scholarly journals Self-management advice, exercise and foot orthoses for plantar heel pain: the TREADON pilot and feasibility randomised trial

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Linda S. Chesterton ◽  
Martin J. Thomas ◽  
Gordon Hendry ◽  
Ying Chen ◽  
David Goddin ◽  
...  
Keyword(s):  
General Practice ◽  
Cost Effectiveness ◽  
Sample Size ◽  
Heel Pain ◽  
Self Management ◽  
Foot Orthoses ◽  
Main Trial ◽  
Plantar Heel Pain ◽  
Pain Subscale ◽  
Management Advice

Abstract Background Plantar heel pain (PHP) is common and impacts negatively on physical function and quality of life. Initial treatment usually comprises analgesia and self-management advice (SMA), with referral to a physiotherapist or podiatrist recommended only when symptoms persist. Systematic reviews highlight limitations of existing evidence for the effectiveness of exercises and orthoses. The objective of the TREADON pilot and feasibility trial was to inform the design of a future main trial to compare the clinical and cost-effectiveness of self-management advice (SMA), individualised exercises and foot orthoses for PHP. Methods This was a four-arm randomised feasibility and pilot trial with 12-week follow-up. Adults aged ≥ 18 years with PHP were identified from primary care by general practice consultation, retrospective general practice medical record review or a population survey. Participants were randomised to either (i) SMA, (ii) SMA plus individualised exercises (SMA-exercises), (iii) SMA plus prefabricated foot orthoses (SMA-orthoses) or (iv) SMA plus combined individualised exercises and prefabricated foot orthoses (SMA-combined). Feasibility outcomes were recruitment; retention; intervention adherence, credibility and satisfaction; performance of three potential primary outcome measures (pain numeric rating scale (NRS), Foot Function Index-pain subscale (FFI-pain), Manchester Foot Pain and Disability Index-pain subscale (MFPDI-pain)); and parameters for informing the main trial sample size calculation. Results Eighty-two participants were recruited. All three identification methods met the target number of participants. Retention at 12 weeks was 67%. All interventions were successfully delivered as per protocol. Adherence (range over 12 weeks 64–100%) and credibility (93%) were highest in the SMA-combined arm. Satisfaction with treatment was higher for the three clinician-supported interventions (SMA 29%, SMA-exercises 72%, SMA-orthoses 71%, SMA-combined 73%). Responsiveness (baseline to 12 weeks) was higher for FFI-pain (standardised response mean 0.96) and pain NRS (1.04) than MFPDI-pain (0.57). Conservative sample size parameter estimates for standard deviation were pain NRS 2.5, FFI-pain 25 and MFPDI-pain 4, and baseline-outcome correlations were 0.5–0.6, 0.4 and < 0.3, respectively. Conclusions We demonstrated the feasibility of conducting a future main randomised clinical trial comparing the clinical and cost-effectiveness of SMA, exercises and/or foot orthoses for PHP. Trial registration number ISRCTN 12160508. Prospectively registered 5th July 2016.

Evaluating the Clinical Effectiveness and Cost-effectiveness of Foot Orthoses in the Treatment of Plantar Heel Pain

2004 ◽  
Vol 94 (3) ◽  
pp. 229-238 ◽  
Author(s):  
Keith Rome ◽  
Joanne Gray ◽  
Fiona Stewart ◽  
Stephen Charles Hannant ◽  
Des Callaghan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Status ◽  
Health Service ◽  
Clinical Effectiveness ◽  
Heel Pain ◽  
Foot Orthoses ◽  
Foot Pain ◽  
Foot Health ◽  
Plantar Heel Pain ◽  
Health Service Costs

This study evaluated the clinical effectiveness and cost-effectiveness of two different types of foot orthoses used to treat plantar heel pain. Forty-eight patients were randomly assigned to receive either a functional or an accommodative orthosis. General (EuroQol) and specific (Foot Health Status Questionnaire) health-status measures were used. Data were also collected using economic questionnaires relating to National Health Service costs for podia-try, other health-service costs, and patient costs. Data were measured at baseline and at 4- and 8-week intervals. Thirty-five patients completed the study. The results demonstrated a significant decrease in foot pain and a significant increase in foot function with the functional foot orthoses over the 8-week trial. The accommodative foot orthoses demonstrated a significant reduction in foot pain only at 4 weeks. The cost-effectiveness analysis demonstrated that functional orthoses, although initially more expensive, result in a better quality of life. Use of functional orthoses resulted in an increased cost of £17.99 ($32.74) per patient, leading to an incremental cost per quality-adjusted life year of £1,650 ($3,003) for functional orthoses. (J Am Podiatr Med Assoc 94(3): 229–238, 2004)

scholarly journals The incidence, prevalence, and management of plantar heel pain in Dutch general practice

