Plantar Fasciitis Physiotherapy
The objectives of this study are to identify the current state of plantar fasciitis management in UK physiotherapists.
Design: Online questionnaire survey.
Participants: UK practicing physiotherapists treating patients suffering from plantar faciitis.
Methods: Physiotherapists could be reached via the ‘interactive Chartered Society of Physiotherapy’ (CSP), an online network of South West England clinical educators and an email database. An online questionnaire was developed by reviewing similar existing physiotherapy surveys and consultation with experienced musculoskeletal researchers/clinicians. For analysis, data were analyzed using descriptive statistics.
Results: 285 physiotherapists responded, with 257 complete survey responses. These were followed by pain palpation, early morning and late-night pain. Some physiotherapists didn’t use any formal criteria. The most common methods of treatment were advice (237) 257, 92%, and plantar faciitis education (207/257), 81%). General stretching exercises (189/257), 74%) are also used. Prefabricated orthotics, custom made orthotics and night splints were seldom always used. The most common modalities for manual therapy were myofascial relaxation, massage, soft tissue mobilisations, and myofascialtriggering point therapy. Commonly used outcome measures were pain assessment, functional tests and range of movement.
Conclusions: While physiotherapists appear to have followed most established criteria for diagnosing PF, they did not follow established outcomes measure guidelines. Advice as well as education with an emphasis on self-management including calf/hamstring stretching was the most commonly reported treatment approach. It was unclear whether the approach accurately represented the UK’s clinical practice, due to possible response biases/unknown rate and low numbers of patients suffering from PF being treated by respondents.
Keywords: Physiotherapy; Plantar fasciitis; Questionnaire survey; Self-management.
Copyright (c) 2016, Chartered Society of Physiotherapy. All rights are owned by Elsevier Ltd.
The objective: To evaluate radial shockwave therapy and conventional physiotherapy to treat plantar fasciitis.
Materials and Methods: This study included 32 patients suffering from plantar fasciitis. The patients were randomly split into two groups. One group included 16 patients. They received 10 sessions each of physiotherapy. This consisted of ultrasound, Kinesiotherapy, stretching instruction, and kinesiotherapy. For Group 2, 16 patients received three sessions of radial stresswaves, once per week. Instruction was given for at-home stretching exercises. Before treatment began, pain and function were assessed immediately afterward and again three months later. A mean age of 47.3 +/-10.3 years was recorded (range 25 to 68); 81% were women, 87% were overweight and 56% were with bilateral impairment. 75% also used analgesics on a regular basis.
Results: Both the shockwaves and physiotherapy were both effective in pain management as well as improving the functional capabilities of patients with plantar faciitis. The effect of the shockwaves was apparent sooner than physiotherapy after the onset of treatment.
Conclusion: Shockwave treatment was no more effective than conventional physiotherapy treatment when evaluated three months after the end of treatment.
Follow-up after treatment for plantar fasciitis. Radial shockwaves or 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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In a random controlled trial, we compared the effectiveness of ultrasound therapy and radioextracorporeal shatter wave therapy when treating chronic plantar fistulasis.
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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 for extracorporeal shockwave, ultrasound, low level laser therapy, noninvasive interstimulation, pulsed radiationfrequency treatment for plantar fasciitis. A systematic review.
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Daia C, Scheau C, Toader C, Bumbea AM, Caimac VD, Andone I, Popescu C, Spanu A, Onose G. Daia C, et al. J Clin Med. 2021. April 15th;10(8) 1701. doi: 10.3390/jcm10081701. J Clin Med. 2021. PMID: 33920890 No PMC Article
Effectiveness of a Double Air-Cushioned Shoe Compared with Physiotherapy in the Treatment of Plantar Fasciitis.
Eun SS, Chachan S, Lee SH. Eun SS, et al. Biomed Res Int. 2020 Apr 2;2020:9468302. doi: 10.1155/2020/9468302. eCollection 2020. Biomed Res Int. 2020. PMC free article: PMID: 32337285
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 Free Article
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As an alternative to musculoskeletal problems, shockwaves are used since 15 years.
This treatment uses mechanical acoustic signals that are sent through fluid and gaseous media.
They have a biological impact due to the mechanical action (mechanical) of ultrasonic vibrations upon tissues.
Shockwaves can be focal or radial. Focal shockwaves possess high tissue penetration (10 cm) as well as high impact force (0.08-2.28 Mj/mm2). They can have both biological and mechanical side effects that are greater, including the destruction and stimulation of new blood vessels in the treated tissue.
Radial shockwaves are pneumatic waves that are generated by air compressors. They radiate radially but with less penetration (3cm), lesser impact (0.02 mj/mm2) of biological action and limited biological effects.
They are effective in treating superficial musculoskeletal diseases, which have clinical results comparable to focal shockwaves.
Radial shockwaves have a less powerful effect, however they can cause disintegration and calcifications as well as increase blood flow to the area being treated.
Plantar faciitis is a disease of the plantar fascia which can cause severe pain and disability in up to 10%.
