Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review

Abstract

Objective: To assess if manual therapy (MT) in the treatment of plantar fasciitis (PF) patients improves pain and function more effectively than other interventions.

Methods: A systematic review of all randomized control trials (RCTs) investigating the effects of MT in the treatment of human patients with PF, plantar fasciosis, and heel pain published in English on PubMed, CINAHL, Cochrane, and Web of Science databases was conducted. Research quality was appraised utilizing the PEDro scale. Cohen's d effect sizes (ES) and associated 95% confidence intervals (CI) were calculated between treatment groups.

Results: Seven RCTs were selected that employed MT as a primary independent variable and pain and function as dependent variables. Inclusion of MT in treatment yielded greater improvement in function (6 of 7 studies, CI that did not cross zero in 14 of 25 variables, ES = 0.5-21.5) and algometry (3 of 3 studies, CI that did not cross zero in 9 of 10 variables, ES = 0.7-3.0) from 4 weeks to 6 months when compared to interventions such as stretching, strengthening, or modalities. Though pain improved with the inclusion of MT, ES calculations favored MT in only 2 of 6 studies (3 of 13 variables) and was otherwise equivalent in effectiveness to comparison interventions.

Discussion: MT is clearly associated with improved function and may be associated with pain reduction in PF patients. It is recommended that clinicians consider use of both joint and soft tissue mobilization techniques in conjunction with stretching and strengthening when treating patients with PF.

Level of evidence: Treatment, level 1a.

Keywords: Mobilization; aponeurosis; heel pain; manipulation; plantar fascia; soft tissue.

Figures

Figure 1.

Study selection process and search results with outcome measures of concern.

Figure 2.

Effect sizes and 95% CIs of patient-reported outcome measures of pain comparing manual therapy with control interventions in patients with plantar fasciitis.

Figure 3.

Effect sizes and 95% CIs of patient-reported outcome measures of function comparing manual therapy with control interventions in patients with plantar fasciitis.

Figure 4.

Effect sizes and 95% CIs of algometry/pressure-pain thresholds comparing manual therapy with control interventions in patients with plantar fasciitis.