Physiotherapy Plantar Fasciitis
Design: Online questionnaire survey.
Participants: UK-based practicing physiotherapists for patients with plantar faciitis.
Methods: Physiotherapists were contacted via the ‘interactive Chartered Society of Physiotherapy(CSP) online networks as well an email list of South West England-based clinical educators. An online questionnaire was developed by reviewing similar existing physiotherapy surveys and consultation with experienced musculoskeletal researchers/clinicians. The data were analysed using descriptive statistics.
Results: 285 of the 257 physiotherapists who responded to our survey completed it. The most commonly used diagnostic criteria were pain on palpation or early morning pain. Some physiotherapists did not use formal tests. Most commonly, advice (237/257; 92%), education on plantar fasciitis (207/257 (81%)) and general stretching (189/257 (74%) was used. Night splints, prefabricated orthotics, and custom-made orthotics were rarely used. Myofascial Release, specific soft tissues mobilisations, massage and trigger point therapy are the main modalities used for manual therapy. Pain assessment, functional testing and range of motion are the most common outcome measures.
Conclusions: Physiotherapists appeared to follow most of the established diagnostic criteria for PF, but have not followed established outcome measure guidelines. Advice as well as education with an emphasis on self-management including calf/hamstring stretching was the most commonly reported treatment approach. The low response rate of the respondents and potential bias/unknown response rate made it difficult to know if the treatment was accurate.
Keywords: Physiotherapy; Plantar fasciitis; Questionnaire survey; Self-management.
Copyright (c), 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All Rights Reserved.
Objective: To assess the effects of conventional and radial physiotherapy on plantar fasciitis.
Materials and Methods: This study included 32 patients suffering from plantar fasciitis. These patients were random divided into 2 groups. One group included 16 patients. They received 10 sessions each of physiotherapy. This consisted of ultrasound, Kinesiotherapy and home exercises. The second group consisted of 16 patients, who received instructions for home stretching and three applications of radio shockwaves once a week. Patients were assessed for pain and functional ability before, at the end of treatment and 3 months later. Average age was 47.3+/- 10.3 (range 25-68); 81% of patients were females, 87% were obese, 56% suffered from bilateral impairment and 75% took analgesics frequently.
The results: Both treatment options were successful in reducing pain and improving functional ability for patients suffering from plantar fasciitis. Treatment began sooner than usual due to the quicker effects of shockwaves.
When compared to conventional physiotherapy, shockwave therapy was not more efficient than traditional physiotherapy three months later.
One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy.
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Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial.
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A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial.
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Radial shockwave treatment is not as effective as combined radial shockwave treatment with tissue-specific plantstretching for patients suffering from chronic plantar heel pain.
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Comparative effectiveness in extracorporeal shock wave and ultrasound treatment of plantar fasciitis.
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Radial Extra Corporeal Shockwave Therapy versus Ultrasound Therapy for the Treatment of Plantar Fasciitis
Dedes V, Tzirogiannis K, Polikandrioti M, Dede AM, Nikolaidis C, Mitseas A, Panoutsopoulos GI. Dedes V, et al. Acta Inform Med. 2019 Mar;27(1):45-49. doi: 10.5455/aim.2019.27.45-49. Acta Inform Med. 2019. PMC Article: Free PMID 31213743
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Aydin A, Atic R. Aydin A, et al. J Pain Res. 2018 Aug 2:11:1459-1467. doi.10.2147/JPR.S166679. eCollection 2018. J Pain Res. 2018. PMC Free Article
Since 1995, shockwaves have been an alternate treatment for musculoskeletal conditions.
The mechanical acoustic waves are used to treat the condition. They can be transmitted via liquid or gaseous media.
These vibrations have an effected biological action on tissue by the mechanical action of the ultrasonic waves.
Focal shockwaves may be radial or focal. Focal shockwaves have high tissue penetration power (10 cm) and impact force (0.08-0.28 mj/mm2). They have stronger biological and mechanical effects.
Radial Shockwaves are pneumatic shockwaves that can be generated from air compressors. These waves transmit radially with a lower penetration (3 cm), less impact (0.02 mj/mm2), and limited biological effects.
They have been shown to be effective for treating musculoskeletal disorders that are more superficial, with clinical results that are similar to those of focal shockwaves.
Radial shockwaves produce a weaker effect but can still cause disintegration or calcifications, and increased blood circulation.
Plantar fasciitis, a condition that causes degenerative changes in the plantar fascia, can affect up to 10%.
Shortening caused by changes in the collagen matrix of the plantar fascia is the pathophysiological basis of this disease, which evolves to include pain and functional changes of gait.
