PROFORMA FOR REGISTATION OF SUBJECTS
FOR DISSERTATION
DISSERTATION PROPOSAL
Topic:-
“A STUDY ON EFFICACY OF STRETCHING EXERCISES Vs TAPING TECHNIQUE ON REDUCING PAIN AND DISABILITY IN SUBJECTS WITH PLANTAR FASCITIS”.
-Comparative study
SUBMITTED BY:
NIDHINI CHANDRAN T
I YEAR MPT [2009-10 BATCH]
SHRIDEVICOLLEGE OF PHYSIOTHERAPY
TUMKUR-572106
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE
BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / NIDHIN CHANDRAN TMPT -1 ST YEAR, SHRIDEVICOLLEGE OF PHYSIOTHERAPY LINGAPURA, SIRA ROAD, TUMKUR -572106
2 / NAME OF THE INSTITUTION / SHRIDEVICOLLEGE OF PHYSIOTHERAPY, TUMKUR
3 / COURSE OF STUDY AND SUBJECT / IST YEAR MPT –[MUSCULOSKELETAL DISORDER AND SPORTS PHYSIOTHERAPY]
4 / DATE OF ADMISSION TO COURSE / 06/06/2009
5 / TITLE OF THE STUDY / “A STUDY ON EFFICACY OF STRETCHING EXERCISES Vs TAPING TECHNIQUE ON REDUCING PAIN AND DISABILITY IN SUBJECTS WITH PLANTAR FASCITIS”.
-Comparative study
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Heel pain is one of the most common form of foot pain. Heel pain is most common in active people over the age of 40. It often occurs as a result of daily activities and life style. The structure located on the bottom (sole) of the foot are primary associated with heel pain: The Plantar Fascia- a band of fibrous tissue and the Flexor Digitorum Profundus-muscle, which supports the arch of foot and Flexes four small toes.1
Plantar Fascitis is the most common condition that causes Heel Pain. Plantar Fascitis is a painful inflammatory process of the Plantar Fascia. The Plantar Fascia is a thick fibrous band of tissue originating on the bottom surface of the calcaneum ( Heel Bone ) and extending along the sole of the foot towards five toes. The term “fascitis’ is due to the irritation and inflammation of the tight tissue that forms arch of the foot.2
It has been reported that Plantar Fascitis occurs in 2 million Americans a year and 10% of the population over a life time. Plantar Fascitis accounts for abouts 10% of runner-releated injuries and it 15% of all foot symptoms. It is though to occur 10% of the general population as well. This condition occurs equally in both sexes. This condition can occur at any age. But a peak incidence may occur in women aged 40-60 years.3
The cause of Plantar Fascitis is unclear and may be multifactorial. Because of the high incidence in runners, it is best postulated to be caused by Repetitive Microtrauma. Possible risk factors include Obesity, Occupation requiring prolonged standing, Heel spurs, PesPlanus and Reduced Dorsi Flexion of the Ankle.4
Plantar Fascitis may leads to significant pain and morbidity.Placing strict activity limitations on the patients with Plantar Fascitis report interior heel pain with the first few steps taken in the morning or often other long periods of non weight bearing. Initially, the pain decreases with ambulation but then increases through out the day as activity increases. Pain is worsened by walking barefoot on hard surfaces or by walking up stairs.5
Heel Pain may also caused by cases other than Plantar Fascitis such as Stress Fracture, Tendonitis, Arthritis, Nerve Irritation. Cyst, soit is important to have heel pain properly diagnosed.
