One out of 10 people in the United States experience persistent pain along the bottom of the foot, a condition known as plantar fasciitis. In this country alone, outpatient clinics receive more than 1 million visits a year from people seeking help for this type of foot pain. In 2014, the Orthopedic Section of the American Physical Therapy Association published updated clinical practice guidelines on the best treatments for patients with plantar fasciitis. The guidelines present evidence that strongly suggests a combination of manual therapy and rehabilitative exercises to help patients with this foot condition. In a more recent study published in the February 2017 issue of JOSPT, researchers reviewed the records of people with plantar fasciitis who were sent to physical therapy to determine whether this treatment lessened their pain.
NEW INSIGHTS
The researchers studied a database of 819 963 patients diagnosed with plantar fasciitis. Only 7.1% of these patients were prescribed physical therapy. Overall, patients sent to physical therapy received evidence-based treatment. These patients were given manual therapy 87% of the time and supervised rehabilitative exercises 90% of the time. The researchers found that patients who received manual therapy as part of their treatment averaged fewer visits and had a lower cost of care of $340. These results support prior studies that show faster recovery time for those who receive evidence-based physical therapy for their foot pain.
This study shows that despite strong evidence on the benefits of physical therapy for plantar fasciitis, very few patients were given this treatment. If you have foot pain, evidence suggests that physical therapy will help you recover faster and cost you less than if you do not receive this treatment. This study also indicates that physical therapists are quickly adopting the recommendations in the updated clinical practice guidelines on plantar fasciitis. Therapists’ use of manual therapy increased from 78% in 2007 to 94% by 2011, while their use of supervised rehabilitative exercises increased from 85% to 91% during this same period. If you have been diagnosed with plantar fasciitis, physical therapy offers evidence-based treatment options to help you recover from your pain.
EXERCISES AND MANUAL THERAPY TO LESSEN FOOT PAIN
Your physical therapist may offer a combination of manual therapy and exercises, which have been shown to reduce your pain. These treatment options include calf stretches (A), foot stretches (B), and hands-on therapy (C). For calf stretches, while standing with your foot straight ahead, lean forward and keep your heel on the floor until you feel a stretch sensation in your calf. Perform this stretch first with the back leg straight and then repeat it with the back knee bent. For foot stretches, while seated, grab the base of your toes and pull them toward your shin. Your physical therapist can add manual therapy to your treatment, such as the ankle mobilization shown here.
Do you have heel pain? Is the heel pain worse first thing in the morning or after sitting for a while? Research has supported the use of certain stretches to the foot and calf muscles, foot taping, night splints, use of foot orthoses, and hands-on manual therapy (by a licensed physical therapist) to decrease heel pain. In addition, application of cold packs and correction of certain hip/knee muscle imbalances and/or joint stiffness may help alleviate heel pain. Consult with your doctor to see if physical therapy would help alleviate heel pain and make walking more tolerable. – Dr. Alex Kranz