Chronic bone traction in your heel can result from a shorterening plantar fascia, which causes heel spurs to form and leads to chronic bone loss. The preferred treatment is physiotherapy, with the aim of suppressing pain and restoring the mechanical function of the plantar fascia for gait improvement. One of the most common therapeutic options is ultrasound, which promotes analgesia by stretching the posterior leg muscles and plantar fascia.
Shockwaves, which are mechanically acoustic sounds transmitted via fluid or gaseous media ( They have been used for more than 15 years for treating musculoskeletal conditions ( ). The biological effect of shockwaves is produced through the mechanical action of the ultrasonic vibrations of tissues ( ). You can choose to shockwave radially or focally. Focal shockwaves have great tissue penetration power (10 cm) and impact force (0.28-0.6 mJ/mm2). These shockwaves have both biological and mechanical effects. They can cause tissue destruction and stimulate neovascularization ( ). Radial shockwaves can be described as pneumatic waves that are generated by compressors. They are shorter in penetration (three cm), have a lower impact (0.02 mJ/mm2), and produce a limited biological effect (). These shockwaves have similar results to focal shockwaves in the treatment of superficial conditions. Radial shockwaves have a less powerful effect, however they can cause fibroses to disintegrate and calcifications to occur and improve blood circulation. They are created by an air compressor and make use Newton’s Third Law (action and response). These shockwaves are sent radially. The greatest amount of energy occurs in the outermost regions and the lowest in the deepest. Although the biological effects of these waves (cavitation and neovascularization) are identical to other generators’, their physical properties are quite different. At the point of contact, where there is most application, a greater amount of ballistic pressure can be produced. Radial waves have been used most often in cases such as plantar faciitis, lateral Epicondylitis (tennis knee), patellar tendinitis., trochanteric Bursitis., trochanteric bursitis., calcareous tendinitis on the shoulder., tendinitis to the calcaneus. And, more recently, tendinitis around the trigger points for myofascial disorders. Radial shockwaves can be used for soft-tissue conditions and at more distant locations. Focal shockwaves should be used in deeper cases, like unconsolidated fractures. Physiotherapy is the best option for treating plantar fasciitis. It targets the suppression of pain, restoration of mechanical function and improvement of gait. Plantar fasciitis can also be treated with ultrasound, which promotes analgesia. It is used together with stretching and strengthening the plantar fibra. There have been good results for treating plantar faciitis with focal or radial shockwaves. However, only a few applications were made (three to six). The purpose of this pilot study was to examine the effect of different standard treatments on the pain of the calcaneus a year after they had occurred. The program consisted of three sessions with extracorporeal radiation shockwaves, along with suggestions for performing therapeutic exercises. It was also compared with a 10-session program consisting of ultrasound and a standard comprehensive therapy exercise routine.
Capital Physio: How can we help?
After answering the question “What’s plantar fasciitis?” we can now discuss exactly how physiotherapy could help. Capital Physio believes that it’s important to use a holistic approach when treating plantar fasciitis.
This means that we will be more likely to treat your symptoms if you identify and address all possible causes.
The physiotherapists complete an extensive assessment in order to give you a precise diagnosis. Once you have received a correct diagnosis and are deemed fit for physiotherapy treatment, your team will arrange a time to start the process.
The Treatment goals may include the following:
What is the Best Treatment for Plantar Fasciitis
Physiotherapy was shown to be very effective for the treatment and prevention of plantar fasciitis. Plantar fasciitis treatment is very similar to tendon pain management. In order to reduce the possibility of recurrence, it is important to first manage symptoms. Next, you need to load your soft tissue slowly to strengthen.
The first stage of treatment is to reduce symptoms such as pain and stiffness as quickly as possible. Using an ice pack is a simple and effective method to reduce pain. It’s easy to make ice by rolling a frozen glass bottle. You can also gently massage your plantar fascia with this method. You may be able to use an anti-inflammatory drug in some instances.
You may also be able to have your physiotherapist use joint mobilizations and massage for pain relief. Taping, braces, or heel cups may be used depending on the root cause of the plantar fasciitis. Flexibility exercises for the calf can also be beneficial. This includes using a foam roller or calf stretches. You can hold the stretch below for at most 15 seconds, four to five times a day.
Rehabilitation continues with the rehabilitation of and how to gradually load and load the plantar fascia. An exercise that is specifically used to load the plantar fascia includes a heel raise with an elevated big toe. A towel or dowel can be used to place more weight through the plantar facia by elevating the big thigh onto the towel. Begin by using one of the feet. Then, move onto the affected leg.
A physiotherapist can address any other contributing factors to plantar faciitis. These include poor footwear, decreased joint flexibility (big toe and ankle), reduced muscle strength or endurance, as well as diminished joint mobility.
.Physiotherapy Plantar Fasciitis
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