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Table 2 Physical therapist guide for intervention delivered to the early physical therapy intervention group

From: Comparison of usual podiatric care and early physical therapy intervention for plantar heel pain: study protocol for a parallel-group randomized clinical trial

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]