Background: Plantar fasciitis is an overuse injury causing inflammation at the origin of the plantar fascia and is characterized by plantar heel pain that is provoked by taking the first few steps in the morning and by prolonged standing. Dorsiflexion night splints are used to address early morning pain by preventing contracture of the plantar fascia and Achilles tendon overnight. Medial arch supports, on the other hand, address the end of the day pain by preventing overstretch of the plantar fascia during prolonged weight bearing. Therefore, both night splints and arch supports may be necessary to treat plantar fasciitis as they complement each other by both controlling nocturnal contracture of the plantar fascia and Achilles tendon and reducing stresses imposed on the plantar fascia during the day, respectively. Hypotheses: We hypothesized that the night splint and arch support together would be more effective in the treatment of plantar fasciitis than a night splint or arch support alone in terms of increasing the range of pain-free passive ankle dorsiflexion, relieving heel tenderness and pain, and reducing disability imposed by the heel pain/plantar fasciitis. A secondary hypothesis of this study was that those with less passive dorsiflexion of the ankle would benefit from a night splint more than those with greater passive dorsiflexion of the ankle and those with a lower medial longitudinal arch would benefit from an arch support more than those with a higher medial longitudinal arch in terms of the previously mentioned outcome measures. Methodology: Subjects of this study were randomly assigned to one of three treatment groups. Group I was treated with night splints, group II with arch supports, and group III with a combination of night splints and arch supports. Range of motion was measured with a goniometer; heel tenderness was measured with a pressure algometer; and pain and disability were measured by the Foot Function Index before and after six weeks of treatment. Results: Ninety patients with plantar fasciitis (23 men and 67 women) were enrolled in the study, 30 in each group. Demographic, compliance and baseline evaluation data showed no significant differences between the groups. Analysis of the post-intervention evaluation data demonstrated significant differences between group I and III and group II and III, but not between group I and II, for all outcome measures. The range of pain-free passive ankle joint dorsiflexion and medial longitudinal arch height were not useful predictors of the success of treatment with a night splint and arch support for all outcome measures. Discussion: Using night splints and arch supports together may speed time to recovery by accelerating the healing process. Limitations of the study include observers bias, subjects bias, and short follow-up period. Conclusion: It was concluded that a night splint and arch support together may be more effective in the treatment of plantar fasciitis than either a night splint or arch support alone. Patients with plantar fasciitis who have less passive dorsiflexion of the ankle joint do not benefit from a night splint more than those with greater passive dorsiflexion of the ankle joint. Patients with plantar fasciitis who have a lower medial longitudinal arch do not benefit from an arch support more than those with a higher medial longitudinal arch.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-11112006-133842 |
| Date | 15 November 2006 |
| Creators | Alghadir, Ahmad |
| Contributors | Dane Wukich, MD, Ray Burdett, PhD, PT, CPed, James Irrgang, PhD, PT, ATC, Anthony Delitto, PhD, PT, FAPTA |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-11112006-133842/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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