A comparative study to analyze the effect of planter fascia stretch and heel pad with moist heat in the patients of planterfascitis

Background: This study investigated the effect of planter fascia stretch and heel pad with moist heat in the patients of planterfascitis among subjects aged 20-40. Planter fascia is a thickened fi brous sheet of connective tissue which begins from medial tubercle on undersurface of calcaneus and fans out joining to the metatarsophalangeal joints plates to form longitudinal foot arch. Manual active stretching or passive stretching of planter fascia and Achilles tendon are effective treatment option for patient with planter fasciitis. Aims and objectives: objectives of this study were to see the effect of planter fascia stretch and heel pad with moist heat in the patients of planterfascitis.


Introduction
Planter fascia is a thickened fi brous sheet of connective tissue which begins from medial tubercle on undersurface of calcaneus and fans out joining to the metatarsophalangeal joints plates to form longitudinal foot arch. Planter fasciitis is a degenerative syndrome of planter fascia due to repeated trauma as its origin on the calcaneus. Planter fasciitis is very signifi cant cause of pain of heel on slightly inferior side [1]. Discomfort Sometimes it becomes severe and take month or even year to resolve and become challenging for clinicians .Other names for planter fascitis includes calcaneodynia, sub calcaneal pain, runners heel, heel spur syndrome and painful heel syndrome. Decreased ankle dorsifl exion, weight bearing for long period, pes planes and sudden weight gain are the major risk factors for planter fasciitis. Signs and Symptoms are localized tenderness of calcaneus bone at anteromedial aspect, stiffness of Achilles tendon, pain increased by passive dorsifl exion of toes after standing on tip of toes [2]. Signifi cant pain after performing heavy activities or after weight bearing exercise. The exact presentation of planter fascitis is pain on the sole foot at inferior border of heel. Patient feels severe pain after taken few steps in morning [4].
Most options for treatment are available which show different level of effi ciency. Some conservatives options for treatment like rest, avoiding aggressive or heavy activity, strengthening and stretching excercises,night splinting and orthotics.Other options to treat planter fascitis are anti infl ammatory agents, electrotherapy (Ultrasonic shock wave therapy), steroidal injection and surgery.Time to resolve this issue varies from almost 6 to 18 months. Sometimes may be longer which may become challenge for both patient and clinician.Many experts think identifi cation, diagnosis and treatment in early stage of disease brings better recovery in comperatively short period of time [5,6].
Splinting and walking casts help the patient of planter fascitis to keep his foot in neutral position overnight.It reduces the pressure on heel at heel strike.Silicon insole is a noninvasive treatment option which add comfort and provide soothing effect to heal as it absorbs about 50% of shock during walking. Some studies suggests that silicon insole provide good relief to patient with planter fascitis that the custom made orthotics and stretching exercises do alone and it is one of most effective treatment option for increasing functional status and decreasing pain in patient with planter fascitis pain [7,8].
Manual active stretching or passive stretching of planter fascia and Achilles tendon are effective treatment option for patient with planter fascitis. There are many studies have been tested the effi ciency of planter fascia stretch and Achilles tendon stretch with positive result. Some studies also evaluated the effectiveness of combined treatment including ultrasound or radial shock wave therapy and stretching exercises the result of the same studies suggested that combined treatment of stretching of gastrocnemius and ultrasound and planter fascia being are as effective as radial shock wave therapy and stretching of planter fascia and gastrocnemius.Some studies showed the result for combined treatment of calcaneal taping and planter fascia stretch. [9].
Stretching of calf muscle is also very effective in patient of planter fascia according to same studies. Only some studies that suggest the superior of calf stretch over planter fascia stretch or planter fascia stretch over calf stretch. Some studies also compared the superiority of planter stretch over stretch of tendon Achilles and the result revealed the stretch of planter fascia is relatively more effective than tendon Achilles stretch in patient of planter fascia. Combination of both stretch (planter fascia stretch and calf stretch) are very effective in resolving the issue, restoring the normal range of motion and decreasing the pressure from stiff and tight planter fascia.But there is no study has identifi ed the independent effi ciency of these exercises [10,11].
Some studies show that non-steroidal anti-infl ammatory drugs in decreasing pain and reducing the infl ammation of planter fascia, but the effi ciency of these drugs in patient with chronic issue still remain obscure [12]. Some researches show the positive result with moist heat while treating patient with planter fascia but the effectiveness of moist heat in isolation remains uncertain. Moist heat shows better result when used in combination with other modalities like heel pad [13,14].
To our knowledge ,there will be no literature of study that has compared and assess independent effi ciency of two common used treatment modalities like heel pad with hot fomentation and stretching exercises of planter fascia. So, the objective of recent study is to evaluate the response of planter fascitis patient to different treatment options when given separately that may support to establish a conclusive treatment strategy for managing patient with planter fascitis [3,14].

Material and methodology
This study was quasi experimental study. Sample size was 80 that had been collected by convenient sampling from

Statistical analysis
Statistical Analysis Data were analyzed using SPSS version 23.0. Intragroup comparison of differences between pre and post intervention scores of FFI and FADI was analyzed using independent T Test. The results were considered statistically signifi cant if p values were less than 0.05.

Results
Total 80 patients were included in our study. 40 were randomly allocated to group A and 40 were allocated to group B.
Out of 80 patients 34(42%) were male and 46(58%) were female ( Figure 1). Out of 80 patients 11 were lie in age group of 20-25, 17 were lie in age group of 26-30, 23 were lie in age group of 31-35 and 29 were lies in age group of 36-40. Average age was 32.61±3.94 (Figure 2). Out 80 patients 57 were overweight and 23 were not overweight. Average BMI was 27.32±4.82 ( Figure   3). Signifi cant difference was founded on FADI score on both pairs with p-value 0.000 (Table 1). Signifi cant difference was founded on FFI score on both pairs with p-value 0.000 (Table   2). No statistically signifi cant difference was observed in pre intervention score between the groups on FADI (p = 0.211) and FFI (p = 0.365), but, statistically signifi cant difference was observed between all the groups on post intervention score with respect to FADI (p=0.000) and FFI (p=.001) as analyzed by independent t test (Tables 3,4).

Discussion
Plantar fasciitis is a debilitating condition that causes pain on the inferior aspect of the foot, particularly when taking the fi rst few steps in the morning. Most options for treatment are available which show different level of effi ciency. Some conservativesoptions for treatment like rest, avoiding aggressive or heavy activity, strengthening and stretching excercises, night splinting and orthotics [15]. To our knowledge, there will be no literature of study that has compared and assess independent effi ciency of two common used treatment modalities like heel pad with hot fomentation and stretching exercises of planter fascia [6]. So, the objective of recent study is to evaluate the response of planter fascitis patient to different treatment options when given separately that may support to establish a conclusive treatment strategy for managing patient with planter fascitis. In our study total 80 patients were included and randomly allocated to group A and B. Out of 80 patients 34(42%) were male and 46(58%) were female. In the present study, we have observed the predominance of female 42% 58% Gender distribution male female     Table 3: Independent t test on pre and post intervention FADI score of both groups.

Independent T test p-value
Pre Intervention 0.211 Post Intervention 0.000 Table 4: Independent t test on pre and post intervention FFI score of both groups.