Physical therapist decision-making in managing plantar heel pain: cases from a pragmatic randomized clinical trial

ABSTRACT

Introduction

Plantar heel pain (PHP) is a common condition managed by physical therapists that can, at times, be difficult to treat. Management of PHP is complicated by a variety of pathoanatomic features associated with PHP in addition to several treatment approaches with varying efficacy. Although clinical guidelines and clinical trial data support a general approach to management, the current literature is limited in case-specific descriptions of PHP management that addresses unique combinations of pathoanatomical, physical, and psychosocial factors that are associated with PHP. Purpose: The purpose of this case series is to describe physical therapist decision-making of individualized multimodal treatment for PHP cases presenting with varied clinical presentations. Treatment incorporated clinical guidelines and recent evidence including a combination of manual therapy, patient education, stretching, resistance training, and neurodynamic interventions. A common clinical decision-making framework was used to progress individualized treatment from a focus on symptom modulation initially to increased load tolerance of involved tissues and graded activity. In each case, patients met their individual goals and demonstrated clinically meaningful improvements in pain, function, and global rating of change that were maintained at the 1–2-year follow-up. Implications: This case series provides details of physical therapist management of a variety of PHP clinical presentations that can be used to complement clinical practice guidelines in the management of PHP.

KEYWORDS:

• Plantar fasciitis
• clinical reasoning
• exercise
• manual therapy
• education
• case series

Acknowledgments

Thank you to the Des Moines University Foot and Ankle and Physical Therapy Clinics, Sharon Johansen, Adam Phillips, Ellen Barton, and Alec Standiford for their essential contributions. Portions of this work was completed as part of PhD dissertation research through Rocky Mountain University of Health Professions.

Declaration of Interest

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Orthopaedic Section, American Physical Therapy Association [not applicable];Iowa Osteopathic Education Research Fund at Des Moines University [09-16-03], Des Moines, IA.