MANUAL PHYSICAL THERAPY APPROACH IN THE TREATMENT OF HEEL PAIN: A CASE
REPORT
Manual Therapy Fellowship
Introduction:
Little is known of the underlying
disease process causing chronic
heel pain and evidence for the
effectiveness of current
treatments are unclear . 1
Consequently, clinicians are left
with little to guide clinical decision
making in the treatment of this
condition. Enthesopathy,/soft
tissue insertion inflammation, the
most common believed cause of
heel pain, should not be the sole
treatment focus.
Purpose:
To describe the examination,
interventions, and clinical decision
making for a patient with heel
pain utilizing thrust manipulation
and neurodynamic techniques.
Currently there are no case
studies describing combination
utilization of neurodynamic
techniques and thrust
manipulation.
Subject:
A 59 y.o. male presented to
physical therapy with an
Orthopaedic referral for a 3 month
history of right heel pain. His pain
was worst in the morning and
after driving for longer than 10
minutes. His management
program consisted of physician
prescribed NSAIDs and a self
Chad Garvey, PT, DPT, OCS, CSCS1
Julie Whitman, PT, DSc, OCS, FAAOMPT
Fellow - Regis University Manual Physical Therapy Fellowship Program
Faculty - Regis University Manual Physical Therapy Fellowship Program
Exam Findings/Impairments:
Outcomes:
•Tenderness over medial/inferior
calcaneus near the plantar fascia insertion
•3 degrees AROM R ankle DF
•Reproduction of heel pain with ipsilateral
slump test and great toe dorsiflexion
•4/5 MMT ipsilateral hip abductors and
extensors
•Foot and Ankle Measure (FAAM) score
Treatment:
42%
•Primary interventions included thrust
manipulation of the talo-crural and lateral
midfoot joints, along with tibial nerve
oscillation mobilizations performed in the
slump position with great toe extension.
Also included were self nerve
mobilizations, hip strengthening and heel
soft tissue mobilization HEP.
•The patient was seen for 4 visits over
the course of 7 days
Talo-crural Slump tibial nerve
distraction thrust mobilization
manipulation
2
Discussion:
There was a complete
resolution of symptoms
•FAAM score increase from 42% to 94%
following 4 treatments of
•Global Rating of Change +7 manual physical therapy and
exercise. Symptom
•Negative slump test
resolution remained at a 1
•5/5 hip extensor and abductor strength year follow up.
•Resolution of presenting symptoms
Conclusion:
•7 degrees AROM DF R (=L) The manual physical therapy
•No pain with driving or upon 1st morning step to the foot and ankle
coupled with neurodynamic
down techniques were effective at
resolving the patient’s heel
pain.
Clinical Relevance:
Although manual therapy is
not specifically supported in
high level peer reviewed
literature , clinically
1
reasoned manual therapy
may provide significant
benefit in the treatment of
chronic heel pain with a
similar presentation. As
well, despite demonstrated
effectiveness within the
study, higher quality
evidence examining this
References:
intervention would be
1. Crawford F, Thomson C.
needed to establish efficacy.
Interventions for treating plantar
heel pain. The Cochrane
Collaboration. 2007, Issue 4.