual Life Res. for excessive foot pronation: a meta-analysis. Br J Sports Med.
2008;17:1081-1091. http://dx.doi.org/10.1007/s11136-008-9381-y 2011;45:743-751. http://dx.doi.org/10.1136/bjsm.2010.079780
Landorf KB, Radford JA. Minimal important difference: values for the Franettovich M, Chapman A, Blanch P, Vicenzino B. Continual use
Foot Health Status Questionnaire, Foot Function Index and Visual of augmented low-Dye taping increases arch height in standing
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a29
ONLINE APPENDIX E
but does not influence neuromotor control of gait. Gait Posture. 2011;45:743-751. http://dx.doi.org/10.1136/bjsm.2010.079780
2010;31:247-250. http://dx.doi.org/10.1016/j.gaitpost.2009.10.015 Chia KK, Suresh S, Kuah A, Ong JL, Phua JM, Seah AL. Com-
Franettovich M, Chapman A, Blanch P, Vicenzino B. A physiological parative trial of the foot pressure patterns between corrective
and psychological basis for anti-pronation taping from a critical orthotics, formthotics, bone spur pads and flat insoles in pa-
review of the literature. Sports Med. 2008;38:617-631. tients with chronic plantar fasciitis. Ann Acad Med Singapore.
Franettovich M, Chapman A, Vicenzino B. Tape that increases medial 2009;38:869-875.
longitudinal arch height also reduces leg muscle activity: a pre- Collins N, Bisset L, McPoil T, Vicenzino B. Foot orthoses in lower
liminary study. Med Sci Sports Exerc. 2008;40:593-600. http:// limb overuse conditions: a systematic review and meta-analysis.
dx.doi.org/10.1249/MSS.0b013e318162134f Foot Ankle Int. 2007;28:396-412. http://dx.doi.org/10.3113/
Franettovich M, Chapman AR, Blanch P, Vicenzino B. Augmented low- FAI.2007.0396
Dye tape alters foot mobility and neuromotor control of gait in in- Drake M, Bittenbender C, Boyles RE. The short-term effects of treat-
dividuals with and without exercise related leg pain. J Foot Ankle ing plantar fasciitis with a temporary custom foot orthosis and
Res. 2010;3:5. http://dx.doi.org/10.1186/1757-1146-3-5 stretching. J Orthop Sports Phys Ther. 2011;41:221-231. http://
Franettovich MM, Murley GS, David BS, Bird AR. A comparison of dx.doi.org/10.2519/jospt.2011.3348
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
augmented low-Dye taping and ankle bracing on lower limb Ferber R, Benson B. Changes in multi-segment foot biomechanics
muscle activity during walking in adults with flat-arched foot pos- with a heat-mouldable semi-custom foot orthotic device. J Foot
ture. J Sci Med Sport. 2012;15:8-13. http://dx.doi.org/10.1016/j. Ankle Res. 2011;4:18. http://dx.doi.org/10.1186/1757-1146-4-18
jsams.2011.05.009 Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot ortho-
Landorf KB, Menz HB. Plantar heel pain and fasciitis. Clin Evid ses for the treatment of foot pain. Cochrane Database Syst
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
of plantar fasciosis: a systematic review of controlled trials. J Am fasciitis? A meta-analysis. Phys Ther Sport. 2009;10:12-18. http://
Podiatr Med Assoc. 2010;100:41-51. dx.doi.org/10.1016/j.ptsp.2008.09.002
Van Lunen B, Cortes N, Andrus T, Walker M, Pasquale M, Onate J. Lee WC, Wong WY, Kung E, Leung AK. Effectiveness of adjustable dor-
Immediate effects of a heel-pain orthosis and an augmented siflexion night splint in combination with accommodative foot or-
low-dye taping on plantar pressures and pain in subjects with thosis on plantar fasciitis. J Rehabil Res Dev. 2012;49:1557-1564.
plantar fasciitis. Clin J Sport Med. 2011;21:474-479. http://dx.doi. Marabha T, Al-Anani M, Dahmashe Z, Rashdan K, Hadid A. The rela-
org/10.1097/JSM.0b013e3182340199 tion between conservative treatment and heel pain duration in
Vicenzino B, McPoil T, Buckland S. Plantar foot pressures af- plantar fasciitis. Kuwait Med J. 2008;40:130-132.
ter the augmented low Dye taping technique. J Athl Train. Mills K, Blanch P, Chapman AR, McPoil TG, Vicenzino B. Foot
2007;42:374-380. orthoses and gait: a systematic review and meta-analysis of
Yoho R, Rivera JJ, Renschler R, Vardaxis VG, Dikis J. A biomechani- literature pertaining to potential mechanisms. Br J Sports Med.
cal analysis of the effects of low-Dye taping on arch deforma- 2010;44:1035-1046. http://dx.doi.org/10.1136/bjsm.2009.066977
tion during gait. Foot (Edinb). 2012;22:283-286. http://dx.doi. Stolwijk NM, Louwerens JW, Nienhuis B, Duysens J, Keijsers NL.
org/10.1016/j.foot.2012.08.006 Plantar pressure with and without custom insoles in patients with
common foot complaints. Foot Ankle Int. 2011;32:57-65. http://
Foot Orthoses dx.doi.org/10.3113/FAI.2011.0057
Al-Bluwi MT, Sadat-Ali M, Al-Habdan IM, Azam MQ. Efficacy of Stratton M, McPoil TG, Cornwall MW, Patrick K. Use of low-frequency
EZStep in the management of plantar fasciitis: a prospective, electrical stimulation for the treatment of plantar fasciitis. J Am
randomized study. Foot Ankle Spec. 2011;4:218-221. http://dx.doi. Podiatr Med Assoc. 2009;99:481-488.
org/10.1177/1938640011407318 Trotter LC, Pierrynowski MR. Changes in gait economy between full-
Bonanno DR, Landorf KB, Menz HB. Pressure-relieving properties contact custom-made foot orthoses and prefabricated inserts in
of various shoe inserts in older people with plantar heel pain. patients with musculoskeletal pain: a randomized clinical trial. J
Gait Posture. 2011;33:385-389. http://dx.doi.org/10.1016/j. Am Podiatr Med Assoc. 2008;98:429-435.
gaitpost.2010.12.009 Uden H, Boesch E, Kumar S. Plantar fasciitis – to jab or to support?
