Evidence based project report by kanchan koul

EFFECTIVENESS OF TAPING IN PLANTAR FASCIITIS

By Kanchan koul

Department Of Physiotherapy M.S.Ramaiah

Medical College and Teaching Hospital Bangalore, India.

EVIDENCE BASED PROJECT

EFFECTIVENESS OF TAPING IN PLANTAR FASCITIS

ii | P a g e


M.S.Ramaiah Medical College

Department Of Physiotherapy

Declaration by the

candidateI hereby declare that this Evidence Based Project work entitled “EFFECTIVENESS

OF TAPING IN PLANTAR FASCIITIS” is an original and genuine research work Carried out by me under the guidance of DR. RAMESH DEBUR P.TASSTITANTPROFFESSOR, Department of physiotherapy, M.S.Ramaiah Medical College And Teaching Hospital.

iii | P a g e

Kanchan KoulDate: 06-07-2012

Place: Bangalore. India.


Certificate

This is to certify that Ms. Kanchan Koul has done

evidence based project titled “EFFECTIVENESS OF

TAPING IN PLANTAR FASCIITIS” under supervision

of Dr. Ramesh Debur as a part of their curriculum.

iv | P a g e

Place: India

HOD & ProfessorMrs. Savita RavindraDepartment of Physiotherapy M.S.Ramaiah Medical College & Teaching

Place: India

Dr. Ramesh DeburAssistant ProfessorDepartment of Physiotherapy M.S.Ramaiah Medical College & Teaching


S.NO

1

2

3

4

5

6

7

8

9

10

11

12

CONTENTS

INTRODUCTION

PATHOPHYSIOLOGY

CAUSES

CLINICAL FEATURES

DIFFERENTIAL DIAGNOSIS

TREATMENT

TAPPING

EVIDENCES AVAILABLE

SUMMARY

CONCLUSSION

FOOT NOTES

BABILLOGRAPHY

PAGE NO.

3

4

4

5

6

7

8

11

15

15

15

16

v | P a g e


INTRODUCTION:

Plantar fasciitis is a common clinical condition called as ‘repetitive strain injury’. Two million people in U.S are being treated every year for plantar fasciitis [1, 2]. National centre of health statistics reports that more than 11 million people in U.S suffer foot and ankles injures every year. American academy of orthopaedic surgeon estimates that 2 million people seek treatment for plantar fasciitis every year. It is also estimated that 90-95% of patient who have true plantar fasciitis recover with conservative treatment [5]. Literature studies indicate that plantar fasciitis may be successfully treated using a conservative approach. Plantar fasciitis is commonly known as heel pain or a “dog’s heel”. Previously it was known as “flip flop” diseases among podiatrist .Patient comes to the outpatient department with the complaint of sharp pain in the inner aspect of the heel and arch of the foot with the few steps in the morning or after long period of non-weight bearing. Pain improves while waking and may become worst at the end of the day [3]. The plantar fascia works in two-fold process, statically it stabilized the longitudinal arch (medial), and dynamically by restoring arch and reconfiguring foot in efficient toe-off. It is a common problem in adults. The common cause being the inflammation to the dense tissue extending from the calcaneus to the me- tarsal, region, damaged fascia lead to painful condition and further inflammation to the muscles and fat pad. Due to repetitive nature of walking, plantar fasciitis may also be repetitive stress disorder [4]. Symptom being the throbbing, a dull arch or a fatigue- like sensation in the medal arch of the foot after prolonged period of standing.

Half of the population with plantar fasciitis gets heels spurs and when thickened, inflamed fascia rubs against a heel spur patient gets a severe pain [6]. Plantar fascia loads the maximum tension of approximately two times the body weight .Maximum tension further increase when there is lack of flexibility of the muscle of foot and calf. It is major problem faced by obese patients as heel pain stops their ability to walk and exercise. On palpation there is point tenderness over the medial tuberosity of the calcium or all over the fascia [7] .Mostly Seen in the middle age adults and the incident increases after the 5-6 decade of life [8]. Commonly seen in obese individuals, athletes occupation related work that required long time standing e.g. labourers, cooks, traffic police, nurses and military personals .Recent studies had shown that there is no radiological changes in plantar fasciitis. As a main stabilizer of medial longitudinal arch of the foot ,it also help in reducing the ground reactive forces therefore act as shock absorber plantar fascia’s efficient function on the configuration

