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Randomized Controlled Trial
. 2024 Aug;32(4):368-377.
doi: 10.1080/10669817.2023.2214020. Epub 2023 May 24.

Comparison of Structural Diagnosis and Management (SDM) approach and MyoFascial Release (MFR) for improving plantar heel pain, ankle range of motion and disability: A randomized clinical trial

Sapia Akter  1 , Mohammad Shahadat Hossain  1 , K M Amran Hossain  1   2 , Zakir Uddin  3 , Mohammad Anwar Hossain  4 , Foisal Alom  5 , Md Feroz Kabir  2 , Lori Maria Walton  6 , Veena Raigangar  7
Affiliations
Randomized Controlled Trial

Comparison of Structural Diagnosis and Management (SDM) approach and MyoFascial Release (MFR) for improving plantar heel pain, ankle range of motion and disability: A randomized clinical trial

Sapia Akter et al. J Man Manip Ther. 2024 Aug.

Abstract

[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 (n = 32) and SDM (n = 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 (p < .05). The SDM group showed more improvements than MFR for FFI pain (p < .01), FFI activity (p < .01), FFI (p < .01) and FADI (p = <.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.

Keywords: Disability; FADI; FFI; MFR; Plantar heel pain; SDM.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
The windlass mechanism following Bolgla and Malone [14], plantar fascia supports the maintenance of arch and weight distribution of stress through the feet, forefoot varus contributes to excessive pronation and higher arch during ambulation, creating more stress to the plantar musculature and fascia, and creating biomechanical abnormality in the global mobilizer of the ankle. The horizontal line in the figure is the plantar fascia stress like “Spanish Windlass”.
Figure 2.
Figure 2.
CONSORT 2010 flow diagram for the study.
Figure 3a.
Figure 3a.
MFR and SDM interventions.
Figure 3b.
Figure 3b.
(Continued).
See this image and copyright information in PMC

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