Intervention category | Initial tier interventions | Second tier interventions |
---|---|---|
Exercise | Stretching/mobility: Plantar fascia-specific, ankle dorsiflexion (knee bent and straight), self-lateral heel glide [10, 19] | Stretching/mobility of the posterior thigh [39–41], and identified impairments of areas proximal to the lower leg |
Muscle performance training of foot and lower leg [12, 42–47], in addition to identified impairments of proximal regions [48, 49] | ||
Manual therapy | Impairment based treatment directed at the ankle and foot [10, 25, 26] | Impairment based treatment directed at regions proximal to the ankle and foot including neurodynamic impairments [10, 50, 51] |
Modalities | Iontophoresis with dexamethasone in cases with highly irritable and acute symptoms [19] | – |
Tape/Orthotics | If participants do not present with an orthotic and did not receive one from their podiatry visit, the Treatment Direction Test [52] will be used for short-term pain relief and orthotic consideration. | – |
Night splint | If symptoms persist for >6 months and this has not been tried previously [19] | – |
Education | Preliminary information about plantar heel pain including prognosis, home program, and modifiable contributing factors (e.g., footwear, body weight, flexibility, foot loading/weight-bearing) | Brief pain neuroscience if central sensitization or peripheral neuropathic pain mechanisms are identified [53, 54] |
Home program | Home program will include less than 5 of Tier 1 or 2 exercises to facilitate adherence [55] |