Physical therapy added to podiatric care for plantar heel pain has minimal benefits

USA: Podiatric care plus physical therapy treatment (uPOD+PT) for plantar heel pain (PHP) patients yielded no improvement in foot and ankle ability after 6 months, finds a recent study published in the journal BMC Musculoskeletal Disorders. However, the patients who completed treatment reported decreased pain at 6 weeks and 1 year after the treatment.

Plantar heel pain is a common foot condition managed by various healthcare providers including podiatrists, physical therapists, primary care physicians, orthopedic surgeons, and chiropractors. Physical therapists provide treatment that is not a part of the routine podiatric care for PHP and may provide additional improvement.

Shane M. McClinton, Doctor of Physical Therapy Program, Des Moines University, Des Moines, IA, USA, and colleagues examined the effects of interdisciplinary care for PHP that incorporated physical therapy treatment after initiating podiatric treatment.

The study included people with PHP that presented to a podiatrist. They were randomized to receive usual podiatric care (uPOD) or usual podiatric care plus physical therapy treatment.

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 ratings of change scale rankings.

The 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. 95 individuals participated and were included in the ITT analysis, and 79 were included in the PP analysis.

Key findings of the study include:

• For the primary outcome of FAAM change from baseline to 6-months, both groups improved significantly (uPOD+PT: 26.8; uPOD: (20), but there was no between-group difference (4.3).


• For secondary outcomes, the uPOD+PT group demonstrated greater improvement in NPRS at 6 weeks (0.9) and 1 year (1.5) in the ITT analysis.


• In the PP analysis, the uPOD+PT group demonstrated greater improvement in FAAM at 6 months (7.7) and 1 year (5.5), NPRS at 6 weeks (0.9), 6 months (1.3) and 1 year (1.3), and in patient-reported success (relative risk at 6 weeks (2.8), 6 months (1.5), and 1 year (1.5).

"The ITT analysis indicated no additional benefit of uPOD+PT to uPOD in the primary outcome of FAAM change at 6 months. Secondary outcomes from ITT analysis demonstrated improvements in pain at 6 weeks and 1 year that favored the uPOD+PT group," wrote the authors.

"Per-protocol analysis demonstrated additional benefit and a higher rate of success of uPOD+PT, but due to potential bias of PP analysis, these findings require more rigorous investigation," they concluded.

The study, "Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel pain: a randomized clinical trial," is published in the journal BMC Musculoskeletal Disorders.

DOI: https://doi.org/10.1186/s12891-019-3009-y