Age, weight, and duration of symptoms have been associated with a poor response to treatment for plantar heel pain (PHP), but no studies were identified that examined predictors of response to physical therapy intervention. The purpose of this investigation was to examine the influence of age, body mass index (BMI), and symptom duration on treatment response to physical therapy intervention.
Methods:
Sixty participants received 6 visits over 4 weeks of physical therapy intervention that included manual therapy and exercise or electrophysiological agents and exercise. Outcomes were assessed using the Foot and Ankle Ability Measure (FAAM), Numeric Pain Rating Scale (NPRS), and Global Rating of Change Scale (GRC). Logistic regression (P < .05) was used to analyze age, BMI, and symptom duration as potential predictors of a successful response based on the minimal clinically important difference of the outcome measures. Sensitivity analysis was used to assess the influence of success based on minimal clinically important changes in the FAAM, NPRS, and GRC or only the FAAM and NPRS. Receiver operating curves were used to determine the cut point for the significant predictor.
Results:
At the 6-month follow-up to physical therapy intervention, NPRS was improved by 3 points (95% CI, 2.4-3.6) and FAAM improved by 22.5 points (95% CI, 16.8-28.2). Individuals with symptoms less than 7.2 months were 4.2 (95% CI, 1.3-13.8; P = .016) and 8.5 (95% CI, 2.5-28.9; P = .001) times more likely to respond to treatment based on the NPRS/FAAM/GRC and NPRS/FAAM success criteria, respectively. Age and BMI were not significant predictors (P ≥ .455 and P ≥ .450, respectively).
Conclusion:
Age and BMI were not associated with outcomes and obese individuals did achieve a successful outcome with the physical therapy intervention used in the clinical trial. Individuals with PHP symptoms longer than 7 months require additional consideration and further investigation of effective strategies to improve treatment response.
AjimshaMSBinsuDChithraS. Effectiveness of myofascial release in the management of plantar heel pain: a randomized controlled trial. Foot (Edinb). 2014;24:66-71.
2.
Al Fischer Associates Inc. 2002 Podiatric Practice Survey. Statistical results. J Am Podiatr Med Assoc. 2003;93:67-86.
3.
AllenRHGrossMT. Toe flexors strength and passive extension range of motion of the first metatarsophalangeal joint in individuals with plantar fasciitis. J Orthop Sports Phys Ther. 2003;33:468-478.
BeyzadeogluTGokceABeklerH. The effectiveness of dorsiflexion night splint added to conservative treatment for plantar fasciitis. Acta Orthop Traumatol Turc. 2007;41:220-224.
6.
BuchbinderR. Clinical practice. Plantar fasciitis. N Engl J Med. 2004;350:2159-2166.
7.
ChildsJDPivaSRFritzJM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976). 2005;30:1331-1334.
8.
ClelandJAAbbottJHKiddMO. Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2009;39:573-585.
9.
ClelandJAChildsJDFritzJMWhitmanJMEberhartSL. Development of a clinical prediction rule for guiding treatment of a subgroup of patients with neck pain: use of thoracic spine manipulation, exercise, and patient education. Phys Ther. 2007;87:9-23.
10.
ClelandJAFritzJMWhitmanJMHeathR. Predictors of short-term outcome in people with a clinical diagnosis of cervical radiculopathy. Phys Ther. 2007;87:1619-1632.
CotchettMPMunteanuSELandorfKB. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Phys Ther. 2014;94(8):1083-1094.
13.
CotchettMPWhittakerGErbasB. Psychological variables associated with foot function and foot pain in patients with plantar heel pain [published online March20, 2014]. Clin Rheumatol. 2014. doi:10.1007/s10067-014-2565.
14.
CoveyCJMulderMD. Plantar fasciitis: how best to treat?J Fam Pract. 2013;62:466-471.
DiGiovanniBFNawoczenskiDALintalME. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003;85-A:1270-1277.
17.
DiGiovanniBFNawoczenskiDAMalayDP. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2006;88:1775-1781.
18.