A decrease in length due to changes within the collagen matrix at the plantar facia is the cause of this disease. It evolves to include functional gait and pain.
Shortening of the plantar fascia leads to chronic bone traction in the heel and formation of heel spurs. For gait improvement, physiotherapy is recommended. This treatment aims at suppressing pain as well as restoring mechanical function to the plantar fascia. A common treatment option is to use ultrasound for analgesia, with the stretching of the posterior leg muscles and plantar fascia.
Shockwaves are mechanical acoustic waves transmitted through fluid and gaseous media ( ). For the treatment of musculoskeletal problems ( ), they have been around for 15 years. Ultrasonic vibrations in tissues create the biological effects of shockwaves ( ). The shockwaves may be either focal, or radial. Focal shockwaves can penetrate tissue up to 10 cm and have a high impact force of 0.28 to 0.6 mJ/mm2. These shockwaves can have biological and mechanical consequences, including the destruction of fibrils and stimulation of neovascularization. Radial shockwaves, pneumatic waves created by air compressors transmit radially but with a shorter penetration (3cm), less impact (0.02 – 0.08 mJ/mm2) or limited biological action (). Radial shockwaves can be used to treat musculoskeletal disorders that have a more superficial impact. They are clinically comparable with focal shockwaves. The effect of radial shockwaves is less intense, but they cause disintegration of fibroses and calcifications and increase the blood circulation at the treated site ( Radial shockwaves make use of Newton’s third law (action and reaction) and are generated through the action of an air compressor. These waves are transmitted radially, with the greatest energy in the surface region of the skin and progressive diminution in the deeper regions. While the biological effects, such as cavitation, neurovascularization, and analgesia, are comparable to others wave generators are, they have different physical properties. The point of impact is where the ballistic pressure produces the greatest force, and is therefore the most important area for application. Radial waves are used preferentially in cases of plantar fasciitis, lateral epicondylitis (tennis elbow), patellar tendinitis, trochanteric bursitis, calcareous tendinitis of the shoulder, tendinitis of the calcaneus and, most recently, tendinitis at the trigger points in myofascial syndromes. Radial shockwaves can be used for soft-tissue conditions and at more distant locations. Focal shockwaves are used preferentially in cases of deeper lesions, such as unconsolidated fractures ( Plantar fasciitis is a degenerative alteration of the plantar fascia that affects up to 10% of the population ( ). The best option is physiotherapy. It has the goal of relieving the pain, improving gait and restoring mechanical function to the plantar facia. An alternative treatment for plantar fistula is to use ultrasound. The combination of stretching the plantar and posterior fascias, as well as analgesia, can be found in the form of physiotherapy ( ). Plantar fasciitis treatment using radial and focal shockwaves has shown positive results in terms of pain relief, functional improvement and only three to six application. ( This pilot study was designed to evaluate the impact of pain-reducing interventions on the plantar fasciitis calcaneus after one year. The program consisted of three sessions with extracorporeal radiation shockwaves, along with suggestions for performing therapeutic exercises. It was also compared with ten sessions with comprehensive physiotherapy that includes both ultrasound and a standardized therapeutic exercise routine.
Capital Physio Helps?
We have now answered the question “What is plantar faciitis?”. Now we will discuss how physiotherapy can be of help. Capital Physio strongly believes in a holistic management approach to plantar fasciitis.
It means we’re more likely than ever to solve your symptoms if we can identify all contributing factors.
A thorough evaluation will be done by our physiotherapists to confirm your diagnosis. After you receive a diagnosis, we will make arrangements for you to begin treatment.
These are some Treatment Goals.
What is the Best Treatment for Plantar Fasciitis
Physiotherapy has been shown to be incredibly effective in the treatment of plantar fasciitis. Plantar fasciitis treatment is very similar to tendon pain management. It involves managing symptoms, then loading the soft tissue gradually to encourage strengthening to stop recurrence.
First, reduce pain as fast as you can. It is simple to use an icepack as a pain relief method. The best way to get ice is to use a frozen water bottle. This will allow you to gently massage the plantar fascia. You may be able to use an anti-inflammatory drug in some instances.
You may also be able to have your physiotherapist use joint mobilisations and massage for pain relief. Taping, braces and heel cups are all options depending on what is causing your plantar fasciitis. Also, flexibility exercises can be helpful for the calf. This includes using a foam roller or calf stretches. Try holding the stretches below for at least 15 sec, 4 -5 x day.
Next, you will need to rehabilitate your plantar fascia and load it gradually and with progressives. The heel raise and elevated big toe are two examples of exercises that can be used to load plantar fascia. Elevating the big toe onto a towel or dowel places more load specifically through the plantar fascia. The exercise can be started with one foot and moved to the other.
Your physiotherapist will also address other factors which may be contributing or causing plantar fasciitis. They may include reduced joint flexibility at the ankle or big toe, inadequate footwear, and decreased muscular endurance or strength.
.Plantar Fasciitis Physiotherapy
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