Development of an individualised, supervised and progressed therapist led exercise programme for Plantar Heel Pain (Plantar Fasciitis)

Humphreys, K.; Larkin, T.; Chesterton, L.; Thomas, M.; Roddy, E.; Hendry, G.; Shufflebotham, J.; Foster, N.; Duffy, H.; User Group, Keele Research; Thomas, Martin

Abstract

Purpose: To describe the development, and content of a physiotherapist and podiatrist led individualised, supervised and progressed exercise programme for use in a feasibility and pilot randomised controlled trial (RCT) testing interventions for Plantar Heel Pain (PHP).

Methods: There is limited guidance on how clinicians should use exercise to effectively treat PHP (often referred to as Plantar Fasciitis), which is a common cause of foot pain. The Physiotherapy Research Facilitator team helped develop, arrange and attend a research development group, where a programme was developed from best available evidence, stakeholders (including Physiotherapists, Podiatrists, researchers, GPs, patients, research users), and clinical consensus. A systematic review of randomised and quasi-randomised controlled trials of exercise therapy was undertaken, with an additional synthesis of available national guidelines and previous clinical surveys identifying exercises routinely used in clinical practice. The Results of this provided the basis for a stakeholder group meeting where the principles of the type, dose and delivery of exercise were discussed and prioritised. Assessment requirements and selected exercises were fed into a clinical consensus process through which a protocol for an intervention of Physiotherapist and Podiatrist led exercise was finalised.

Results: The intervention is designed to be individualised and includes a choice from 20 separate exercises which comprise foot specific stretches and exercises of the; plantar fascia, intrinsic foot muscles, key ankle related and lower limb muscle groups as required. Selection is individualised and determined according to clinical assessment of soft tissue tightness or weakness in the foot and ankle complex and lower limb. Each exercise prescribed is supported by a photograph illustration and specific easy to follow instructions aiming to improve patient understanding and adherence. Progression is permitted in up to 6 consultations. The programme developed is accompanied by a high quality patient information and self-management advice leaflet. This exercise programme was then used by the Physiotherapy Research Facilitators to train clinicians in its use for the intervention during the feasibility and pilot RCT.

Conclusion(s): We combined clinical expertise and research evidence with national guidance in order to develop a physiotherapist/podiatrist led, individualised, progressed and supervised exercise intervention for use within a feasibility and pilot RCT. The feasibility of the intervention is being evaluated within the TREADON trial (ISRCTN 12160508).

Implications: Working in collaboration with other Allied Health Professionals, service users, researchers and managers is fast becoming an essential part of any research project. This group structure and facilitation Method allowed for open discussion and group critique for practical application and use.

Citation

Humphreys, K., Larkin, T., Chesterton, L., Thomas, M., Roddy, E., Hendry, G., …Thomas, M. (2017). Development of an individualised, supervised and progressed therapist led exercise programme for Plantar Heel Pain (Plantar Fasciitis). Physiotherapy, 103(S1), e145-e146. https://doi.org/10.1016/j.physio.2017.11.140

• Journal Article Type: Conference Paper
• Online Publication Date: Dec 13, 2017
• Publication Date: 2017-12
• Deposit Date: Nov 1, 2023
• Journal: Physiotherapy (de Gruyter)
• Publisher: De Gruyter
• Peer Reviewed: Peer Reviewed
• Volume: 103
• Issue: S1
• Pages: e145-e146
• DOI: https://doi.org/10.1016/j.physio.2017.11.140
• Keywords: Physical Therapy, Sports Therapy and Rehabilitation
• Additional Information: This article is maintained by: Elsevier; Article Title: Development of an individualised, supervised and progressed therapist led exercise programme for Plantar Heel Pain (Plantar Fasciitis); Journal Title: Physiotherapy; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.physio.2017.11.140; Content Type: simple-article; Copyright: Copyright © 2017 Published by Elsevier Ltd.