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Published in: BMC Musculoskeletal Disorders 1/2007

Open Access 01-12-2007 | Research article

Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial

Authors: Joel A Radford, Karl B Landorf, Rachelle Buchbinder, Catherine Cook

Published in: BMC Musculoskeletal Disorders | Issue 1/2007

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Abstract

Background

Plantar heel pain is one of the most common musculoskeletal disorders of the foot and ankle. Treatment of the condition is usually conservative, however the effectiveness of many treatments frequently used in clinical practice, including stretching, has not been established. We performed a participant-blinded randomised trial to assess the effectiveness of calf muscle stretching, a commonly used short-term treatment for plantar heel pain.

Methods

Ninety-two participants with plantar heel pain were recruited from the general public between April and June 2005. Participants were randomly allocated to an intervention group that were prescribed calf muscle stretches and sham ultrasound (n = 46) or a control group who received sham ultrasound alone (n = 46). The intervention period was two weeks. No participants were lost to follow-up. Primary outcome measures were 'first-step' pain (measured on a 100 mm Visual Analogue Scale) and the Foot Health Status Questionnaire domains of foot pain, foot function and general foot health.

Results

Both treatment groups improved over the two week period of follow-up but there were no statistically significant differences in improvement between groups for any of the measured outcomes. For example, the mean improvement for 'first-step' pain (0–100 mm) was -19.8 mm in the stretching group and -13.2 mm in the control group (adjusted mean difference between groups -7.9 mm; 95% CI -18.3 to 2.6). For foot function (0–100 scale), the stretching group improved 16.2 points and the control group improved 8.3 points (adjusted mean difference between groups 7.3; 95% CI -0.1 to 14.8). Ten participants in the stretching group experienced an adverse event, however most events were mild to moderate and short-lived.

