Plantar fasciitis (PF) is a common condition in the population. One of the interventions used to resolve this condition is myofascial release (MR), which consists of massages that help reduce pain and increase mobility. MR has shown efficacy when applied for 30 minutes, however, it is necessary to compare it with a 15-minute MR intervention, since in clinical practice optimizing time is essential. Accordingly, the present research seeks to evaluate whether there are differences in the application time of myofascial release in people with PF.
Study participants must be diagnosed with PF
Age between 18 to 60 years a clinical diagnosis of unilateral PF according to the clinical practice guidelines of the orthopedic section of the American Physical Therapy Association (APTA).
Pain intensity > 2 on the numerical pain rating scale (NPRS).
Pain that is most intense upon awakening and decreases during walking. • Duration of pain greater than 3 months and less than 7 months.
Who have received ankle or foot interventions within the previous three months, such as physical therapy (manual therapy, exercise, physical agents), injections, long-term history of steroid use.
History of surgery on the ankle, foot, or inner leg.
Other causes of heel pain: arthritic (fibromyalgia, gout, rheumatoid arthritis, seronegative spondyloarthropathies), infectious (diabetic ulcers, osteomyelitis, plantar warts), neurological (lumbar radiculopathy (L4-S2), nerve entrapment (branches of posterior tibial nerve), neuroma, tarsal tunnel syndrome, (posterior tibial nerve), trauma (calcaneal stress fracture), tumor (Ewing's sarcoma, neuroma), vascular and pregnancy.
Parallel
Myofascial release
Other interventionNine myofascial release techniques will be applied to each group: Transverse hamstring play; Transverse hamstring and adductor magnus play: posterior to anterior pressure; Transverse gastrocnemius-soleus play; Tibia bone clearing: posterior tibia; Tibia bone clearing: prone grip with half chisel; Lateral fascial distraction of the tibia; Lateral elongation of the peroneal tissue; Cross-friction of the gastrocnemius-soleus musculotendinous junction; Manipulation of the plantar fascia.
Morning pain intensity measured with the Numeric Pain Rating Scale (NPRS)
The Numeric Pain Rating Scale (NPRS) measures pain intensity from 0 to 11 points (0, no pain; 10, worst pain imaginable).(18) Numeric pain scales have been shown to be reliable and valid.(25) In addition, the DCMI (minimally clinically important difference) has been reported to be 2 points.(26)
Pressure pain threshold (PPT)
The pressure pain threshold (PPT), defined as the minimum pressure to induce a change from a pressure sensation to a pain sensation.(27) The score is obtained from the average of 3 repeated measurements, with a 30 second rest between each one, a method that has demonstrated validity and high reliability with ICC=0.91 (95% CI: 0.82, 0.97).(19, 28) The PPT will be evaluated with an Algometer (Wagner Instruments FPX 50). The pressure (force divided by the surface area) will be applied at a speed of approximately 1kg/cm2/s. It will be measured on the most sensitive point of the lower surface of the calcaneus, posterior surface of the calcaneus, soleus muscle and internal and lateral gastrocnemius muscle.(13, 29) To measure each of these points, the subject must be placed face down on the stretcher, with the extremity to be evaluated uncovered.
Calf muscle stiffness (Silfverskiöl test)
Gastrocnemius stiffness or tightness will be assessed with the Silfverskiöld test.(20)The measurement explores the degree of passive dorsiflexion of the ankle in the supine position (with a goniometer), in two positions: with the knee extended and flexed (90°), where the hindfoot is in a neutral or varus position. A moderate force load is applied under the forefoot (it is recommended to apply the goniometric measurement with a force between 1.7 and 2kg),(30) the expected difference for the test to be positive is a minimum of 13 degrees of difference.(20) The reliability at the intra-evaluator level with ICC (95% CI) that fluctuates between 0.845 to 0.924.(31) A digital goniometer will be used (brand: baseline evaluation instruments; model: 12-1027; company: enterprises; Country: USA).
Functionality (Foot Function Index (FFI))
Functionality will be assessed through the Foot Function Index (FFI), recommended for subjects who suffer from heel pain,(5) and validated in Spanish.(21) It is a self-administered index consisting of 23 items that measure pain, disability and activity restriction, which has been shown to be reliable, valid and sensitive to foot alterations.(34-36)
Health-related quality of life (SF-12)
Health-related quality of life will be assessed with the SF-12 health questionnaire, which is a shortened version of the SF-36. This scale has 12 items with Likert-style response opinions (3 to 6 points) and a dichotomous scale, it has two summary components, physical (PCS) and mental (MCS), and it summarizes 8 dimensions: physical function, physical role, bodily pain, general health, vitality, social function, emotional role and mental health. The maximum score of the survey indicates good quality of life and is valid in Spanish (correlation with back pain PCS-12 (r= -0.405, P\<0.001) and MCS-12 (r=-0.326, P=0.0001)) and reliable (Cronbach's alpha coefficient PCS-12 was 0.77 and MCS-12 was 0.8), in patients with musculoskeletal pain.
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