Abstract
BackgroundMany patients will seek care from a podiatrist for plantar heel pain (PHP), while few of these patients will also be seen by a physical therapist. Physical therapists can provide treatment that is not a part of routine podiatric care for PHP and may provide additional improvement. Therefore, the purpose of this study was to examine the effects of interdisciplinary care for PHP that incorporated physical therapy treatment after initiating podiatric treatment.MethodsEligible individuals with PHP that presented to a podiatrist were randomized to receive usual podiatric care (uPOD) or usual podiatric care plus physical therapy treatment (uPOD+PT). The primary outcome was change in foot and ankle ability measure (FAAM) at 6-months. Secondary outcomes included change in numeric pain rating scale (NPRS), patient-reported success, and 6-week and 1-year endpoints. Patient-reported success was defined as the top two global rating of change scale rankings. Primary analysis was intention-to-treat (ITT) using analysis by covariance adjusted to baseline scores, and a secondary per-protocol (PP) analysis was performed analyzing only those who completed treatment.ResultsNinety-five individuals participated and were included in the ITT analysis, and 79 were included in the PP analysis. For the primary outcome of FAAM change from baseline to 6-months, both groups improved significantly (uPOD+PT: 26.8 [95% CI 21.6, 31.9]; uPOD: (20 [15.6, 24.4]), but there was no between-group difference (4.3 [− 1, 9.6]). For secondary outcomes, the uPOD+PT group demonstrated greater improvement in NPRS at 6 weeks (0.9 [0.3, 1.4]) and 1 year (1.5 [0.6, 2.5]) in the ITT analysis. In the PP analysis, the uPOD+PT group demonstrated greater improvement in FAAM at 6 months (7.7 [2.1, 13.3]) and 1 year (5.5 [0.1, 10.8]), NPRS at 6 weeks (0.9 [0.2, 1.6]), 6 months (1.3 [0.6, 2.1]) and 1 year (1.3 [0.6, 2.1]), and in patient-reported success (relative risk [95% CI]) at 6 weeks (2.8 [1.1, 7.1]), 6 months (1.5 [1.1, 2.1]), and 1 year (1.5 [1.1, 1.9]).ConclusionsThere was no significant benefit of uPOD+PT in the primary outcome of FAAM change at 6 months. Secondary outcomes and PP analysis indicated additional benefit of uPOD+PT, mostly observed in individuals who completed treatment.Trial registrationProspectively registered May 24, 2013 at www.clinicaltrials.gov (NCT01865734).
Highlights
Many patients will seek care from a podiatrist for plantar heel pain (PHP), while few of these patients will be seen by a physical therapist
Participant characteristics were similar between groups, 6 more participants in the usual podiatric care (uPOD) group had a prior history of PHP
Participants in the uPOD+Physical therapist (PT) group were seen for a median of 6 visits with a podiatrist or a physical therapist compared to 2 visits with a podiatrist in the uPOD group (Table 1)
Summary
Many patients will seek care from a podiatrist for plantar heel pain (PHP), while few of these patients will be seen by a physical therapist. Other treatments described to manage PHP include wearing supportive footwear, foot taping, manipulation/mobilization of the foot, ankle, and lower leg, foot and lower leg strengthening, and platelet-rich plasma injections [2, 12,13,14,15,16,17,18] Consistent with these treatments that are local to the painful area, many impairments associated with PHP include altered foot posture/ mobility, limited ankle or hallux dorsiflexion, increased daily weightbearing, lower leg/foot muscle performance, and inflammation, thickening or degeneration of the plantar fascia [1, 2, 4, 19,20,21,22,23]. In individuals who initially recover from PHP, 30% will have a recurrence of symptoms [28]
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