Interventions for treating plantar heel pain.
BACKGROUND
Ten percent of people may experience pain under the heel (plantar heel pain) at some time. Injections, insoles, heel pads, strapping and surgery have been common forms of treatment offered. The absolute and relative effectiveness of these interventions are poorly understood.


OBJECTIVE
The objective of this review was to identify and evaluate the evidence for effectiveness of treatment in treating plantar heel pain.


METHODS
MEDLINE (from 1966 to December 1997), EMBASE and the Cochrane Library were searched. Three podiatry journals (The Foot, The Chiropodist (later The Journal of British Podiatric Medicine), and The British Journal of Podiatric Medicine) were handsearched. We contacted known investigators in the field to identify unpublished data or research in progress. Non English language reports were excluded from the review.


METHODS
Randomised and quasi randomised trials of interventions for plantar heel pain in adults.


METHODS
Two reviewers independently evaluated studies for inclusion, extracted data and assessed study quality. Additional information was obtained by direct contact with investigators. No poolable data were identified. Where measures of variance were available we have calculated the weighted mean differences based on visual analogue scale (VAS) scores.


RESULTS
Eleven randomised trials involving 465 participants were included. Study quality was generally poor, and pooling of data was not possible. All studies measured a reduction in heel pain as the primary outcome. Seven trials evaluated interventions against placebo/dummy or no treatment. There was limited evidence for the effectiveness of topical corticosteroid, administered by iontophoresis in reducing pain. There was no evidence for the effectiveness of injected corticosteroid. There was limited evidence for the effectiveness of low energy extracorporeal shock wave therapy in reducing night pain, resting pain and pressure pain in the short term (12 weeks). In individuals with chronic pain (longer than six months), there was limited evidence for the effectiveness of dorsiflexion night splints in reducing pain. There was no evidence to support the effectiveness of therapeutic ultrasound, low-intensity laser therapy, exposure to an electron generating device or insoles with magnetic foil. No randomised trials evaluating orthotic devices, surgery, or radiotherapy against a control population were identified. There was limited evidence for the superiority of corticosteroid injections over orthotic devices.


CONCLUSIONS
Although there is limited evidence for the effectiveness of local corticosteroid therapy, the effectiveness of other frequently employed treatments in altering the clinical course of plantar heel pain has not been established in comparative studies. Well designed and conducted randomised studies are required.
Crawford
F
F
Department of Health Sciences & Clinical Evaluation, The University of York, Alciun College, Heslington, York, UK, YO1 5DD. fc5@york.ac.uk
Atkins
D
D
Edwards
J
J
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D055590:Electromagnetic Phenomena; D005534:Foot Diseases / Q000628:therapy*; D006801:Humans; D053685:Laser Therapy; D009989:Orthotic Devices; D059408:Pain Management; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D014464:Ultrasonic Therapy
D000305:Adrenal Cortex Hormones