Akter Sapia, Hossain Mohammad Shahadat, Hossain K M Amran, Uddin Zakir, Hossain Mohammad Anwar, Alom Foisal, Kabir Md Feroz, Walton Lori Maria, Raigangar Veena
Department of Musculoskeletal Medicine, Institute of Advanced Mechanical Correction Therapy, Dhaka, Bangladesh.
Department of Physiotherapy & Rehabilitation, Jashore University of Science & Technology, Jashore, Bangladesh.
J Man Manip Ther. 2024 Aug;32(4):368-377. doi: 10.1080/10669817.2023.2214020. Epub 2023 May 24.
[Purpose] The purpose of this study was to compare the effectiveness of the Structural Diagnosis and Management (SDM) approach with Myofascial Release (MFR) in improving plantar heel pain, ankle range of motion, and disability. [Subjects] Sixty-four subjects, aged 30-60 years, with a diagnosis of plantar heel pain, plantar fasciitis, or calcaneal spur by a physician according to ICD-10, were equally allocated to the MFR ( = 32) and SDM ( = 32) groups by hospital randomization and concealed allocation. [Methods] In this assessor-blinded randomized clinical trial, the control group performed MFR to the plantar surface of the foot, triceps surae, and deep posterior compartment calf muscles, while the experimental group performed a multimodal approach utilizing the SDM concept for 12 sessions over 4 weeks. Both groups also received strengthening exercises, ice compression, and ultrasound therapy. Pain, activity limitations and disability were assessed as primary outcomes using the Foot Function Index (FFI) and Range of motion (ROM) assessment of the ankle dorsiflexors and plantar flexors using a universal goniometer. Secondary outcomes were measured using the Foot Ankle Disability Index (FADI) and a 10-point manual muscle testing process for the ankle dorsiflexors and plantar flexors. [Results] Both MFR and SDM groups exhibited significant improvements from baseline in all outcome variables, including pain, activity level, disability, range of motion, and function after the 12-week intervention period ( < .05). The SDM group showed more improvements than MFR for FFI pain ( < .01), FFI activity ( < .01), FFI ( < .01) and FADI ( = <.01). [Conclusion] Both MFR and SDM approaches are effective in reducing pain, improving function, ankle range of motion, and reducing disability in plantar heel pain, however, the SDM approach may be a preferred treatment option.
[目的] 本研究旨在比较结构诊断与管理(SDM)方法和肌筋膜放松(MFR)在改善足跟足底疼痛、踝关节活动范围和功能障碍方面的效果。[受试者] 64名年龄在30至60岁之间的受试者,经医生根据ICD - 10诊断为足跟足底疼痛、足底筋膜炎或跟骨骨刺,通过医院随机化和隐蔽分配法平均分为MFR组(n = 32)和SDM组(n = 32)。[方法] 在这项评估者盲法随机临床试验中,对照组对足部足底表面、腓肠肌和小腿后深肌群进行肌筋膜放松,而实验组采用基于SDM概念的多模式方法,在4周内进行12次治疗。两组均接受强化训练、冰敷和超声治疗。使用足部功能指数(FFI)评估疼痛、活动受限和功能障碍作为主要结局,并使用通用测角仪评估踝关节背屈肌和跖屈肌的活动范围(ROM)。次要结局通过足踝功能障碍指数(FADI)和踝关节背屈肌与跖屈肌的10分徒手肌力测试进行测量。[结果] 在为期12周的干预期后,MFR组和SDM组在所有结局变量上均较基线有显著改善,包括疼痛、活动水平、功能障碍、活动范围和功能(P <.05)。SDM组在FFI疼痛(P <.01)、FFI活动(P <.01)、FFI总分(P <.01)和FADI(P <.01)方面的改善比MFR组更明显。[结论] MFR和SDM方法在减轻足跟足底疼痛、改善功能、踝关节活动范围和减少功能障碍方面均有效,然而,SDM方法可能是更优的治疗选择。
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