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Foot Ankle Biomechanics: Effects of Manipulative Intervention on Plantar Fasciitis Subjects

Journal: The Journal of the American Osteopathic Association Date: 2007/08, 107(8):Pages: 333. doi: Subito , type of study: case control study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2007.107.8.327/html)

Keywords:

ankle [43]
biomechanics [63]
case control study [54]
foot [66]
OMT [3752]
osteopathic manipulative treatment [3772]
plantar fasciitis [5]

Abstract:

Counterstrain (CS), an Osteopathic Manipulative Medicine (OMM) technique that involves passively shortening painful tissues, significantly reduced plantar fasciitis (PF) pain in a prior OUCOM study (Wynne, et. al., JAOA Sep 2006; 106:547-556). Triceps surae peak force (Torque) production as well as time needed to reach peak force increased in both PF and control subjects without altered muscle spindle gain (H-reflex). This lack of a neuroreflexive explanation prompts possible involvement of passive mechanical tissue properties of the foot/ankle complex. In order to isolate these properties, force production was measured on the same apparatus, and the ankle was dorsiflexed the same number of repetitions and degrees as the former study; but slow enough to prevent eliciting an Achilles tendon reflex. Non-therapeutic passive 90 second shortening represented a sham for CS. Hypotheses: Alteration of passive mechanical tissue properties of the foot/ankle complex by stretching or shortening the plantar surface of the foot will result in: 1. Increased force production and time to reach peak force, 2. Decreased PF pain. Methods: Case-control study following informed consent per OU IRB. Cohort: 12 subjects with plantar fasciitis, 5 controls. Force against the foot plate of a motor driven apparatus was recorded in supine subjects while the ankle was dorsiflexed (5° over 500 msec) 10 times followed by a 30 second rest then repeated 10 times. This was done at baseline and after two manipulative interventions: 1) a 90 second hold of the plantar fascia in a shortened position and 2) a 90 second stretch of the plantar fascia. Subjects were randomized to receive either stretching or shortening first. Results: RMANOVA statistical analysis showed no difference, following either intervention, in peak force production or time needed to reach peak force (p ≥ 0.05). Plantar fasciitis subjects reported no change in foot pain following either or both interventions. Conclusion: If the decrease in pain or increases in peak force production and in time needed to reach peak force seen in the previous experiment resulted primarily from an alteration in the passive biomechanical components of the foot-ankle complex, similar results would be expected in this study. This was not the case. Force generation under the ball of the foot may also be influenced by reflex activity of intrinsic foot muscles and is the subject of future study. Further research into the mechanisms of CS is warranted.


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