vi | P a g e


of the mid foot and rare foot articulation during the different phases of the gait [9] .Plantar fascia act on windlass mechanism creating tension on the distal aspect of the foot transmitting to the proximal attachment on the medial side the heel there by causing the calcaneus to invert , medial arch rises causing four foot re-approximation with rare foot [10]. Preventive protocols and conservative treatment together have shown as effective in reducing the symptoms. This paper will review the causes, pathophysiology of plant fasciitis with principle of tapping together with effectiveness of applying tapping during and after treatment program. Tape to the plantar fascia is decided on the basis of its cost, effectiveness, easily availability, and easy applicability, reduce treatment timing and cosmetic treatment.

PATHO PHYSIOLOGY OF PLANTAR FASCIITIS: Origin of plantar fascia from the medial calcaneal tuberosity which splits into medial, lateral and central bands fascia further divides into five slips and turn over metatarsophalangeal joints and attaches to phalanges of digits [19].It is the place were plantar fascia commonly becomes swollen and inflamed. Repetitive trauma to the plantar fasciitis’s ability to recover may lead degenerative changes and an increases risk of injuries with pain and excessive pronation of the foot. Excessive inflammation to fascia called as plantar fasciitis, if the inflammation is limited to the insertion it is called as ‘HEEL PAIN’.MRI

Studies have shown the increase height of navicluar by 10mm .

CAUSES:

1. Poor foot biomechanics, over pronated foot, age, obesity/ weight styles, bad foot were, repetitive activities.

2. Increasing loading of plantar fasciitis (walking on hard surface)3. Abnormal foot alignment

a. cavus foot (high arch)b. Plano valgus footc. limb length discrepancyd. Extremely rotated lower limb.

4. Fat pad atrophy5. Tight Achilles tendon6. Local inflammatory condition

a. Sprain of the footb. Nerve entrapment

vii | P a g e


c. Sub calcaneal bursitisd. Inflammatory arthritise. gount

7. Bony disordersa. Sub talar instabilityb. Calcaneal spurc. Calcaneal stress fracture

viii | P a g e


CLINICAL FEATURES- Assessment:

1. Patients Complaint of-pain when he takes first steps after getting out of bed or after sitting for a long time.2 .Area of symptom: medial lateral aspect of the foot.3. Type of pain: Gradual, intermittent, insidious, more in the morning.

Aggravated by–walking, standing for long, standing on toes cycling, aerobics

Prolonged ambulation, climbing stairs, or doing toe raises Relieved by- rest, cold application, Irritability- moderate to severe Screening Question- pain in bottom of the heel

4. Objective examination-posture -pronated feet.5. Local observation –swelling present on bottom of foot.

6. gait- excessive pronation while walking.

7. Palpation – tender spot deep in the tissue, tenderness present in middle of plantar ligament.

8. Range of motion –dorsiflexion reduces, excessive pronation.

9. Muscle power-weakness of dorsiflexion.

10. Muscle length- tendon Achilles tightness.

DIFFERENTIAL DIAGNOSES:

It includes calcaneal stress fractures, patient on corticosteroid injections, bursitis of the plantar heel and tarsal tunnel syndrome, entrapment of the nerves -posterior tibia Nerve, medial plantar nerve, and lateral plantar nerve can cause symptoms mimicking plantar fasciitis. Patient with chronic foot pain it is suggested to rule out fibro sarcoma and lumber radiculopathy. It can be misdiagnosed as heel spur.

ix | P a g e


TREATMENT METHODS

1. Rest the foot –avoid standing or walking for too long. Avoid wearing tight shoes.

2. Cold therapy- Provide temporary relief in symptoms.

3. Exercise- Stretch to the foot muscles and calf muscles or significantly improves the outcome .[18]

A. towel stretching

B. standing calf stretch

C. Plantar fascia stretch

4. Foot wear correction- Literature revive has shown the significant of using custom orthotic and shoe insert of pre-fabricated type are effective in reducing symptoms .[18]

5. Heel pads raises by 1cm

6. Taping - Recent studies have evaluated the effectiveness of taping in heel pain.

8. Splint at night- prevent excessive plantar flexing and maintains and toe in full extension and dorsiflexion. [17]

9. Iontophoresis-with acetate 0.10%- Best used in athletes it is one of the useful method used combined with other treatment.

