Management of plantar heel pain: a best practice guide synthesising systematic review with expert clinical reasoning and patient values

Abstract Objective To develop a Best Practice Guide for managing people with plantar heel pain (PwPHP)Design a mixed methods designData sources Medline, Embase, CINAHL, SportsDiscus, Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, reference lists, and citation tracking. Semi-structured interviews with world experts and a patient survey.Eligibility criteria RCTs evaluating any intervention for PwPHP in any language were included subject to strict quality criteria. Trials with a sample size greater than 38 were considered for proof of efficacy. International experts were interviewed using a semi-structured approach and PwPHP surveyed online.Results Forty PwPHP completed the survey and 14 experts were interviewed resulting in 7 themes and 38 sub-themes. Fifty-one eligible trials enrolled 4351 participants, with 10 interventions suitable to determine proof of efficacy. There was good agreement between the interview data and systematic review findings about taping (SMD: -0.47, 95% CI -0.88 to -0.05) and stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term, with clinical reasoning guidance to combine these interventions with education and footwear advice as a core approach. There was good agreement to stepped care with focussed shockwave for first step pain in the short term (OR: 1.72, 95% CI 1.14 to 2.61), medium term (SMD -1.31, 95% CI -2.01 to – 0.61) and long term (SMD -1.67, 95% CI -2.45 to -0.88) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). Good agreement for stepped care was also revealed for custom foot orthoses for pain in the short term (SMD: -0.41, 95% CI -0.74 to – 0.07) and medium term (SMD: -0.55, 95% CI -1.02 to -0.09).ConclusionA best practice guide was formulated based on robust evidence, with application guided by expert reasoning and patients’ perspectives.Systematic review registration Prospero CRD42018102227