About 95% of individuals with Plantar Fascitis improve with conservative treatment. Treatment may consist of performing exercise to stretch the Achilles tendon, going to physical therapy, taping or casting the foot icing the foot , using heel pads, arch supports, NSAID’S, Electric Nerve Stimulation. Sometimes a splint is worn at night to stretch out the Plantar Fascia. Weight loss is essential if the individual is obese.6
6.1. NEED FOR THE STUDY
The heel is the largest of the human foot. It is designed to provide a firm support for the weight of your body. The heel absorbs the impact when the feet hit the ground when walking and running, and it springs the body forward, ready for the next step. While walking, the stresses placed on feet can be one and a quarter times ( 1 ¼ times ) of body weight. So it is not surprising that heel pain is common.7
Although heel pain can be mild and will sometimes disappear on its own, in some cases the pain persists and can become a severe, chronic problem. Heel Pain has a variety of different causes, although the most common is a condition called Plantar Fascitis.8
Plantar Fascitis is most often seen in middle aged men and women, but it can be found in all age groups,. Plantar Fascitis is diagnosed with the classic symptoms of pain, well localized over the heel area of the bottom of the foot. Often the pain from Plantar Fascitis is most severe when the patient first stands on the feet in the morning. Pain often subsides quickly, but then returns after prolonged standing or walking.9
Plantar Fascitis most commonly occurs in people between 40-60 years of age. Under normal circumstances, the Plantar Fascia acts like a shock absorbing bowstring, supporting the arc of the foot. But if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive tearing can cause the fascia to become irritated or inflamed leads to Plantar Fascitis.10
Age of more than 40 years, Female Gender, certain Stressful Foot activities, Faulty Foot Mechanics, Obesity, Occupations that require a lot of walking or standing, and Improper Shoes are the certain risk factors that may increase the risk of developing Plantar Fascitis.11
Contributing factors of this condition suggest several treatments, which includes loss of weight, wearing proper foot wear, modification of activities, anti-inflammatory medications, physical therapy. night splint, orthotics etc.12
Physical Therapy plays an integral part in the treatment of Plantar Fascitis. Most of the Physical Therapists are well trained in treatment of this condition because it is so common. Physical Therapy measures can includes stretching exercises, strengthening, Ultrasound Therapy, Contrast bath etc.13
Stretching of the calf and Plantar Fascia can provide good results. Pain with the first steps in the morning can be markedly reduced by stretching the Plantar Fascia and Achilles Tendon.Taping can be used to keep the foot in dorsi flexed position during sleep to improve Calf muscle flexibility and reduction of pain on walking.14
In general, Plantar Fascitis is a self limiting condition. Unfortunately the time until resolution is often 6-18 months, which can lead to frustration for patients deal with it long term and need to learn to manage symptoms on their own.15
Even though many Non- surgical treatments are available, there is lacking of evidence to strongly support any type of treatment for Plantar Fascitis. 16
Thus in an effort to find out the suitable , evidence based treatment procedure for Plantar Fascitis, this study is very much needed to compare the efficacy two different approaches the Stretching exercises and Taping technique onreducing pain and disability caused by Plantar Fascitis.
6.2. OBJECTIVE OF THE STUDY
- To find out the efficacy of Stretching exercises on reducing pain and disability in subjects with Plantar Fascitis,
- To find out the efficacy of Taping Technique on reducing pain and disability in subjects with Plantar Fascitis.
- To compare the efficacy of Stretching exercises and Taping Technique on reducing pain and disability in subjects with Plantar Fascitis.
6.3. HYPOTHESIS
1. Null Hypothesis
There is no significant difference exists between the efficacy of Stretching Exercises and Taping Technique on reducing pain and disability in subjects with Plantar Fascitis.
2. Alternate Hypothesis
There is significant difference exists between the efficacy of Stretching Exercises and Taping Technique on reducing pain and disability in subjects with Plantar Fascitis.
6.4 REVIEW OF LITERATURE
1) Johnson RE et al
Plantar Fascitis is a common, Painful Foot Condition. It refers to the syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot. About 70% of patients with Plantar Fascitis have been noted to have a heel spur that can be seen on X-ray.17
2) Deepika Singh et al
Plantar Fascitis is sometimes, but not always associated with a rapid gain of weight; Plantar Fascitis is also sometimes seen in recreation athelets, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arc of the foot.18
3) Kauffman et al
Plantar Fascitis is an inflammation of the Plantar Fascia. “Plantar” means bottom of the foot, “fascia” is a type of connective tissue, and “it” means inflammation. The classic sign of Plantar Fascitis is heel pain with the first few steps in the morning.19
4) Murphy A et al
The Plantar Fascilis is usually caused by a change or increase in activities, no arch support, lack of flexibility in the calf muscles, being over weight, a sudden injury, using shoes with little cushion on hard surfaces or spending too much time on the feet.20
5)Giavanni BF et al
Routeine stretching is very important to healing Plantar Fascitis. Most of those affected by Plantar Fascitis have decreased flexibility and tight Achilles Tendons. The stretching exercises includes towel stretch, calf stretch, toe stretch, stair stretch, and frozen can stretch.21
6) Benedick A et al
One of the easiest and most cost effective conservative modalities in treatment of Plantar Fascitis is Stretching. The study aimed to find out the effective non- surgical treatment of Plantar Fascitis concluded that the stretching program was the most helpful treatment prescribe.22
7) Atkins D et al
Heel pain can be caused by stress placed on the plantar fascia ligament when it is stretched irregularly, which causes small tears and inflammation. Stretching and strengthening exercises can help the ligament become more flexiable and can strengthen muscles that support the arch, in turn reducing stress on the ligament.23
8) Roxos M et al
Stretching the Achilles tendon is generally included in most treatment plans for planar fascitis. In thish study 72% of patients assigned to stretching alone noted significant improvement. 24
9) Osborne et al
Taping cam help protect the plantar fascia and allow time for healing to occur. It can also enable a patient with severe pain to walk again. The tape should tighten when standing to demonstrate that it is absorbing some of the tension that would have been in the fascia. The pain may be relieved immediately.25
10) Ruther ford et al:
Plantar fascitis taping is often used to alleviate stress on the plantar fascia ligament since it limits the movements of the fascia. Plantar fascitis taping thus can relieve some pain and inflammation associated with plantar fascitis. 26
11) Budiman et al :
A foot function Index [FFI] was developed to measure the impact of foot pathology on function in terms of pain, disability and activity restriction. The FFI is a self administered index consisting of 23 items divided into 3 sub scales. Both total and sub- scale scores are produced. The analysis supported the criterian validity and reliability of the index. 27
7. MATERIAL AND METHODOLOGY
7.1. Sources of Data
- ShrideviHospital, Tumkur.
