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Treatments for plantar heel pain

Clinical bottom line: There is insufficient information on interventions for plantar heel to assess their efficacy.


Plantar heel is a common condition, although runners and patients with inflammatory rheumatic disease are especially affected. The underlying disease process is poorly understood, but is likely to have either an inflammatory or mechanical origin. Disease severity ranges from a dull ache to sever pain resulting in a sedentary lifestyle. Treatments include corticosteroid injection, non-steroidal anti-inflammatory drugs, heel pads, orthoses, exercises, night splints and, in intractable cases, surgical procedures.

Systematic review

Atkins D, Crawford F, Edwards J, Lambert M. A systematic review of treatments for the painful heel. Rheumatology 1999; 38:968-973.

Date review completed: June 1998

Number of trials included: 11 (5 double/single-blind)

Number of patients: 456 (133 single- or double-blind)

Control group: active and placebo

Main outcomes: improvement in pain

Inclusion criteria were randomised or quasi-randomised, controlled trials of treatments for plantar heel pain; English language; published and unpublished reports.

Reviewers provided a descriptive summary of results, as data pooling was not possible. We have only summarised information from double- and single-blind trials.

Findings

Of the 11 included trials, duration of pain ranged from approximately two weeks to 15 years, length of measurements ranged from 1 month to 1 year. Outcomes were mainly pain measured using a VAS. Most trials were small, and probably lacked internal sensitivity. Reviewers did not always provide complete information on treatments and outcomes. Trials were of very poor methodology.

Placebo controls

Low-intensity laser therapy

One double-blind trial of 32 patients showed no benefit of low-intensity laser therapy (30 mW continuous-wave for three periods of 33 sweeps) compared with sham laser.

Ultrasound

One double-blind trial of 19 patients showed no benefit of ultrasound (eight sessions in four weeks, dose 0.5 W/cm 2 , pulsed 1:4, 3 Mz for 8 minutes) compared with sham ultrasound.

Bioelectron MKII (electron beams delivered to skin via probe)

One double-blind trial of 27 patients showed that treatment of five minutes three x daily over 21 days was no better than sham treatment.

Steroid injection plus sponge heel pad versus pad alone

One double-blind trial of 19 patients showed no benefit of steroid injection with heel pad (25 mg hydrocortisone) compared with pad alone

Extracorporeal shock wave therapy (ESWT)

Two non-blind trials reported benefit of ESWT once weekly for three weeks.

Active controls

Ionophoresis plus steroid versus ionophoresis alone

One single-blind trial of 36 patients showed significant improvement with ionophoresis plus dexamethasone at four weeks compared with ionophoresis alone. This benefit was measured at one month only. (Treatment details not described).

Steroid injection versus heal pads

Two non-blind trials reported mixed findings.

Insoles

One non-blinded trial showed no difference between two types of insoles.

Night splints

One non-blinded trial showed benefit with night splint, but only for the first part of the crossover period of the trial.

There were no single- or double-blind trials available for the following interventions: extracorporeal shock wave therapy, night splints, heel pads or insoles.

Adverse effects

Reviewers did not report on adverse effects

Further reading


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