From Feb. 21-24, New Orleans will play host to the largest annual physical therapy conference in the country. The American Physical Therapy Association (APTA) Combined Sections Meeting (CSM) is expected to draw more than 12,000 PT professionals and students to “The Big Easy,” where they will enjoy access to course programming designed by all 18 of the APTA’s specialty sections, as well as hundreds of poster presentations.
At a recent CSM, I presented a poster titled, “Utilization of Manual Therapy Including Instrument Assisted Soft Tissue Mobilization (IASTM) for Recalcitrant Plantar Heel Pain.” My co-authors included Temple University colleagues Dr. Ziad Labbad, DPM, MD, Dr. Andrew J. Meyr, DPM, FACFAS, and podiatric medical student Chinenye Ezike, BS.
Statement of Purpose
We noted that plantar heel pain (or plantar fasciosis) is a painful, degenerative, non-inflammatory condition that limits daily function.1 Patients often describe “first-step” pain after periods of non-weight bearing and heel pain that progressively becomes worse with prolonged standing and walking.2
The literature describes multimodal treatment options including modalities, orthotics, stretching, non-steroidal anti-inflammatory drugs, injection and surgery, with differing levels of success.2 Recent evidence suggests that manual therapy techniques are superior to physical agents in the treatment of heel pain.3-5 These manual techniques include mobilization of both the soft tissue and joint.
Our case study described the deliberate use of manual therapy techniques that included joint mobilization and IASTM for a 50-year-old female patient. She was referred to me by a podiatric surgeon for physical therapy, based on a seven-year history of plantar heel pain that had been unresponsive to conservative management.
This patient was employed as a respiratory therapist and noted significant pain during her workday. Previous unsuccessful treatments included custom orthotics, stretching, corticosteroid injection, night splints, strappings and electrocorporeal shock-wave therapy.
I initiated treatment that included IASTM to the calf and plantar fascia, lateral calcaneal glide mobilizations, and passive dorsiflexion stretching. A home-exercise program was prescribed for the gastrocnemius, soleus and fascia-specific flexibility. We utilized the Foot Function Index (FFI) as primary outcomes measure for pain and functional improvement.
The patient completed five physical therapy sessions over seven weeks. On initial examination, her FFI score was 45 percent, indicative of moderate perceived level of disability. After four treatments, the FFI score had been reduced to 16 percent. On discharge following the fifth visit, her score stood at 5 percent. At two months follow-up, the patient reported being completely pain-free and without limitations.
The findings of this case study highlighted the efficiency of IASTM and manual therapy in the treatment of plantar heel pain. To date, limited research is available specific to the utilization of IASTM for chronic heel pain. Evidence has revealed the benefit of IASTM in rat models for accelerating the healing of medial collateral ligament tears.6
It is theorized that the microtrauma from IASTM assists in soft tissue healing. This technique has been associated with improving collagen synthesis and orientation by promoting fibroblast proliferation. Further research is needed to accurately assess IASTM for management of soft tissue pathologies.
- Lemont H, Ammirati KM, Usen N. Plantar fasciitis: A degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003. 93(3):234-237.
- Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: Revision 2014. J Orthop Sports Phys Ther. 2014. 44(11):A1-33.
- Ajimsha MS, Binsu D, Chithra S. Effectiveness of myofascial release in the management of plantar heel pain: A randomized controlled trial. Foot (Edinb). 2014. 24(2):66-71.
- Cleland JA, Abbott JH, Kidd MO, et al. Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: A multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2009. 39(8):573-585.
- Renan-Ordine R, Alburquerque-Sendin F, de Souza DP, et al. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: A randomized controlled trial. J Orthop Sports Phys Ther. 2011. 41(2):43-50.
- Loghmani MT, Warden SJ. Instrument-assisted cross-fibre massage accelerates knee ligament healing. J Orthop Sports Phys Ther. 2009. 506-514.
Dr. Steven J. Pettineo is a clinical assistant professor and chair of the Department of Podiatric Biomechanics at Temple University School of Podiatric Medicine in Philadelphia.
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