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Journal: Journal of Orthopedic Sports Physical Therapy
Authors: Joshua A. Cleland, J. Haxby Abbott, Martin O. Kidd, Steve Stockwell, Sheryl Cheney, David F. Gerrard, Timothy W. Flinn
Level of Evidence: Ib
Purpose: To compare the effectiveness of 2 different conservative management approaches in the treatment of plantar heel pain.
Target Population: Patients with a primary report of plantar heel pain
Type of Electrotherapy Used: Iontophoresis
• Therapeutic Ultrasound—3 MHz, 1.5 W/cm2, 100 Hz frequency, 20% duty cycle for 5 minutes (For enhanced skin permeability)
• Iontophoresis with dexamethasone—Dose: 40 mA-min (an example of this would be 2 mA x 20 minutes)
• Patients in both groups were treated 2 times per week for 2 weeks, followed by 1 time per week for 2 weeks, for a total of 6 visits over 4 weeks.
• Patients in the Electrophysical Agents and Exercise (EPAX) group received above treatment protocol and were taught stretching and strengthening exercises to be performed 3x/day. Following treatment ice was applied for 15 minutes.
• Patients in the Manual Physical Therapy and Exercise Group (MTEX) received 5 minutes of aggressive soft tissue and rear foot eversion mobilization and an impairment based manual therapy to the hip, knee, ankle, and foot based on a clinical decision of the treating therapist. Patients were also instructed in ankle eversion soft tissue self mobilization and plantar fascia soft tissue mobilization and the same stretches as the EPAX group.
Outcome: Between group differences demonstrated that the MTEX group had statistical significantly greater improvements in the LEFS, FAAM, and greater improvement in NPRS at 4 week follow up compared toe the EPAX group. Both groups showed statistically significant change however only the MTEX group revealed a difference reached the MCID for the test at 4 week follow up. The results of this study demonstrated Manual Therapy with Exercise as a superior treatment approach for improved function compared to Electrophysical Agents and Exercise for plantar fascia heel pain.
Opinion: Based on this article and my prior education, I would not recommend using iontophoresis in the clinic for plantar fascia heel pain as results show faster and clinically significant improvements with manual therapy and exercise.
Citation: 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.