10. Myofascial release- None of the studies have proved effectiveness of using myofascial release.

11. Deep tissue procedures such as Garston technique.

12. Tendon Achilles stretching.

14. Extracorporeal shock wave therapy. - Recently systemic review had shown the effective ness of using extracorporeal shock wave therapy.

x | P a g e


Tapping:

Principles:

Taping done either in circular or semi-circular pattern on either of the injury reduces the excessive pressure on the medial and longitudinal arches. Supportive strips of varying degrees of viscoelasticity not only improve the elasticity of the skin but strengthen the arches as well results in better outcome and function. Main principle however lies in providing biomechanical support during physical activities. If taping is done to make patient aware of the faulty movement that can aggravate the injury then the idea behind it is the use of skin proprioceptors to create a stimulated pain reflex.

TYPES OF TAPING:

1- Low dye taping:Application of low dye taping on the foot maintains the medial longitudinal arch. Thus helps in preventing excessive pronation of the rare foot.

xi | P a g e


3. Kineso taping:

Useful in preventing over contraction, assist and give support to the medial arch of the foot. It maintains full R.O.M as taping is done over and around the muscle. Patient returns to its normal physical activities as Kineso Taping limits the over use and facilitate proper blood flow within 24 hours. Best used method in acute stage.

4. Arch Taping:

Before suggesting a foot orthotics to a patient arch taping helps in supporting the longitudinal arch mechanically and relieve the stress on the nearby structures to accelerate healing process.

5. Double X Taping:

As the name suggests double it means in the taping help in maintaining the longitudinal and medial arch together.

xii | P a g e


SEARCH STRATEGY:

Table1.

Sites searched and databases

Keywords used Limit used

PubMed central

Google searched

Pedro

CINAHL

Cochrane data base

Science direct

Plantar fasciitis

Taping

Effectiveness of conservative treatments

Heel pain

Foot and ankle injuries

Low dye taping

Adults

Women’s

English language

INCLUSION AND EXCLUSION CRITERIA:Inclusion: adult women’s age 15-45 years, pain at the medial and lateral aspect of heel, excessive pronation,Painful first few steps:

Exclusion: Patient earlier taking treatments, any nerve entrapment, fracture of foot, fibro sarcoma or lumber radiculopathy.

xiii | P a g e


RESULT OF THR SEARCH:

Table2. Summary of study designs of articles retrieved

xiv | P a g e

Methodology of article retrieved/ study design

level Author(year)

Randomized control 1 JOEL A Radford (2006).

Bill vicenzino et al (2007).

Sonia J Russo and Lucy (2001).

Controlled case studies

5 Kieran o Sullivan et.al. (2008).

Bvicenzino, Mfranettovich (2005).

Damien Nolan And Kennedy (2010).


