Foot Exercise and Education in the Treatment of plantar heel pain (FEET trial): A feasibility study.

Foot exercise and education This group will attend eight individual (one on one) physiotherapy sessions during the twelve-week intervention period. Sessions will be scheduled at week 1, 2, 3, 4, 5, 6, 8 and 10. Each physiotherapy session will be 30 minutes duration. At the first session participants will be prescribed a progressive exercise programme for the intrinsic foot muscles and receive detailed education relating to self-management strategies. Subsequent sessions will involve review and reinforcement of the self-management strategies and review and progression (as able) of the exercise programme. Participants will be asked to maintain a daily logbook to record exercises performed, symptoms, other physical activity performed, details of adverse events and details of treatment outside the study. The 12 week exercise programme comprises 2 components: 1) Daily exercises: Will be performed daily throughout the 12 week intervention and consists of 4 foot and toe movements and 2 weight bearing exercises. Exercises will take approximately 5 minutes to complete. 2) Exercises to perform 3 times a week: 4 exercises will be performed 3 times per week throughout the 12 week intervention. The exercises include: doming, resisted toe flexion, seated heel raise and standing heel raise. To allow for progression, 3 stages of each exercise are provided. Progression is provided by varying the number of repetitions and sets, amount of load, or rate of loading. Progression is individualised and made when the indicated repetitions and sets are reached for that stage, provided that (i) the therapist considers that patient can recruit adequate intrinsic muscle contraction without excessive extrinsic contribution, or perform local joint motion at the foot and ankle with optimal control i.e. smooth motion through intended plane of action without unintended overflow into adjacent planes or joints; (ii) the participant’s rating of subjective effort of each exercise using Modified Borg Scale is 0-5 / 10, (iii) the participant’s pain response to loading (remains <5/10 on a numerical rating scale). Exercises will take approximately 20 minutes to complete. The education component will include information about the condition and self-management strategies including monitoring of load and symptom response and advice regarding footwear, posture and gait. This will be delivered at the one-on-one by the physiotherapist at the first session and supported by the provision of a handout (brochure) detailing all of the information discussed with the physiotherapist. The handout has been specifically designed for this study. Review and reinforcement of self-management strategies will be included at all subsequent physiotherapy sessions.