Conclusion

When used for the short-term treatment of plantar heel pain, a two-week stretching program provides no statistically significant benefit in 'first-step' pain, foot pain, foot function or general foot health compared to not stretching.
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Literature
1.
go back to reference Riddle DL, Schappert SM: Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004, 25 (5): 303-310.PubMed Riddle DL, Schappert SM: Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004, 25 (5): 303-310.PubMed
2.
go back to reference Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB: Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol. 2004, 159 (5): 491-498. 10.1093/aje/kwh071.CrossRefPubMed Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB: Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol. 2004, 159 (5): 491-498. 10.1093/aje/kwh071.CrossRefPubMed
3.
go back to reference Badlissi F, Dunn JE, Link CL, Keysor JJ, McKinlay JB, Felson DT: Foot musculoskeletal disorders, pain, and foot-related functional limitations in older persons. J Am Geriatr Soc. 2005, 53 (6): 1029-1033. 10.1111/j.1532-5415.2005.53315.x.CrossRefPubMed Badlissi F, Dunn JE, Link CL, Keysor JJ, McKinlay JB, Felson DT: Foot musculoskeletal disorders, pain, and foot-related functional limitations in older persons. J Am Geriatr Soc. 2005, 53 (6): 1029-1033. 10.1111/j.1532-5415.2005.53315.x.CrossRefPubMed
4.
5.
go back to reference Clement DB, Taunton JE, Smart GW, McNicol KL: A survey of overuse running injuries. Phys Sportsmed. 1981, 9 (5): 47-58. Clement DB, Taunton JE, Smart GW, McNicol KL: A survey of overuse running injuries. Phys Sportsmed. 1981, 9 (5): 47-58.
6.
8.
go back to reference Agosta J: Epidemiology of a podiatric sports medicine clinic. Aust Podiatrist. 1994, 28 (4): 93-96. Agosta J: Epidemiology of a podiatric sports medicine clinic. Aust Podiatrist. 1994, 28 (4): 93-96.
9.
go back to reference Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD: A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002, 36 (2): 95-101. 10.1136/bjsm.36.2.95.CrossRefPubMedPubMedCentral Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD: A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002, 36 (2): 95-101. 10.1136/bjsm.36.2.95.CrossRefPubMedPubMedCentral
10.
go back to reference Riddle DL, Pulisic M, Pidcoe P, Johnson RE: Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003, 85-A (5): 872-877.PubMed Riddle DL, Pulisic M, Pidcoe P, Johnson RE: Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003, 85-A (5): 872-877.PubMed
11.
go back to reference Irving DB, Cook JL, Menz HB: Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006, 9 (1-2): 11-22. 10.1016/j.jsams.2006.02.004.CrossRefPubMed Irving DB, Cook JL, Menz HB: Factors associated with chronic plantar heel pain: a systematic review. J Sci Med Sport. 2006, 9 (1-2): 11-22. 10.1016/j.jsams.2006.02.004.CrossRefPubMed
12.
go back to reference Crawford F, Thomson C: Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003, CD000416-3 Crawford F, Thomson C: Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003, CD000416-3
13.
go back to reference Landorf KB, Keenan AM, Herbert RD: Effectiveness of three foot orthoses for plantar fasciitis: a randomised trial. Arch Intern Med. 2006, 166 (12): 1305-1310. 10.1001/archinte.166.12.1305.CrossRefPubMed Landorf KB, Keenan AM, Herbert RD: Effectiveness of three foot orthoses for plantar fasciitis: a randomised trial. Arch Intern Med. 2006, 166 (12): 1305-1310. 10.1001/archinte.166.12.1305.CrossRefPubMed
14.
go back to reference Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C: Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med. 2006, 40 (10): 870-875. 10.1136/bjsm.2006.029348.CrossRefPubMedPubMedCentral Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C: Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med. 2006, 40 (10): 870-875. 10.1136/bjsm.2006.029348.CrossRefPubMedPubMedCentral
15.
go back to reference Carlson RE, Fleming LL, Hutton WC: The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle. Foot Ankle Int. 2000, 21 (1): 18-25.PubMed Carlson RE, Fleming LL, Hutton WC: The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle. Foot Ankle Int. 2000, 21 (1): 18-25.PubMed
16.
go back to reference Erdemir A, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA: Dynamic loading of the plantar aponeurosis in walking. J Bone Joint Surg Am. 2004, 86-A (3): 546-52.PubMed Erdemir A, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA: Dynamic loading of the plantar aponeurosis in walking. J Bone Joint Surg Am. 2004, 86-A (3): 546-52.PubMed
17.
go back to reference DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF: Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. J Bone Joint Surg Am. 2003, 85-A (7): 1270-1277.PubMed DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF: Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. J Bone Joint Surg Am. 2003, 85-A (7): 1270-1277.PubMed
18.
go back to reference Porter D, Barrill E, Oneacre K, May BD: The effects of duration and frequency of Achilles tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomised, blinded, control study. Foot Ankle Int. 2002, 23 (7): 619-624.CrossRefPubMed Porter D, Barrill E, Oneacre K, May BD: The effects of duration and frequency of Achilles tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomised, blinded, control study. Foot Ankle Int. 2002, 23 (7): 619-624.CrossRefPubMed
19.
