PT added to podiatric care for plantar heel pain yields mixed results

  • McClinton SM & al.
  • BMC Musculoskelet Disord
  • 28.12.2019

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Physical therapy (PT) added to usual podiatric care for plantar heel pain (PHP) yielded no improvement in foot and ankle ability after 6 months. 
  • Patients who completed treatment did report decreased pain at 6 weeks and 1 year after treatment.

Why this matters

  • There is no consensus on the most effective treatment regimen for PHP, and whether PT might improve outcomes was unknown.

Study design

  • Parallel-group, randomized pragmatic clinical trial on patients with PHP:
    • Intention-to-treat analysis (ITT): n=95.
    • Per protocol analysis (PP): n=79.
  • Treatment groups:
    • Usual podiatric care (uPOD): n=41.
    • Usual podiatric care plus physical therapy treatment (uPOD+PT): n=38.
  • Funding: Orthopaedic Section, American Physical Therapy Association; others.

Key results

  • At 6 months, the change in foot and ankle ability measure scores was significant (P<.001 in: style="list-style-type:circle;">
  • ITT: uPOD+PT, 25.7 vs uPOD, 85.2.
  • PP: uPOD+PT, 30.1 vs uPOD, 85.1.
  • However, between-group differences were not significant in ITT (4.5; P=.153) and PP (7.7; P=.008) analyses.
  • The numeric pain rating scale (NPRS) showed a significant between-group difference in ITT analysis at:
    • 6 weeks: 0.9 (P=.003).
    • 1 year: 1.5 (P=.001).
  • The NPRS in PP analysis showed a significant between-group difference at:
    • 6 weeks: 0.9 (P=.008).
    • 6 months: 1.3 (P=.001).
    • 1 year: 1.3 (P=.001).
  • Limitations

    • Limited generalizability.

    Coauthored with Chitra Ravi, MPharm