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703217
Author(s):  
Nadine Rasenberg ◽  
Sita MA Bierma-Zeinstra ◽  
Patrick Bindels ◽  
Johan van der Lei ◽  
Marienke Van Middelkoop
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Medical Records ◽  
Search Algorithm ◽  
Heel Pain ◽  
Future Research ◽  
Healthcare Database ◽  
Plantar Heel Pain ◽  
Wait And See ◽  
Multiple Interventions

BackgroundPlantar heel pain (PHP) is a common cause of foot complaints, but information on the occurrence in primary care is scarce.AimThe objective of this study was to determine the incidence and prevalence of PHP and to gain insight in types of treatments provided to patients with PHP in primary care.MethodA cohort study was conducted in a healthcare database containing the electronic general practice medical records of approximately 1.9 million patients throughout the Netherlands. A search algorithm was defined and used to identify cases of PHP in the years 2013–2016. Descriptive statistics were used to obtain the incidence and prevalence of PHP. Data on the management of PHP was extracted in a random sample of 1000 patients.ResultsThe overall incidence of PHP was 3.81 (95% confidence [CI] = 3.75 to 3.87) per 1000 patient years and the overall prevalence of PHP was 0.4374% (95% CI = 0.4369 to 0.4378). Incidence of PHP peaked in the last quarter of every calendar year. The GP applied a wait-and-see policy at the first consultation for PHP in 18.0% of patients. The most commonly applied interventions included prescription for NSAID (19.9%), referral to a paramedical podiatric specialist (19.7%), and advice to wear insoles (16.4%): 34.0% of patients received multiple interventions (range 2–11) and 30.9% had multiple consultations for PHP (range 2–8).ConclusionPHP appears to be common in primary care. Despite a lack of evidence for most treatments, multiple interventions are applied. This urges the need for future research on effectiveness of treatments.

Comparative effectiveness of exercise or self-management of plantar heel pain: a systematic review and meta-analysis

Physiotherapy ◽  
2020 ◽  
Vol 107 ◽  
pp. e9
Author(s):  
D. Thacker ◽  
B. Smith ◽  
P. Hendrick ◽  
R. Webber ◽  
M. Rathleff ◽  
...  
Keyword(s):  
Systematic Review ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Heel Pain ◽  
Self Management ◽  
Plantar Heel Pain

Patients’ experiences of the management of lower back pain in general practice: use of diagnostic imaging, medication and provision of self-management advice

2015 ◽  
Vol 21 (3) ◽  
pp. 342 ◽  
Author(s):  
Mariko Carey ◽  
Heidi Turon ◽  
Stacy Goergen ◽  
Rob Sanson-Fisher ◽  
Sze Lin Yoong ◽  
...  
Keyword(s):  
General Practice ◽  
Back Pain ◽  
Diagnostic Imaging ◽  
Lower Back Pain ◽  
Self Management ◽  
Red Flags ◽  
Cross Sectional ◽  
Lower Back ◽  
Australian General Practice ◽  
Management Advice

Lower back pain is prevalent in the general community. Guidelines recommend against the use of diagnostic imaging unless ‘red flags’ are present that may indicate a potentially serious cause. This paper reports on a cross-sectional electronic survey to investigate self-reported experiences of lower back pain management among Australian general practice patients. Of the 872 participants, 551 (63%) reported that they had experienced lower back pain in the past 12 months. Approximately 40% of patients who had experienced lower back pain reported that they had consulted their general practitioner (GP) regarding this issue. Among those who sought general practice care, 67% reported being referred for diagnostic imaging. Those who received imaging were more likely to have been prescribed medication by their GP, but received self-management advice at the same rate as those who had not been referred. Rates of self-reported referral for diagnostic imaging were higher than expected, given the low prevalence of potentially serious causes for lower back pain reported in the international literature. However, it remains unclear whether this is due to poor guideline adherence by GPs or lack of specificity in the red flags identified in guidelines. Findings suggest the need for improvements in the provision of evidence-based self-management advice.

