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Examining the degree of pain reduction using a multielement exercise model with a conventional training shoe versus an ultraflexible training shoe for treating plantar fasciitis.
Ryan M, Fraser S, McDonald K, Taunton J. Phys Sportsmed. 2009 Dec;37(4):68-74.
Quote:
Plantar fasciitis is a common injury to the plantar aponeurosis, manifesting as pain surrounding its proximal insertion at the medial calcaneal tubercle. Pain is typically worse in the morning when getting out of bed, and may subside after the tissue is sufficiently warmed up. For running-based athletes and individuals who spend prolonged periods of time on their feet at work, plantar fasciitis may become recalcitrant to conservative treatments such as ice, rest, and anti-inflammatory medication. Exercise-based therapies have received only limited attention in the literature for this common problem, yet they are becoming increasingly validated for pain relief and positive tissue remodeling at other sites of similar soft-tissue overuse injury. This study reports on pain outcomes in individuals experiencing chronic plantar fasciitis whiles wearing a shoe with an ultraflexible midsole (Nike Free 5.0) (FREE) versus a conventional training (CON) shoe in a 12-week multielement exercise regimen, and after a 6-month follow-up. Adults with >/= 6-month history of painful heel pain were recruited and randomly assigned to wear 1 of the 2 shoes. All subjects completed the same exercise protocol. A visual analogue scale item tracked peak pain in the preceding 24 hours taken at baseline, 6- and 12-week points, and at the 6-month follow-up. Twenty-one subjects completed the program (9 FREE; 12 CON). Both groups reported significant improvements in pain by the 6-month follow-up, and the FREE group reported an overall reduced level of pain throughout the study as a result of lower mean pain scores at the midpoint and post-test compared with the CON group. The exercise regimen employed in this study appears to reduce pain associated with chronic plantar fasciitis, and in doing so, the Nike 5.0 shoe may result in reductions in pain earlier than conventional running shoes.
Re: Plantar fasciitis symptoms and two different running shoes
I finally had a chance to read the full paper. I see BIG problems with the authors conclusions.
The way the study is reported does not meet the CONSORT statement for the transparent reporting of clinical trials.
There was a statistical difference in the duration of symptoms at baseline between the two groups - they should have used an ANCOVA for the analysis and not the 2-way ANOVA that they did use to account for this.
Two subjects in the Nike free group got worse and were eliminated from the data analysis. The standard way of analysing RCT's is to use 'intention to treat' analysis (as per the CONSORT statement). These subjects data should have been included in the analysis.
They should have used a validated measure for foot pain (eg FHSQ) and not the oversimplified VAS score.
I would be surprised if the authors could have made the same conclusion if this study was analysed as per the recommended guidelines (ie CONSORT):
Quote:
the Nike 5.0 shoe may result in reductions in pain earlier than conventional running shoes.
Can you see how the elimination of the two subjects who got worse from the Nike Free group would have massively biased the results?
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
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Re: Plantar fasciitis symptoms and two different running shoes
Quote:
Originally Posted by Michael Nitschke
What is a conventional training shoe?
In this study it was just the running shoes that the athlete was currently wearing.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Re: Plantar fasciitis symptoms and two different running shoes
Quote:
Originally Posted by Simon Spooner
The shoes they got the injury in.
Yes.....
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Plantar fasciitis symptoms and two different running shoes
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