DrakeMBittenbenderCBoylesRE. The short-term effects of treating plantar fasciitis with a temporary custom foot orthosis and stretching. J Orthop Sports Phys Ther. 2011;41:221-231.
19.
EhrmannCMaierMMengiardiBPfirrmannCWSutterR. Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers. Radiology. 2014;272:807-814.
20.
FarrarJTYoungJPJrLaMoreauxLWerthJLPooleRM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149-158.
21.
FaulFErdfelderELangAGBuchnerA. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175-191.
22.
FrenchHPGalvinRCusackTMcCarthyGM. Predictors of short-term outcome to exercise and manual therapy for people with hip osteoarthritis. Phys Ther. 2014;94:31-39.
23.
FureyJG. Plantar fasciitis. The painful heel syndrome. J Bone Joint Surg Am. 1975;57:672-673.
24.
GarrisonCCookC. Clinimetrics corner: the Global Rating of Change Score (GRoC) poorly correlates with functional measures and is not temporally stable. J Man Manip Ther. 2012;20:178-181.
25.
GillLHKiebzakGM. Outcome of nonsurgical treatment for plantar fasciitis. Foot Ankle Int. 1996;17(9):527-532.
26.
HagenEMSvensenEEriksenHR. Predictors and modifiers of treatment effect influencing sick leave in subacute low back pain patients. Spine (Phila Pa 1976). 2005;30:2717-2723.
27.
HarrellFELeeKLMarkDB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361-387.
28.
HendrixCLJollyGPGarbalosaJCBlumePDosRemediosE. Entrapment neuropathy: the etiology of intractable chronic heel pain syndrome. J Foot Ankle Surg. 1998;37:273-279.
29.
IrvingDBCookJLMenzHB. Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006;9:11-22.
30.
IrvingDBCookJLYoungMAMenzHB. Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study. BMC Musculoskelet Disord. 2007;8:41.
31.
JaeschkeRSingerJGuyattGH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407-415.
32.
JapourCJVohraRVohraPKGarfunkelLChinN. Management of heel pain syndrome with acetic acid iontophoresis. J Am Podiatr Med Assoc. 1999;89:251-257.
33.
JensenMPMcFarlandCA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. 1993;55:195-203.
34.
JensenMPTurnerJARomanoJMFisherLD. Comparative reliability and validity of chronic pain intensity measures. Pain. 1999;83:157-162.
35.
JonesMLEvansNTefertillerC. Activity-based therapy for recovery of walking in chronic spinal cord injury: results from a secondary analysis to determine responsiveness to therapy [published online August4, 2014]. Arch Phys Med Rehabil. doi:10.1016/j.apmr.2014.07.401.
36.
KiblerWBGoldbergCChandlerTJ. Functional biomechanical deficits in running athletes with plantar fasciitis. Am J Sports Med. 1991;19:66-71.
37.
LooneyBSrokoseTFernandez-de-las-PenasCClelandJA. Graston instrument soft tissue mobilization and home stretching for the management of plantar heel pain: a case series. J Manipulative Physiol Ther. 2011;34:138-142.
38.
LouwADienerIButlerDSPuenteduraEJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92:2041-2056.
39.
LynchDMGoforthWPMartinJEOdomRDPreeceCKKotterMW. Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. 1998;88:375-380.
40.
MartinRLIrrgangJJBurdettRGContiSFVan SwearingenJM. Evidence of validity for the Foot and Ankle Ability Measure (FAAM). Foot Ankle Int. 2005;26(11):968-983.
41.
MartinRLIrrgangJJContiSF. Outcome study of subjects with insertional plantar fasciitis. Foot Ankle Int. 1998;19(12):803-811.
42.
McClintonSMFlynnTWHeiderscheitBC. Comparison of usual podiatric care and early physical therapy intervention for plantar heel pain: study protocol for a parallel-group randomized clinical trial. Trials. 2013;14:414.
43.
McMillanAMLandorfKBGreggJMDe LucaJCotchettMPMenzHB. Hyperemia in plantar fasciitis determined by power Doppler ultrasound. J Orthop Sports Phys Ther. 2013;43:875-880.
