Clinical Predictive Rules for Management of Plantar Heel Pain

Medical professionals rely on clinical practice guidelines to have better outcomes, lower utilization of care, and lower costs. These guidelines have limited value since they often fail to keep up with new research findings or recently available diagnostic or therapeutic interventions.

For example:  clinical practice guidelines are available for plantar heel pain (plantar fasciitis) from the Orthopedic Section of the American Physical Therapy Association; the American Family Physicians, and the American College of Foot and Ankle Surgeons. Unfortunately, these three sets of guidelines disagree with each other leading to confusion aspects of plantar heel pain management.

An alternative to set clinical guidelines are clinical predictive rules (CPRs). These rules utilize health care research and expert opinions to provide quick and inexpensive estimates of the probability of a patient problem. CPRs help clinicians in their evaluations, diagnoses, and interventions and augment their clinical judgements in patient care.

To date, there is only one investigation using CPR process for plantar heel pain. This investigation did not use measures of gait nor gait training in the development of the clinical prediction rule. The research literature supports incorporating gait analysis and gait training in plantar heel management. CPRs can be developed to promote interventions proven to be beneficial and discourage ineffective tests, examinations and interventions.  

We know that plantar heel pain is aggravated by standing, walking, and running. These activities are essential functions of daily living so plantar heel pain can have a significant impact on quality of life. CPRs for plantar heel pain that identify associated gait deviations guide clinicians in more effective and less expensive evaluations, diagnoses, and treatments. In this way, CPRs improve patient outcomes.

CPRs can incorporate the growing body of anecdotal evidence of gait deviations as contributing factors to the development of plantar heel pain. Specific gait deviations to explore include: too long stride/step, foot crossing the mid-line of the body, loud foot strike, excessive toe-out or toe-in relative to the line of progression, excessive/prolonged pronation, limited big toe motion, excessive big toe motion, late heel off, and early heel off.

Bottom line: CPRs can help but the process starts with you

• If you have plantar heel pain when walking or running share with your healthcare professional your questions about “what can’t I do?” and “what can I do?” when walking or running to manage my heel pain.
• If you are a healthcare professional CPRs can guide but they cannot replace your clinical reasoning and practice knowledge. Seeking a second opinion from a mentor or peer regarding gait analysis and gait training can change the management of plantar heel pain for the better. 

The information on this website is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. You are encouraged to perform additional research regarding any information contained on available through this website with other sources and consult with your physician.

Damien Howell Physical Therapy – 804-647-9499 – Fax: 866-879-8591 At-Home, At Office, At Fitness Facility – I come to you, I do home visits Damien@damienhowellpt.com