Guideline Title Heel pain - plantar fasciitis: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Bibliographic Source(s) McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain--plantar fasciitis: clinical practice guidelines linked to the International Classification of Function, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008 Apr;38(4):A1-18. [61 references] PubMed Guideline Status This is the current release of the guideline. This guideline will be considered for review in 2012, or sooner if new evidence becomes available. Any updates to the guideline in the interim period will be noted on the Orthopaedic Section of the American Physical Therapy Association (APTA) Web site: orthopt.org . Scope Disease/Condition(s) • Plantar fasciitis • Heel pain Guideline Category Diagnosis Evaluation Management Risk Assessment Treatment Clinical Specialty Family Practice Internal Medicine Orthopedic Surgery Physical Medicine and Rehabilitation Podiatry Sports Medicine Intended Users Physical Therapists Physicians Podiatrists Students Utilization Management Guideline Objective(s) • To describe evidence-based physical therapy practice including diagnosis, prognosis, intervention, and assessment of outcome for musculoskeletal disorders commonly managed by orthopaedic physical therapists • To classify and define common musculoskeletal conditions using World Health Organization terminology related to impairments of body function and body structure, activity limitations, and participation restrictions • To identify interventions supported by current best evidence to address impairments of body function and structure, activity limitations, and participation restrictions associated with common musculoskeletal conditions • To identify appropriate outcome measures to assess changes resulting from physical therapy interventions in body function and structure, as well as in activity and participation of the individual • To provide a description to policy makers, using internationally accepted terminology, of the practice of orthopaedic physical therapists • To provide information for payers and claims reviewers regarding the practice of orthopaedic physical therapy for common musculoskeletal conditions • To create a reference publication for orthopaedic physical therapy clinicians, academic instructors, clinical instructors, students, interns, residents, and fellows regarding the best current practice of orthopaedic physical therapy Target Population Patients with heel pain or plantar fasciitis Interventions and Practices Considered Diagnosis/Evaluation/Risk Assessment 1. Assessment of pathoanatomical features 2. Risk factor assessment 3. Diagnosis and classification according to International Statistical Classification of Diseases and Related Health Problems (ICD) criteria and International Classification of Functioning, Disability, and Health (ICF) criteria 4. Differential diagnosis 5. Physical examination • Validated self-report questionnaires • Easily reproducible functional limitation and activity restriction measures Treatment/Management Interventions 1. Dexamethasone 0.4% or acetic acid 5% delivered by iontophoresis 2. Manual therapy 3. Short-term calf muscle and/or plantar fascia–specific stretching 4. Calcaneal or low-Dye taping 5. Short-term prefabricated or custom foot orthoses 6. Night splints Major Outcomes Considered • Diagnostic accuracy (sensitivity, specificity, positive and negative likelihood ratios) • Pain relief • Ankle dorsiflexion range of motion • Functional outcomes scores • Mobility Back to top Methodology Methods Used to Collect/Select the Evidence Hand-searches of Published Literature (Primary Sources) Hand-searches of Published Literature (Secondary Sources) Searches of Electronic Databases Description of Methods Used to Collect/Select the Evidence It was acknowledged by the Orthopaedic Section of the American Physical Therapy Association (APTA) that a systematic search and review of the evidence related to diagnostic categories based on International Statistical Classification of Diseases and Health Related Problems (ICD) terminology would not be useful for these International Classification of Functioning, Disability, and Health (ICF)-based clinical practice guidelines, as most of the evidence associated with changes in levels of impairment or function in homogeneous populations is not readily searchable using the current terminology. This approach, although less systematic, enabled the content experts to search the scientific literature related to classification, outcome measures, and intervention strategies for musculoskeletal conditions commonly treated by physical therapists. Number of Source Documents Not stated Methods Used to Assess the Quality and Strength of the Evidence Weighting According to a Rating Scheme (Scheme Given) Rating Scheme for the Strength of the Evidence Levels of Evidence Individual clinical research articles were graded according to criteria described by the Centre for Evidence-Based Medicine, Oxford, United Kingdom. I. Evidence obtained from high-quality randomized controlled trials, prospective studies, or diagnostic studies II. Evidence obtained from lesser-quality randomized controlled trials, prospective studies, or diagnostic studies (e.g., improper randomization, no blinding,
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