Effectiveness of Manual Therapy Combined With Standard Treatment in the Management of Plantar Fasciitis
מילות מפתח
תַקצִיר
תיאור
A prospective randomized double-blinded controlled clinical trial. Setting: Bat-Yamon physical therapy clinic of Clalit health services in Bat Yam.
Ethical considerations: The research proposal will be submitted for the approval of the Helsinki Committee at Meir Hospital in Kefar Saba. All patients will sign informed consent form according to the laws of medical ethics.
Subjects will be recruited from all the population of patients who are referred to physical therapy for the treatment of PF with diagnosis of plantar fasciitis or calcaneal spur.
Randomization will be carried out using envelopes that will be prepared in advance. Each patient will receive at the end of the baseline examination envelope with the type of treatment for which will be delivered only to the therapist so that the examiner and the patient will be blind to the treatment group.
Baseline and final evaluations will be performed by the examiner-therapist and treatments performed by three physical therapists at the Bat-Yamon clinic with experience of at least 3 years which will receive proper instruction and training.
Baseline examination will be performed after completing informed consent form and will include demographic information to be filled by patient, clinical interview and examination by the examiner. Demographic information includes age, gender, weight, BMI (calculated by the examiner), history of the problem, habits related to physical activity and occupation and general health.
The interview will refer to etiology and nature of symptoms. The clinical examination will include observation of foot structure and gait pattern, the presence of hit or swelling. Palpation for pain location and for ruling out fat pad Syndrome, clunk test and neurodynamic of tibial nerve will be performed to rule out tarsal tunnel syndrome (TTS). Patients with suspicion for one of these diagnoses will not be recruited. Dorsi flexion range of motion in both legs will be measured and compared to the range at the end of treatment. Measurement will be taken in two ways, once weight bearing with inclinometer - the patient stands in lounge position while tested leg in front and asked to bend the knee of this leg as possible without lifting the heel off the floor. The angle measured is the angle between the tibia and a vertical line to the floor.Second time without weight bearing with Goniometer- the patient lies on his back with a pillow under the tested knee , the therapist performs maximum dorsi flexion passively and asks the patient to add an active movement in the same direction. The angle measured is between fibula and fifth metatarsus
תאריכים
| אומת לאחרונה: | 08/31/2011 |
| הוגש לראשונה: | 09/19/2011 |
| ההרשמה המשוערת הוגשה: | 09/21/2011 |
| פורסם לראשונה: | 09/22/2011 |
| העדכון האחרון הוגש: | 02/16/2013 |
| עדכון אחרון פורסם: | 02/19/2013 |
| תאריך תחילת לימוד בפועל: | 09/30/2011 |
| תאריך סיום משוער משוער: | 12/31/2012 |
| תאריך סיום משוער ללימודים: | 01/31/2013 |
מצב או מחלה
התערבות / טיפול
Device: ankle mobilization for pain release
שלב
קבוצות זרועות
| זְרוֹעַ | התערבות / טיפול |
|---|---|
| Experimental: ankle mobilization for pain release stretching exercise for the plantar fascia and triceps surae muscles three times a day throughout the study period.
During each visit the exercise performance will be checked by the therapist. In addition, participants from both groups will get ultra sound therapy in frequency of 1 MHz, power of 1.5 watts per centimeter-squared, pulses of 50% for 5 minutes.
The study group will receive the same treatment and a number of manual techniques that include antero-posterior (AP) mobilization for talocrural joint in two variations (weight baring and non-weight baring) to improve the range of dorsi flexion, subtalar joint mobilization to improve range of eversion and mid-tarsal mobilization to improve pronation / supination of the forefoot. Each technique will be carried out for 1 to 1.5 minutes for a total of 5 minutes of manual treatment.
All patients will receive information and guidance to practice at home. | Device: ankle mobilization for pain release Pressure algometer (Algometry) - This is an instrument that measures pain threshold (the minimum pressure required to produce pain). The instrument consists of a flat disk size centimeter square attached to pressure transducer and measuring electrodes. The disk is placed vertically on the point of pain and therapist increases the intensity of the pressure until initial pain appears (when sense of pressure becomes sense of pain.) Score is determined by average of three repeated measurements with 30 seconds break between each.
The algometer allows an objective assessment of pain in addition to LEFS score which is a subjective tool. The algometer test was found to be valid and reliable in repeated measurements (interrater, intrarater) by Andrew A. Fischerin 1987 with healthy people [Andrew 1987]. In another study high reliability was found for averaging between three repeated tests: ICC = 0.91 (CI 0.82; 0.97 95%). [Linda et al 2007] |
קריטריונים לזכאות
| גילאים הזכאים ללימודים | 18 Years ל 18 Years |
| מינים הזכאים ללימודים | All |
| מקבל מתנדבים בריאים | כן |
| קריטריונים | Inclusion Criteria: - Age 18-75 - Pain allocated at the bottom of heel and produced by pressure - Pain in the morning at first steps or after prolonged non-weight bearing - NPRS morning pain score of 3 or higher Exclusion Criteria: - Tumors - Prolonged use of steroids - Fracture below knee during the last year - Prior foot surgeries - A positive diagnosis of Tarsal Tunnel Syndrome (TTS) / Fat Pad Syndrome - Pregnancy - Lack of availability in the coming month |
תוֹצָאָה
מדדי תוצאות ראשוניים
1. Numeric Pain Rating Scale 0-10 [one year and two months]
