Combining A Comprehensive Physical Therapy Program And Electrocorpeal Shockwave Therapy For Plantar Fasciitis: A Case Report

Background and Purpose: Plantar fasciitis (PF) is present in 2 million Americans a year, and in 10% of the population over a lifetime. Conventional physical therapy (PT) for PF has included strengthening of foot and hip musculature, and lower extremity stretching. Extracorporeal shockwave therapy (ECSW) has also been utilized with success in treatment of PF. While these two treatments have been used individually, their combined effect has not been studied. The purpose of this case report investigated a combined plan of care utilizing conventional PT, targeted hip strengthening, and ECSW. Case Description: The patient was a 48-year-old female who presented with chronic PF. She was seen for 11 visits over 4 weeks. Initial deficits were found in strength, gait, tenderness to palpation, impaired ADLs, and functional tasks. She reported prior treatment of ECSW and PT, but no combination of both simultaneously. Treatment included traditional PT with a focus on intrinsic foot strengthening, hip strengthening, and taping. Outcomes: From initial evaluation to re-evaluation, Lower Extremity Functional Scale (LEFS) improved from 31/80 to 53/80, pain decreased from 4/10 to 0/10, tenderness decreased from diffuse pain to point tenderness at the plantar fascia insertion. Manual muscle testing improved as follows: right gastrocnemius 4/5 to 4+/5, extensor hallucis left 4+/5 to 5/5 and right 3+/5 to 4/5, flexor hallucis left 4+/5 to 5/5 and right 3+/5 to 4/5. Her gait no longer demonstrated a Trendelenburg pattern. Discussion: Traditional PT with a focus on hip strengthening combined with ECSW therapy was beneficial in treating a patient with PF. Future studies may want to consider investigating the most efficient hip and ECSW therapy protocols for maximum benefits. achievement would require targeted content coaching and professional development. The data showed that out of the nine themes, seven focused on providing teachers with targeted instructional support. Recommendations from the study suggest: A plan should be collaboratively developed between the school leadership and LTP for the first year the LTP transitions out. The needs assessment, scope of work, and plan delivery should be built into the turnaround process; the VDOE and district leadership should develop a three-year sustainable improvement plan that is continuously monitored by state provided Lead Partners, Division Superintendents, and School Administrators; the monitoring process should be extended for an additional two to three years after the services of the LTPs have been concluded