1. Evidences: “In 2006 Joel A. Radford, karnlandorf summarises the effectiveness of low dye taping for the short term treatment of plantar heel pain”.it was taken as first randomized study to evaluate the effectiveness of foot taping for plantar fasciitis. Treatment based on first step foot pain, foot function and general foot health leads to improvement in outcome and to overcome symptoms. Taping method of treatment had shown the significant improvement in functional group and is effective method for short term treatment.Study design participant blinded randomized control trail sample: total (92 participants were taking in 2005. (46) In each group average age selected (50-65) years. Sample size shows 80% probability for detecting difference between groups on pain domain.Procedure-two groups were made and participants were equally distributed among them. Low dye taping group with sham ultrasound were made as one group and sham ultrasound was made as second group. Baseline variable collected are age, sex, duration of symptoms, self-reported hours on feet, ankle range of motion and foot posture. By using a linear regression approach, analysis of covariance (ANCOVA) was calculated. They follow up the both cases for at least one week with strict protocols outcome measure used are visual analogue scale, foot health status questionnaire to measure foot pain .foot function and general foot health .RESULTS- after one weak of treatment the first group that received the low dye taping with sham ultrasound showed great improvement in first step pain when compared to other group. (ANCOVA) adjusted mean differences (-12.3mm; 95%confidence interval (-22.4 to -2.2) p=0.017.for foot health status questionnaire there was no statistically difference between two groups. Whereas on 100 mm visual analogue scale 30mm reduction in pain were seen in functional group and 19 mm in sham taping group. Strength of study lies in that independent researcher’s perform a blinded data entry -patient not were about whether they are in active group or not. Ethical clearance was done by “university of western Sydney human resource ethics committee”. Inclusion and exclusion criteria were satisfied, selected participant completed the baseline assessment and clinical protocols were strictly followed. However 13 participants experienced adverse effects, follow up was because 5 participants removed their

xv | P a g e


tape during treatmrnt.no data collected in case of drop out case .trials are done only for one type of taping technique the. Final conclusion of this research paper was that low dye taping is a cost- effective short term treatment method to reduce heel pain.

2. EVIDENCES: By b.vicenzio-et al 2005 summarises the effect of anti-pronation tape on the medial long arch during walking and running. Subject between the age group (21-31 year) were taken where experimental and control group was divided as taped and non-taped. Low dye tape group subjects showed significant increases in arch-height ratio and reduced pronation during static and dynamic foot postures using video motion analysis system. Study design was Randomized controlled repeated measure study with cross over design. Sample size-seventeen subjects were taken between the age group of (27-31 year) with vertical navicular drop of greater than 10mm participants with lower limb injuries and metabolic disorder were excluded. Participants are divided into two test method groups former the Screening session group and later Testing- session group. Subject with naviclar drop more than 10mm were selected for tape video footage were taken while standing, walking and jogging before and after treatment. Five indices were calculated using video footage and Microsoft visual basic. Three independent indices were incorporated into the research design Condition (tape, controller), time (before, after), task (standing, walking, jogging).Outcome measure used was interclass correlation coefficient and Microsoft video motion analyser. The experimental group showed a mean increase in arch height after application of tape. There was significant differences in mean (p<0.002).there by relative increases in medial long arch height confirms the anti- pronation effect also.

Strength of the paper lies as in this is the first kind of study that presents anti- pronation effect during dynamic foot postures like walking and jogging and done as Randomized control study with limited sample. However the study requires a high degree of skill to mark the navicular tuberosity before and after tape there can be substantial error in measuring underlining position of navicular bone. No close and continuous watch was done as there are high chances for coupling effect from nearby segments. It was not mentioned whether the examiners were expert in taking the measurement. Intervention at the foot is achieved by a sensorimotor feedback loop

xvi | P a g e


and not by motion control. How increases in arch height reduce the future injury to the foot is not specified Speed of walking is not clearly mention as it varies with person to person. Treatment was not individually designed and test was not applied to full spectrum of patient. Both treatment methods are practical. Statistical validity fully confirms the effectiveness of taping as anti-pronation effect and increases in medial longitudinal arch ration.

3. EVIDENCES:

KIERAN’O’ SULLIVAN ET.AL in2008 Summarized the immediate effect of low dye taping using 3d motion and plantar pressure distribution analysis using repeated measure cross over study design and out of (28) patient chosen( 8) were eliminated because of unknown reasons out of( 20),(60)were male and( 14) female average age( 22.1+-5year).

Subjects were made to walk to meters looking straight ahead. Study result in increase in peak plantar pressure and reduced in total range of motion of the ankle.

STATISTICAL VALIDITY: P value comparisons (t-test)

Lat.mid foot med fore foot

P=0.000 0.014

P=0.007 0.00

Outcome measures used are- CODA MPX motion analysis system was used to calculate joint angle based on skin marker position. F-scan a computerized insole sensor system was used to measure plantar pressure.

