Comparison of Structural Diagnosis and Management (SDM) approach and Myofascial Release (MFR) for improving planter heel pain, ankle range of motion and disability: A Randomized Clinical Trial

PurposeThis study compared the effect of Structural Diagnosis and Management (SDM) approach over Myofascial Release (MFR) on gastrocnemii, soleus and plantar fascia in patients with plantar heel pain. SubjectsSixty-four (n=64) subjects, aged 30-60 years, with a diagnosis of plantar heel pain, plantar fasciitis or calcaneal spur by a physician and according to ICD-10. Participants were equally allocated to MFR (n=32) and SDM (n=32) group by hospital randomization and concealed allocation. MethodsIn this assessor blinded randomized clinical trial, the control group performed MFR (three tissue specific stretching techniques) and the experimental group performed 2 tissue-specific interventions utilizing the Structural Diagnosis and Management (SDM) concept for 12 sessions over a 4-week period. In addition, both groups received strengthening exercises and other conventional treatments. Pain, activity limitations and disability were assessed as primary outcomes utilizing the foot function index (FFI) and range of motion (ROM) of the ankle dorsiflexors and plantar flexors were measured with a universal goniometer. Secondary outcomes were measured using the Foot Ankle Disability Index (FADI) and 10-point manual muscle testing process for the ankle dorsiflexors and plantar flexors. ResultBoth 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 significant improvements than MFR for FFI pain (p=.001), FFI activity (p=.009), FFI (p= .001) and FADI (p=.002). ConclusionMFR and SDM approaches are both effective to reduce pain, improving function, ankle range of motion, and reduce disability in plantar heel pain. However, the SDM approach is significantly superior (for reducing pain, improving function and reducing disability (p<.05).