Cheung RT, Chung RC, Ng GY. Efficacies of different external controls A systematic review of the current best evidence. J Multidiscip
for excessive foot pronation: a meta-analysis. Br J Sports Med. Healthc. 2011;4:155-164. http://dx.doi.org/10.2147/JMDH.S20053
a30 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
ONLINE APPENDIX E
Sheridan L, Lopez A, Perez A, John MM, Willis FB, Shanmugam R. ventional training shoe versus an ultraflexible training shoe for
Plantar fasciopathy treated with dynamic splinting: a random- treating plantar fasciitis. Phys Sportsmed. 2009;37:68-74. http://
ized controlled trial. J Am Podiatr Med Assoc. 2010;100:161-165. dx.doi.org/10.3810/psm.2009.12.1744
http://dx.doi.org/10.7547/1000161
Education and Counseling for Weight Loss
Physical Agents – Electrotherapy Butterworth PA, Landorf KB, Smith SE, Menz HB. The association
Cleland JA, Abbott JH, Kidd MO, et al. Manual physical therapy and between body mass index and musculoskeletal foot disorders:
exercise versus electrophysical agents and exercise in the man- a systematic review. Obes Rev. 2012;13:630-642. http://dx.doi.
agement of plantar heel pain: a multicenter randomized clinical org/10.1111/j.1467-789X.2012.00996.x
trial. J Orthop Sports Phys Ther. 2009;39:573-585. http://dx.doi.
Journal of Orthopaedic & Sports Physical Therapy®
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a31
ONLINE APPENDIX F
Pathoanatomic/Risk/
Intervention/ Clinical Course/Prognosis/ Diagnosis/Diagnostic Prevalence of
Level Prevention Differential Diagnosis Accuracy Condition/Disorder Exam/Outcomes
I Systematic review of Systematic review of Systematic review of high- Systematic review, high- Systematic review of
high-quality RCTs prospective cohort studies quality diagnostic studies quality cross-sectional prospective cohort
High-quality RCT† High-quality prospective cohort High-quality diagnostic study§ studies studies
study‡ with validation High-quality cross-sectional High-quality prospective
study11║ cohort study
II Systematic review of Systematic review of Systematic review of explor- Systematic review of Systematic review of lower-
high-quality cohort retrospective cohort study atory diagnostic studies or studies that allows quality prospective
studies Lower-quality prospective consecutive cohort studies relevant estimate cohort studies
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
High-quality cohort cohort study High-quality exploratory Lower-quality cross- Lower-quality prospective
study‡ High-quality retrospective diagnostic studies sectional study cohort study
Outcomes study or cohort study Consecutive retrospective
ecological study Consecutive cohort cohort
Lower-quality RCT¶ Outcomes study or ecological
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
study
III Systematic reviews of Lower-quality retrospective Lower-quality exploratory Local nonrandom study High-quality cross-
case-control studies cohort study diagnostic studies sectional study
High-quality case- High-quality cross-sectional Nonconsecutive retrospective
control study study cohort
Lower-quality cohort Case-control study
study
IV Case series Case series Case-control study Lower-quality cross-
sectional study
V Expert opinion Expert opinion Expert opinion Expert opinion Expert opinion
Journal of Orthopaedic & Sports Physical Therapy®
a32 | november 2014 | volume 44 | number 11 | journal of orthopaedic & sports physical therapy
ONLINE APPENDIX G
PROCEDURES FOR ASSIGNING LEVELS OF EVIDENCE • Cohort study includes greater than 80% follow-up
• Level of evidence is assigned based on the study design using the • Diagnostic study includes consistently applied reference
Levels of Evidence table (APPENDIX F), assuming high quality standard and blinding
(eg, for intervention, randomized clinical trial starts at level I) • Prevalence study is a cross-sectional study that uses a
• Study quality is assessed using the critical appraisal tool, and the local and current random sample or censuses
study is assigned 1 of 4 overall quality ratings based on the – Acceptable quality (the study does not meet requirements for
critical appraisal results high quality and weaknesses limit the confidence in the
• Level of evidence assignment is adjusted based on the overall accuracy of the estimate): downgrade 1 level
quality rating: • Based on critical appraisal results
– High quality (high confidence in the estimate/results): study – Low quality: the study has significant limitations that substan-
remains at assigned level of evidence (eg, if the randomized tially limit confidence in the estimate: downgrade 2 levels
clinical trial is rated high quality, its final assignment is level • Based on critical appraisal results
I). High quality should include: – Unacceptable quality: serious limitations—exclude from
Downloaded from www.jospt.org at on May 30, 2019. For personal use only. No other uses without permission.
• Randomized clinical trial with greater than 80% follow-up, consideration in the guideline
blinding, and appropriate randomization procedures • Based on critical appraisal results
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
Journal of Orthopaedic & Sports Physical Therapy®
journal of orthopaedic & sports physical therapy | volume 44 | number 11 | november 2014 | a33