Plantar fasciitis (PF) is the most common foot condition treated by healthcare professionals accounting for 15% of foot disorders with more than 10% of the population affected by it over their lifetime 1,2,3,4. It accounts for 7-14% of all sporting injuries 5 and is especially prevalent in sports requiring a posterior depression of the pelvis6.
Current literature suggests that plantar fasciitis is caused by collagen degeneration at the origin of the plantar fascia at the medial calcaneal tubercle so, PF is termed fasciosis because of the chronicity of the disease and the evidence of degeneration rather than inflammation9.
The most common presenting symptom of PF is a sharp pain of insidious onset with maximal tenderness at the anterior medial border of the calcaneus 3,4,6. The pain is worst on the first few steps in the morning 3,4 and with initial steps after prolonged sitting or inactivity 4.
Predominantly, PF is treated conservatively. Conservative management employs many different techniques including rest 6, cryotherapy 11, therapeutic ultrasound 12, stretching and strengthening 13, Manipulation 14, orthotics 13, strapping 15, and night splints6 all of which have been shown to be beneficial along with operative treatment.
There are different ways of strapping available -Low dye taping and Elastic taping. Several authors agree that Low-Dyetaping of the foot is effective in the treatment of PF 14,15. Immobilization by Low-Dye taping shortens the distance between the origin and insertion of the plantar musculature and fascia relieving the strain and tensile forces on weight bearing. In this way the strapping aims to allow healing to occur naturally 8,15.
Kinesio tape is a thin elastic tape invented by Kase in the1970s. It is widely used to prevent injuries in athletes and it has a number of proposed beneficial properties. Studies in 2010 showed that taping with Kinesio tape, in addition to traditional therapy, was more effective in the treatment of PF than traditional therapy alone as it corrects muscle function by strengthening weakened muscles, improves circulation of blood and lymph by eliminating tissue fluid (edema) and bleeding beneath the skin, therefore, decreasing swelling, decreases pain through neurological suppression, repositions subluxated joints by relieving abnormal muscle tension, helping to return the function of fascia and muscle.
The study was approved by RRC and IEC from the Indian spinal injuries center in New Delhi. We recruited 45 subjects from Safdarjung hospital New Delhi, PtDeendayal Upadhyaya National Institute for physically handicapped New Delhi, and the Indian spinal injuries center New Delhi. Subjects diagnosed with plantar fasciitis were included in this study.
Criteria for inclusion were both male and female subjects of age 25 to 50 years, positive windlass test, negative tarsal tunnel test complaining of unilateral involvement of plantar fasciitis from 6 weeks to 3 months 19.
Prior to the treatment, the patients were educated about the protocol and after the treatment, the subjects were assessed for any increase in pain. If no adverse reaction, open wound/skin allergy in the area to be taped was reported further sessions were carried out. 3 sessions of conventional treatment over a period of 1 week.
Within-group analysis, significant improvement was found in all the outcome variables, NPRS, VAS, and RFFI for each group(p=0.00). One-way ANOVA for between-group comparison was done for three groups of which VAS for first-step pain showed a significant difference( F=3.8, p=0.031).
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The statistical analysis of the VAS showed that there was a significant time effect for both groups (p < 0.001) which means that both treatment groups were effective at reducing the mean VAS over the course of the study period. There was a statistically significant treatment effect showing that the Kinesio group improved better than the Low-Dye group. The Kinesio group showed a faster rate of decrease than the Low-Dye group.
First-step pain is the most characteristic pain of PF, worst on the first few steps in the morning13. It is the result of stretching the contracted and damaged plantar fascia causing pain. The pain improves with further ambulation.
The Kinesio tape group decreased morning pain overall. This may be a result of the tape being worn for up to three days over which time the tape could act on correcting intrinsic muscle imbalances in the foot, aiding the correct functioning of the fascia itself, reducing edema and inflammation by stimulating blood circulation and neurologically stimulating the proprioceptive nerve fibers and reducing pain.
The Kinesio group may have been able to more effectively reduce the VAS of participants due to its stimulating effect on proprioceptive A-beta fibers which decrease the effect of nociceptive C fibers, as proven by studies done by Illes in 2009. The Low-Dye tape also reduced mean VAS readings in participants, although less effectively and less effectively. This may have been accomplished by shortening the distance between the origin and insertion of the plantar musculature and fascia which relieved the strain and tensile forces on weight bearing. In this way, the strapping allowed healing to occur naturally with the healing of the plantar fascia also being less painful8.
There was a significant time effect (p < 0.001) indicating that both groups decreased the total FFI score over time within groups.
These findings suggest that both treatments may be effective in reducing the total FFI score because neither one was statistically superior to the other. The overall decrease in the FFI Total score for the Kinesio tape group may be a result of the reduction in edema and inflammation due to the tape lifting the skin. The tape may have also aided the correct functioning of the plantar fascia and intrinsic foot muscles and neurologically suppressed the pain of the PF.
The statistical analysis of the Low-Dye group showed there was also a significant improvement in the participant's FFI Total score. The reason for this improvement may have been due to the Low- Dye tape immobilizing the plantar fascia and allowing healing.
The Kinesio tape group decreased morning pain overall. This may be a result of the tape being worn for up to three days over which time the tape could act on correcting intrinsic muscle imbalances in the foot, aiding the correct functioning of the fascia itself, reducing edema and inflammation by stimulating blood circulation and neurologically stimulating the proprioceptive nerve fibers and reducing pain.
In this study, all three groups received photopheresis as a part of conventional treatment for plantar fasciitis. A study by Cagnie concluded that phonophoresis given as treatment for plantar fasciitis helps in the reduction of pain45.
We also included both weight-bearing Achilles tendon stretching and plantar fascia-specific stretching in the conventional physiotherapy regimen which was received by the subjects. This could have brought this significant result in all the groups19.
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