Before and after treatment results have showed significant improvement. Internal validity and external validity were satisfied. The study reveal reduced both pronation and supination in the rare foot during the stance phase.

1. First study to combine 3d kinematic and plantar pressure

xvii | P a g e


2. First study to use the 3d software motion analysis3. Mean positions are not deviated much during stance phase minimizing

error4. Only one investigator put tape to minimize error.5. Potential bias was minimized by collecting multiple cycles in each

measurement. However various drawbacks of the study are blinding of the data collected has not being done while collecting the subject condition during test procedure. Investigator did not perform any test –retest reliability study. It is difficult to visualized the skin markers while examining the in – shoe plantar pressure therefore co relation between changes in plantar pressure is not appropriate. Absences of force plate conforms that author has to visually check the heel strike and toe off results in more statistical errors. Subjects were not randomly selected because of time constraint. Neither the subjects nor investigator are blinded to treatment conditions therefore no feasibility.

6. Pre and post exercise effects of taping on plantar fasciitis. Study was done to check the taping over the effect of peak plantar pressure after exercise and to know whether low –dye tape is useful in reducing pronation. Total 12 subjects were taken (3 males and 9 females) each sample was check for navicular drop greater than 10mm. navicular drop test was used which conforms the intra- rated reliability of the date. Plantar pressure were measured using F-Scan at 3 stages 1.In untapped patients and then at base line and lastly after tape. Then patients are made to walk for 10 min at normal speed.Ethicall clearance was done. single group repeated measure design was used tape was applied by investigator using standardized protocols 10 min walk followed by 10min walk was given. Plantar pressure measurement was taken before and after taping. Data collected with the help of F scan and were analysed using one way repeated measure.ANOVA was introduced to check the plantar pressure at – untapped condition, base line with tap condition. To check out 3 of 3 condition which one created high difference pressure paired sample t- test are used .Inclusive criteria and exclusive criteria were satisfied.Pre tape condition, excessive pronation was seen in all the subjects .Data analysis showed that there was a significant difference in plantar pressure in all three conditions addition to it paired t- test values (p=0.0039) showed that there is significant reduction of plantar fascia at lateral fore foot after application of tape. At mid foot there was no significant improvement seen and the data was not statistically significant .This explorative study was successful in showing the effect of low dye taping after exercise however the study data collected by f – scan had shown higher variability. Velocity was not including in the article it can be a confounding factor and sample was taken by extremely small subject

xviii | P a g e


was not randomly selected .Further future researches are needed to explore the study. This study has showed the significant anti- pronation changes despite the small sample size and non-randomized nature .This study has shown the immediate effect on reduction of the planter forces post exercise.

4. Evidences:

In July 2007, bill Vincenzo evaluated the effect of augment low dye taping on foot during weight baring and overloading task like jogging and walking .He including 15 women 7 men. All the subjected were randomly selected. Author included the participant with naviclular drop of 10mm .Selection of exclusion criteria was based on deformities, allergic reactions. He used “EMED- SF capacitance transducer matrix platform”. To check the plantar pressure control group was decided on the bases of tap and non-taping condition. Randomly application of tap was done which suggest the subject control 12 meters walk- way was used. Data was equally divided by an auto mask software system. Plantar pressured measured after dynamic task was 0.05 gate velocity between the stance phase were calculated (p<0.001) shows the statistical significance of using tape during walking and jogging. The author had effectively shown that there is change in plantar pressure after application of tape during dynamic tasks. Treatment method has shown that after application of tape it results in increased plantar pressure decreases in medial fore foot.

