The authors of his study defined a “core approach” consisting of plantar fascia stretching, low dye taping and individualised patient education, which should be used for 4-6 weeks before considering additional interventions, such as orthoses or shockwave therapy.
The education intervention included four subcategories:
- Load management: breaking up long periods of static loading (standing) and reducing compressive and stretch-related dynamic loading (e.g., during running);
- Pain education: knowledge about pain and relation to tissue state, developing realistic expectations of prognosis;
- Related conditions: address comorbidities, reducing increased body weight;
- Footwear: supportive, comfortable footwear with rearfoot to forefoot drop, avoiding unsupported footwear and barefoot walking.
If patients with PHP do not improve with the core approach, it is recommended to apply additional electrical shock wave therapy (ESWT). If the core approach and ESWT are not successful, it is recommended to use custom orthoses. If this is also unsuccessful, other treatments such as dry needling, corticosteroid and platelet-rich plasma injection therapy, or resistance exercises can be incorporated.
According to the developed best practice guideline, the clinician should take each patient’s treatment history and experience into consideration. It is also recommended to develop locally audit, monitoring and checklist tools to support implementation of this best practice guideline.
Finally it should be noted that, though this guideline aims to inform and guide patient care, further work is required to update the treatment approach.
> From: Morrissey et al., Br J Sports Med (2021) (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.
Expert opinion
The authors of this study tried to address the problem of existing guidelines that lack clear recommendations for patients with PHP. The combination of a meta-analysis with expert opinions is a great way for this. On top of this, it is fantastic to see that the authors integrated the patient’s perspective, which is unfortunately rarely considered in research.
The authors applied a structured way to analyse and summarise the expert opinion and patients’ views. However, both remain subjective and there is a risk of distortion of current evidence. So, this article should be seen as a first step in the development of a practice guideline for PHP. Hopefully future high-quality studies in the field of PHP will enable the development of a high-quality practical recommendation.
