Case report
Combination of Hip Strengthening and Manipulative Therapy for the Treatment of Plantar Fasciitis: A Case Report

https://doi.org/10.1016/j.jcm.2016.08.001Get rights and content

Abstract

Objective

The purpose of this case report is to describe the management of using a combination of hip strengthening and manipulative therapy (MT) for a patient with plantar fasciitis.

Clinical Features

A 44-year-old patient reported heel pain for approximately 1 year before treatment. The patient reported plantar heel pain and tenderness at the calcaneal tuberosity. The pain was most noticeable in the morning but was reduced after a 30-minute walk. A diagnosis of plantar fasciitis was made at the initial assessment.

Intervention and Outcomes

Initially, a clinical evaluation was performed to measure pain intensity (Numeric Pain Rating Scale), pressure-pain threshold (algometry), and perceived exertion (OMNI Resistance Exercise Scale). The patient then underwent 10 sessions of hip strengthening and MT over a period of 3 months. After the treatment, the intensity of pain and the pressure-pain threshold was reevaluated. The patient reported an improvement in pain intensity (baseline score = 6 vs final score = 1) and an increase in the pressure-pain threshold (initial score = 2.6 vs final score = 7.1). Perceived exertion was also improved after hip muscle strength training (initial score = 10 vs final score = 8).

Conclusion

The combination of hip strengthening and MT improved foot pain in a patient with a clinical diagnosis of plantar fasciitis.

Introduction

Plantar fasciitis (PF) is the most common foot condition treated by health care providers.1 This painful condition can cause impairment of activity and disability.2 In the United States, about 2 million people are treated annually for this complaint.3, 4 Patients usually report pain after palpation of the proximal insertion of the plantar fascia and plantar medial heel, and the pain is most noticeable when patients begin walking after a period of inactivity.1 Clinicians have used many approaches for treating pain and enhancing function.

Manipulative therapy (MT) has been used as a treatment option for PF in several previous studies,5, 6, 7, 8, 9, 10, 11 and randomized clinical trials have recommended MT for improving the pain and function in PF patients.7, 8 The techniques for PF treatment include passive joint manipulation of the ankle and foot; myofascial maneuvers of the gastrocnemius, soleus muscles, and plantar fascia; neural mobilization of the tibial nerve; and stretching of the plantar fascia and triceps surae.1 A recent study reported that strengthening the hip abductors and external rotators is effective for reducing pain in fasciitis.12 The strengthening of hip muscles has been recommended for the treatment of various musculoskeletal disorders, with improvement reported in patients with knee,13 hip,14 and lower back pain.15 The purpose of this case report is to describe use of a combination of hip strengthening and MT in the management of a patient with PF.

Section snippets

Case Report

A 44-year-old woman presented with pain in her right foot. The PF diagnosis was made from the patient history and a physical examination, which was consistent with published PF guidelines.1 The woman had a body mass index of 31.2 kg/m2 and was physically active (jogging), with no hormonal dysfunction or rheumatic disease. The patient reported plantar medial heel pain and tenderness at the calcaneal tuberosity. This pain was most noticeable in the morning but was reduced after a painful

Discussion

Although previous studies have investigated the effects of MT5, 6, 7, 8, 9, 11 and hip strengthening12 separately for the treatment of PF, the combination of these 2 approaches had not been previously evaluated. This case report describes a meaningful improvement in heel pain after a treatment that combined manual therapy with hip strengthening exercises. We also report improvement in muscle strength and in the pressure-pain threshold. The clinical features of this case report (age, obesity,

Conclusion

The combination of hip strengthening and MT resulted in reduced pain intensity, an increased pressure-pain threshold, and increased strength of hip muscles in the patient reported on in this case study.

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Contributorship Information

  • Concept development (provided idea for the research): L.A.C.N., B.S.

  • Design (planned the methods to generate the results): L.A.C.N., B.S.

  • Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): L.A.C.N., B.S., N.A.M.F., T.L.

  • Data collection/processing (responsible for experiments, patient management, organization, or reporting data): B.S.

  • Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results):

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  • Cited by (7)

    • Low back pain and disability in individuals with plantar heel pain

      2018, Foot
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      Thus, it may be warranted to refer individuals with concomitant LBP and PHP to healthcare professionals, such as a physical therapist, who can address both proximal and local factors related to PHP. Although no studies were found that assessed outcomes of concurrent management of low back impairments and PHP intervention, inclusion of hip interventions with local foot and ankle treatment for PHP has been successful [44,45]. Further studies are warranted to determine if management of LBP and low back dysfunction can improve outcomes of individuals with PHP and to determine which patients will benefit from combined low back and PHP treatment.

    • Plantar heel pain

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    • Physical and psychological predictors on pain intensity in conscripts with plantar fasciitis

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      Beyond addressing foot biomechanics, examining gait variables in the area proximal to the foot and ankle may clearly illustrate gait deviations in PF. A number of studies have also mentioned decreased strength of the core trunk and hip muscles as possible risk factors for PF.13,14 The reduction in core strength may alter the lower-extremity movement pattern, resulting in excessive femoral adduction and medial rotation as well as knee valgus, all of which may have significant implications for distal limb function.

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