Best Practice Guide for Heel Pain

May 18, 2021   |   Evidence in Integrative Healthcare

A best practice guide for the management of plantar heel pain based on a systematic review and meta-analysis of randomized controlled trails and qualitative evaluation of expert interviews and patient surveys was published in the British Journal of Sports Medicine in March of 2021. This guideline was designed to offer clear, high-quality recommendations, immediately useful to providers and the patients who suffer from this condition.

The quantitative analysis arm of the study found treatment with the best evidence of short-term efficacy was low dye taping, plantar fascia stretching, a variety of extracorporeal shockwave therapy (ESWT) techniques, and custom orthoses, but no significant effect with prefabricated orthoses, magnetized insoles, dry needling, wheatgrass, or calf stretching. The qualitative analysis arm found patient education was key to prevent recurrence through patient engagement, self-management, understanding of physical and non-physical factors, and reassurance of positive long-term prognosis. Specifically, individualized patient education falls into the categories of load management (static and dynamic), pain education (clarity, prognosis, monitoring), related conditions (long term conditions, body mass index), and footwear (socially acceptable, soft support, rear-foot to fore-foot drop, and comfort). The resultant best practice guide supported 4-6 weeks of simultaneous plantar fascia stretching, low dye taping, and patient education before considering ESTW. Custom orthoses were to be considered if ESTW failed to show adequate improvement after a reasonable trial period.1Morrissey, D., et al., Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med, 2021.