Summary of Research for Massage and Plantar Fasciitis
Plantar Fasciitis (PF) is the most common foot condition treated by physical therapists.(2)  Although it can affect anyone at any age, PF has a higher prevalence in women ages 40-60.(6)  Obesity or sudden weight gain, reduced ankle dorsiflexion, pes planus, and occupations that require prolonged weight-bearing are the greatest risk factors associated with PF.(6)  During evaluation, clinicians may expect patients to report an insidious onset of heel pain that is most acute with the first few steps in the morning or when rising after prolonged sitting.  The pain should be located near the insertion of the plantar aponeurosis at the medial calcaneal tubercle, the insertion of the plantar fascia.  Clinicians can use the questions listed on page 1 as activity limitation measures.(2)  The Foot and Ankle Ability Measure (FAAM), which has been validated in physical therapy practice, can be used as a functional outcome measure for patients with PF.(2) On observation, clinicians might observe an antalgic gait, over-pronation, pes planus or pes cavus and/or decreased ankle dorsiflexion.  On palpation, clinicians may expect pain to be acute at the insertion of the plantar fascia, along the longitudinal arch and/or on the inferior portion of the calcaneus.  Pain might be reproduced during active and/or passive toe extension and the Windlass Test is the special test of choice for structural impairment. When the patient’s symptoms or impairments are not consistent with PF, clinicians should consider differential diagnoses.  When addressing prognosis, the clinician should be aware that although reduction in pain varies with each person, there is a positive outcome for 80% of patients within a 12 month period of treatment.(14)  Regarding modalities, moderate evidence supports iontophoresis delivered dexamethasone 0.4% or acetic acid 5% over the course of 6 visits to provide short-term (2-4 weeks) relief of pain and improved function.(16)  Based on moderate evidence, Gastrocnemius/Soleus stretching or plantar fascia-specific stretching provides short-term (2-4 months) pain relief.(17,20) Based on moderate evidence, myofascial trigger point manual massage therapy combined with self-stretching is of superior benefit to stretching alone when treating plantar heel pain.(31)  Low-Dye taping or Windlass Taping can be used to provide very short-term (1-10 days) of pain relief and may be indicated when subjects are awaiting orthotics.(11,22)  Strong evidence supports the use of either pre-fabricated or custom orthotic devices for the short-term (3 months) reduction of pain and improvement of function.(23,24)  With chronic PF (symptoms longer than 6 months), moderate evidence supports the wearing of a night splint for 1-3 months for the reduction of symptoms and increase in dorsiflexion.(25,26)  For patients that do not respond to treatment, strong evidence supports ESWT as a non-surgical alternative to treat chronic recalcitrant Plantar Fasciitis.(25,27,28)



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