SUMMARY:

Plantar Fasciitis is defined as the inflammation of the plantar fascia. it acts like a tie rod by maintaining the height of the medial longitudinal arch, repetitive stress on the plantar fascia show micro tear in the x-ray positive factor being the altered the biomechanical stress , tight muscles , excessive weight , abnormal gait pattern . It is common in obsess and female patient unable them to do exercise treatment modalities include icing, stretching different type of taping, extracorporeal shocked wave therapy etc. Taping not only and reduce the biomechanical stress but also prevent excessive pronation. Evidences have shown that taping reduces the pain by checking the excessive pressure on foot during stance face of gait. All the studies retrieved were randomized and the quality of the controlled and uncontrolled studies met the basic methodological quality.

xix | P a g e


CONCLUSION:

The literature study concluded that taping the medial longitudinal arch reduces the pain, prevents excessive pronation especially in over adults and patience complaining of first step pain. It’s also a short term treatment for patients waiting for long term treatment e.g. foot orthotics. Visual analogue scale and foot function index: are used as the outcome measured in the most of the studies, which shows good improvement applying the taping during and after the treatment improve the effectiveness of the treatment as it reduces the time of treatment , stabilizes the arches, prevent the further inflammation occur which checking excessive pronation therefore reduces the pain and leads to early recovery of symptoms therefore taping should be combine with exercises like stretching and strengthening muscles of foot.

Foot notes-studies not included are those lacking inclusive, exclusive criteria and not well collected statistical data, lacking in methodological intervention and irrelevant outcome measures.

REFFERENCES:

xx | P a g e


1. Mayt,Judy T,Cowann J. current Treatment of Plantar Fasciitis. Current Sport Medicine Reports 2002;1:278-84.

2. Dipika Singh; plantar fasciitis

Key words: introduction to plantar fasciitis, taping.

www.emedicine.com/emere/topic429

3. Kitaoka, Hb, Z.P. Luo, E.S Growney, L.J.Berglund &K.N. An, Material properties of the plantar Apo neurosis .Foot ankle int; 1994:15{10}; p.557-60.

4. Berkowitz, J.F and S.Rudicel.plantar fascia; M.R imaging Radiology; 1991; 179:p665-667.

5. M.C Guest plantar fasciitis & other causes of heel pain

6. Williams P, the pain full heel.Br H OSPmED 1987; 38:P562-563.

7. Stephens L barett & rober O’Mally.Plantar fasciitis& other causes of heel pain 2007

8. Singh Detal, Plantar fasciitis BMJ 1997; 3315:172-175.

9. Rose Mac Donald Taping technique principles & practice 1994; 4th edition.

10. Anne-Maree Keenan-J Am podiatric medical association 2001; Vol 19; pg 255-261.

11. Barrett, Stephan L, Robert O Malley. Plantar fasciitis and the other causes of the heel pain199; Vol 8:2200-6.

12. Scott’s Book on plantar fasciitis. Heel spurs and heel S RTHOPAEDICS 1993; 16:1153-63.

13. Joel A. Radford et al. Effectiveness of low dye taping for the short term treatment of plantar heel pain: a randomized trial, Journal of the American podiatric Medical Association, 2005; vol 95.

14. Vicenzing et al initial effects of anti-pronation tap on the medial longitudinal arch during walking and running, British Journal of sport Medicine, 2005:Vol 39(12):939-943.

15. Karl B Landlord et.al; Effectiveness of low dye taping for the short term

xxi | P a g e


management of plantar fasciitis, 2005: VOL 95(6):525-530.

16. Hyland MR, Webber Gaffney a. Randomized controlled trial of calcaneal, sham taping and plantar fascia stretching for the short term management of plantar fasciitis; journal of orthopedics Sports Physical Therapy,2005;VOL33:93-95.

16. Kieran O’ Sullivan. Effect of low dye taping on rear motion and plantar pressure single group repeated measure design was used tape was applied by investigator using standardized protocols during stance phase of gait BMC Musculoskeletal Disorder, 2008.17. Wine miller MH, Billow RG, Laskowski ER,Harmsen WS Effect of magnetic vs sham magnetic insoles on plantar heep pain: a randomized controlled trail[published correction appers in jama 2004;291-46]18. Pfeffer G,B,acchetti P, deland ,J,lewis A,Anderson R,Davis W,Etal.1999-20; 214-21.19. Lynch DM,Go forth WP,Martin Odom R,Preece C, Kotter.Conservative treatment of plantar fasciitis.Journal of the American Podiatrac Assocation 1998;88: 375-80.

xxii | P a g e

Evidence based project report by kanchan koul

Documents

Transcript of Evidence based project report by kanchan koul