- Govt.DistrictHospital, Tumkur.
7.2. METHOD OF COLLECTION OF DATA
7.2.1: Sample Design: The samples are selected by using Purposive Random Sampling Technique.
7.2.2. Study Design. Comparative study with pretest and post
test design.
7.2.3. Sample Size. The Sample Size consists of 40 subjects with
Plantar Fascitis.
They were selected randomly and assigned into two groups.
EXPERIMENTAL GROUP-I:
Consists of 20 Plantar Fascitis subjects to be treated with Stretching Exercises.
EXPERIMENTAL GROUP-II:
Consists of 20 Plantar Fascitis subjects to be treated with Tapping Technique.
7.3 SELECTION CRITERIA
Inclusion Criteria
- Subjects diagnosed with Plantar Fascitis.
- Both Genders.
- Age group of between 40-60 years.
- Subjects willing to participate.
Exclusion Criteria
- Subjects with infective conditions of foot, tumor, calcaneal fracture.
- Subjects with impaired circulation to lower extremities.
- Subjects with referred pain due to sciatica and other neurological disorders.
- Subjects with Arthritis.
- Corticosteroid injection in heel preceding 3 months.
- Unwilling, un co operative subjects, subjects with mental illness.
7.4. Duration of the study
One month duration for each subjects.
7.5. Measurement Tools
- Visual Analogue Scale
- Foot Function Index
7.6. PROCEDURE
After checking the inclusion and exclusion criteria, 40 subjects with plantar Fascitis to be selected randomly and assigned into two groups with 20 subjects each. The experimental group-1 consists of 20 Plantar Fascitis subjects to be treated with Stretching Exercises. Theexperimental group-2 consist of 20 Plantar Fascitis to be treated with Taping Technique. Both the groups to be given Therapeutic Ultrasound as an adjacent therapy.
After getting informed consent, a brief introduction about the treatment procedures to be explained to all the subject. Before starting the treatment, both the groups were evaluated for pain and disability by using Visual Analogue Scale and Foot Function Index.
TREATMENT PROCEDURE FOR EXPERIMENTAL GROUP-I
Stretching Exercises
Calf Stretch:-
Stand facing a wall with your hands on the wall at about eye level. Put the leg you want to stretch about a step behind other leg. Keeping back heel on the floor, bend front knee until feel the stretch in back leg. Hold the stretch for 15-20 sec. Repeated 4 times
Achilles Tendon Stretch:-
Stand on a step slow let the heels down over the edge of the step as relax the calf muscles. Hold the stretch for about 15-20 seconds. Then tighten Calf muscle a little to bring the heel back up to the level of the step.
Hamstring Stretch
Extend one leg in front with the foot flexed. Bend other knee and lean back slightly. Pelvis should be tilted forward. Keep the upper body upright, as hold the stretch for 10-20 seconds.
Marble Lift
Place small marbles on the floor next to a cup; using the toes try to lift the marbles up from the floor and deposit them in the cup. Repeat the exercise 15 times.
Towel Stretch
Grab a rolled towel at both ends; hold it under the ball of the foot. Gently pull the towel while keeping the knee straight. Hold this position for 15-20 sec. Repeat 5 times.
B) TREATMENT PROCEDURE FOR EXPERIMENTAL GROUP-II
Taping Technique- Plantar Fascia Taping
- Plantar Fascia Taping can be a great method for relieving the foot and heel pain caused by Plantar Fascitis.
- The Plantar Fascia Taping method helps support the arch of foot and stress applied on the underlying plantar muscles of the foot during walking, running and other activities.
- There are two different types of Plantar Fascia Taping that are commonly used for Plantar Fascitis and other foot and heel pain problems.
Type-1
Using regular white athletic tape
Type-2
Using kinesio taping which has move flexibility that traditional athletic tape.
KEY POINTS FOR SUCESSFUL PLANTAR FASCIA TAPING
- Use a high quality white athletic tape
- Prepare the skin surface clean and dry the fort prior to applying the tape.
- Have a systemic approach to applying the Plantar Fascia Tape
STATISTICAL TEST
Statistical Tests to be used for data analysis are
- Mean
- Standard Deviation
- Independent t-test
- Man- Whitney test
7.7.Does the study require any investigations to be conducted on patients or other human or animals / If so please describe briefly
Yes. This study requires interventions like Taping Technique & stretching exercises to be given to plantar fascitis subjects.
7.8 ETHICAL CLEARANCE
The study will be conducted after the approval of research committee of the college .Permission will be obtained from the head of the institution The purpose and details of the study will be explained to the study subjects and assurance will be given regarding confidentiality of the data collected.
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