scholarly journals Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis

2018 ◽  
Vol 52 (16) ◽  
pp. 1040-1046 ◽  
Author(s):  
Nadine Rasenberg ◽  
Henrik Riel ◽  
Michael S Rathleff ◽  
Sita M A Bierma-Zeinstra ◽  
Marienke van Middelkoop
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Meta Analysis ◽  
Heel Pain ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Foot Orthoses ◽  
Short Term ◽  
Eligibility Criteria ◽  
Plantar Heel Pain

BackgroundPlantar heel pain (PHP) is common. Foot orthoses are often applied as treatment for PHP, even though there is little evidence to support this.ObjectiveTo investigate the effects of different orthoses on pain, function and self-reported recovery in patients with PHP and compare them with other conservative interventions.DesignSystematic review and meta-analysis.Data sourcesA systematic literature search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL and Google Scholar up to January 2017.Eligibility criteria for selecting studiesRandomised controlled trials comparing foot orthoses with a control (defined as no intervention, sham or other type of conservative treatment) reporting on pain, function or self-reported recovery in patients with PHP.ResultsTwenty studies investigating eight different types of foot orthoses were included in the review. Most studies were of high quality. Pooled data from six studies showed no difference between prefabricated orthoses and sham orthoses for pain at short term (mean difference (MD) of 0.26 (95% CI −0.09 to 0.60)). No difference was found between sham orthoses and custom orthoses for pain at short term (MD 0.22 (95% CI −0.05 to 0.50)), nor was there a difference between prefabricated orthoses and custom orthoses for pain at short term (MD 0.03 (95% CI −0.15 to 0.22)). For the majority of other interventions, no significant differences were found.ConclusionsFoot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with PHP.PROSPERO registration numberCRD42015029659.

Should foot orthoses be used for plantar heel pain?

2018 ◽  
Vol 52 (19) ◽  
pp. 1224-1225 ◽  
Author(s):  
Glen A Whittaker ◽  
Shannon E Munteanu ◽  
Hylton B Menz ◽  
Karl B Landorf
Keyword(s):  
Heel Pain ◽  
Foot Orthoses ◽  
Plantar Heel Pain

Instrument-Assisted Soft-Tissue Mobilization for the Management of Chronic Plantar Heel Pain: A Pilot Study

2019 ◽  
Vol 109 (3) ◽  
pp. 193-200
Author(s):  
Edward R. Jones ◽  
Margaret A. Finley ◽  
Stacie J. Fruth ◽  
Thomas G. McPoil
Keyword(s):  
Pilot Study ◽  
Soft Tissue ◽  
Sample Size ◽  
Heel Pain ◽  
Effect Sizes ◽  
Graston Technique ◽  
Plantar Heel Pain ◽  
Final Treatment ◽  
And Function ◽  
Soft Tissue Mobilization

Background: The purpose of this study was to determine feasibility of further investigation of treatment with instrument-assisted soft-tissue mobilization (IASTM), using the Graston technique, compared with conservative care for treatment of chronic plantar heel pain (CPHP). Methods: Eleven participants with plantar heel pain lasting 6 weeks to 1 year were randomly assigned to one of two groups, with each group receiving up to eight physical therapy visits. Both groups received the same stretching, exercise, and home program, but the experimental group also received IASTM using the Graston technique. Outcome measures of pain and function were recorded at baseline, after final treatment, and 90 days later. Feasibility of a larger study was determined considering recruitment and retention rates, compliance, successful application of the protocol and estimates of the treatment effect. Results: Both groups demonstrated improvements in current pain (pain at time of survey), pain with the first step in the morning, and function after final treatment and at 90-day follow up. Medium-to-large effect sizes between groups were noted, and sample size estimates demonstrated a need for at least 42 participants to realize a group difference. A larger-scale study was determined to be feasible with modifications including a larger sample size and higher recruitment rate. Conclusions: This pilot study demonstrates that inclusion of IASTM using the Graston technique for CPHP lasting longer than 6 weeks is a feasible intervention warranting further study. Clinically important changes in the IASTM group and moderate-to-large between-group effect sizes suggest that further research is warranted to determine whether these trends are meaningful.

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