44.
McPoilTGMartinRLCornwallMWWukichDKIrrgangJJGodgesJJ. Heel pain—plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38:A1-A18.
45.
MenzHBDufourABRiskowskiJLHillstromHJHannanMT. Foot posture, foot function and low back pain: the Framingham Foot Study. Rheumatology (Oxford). 2013;52:2275-2282.
46.
MizelMSMarymontJVTrepmanE. Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom. Foot Ankle Int. 1996;17(12):732-735.
47.
National Institutes of Health, United States Department of Health and Human Services. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, MD: National Institutes of Health publication 00-4084. http://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdf. Published October2000. Accessed September 28, 2014.
48.
NeeRJVicenzinoBJullGAClelandJACoppietersMW. Baseline characteristics of patients with nerve-related neck and arm pain predict the likely response to neural tissue management. J Orthop Sports Phys Ther. 2013;43:379-391.
49.
O’BrienDMartinWJ. A retrospective analysis of heel pain. J Am Podiatr Med Assoc. 1985;75:416-418.
50.
OrchardJ. Plantar fasciitis. BMJ. 2012;345:e6603.
51.
PhamTvan der HeijdeDAltmanRD. OMERACT-OARSI initiative: osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage. 2004;12:389-399.
52.
PhamTVan Der HeijdeDLassereM. Outcome variables for osteoarthritis clinical trials: the OMERACT-OARSI set of responder criteria. J Rheumatol. 2003;30:1648-1654.
53.
ProbeRABacaMAdamsRPreeceC. Night splint treatment for plantar fasciitis. A prospective randomized study. Clin Orthop Relat Res. 1999;368:190-195.
54.
ReischlS. Physical therapist foot care survey. Orthop Pract. 2001;13:27.
55.
Renan-OrdineRAlburquerque-SendinFde SouzaDPClelandJAFernandez-de-Las-PenasC. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011;41:43-50.
56.
RiddleDLPulisicMPidcoePJohnsonRE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A:872-877.
57.
RiddleDLSchappertSM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25(5):303-310.
58.
SchererPR. Heel spur syndrome. Pathomechanics and nonsurgical treatment. Biomechanics Graduate Research Group for 1988. J Am Podiatr Med Assoc. 1991;81:68-72.
59.
SchmittJSAbbottJH. Patient global ratings of change did not adequately reflect change over time: a clinical cohort study. Phys Ther. 2014;94(4):534-542.
60.
SchonLCGlennonTPBaxterDE. Heel pain syndrome: electrodiagnostic support for nerve entrapment. Foot Ankle. 1993;14(3):129-135.
61.
ShikoffMDFiguraMAPostarSE. A retrospective study of 195 patients with heel pain. J Am Podiatr Med Assoc. 1986;76:71-75.
62.
SmartKMBlakeCStainesAThackerMDoodyC. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. Man Ther. 2012;17:336-344.
63.
ThomasJLChristensenJCKravitzSR. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49:S1-19.
64.
TongKBFuriaJ. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop (Belle Mead NJ). 2010;39:227-231.
65.
WearingSCSmeathersJESullivanPMYatesBUrrySRDuboisP. Plantar fasciitis: are pain and fascial thickness associated with arch shape and loading?Phys Ther. 2007;87:1002-1008.
66.
WearingSCSmeathersJEUrrySRHennigEMHillsAP. The pathomechanics of plantar fasciitis. Sports Med. 2006;36:585-611.
67.
WearingSCSmeathersJEUrrySRSullivanPMYatesBDuboisP. Plantar enthesopathy: thickening of the enthesis is correlated with energy dissipation of the plantar fat pad during walking. Am J Sports Med. 2010;38:2522-2527.
68.
WearingSCSmeathersJEYatesBUrrySRDuboisP. Bulk compressive properties of the heel fat pad during walking: a pilot investigation in plantar heel pain. Clin Biomech (Bristol, Avon). 2009;24:397-402.