go back to reference Bennett PJ, Patterson C, Wearing S, Baglioni T: Development and validation of a questionnaire designed to measure foot-health status. J Am Podiatr Med Assoc. 1998, 88 (9): 419-428.CrossRefPubMed Bennett PJ, Patterson C, Wearing S, Baglioni T: Development and validation of a questionnaire designed to measure foot-health status. J Am Podiatr Med Assoc. 1998, 88 (9): 419-428.CrossRefPubMed
20.
go back to reference Bennell K, Talbot R, Wajswelner H, Techovanich W, Kelly D: Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother. 1998, 44 (3): 175-180.CrossRefPubMed Bennell K, Talbot R, Wajswelner H, Techovanich W, Kelly D: Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother. 1998, 44 (3): 175-180.CrossRefPubMed
21.
go back to reference Redmond AC, Crosbie J, Ouvrier RA: Development and validation of a novel rating system for scoring foot posture: the Foot Posture Index. Clinical Biomechanics. 2006, 21 (1): 89-98. 10.1016/j.clinbiomech.2005.08.002.CrossRefPubMed Redmond AC, Crosbie J, Ouvrier RA: Development and validation of a novel rating system for scoring foot posture: the Foot Posture Index. Clinical Biomechanics. 2006, 21 (1): 89-98. 10.1016/j.clinbiomech.2005.08.002.CrossRefPubMed
22.
go back to reference Kelly AM: Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain?. Acad Emerg Med. 1998, 5 (11): 1086-1090.CrossRefPubMed Kelly AM: Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain?. Acad Emerg Med. 1998, 5 (11): 1086-1090.CrossRefPubMed
23.
go back to reference Powell CV, Kelly AM, Williams A: Determining the minimum clinically significant difference in visual analog pain score for children. Ann Emerg Med. 2001, 37 (1): 28-31. 10.1067/mem.2001.111517.CrossRefPubMed Powell CV, Kelly AM, Williams A: Determining the minimum clinically significant difference in visual analog pain score for children. Ann Emerg Med. 2001, 37 (1): 28-31. 10.1067/mem.2001.111517.CrossRefPubMed
24.
go back to reference Kelly AM: The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001, 18 (3): 205-207. 10.1136/emj.18.3.205.CrossRefPubMedPubMedCentral Kelly AM: The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001, 18 (3): 205-207. 10.1136/emj.18.3.205.CrossRefPubMedPubMedCentral
25.
go back to reference Vickers AJ, Altman DG: Statistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ. 2001, 323 (7321): 1123-4. 10.1136/bmj.323.7321.1123.CrossRefPubMedPubMedCentral Vickers AJ, Altman DG: Statistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ. 2001, 323 (7321): 1123-4. 10.1136/bmj.323.7321.1123.CrossRefPubMedPubMedCentral
26.
go back to reference Twisk J, Proper K: Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up. J Clin Epidemiol. 2004, 57: 223-228. 10.1016/j.jclinepi.2003.07.009.CrossRefPubMed Twisk J, Proper K: Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up. J Clin Epidemiol. 2004, 57: 223-228. 10.1016/j.jclinepi.2003.07.009.CrossRefPubMed
27.
go back to reference Raab GM, Day S, Sales J: How to select covariates to include in the analysis of a clinical trial. Control Clin Trials. 2000, 21 (4): 330-342. 10.1016/S0197-2456(00)00061-1.CrossRefPubMed Raab GM, Day S, Sales J: How to select covariates to include in the analysis of a clinical trial. Control Clin Trials. 2000, 21 (4): 330-342. 10.1016/S0197-2456(00)00061-1.CrossRefPubMed
28.
go back to reference James KE, Bloch DA, Lee KK, Kraemer HC, Fuller RK: An index for assessing blindness in a multi-centre clinical trial: Disulfiram for alcohol cessation - a VA cooperative study. Stat Med. 1996, 15: 1421-1434. 10.1002/(SICI)1097-0258(19960715)15:13<1421::AID-SIM266>3.0.CO;2-H.CrossRefPubMed James KE, Bloch DA, Lee KK, Kraemer HC, Fuller RK: An index for assessing blindness in a multi-centre clinical trial: Disulfiram for alcohol cessation - a VA cooperative study. Stat Med. 1996, 15: 1421-1434. 10.1002/(SICI)1097-0258(19960715)15:13<1421::AID-SIM266>3.0.CO;2-H.CrossRefPubMed
29.
go back to reference Martin JE, Hosch JC, Goforth WP, Murff RT, Lynch DM, Odom RD: Mechanical treatment of plantar fasciitis: A prospective study. J Am Podiatr Med Assoc. 2001, 91 (2): 55-62.CrossRefPubMed Martin JE, Hosch JC, Goforth WP, Murff RT, Lynch DM, Odom RD: Mechanical treatment of plantar fasciitis: A prospective study. J Am Podiatr Med Assoc. 2001, 91 (2): 55-62.CrossRefPubMed
30.
go back to reference Landorf KB, Radford JA, Keenan AM, Redmond AC: Effectiveness of low-Dye taping for short-term management of plantar fasciitis. J Am Podiatr Med Assoc. 2005, 95 (6): 525-530.CrossRefPubMed Landorf KB, Radford JA, Keenan AM, Redmond AC: Effectiveness of low-Dye taping for short-term management of plantar fasciitis. J Am Podiatr Med Assoc. 2005, 95 (6): 525-530.CrossRefPubMed
31.
go back to reference Pfeffer G, Bacchetti P, Deland J, Lewis A, Anderson R, Davis W, Alvarez R, Brodsky J, Cooper P, Frey C, Herrick R, Myerson M, Sammarco J, Janecki C, Ross S, Bowman M, Smith R: Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int. 1999, 20 (4): 214-221.CrossRefPubMed Pfeffer G, Bacchetti P, Deland J, Lewis A, Anderson R, Davis W, Alvarez R, Brodsky J, Cooper P, Frey C, Herrick R, Myerson M, Sammarco J, Janecki C, Ross S, Bowman M, Smith R: Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int. 1999, 20 (4): 214-221.CrossRefPubMed
Metadata
Title
Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial
Authors
Joel A Radford
Karl B Landorf
Rachelle Buchbinder
Catherine Cook
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2007
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-8-36

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