Comparison of Structural Diagnosis and Management (SDM) approach and MyoFascial Release (MFR) for improving plantar heel pain, ankle range of motion and disability: A randomized clinical trial

ABSTRACT

[Purpose] The purpose of this study was to compare the effectiveness of the Structural Diagnosis and Management (SDM) approach with Myofascial Release (MFR) in improving plantar heel pain, ankle range of motion, and disability. [Subjects] Sixty-four subjects, aged 30–60 years, with a diagnosis of plantar heel pain, plantar fasciitis, or calcaneal spur by a physician according to ICD-10, were equally allocated to the MFR (n = 32) and SDM (n = 32) groups by hospital randomization and concealed allocation. [Methods] In this assessor-blinded randomized clinical trial, the control group performed MFR to the plantar surface of the foot, triceps surae, and deep posterior compartment calf muscles, while the experimental group performed a multimodal approach utilizing the SDM concept for 12 sessions over 4 weeks. Both groups also received strengthening exercises, ice compression, and ultrasound therapy. Pain, activity limitations and disability were assessed as primary outcomes using the Foot Function Index (FFI) and Range of motion (ROM) assessment of the ankle dorsiflexors and plantar flexors using a universal goniometer. Secondary outcomes were measured using the Foot Ankle Disability Index (FADI) and a 10-point manual muscle testing process for the ankle dorsiflexors and plantar flexors. [Results] Both MFR and SDM groups exhibited significant improvements from baseline in all outcome variables, including pain, activity level, disability, range of motion, and function after the 12-week intervention period (p < .05). The SDM group showed more improvements than MFR for FFI pain (p < .01), FFI activity (p < .01), FFI (p < .01) and FADI (p = <.01). [Conclusion] Both MFR and SDM approaches are effective in reducing pain, improving function, ankle range of motion, and reducing disability in plantar heel pain, however, the SDM approach may be a preferred treatment option.

KEYWORDS:

• Plantar heel pain
• MFR
• SDM
• FADI
• FFI
• Disability

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Additional information

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Notes on contributors

Sapia Akter

Sapia Akter is a consultant physiotherapist working in the field of musculoskeletal medicine and Women’s health. She completed her bachelor's and master’s degrees in Physiotherapy from the University of Dhaka. She is a Ph.D. fellow at Jashore University of Science and Technology. She has more than 16 year’s clinical experience. She is the co-founder of the Structural diagnosis and management (SDM) concept of Musculoskeletal Medicine.

Mohammad Shahadat Hossain

Mohammad Shahadat Hossain is the chief consultant of the Department of musculoskeletal medicine at the Institute of Advanced mechanical correction therapy. He completed his bachelor's and master’s degree in Physiotherapy from the University of Dhaka. He is a Ph.D. fellow at Jahangirnagar University. He has more than 16 year’s clinical experience. He is the founder of the Structural diagnosis and management (SDM) concept of Musculoskeletal Medicine.

K M Amran Hossain

K M Amran Hossain is a full-time faculty of Jashore University of Science & Technology. Dr. Amran is the founder of 'Amran's School of Thoughts', which promotes healthcare research in lower-middle-income countries. He completed his graduation and post-graduation degree in Physiotherapy from the University of Dhaka. He is the organizing secretary of the national physiotherapy association accredited by the World Physiotherapy. Also, he is the equity, diversity, and belonging co-director of Long COVID Physio. He received 4 International awards for research and leadership. Dr. Amran is a member of a multi-specialty research team for Long COVID. He is also the Academic editor of PLOS One.

Zakir Uddin

Dr. Zakir Uddin did his bachelor's degree from the University of Dhaka (Bangladesh); master's degree from Kobe University (Japan); doctoral degree from McMaster University and post-doctoral fellowship from McGill University. He has worked in 5 different countries (Bangladesh, Japan, Canada, South Korea, United Arab Emirates) and gained clinical, academic teaching, and research experiences in pain rehabilitation and interdisciplinary health approach. His notable academic works were a full-time teaching faculty at the University of Sharjah, UAE, and Woosong University, South Korea; part-time teaching faculty with McMaster University, Canada; Pain research work at McMaster & McGill Universities, Canada.

Mohammad Anwar Hossain

Mohammad Anwar Hossain is a Senior Consultant & Head of the Physiotherapy Department at the Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh. He is also a faculty member and Associate Professor of Physiotherapy at the Bangladesh Health Professions Institute (BHPI). Dr. Hossain has expertise in Musculoskeletal Physiotherapy and nearly has 20 years of experience in the field. Professor Dr. Anwar completed his bachelor's and master’s degree in Physiotherapy from the University of Dhaka and his Ph.D. from Jashore University of Science and Technology.

Foisal Alom

Foisal Alom is a physiotherapist and academic working in the field of musculoskeletal medicine. He completed his bachelor's degree in Physiotherapy from the University of Dhaka, and a master’s degree in Public health from BSM Medical University. He has more than 6 year’s clinical experience. He is the faculty of the national specialized institute for orthopedics, and traumatology rehabilitation in Bangladesh.

Md. Feroz Kabir

Md. Feroz Kabir is an academic, clinician, and researcher. He is the founder of the Department of Physiotherapy and Rehabilitation at Jashore University of Science & Technology. He completed his graduation and post-graduation degree in Physiotherapy from the University of Dhaka. He is a Ph.D. fellow at the University of Malaysia Sabah. He is the awardee of the World Physiotherapy for promoting Physiotherapy education in lower-middle-income countries. He is also the Academic editor of PLOS One. As a clinician, Dr. Kabir is a consultant physiotherapist at BRB Hospitals, one of the largest corporate hospitals in Dhaka.

Lori Maria Walton

Lori Maria Walton is a professor of neuroscience in the Department of Physical Therapy at The University of Scranton in the USA. Dr. Walton completed a Ph.D. from Nova Southeastern University and a DPT from Creighton University. Dr. Walton was inducted into the International Research Scholars in 2011-present. Dr. Walton’s research is focused on community-based physical therapy programs for vulnerable populations, with a special emphasis on migrant & refugee health.

Veena Raigangar

Veena Raigangar is a Senior Lecturer at the School of Sport and health sciences at the University of Brighton. She has a double Master’s in Physiotherapy and Education and is currently pursuing her Ph.D. in the UK. She is part of the Metabolic Syndrome and Related Disorders Research group at the University of Sharjah, with several high-impact peer-reviewed papers related to physical activity, biomarkers, and stress. She is also a part of funded ongoing research projects in the field of physical activity and pregnancy with the research group and is working on some publications in this area. Dr. Veena worked at the University of Sharjah for nearly 15 years.