Plantar Heel Pain part 3. The final chapter!

OK, so we have discussed what definitely does NOT work for Plantar Heel Pain (PHP), and what MIGHT work for PHP. Now, it is time to look at the evidence for what actually DOES work for PHP!

Understanding what we are trying to achieve with the management of PHP is the single most important key to success. This diagram sums it up beautifully:

iptp_a_1490941_f0001_oc.jpeg

From: Shane McClinton PT, PhD, OCS, FAAOMPT, Bryan Heiderscheit PT, PhD, Thomas G. McPoil PT, PhD & Timothy W. Flynn PT, PhD, OCS, FAAOMPT (2018)Physical therapist decision-making in managing plantar heel pain: cases from a pragmatic randomized clinical trial, Physiotherapy Theory and Practice, DOI: 10.1080/09593985.2018.1490941

I really like the phasing approach to management because it pretty much covers all the bases of the treatment protocol process.

Let's take a look at what really works.

First up is the most reliable and most evidence-based therapy of all for the prevention of PHP...

Weight loss

In a systematic review by Butterworth et al focusing on the relationship between body mass index and foot disorders, 12 of the 25 articles in their search results were related to chronic plantar heel pain conditions. These authors reported a strong association between greater body mass index and chronic plantar heel pain in nonathletic populations. Limited, weak evidence showed some change in pain following weight loss.

Body mass index (BMI) in a non-athletic population and the presence of a calcaneal spur the two factors found to have an association with plantar fasciitis according to a Cochrane review by Irving (2006). A BMI of 25-30 kg/m2 approximately doubles the occurrence of CPHP, and it triples if passive ankle joint dorsiflexion is less than 10°. It increases by 3.6 times in weight-bearing occupations (Sahin et al, 2010).

Simon Bartold
Director of Bartold Clinical

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