Researchers developed a best practice guide for managing people with plantar heel pain. The core treatment, they say, is taping, stretching and individualized education.
To decide what treatment options were best, they used a mixed-methods design study which included systematic review, expert interviews and patient survey.
The study, “Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values,” published online on March 30, 2021 in the British Journal of Sports Medicine included randomized controlled trials which evaluated any intervention for people with plantar heel pain.
Fifty-one eligible trials with 4,351 participants were included in the systematic review. Nine of them were suitable to determine proof of efficacy for 10 interventions. Fourteen experts were interviewed using a semi-structured approach and 40 people with plantar heel pain were surveyed online.
Overall, the researchers found good agreement between the systematic review findings and interview data about taping (SMD: 0:47, 95% CI 0.05 to 0.88) and plantar fascia stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term.
They wrote, “Clinical reasoning advocated combining these interventions with education and footwear advice as the core self-management approach.”
There was also good agreement on recommending stepped care management with focused shockwave for first step pain in the short-term (OR: 1.89, 95% CI 1.18 to 3.04), medium-term (SMD 1.31, 95% CI 0.61 to 2.01) and long-term (SMD 1.67, 95% CI 0.88 to 2.45) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96).
There was also good agreement to “step care” using custom foot orthoses for general pain in the short term (SMD: 0.41, 95% CI 0.07 to 0.74) and medium term (SMD: 0.55, 95% CI 0.09 to 1.02).
The researchers said, “Best practice from a mixed-methods study synthesizing systematic review with expert opinion and patient feedback suggests core treatment for people with plantar heel pain should include taping, stretching and individualized education. Patients who do not optimally improve may be offered shockwave therapy, followed by custom orthoses.”
