Amruta J.Sankhe, Physiotherapist, Rani Shankar Hospital, Thane, India. 2

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International Journal of Therapies and Rehabilitation Research [E-ISSN: 2278-0343] http://www.scopemed.org/?jid=12 IJTRR 2016, 5: 3 I doi: 10.5455/ijtrr.

Sankhe, 1 Garvit Shukla, 2 Vandana J. Rathod, 3* Jagatheesan Alagesan, 4 Iyyappan Manickavasagam, 5 KamalakannanM. 6 1 Amruta J.Sankhe, Physiotherapist, Rani Shankar Hospital, Thane, India.

1 International Journal of Therapies and Rehabilitation Research [E-ISSN: ] IJTRR 2016, 5: 3 I doi: /ijtrr Original Article Open Access The effect of Calcaneal taping versus Low dye taping in treating patients with plantar fasciitis - Randomized Clinical Trial Amruta J. Sankhe, 1 Garvit Shukla, 2 Vandana J. Rathod, 3* Jagatheesan Alagesan, 4 Iyyappan Manickavasagam, 5 KamalakannanM. 6 1 Amruta J.Sankhe, Physiotherapist, Rani Shankar Hospital, Thane, India. 2 Garvit Shukla, Resident Physiotherapist, St. Ignatius Hospital, Honnavar, Karnataka, India. 3 Vandana J. Rathod, Lecturer, SPB Physiotherapy College, SGMERC, Ugat bhesan road, Surat, Gujarat, India. 4 Jagatheesan Alagesan, Assistant Professor-Physical Therapy, College of Allied Health Sciences, Gulf Medical University, Ajman, UAE. 5 IyyappanManickavasagam, Senior Physiotherapist, Dubai Physiotherapy & Rehabilitation Centre, Al Safa, Dubai. 6 KamalakannanM., Lecturer, Saveetha College of Physiotherapy, Chennai, India. Correspondence: Vandana J. Rathod. Abstract Plantar fasciitis is a common cause of heel pain. It occurs in patients of either sex, usually over the age of 40 except in active sportsmen when the patient, usually male, may be in his twenties. It is commonly found in people whose occupation involves prolonged standing or walking. Pain is made worse by activity, such as climbing stairs, walking, or running, may be present at night, and is often present when first getting out of the bed in the morning. It tends to be relieved by rest. The study aims in comparing the effectiveness of Calcaneal taping along with ultrasound therapy and Low dye taping along with ultrasound in reducing pain in Plantar Fasciitis.Randomized clinical trial has been conducted in outpatient department of Alva s College of Physiotherapy and Alva s Physiotherapy Clinic (Extension Unit). 52 patients with acute plantar heel pain are included in the study. They are randomly divided into two different groups. Group A: 26 (subjects receiving Calcaneal taping and ultrasound) and group B: 26 (subjects receiving Low dye taping and ultrasound). The subjects were evaluated for their current level of pain at the plantar aspect of foot during weight bearing using Visual Analogue Scale (VAS) and Foot Function Index Questionnaire (FFI) was filled by the subjects respectively.in the comparison of Group A and Group B there was significant reduction in pain in Group B (p< 0.001). Low dye taping is significantly more effective than Calcaneal taping in reducing pain and increasing the foot function in patients with plantar fasciitis. Key Words: Plantar Fasciitis, Taping, Calcaneal Taping, Low Dye Taping

2 Introduction Plantar heel pain is soreness or tenderness of the heel due to which there is restriction in function of the foot. It often radiates from the central part of the heel pad or the medial tubercle of the Calcaneum, but may extend along the plantar fascia into the medial longitudinal arch of the foot. Severity may range from an irritation at the origin of the plantar fascia, which is noticeable on rising after rest, to an incapacitating pain. 1 Plantar fasciitis is an inflammation of the plantar fascia and the perifascial structures. Chronic stress to the origin of this fascia on the calcaneus may cause calcium to deposit, forming a spur (plantar calcaneal spurs). Plantar Calcaneal spurs and plantar fasciitis involve basically the same symptoms, develop via similar mechanisms, and are treated in the same manner, these common pathologies are often considered together. 1,2 Plantar fasciitis, an overuse condition of the plantar fascia at its attachment to the calcaneus is due to collagen disarray in the absence of inflammatory cells. Thus, the pathology resembles that of tendinosis and the condition should be more correctly referred to as plantar fasciosis or fasciopathy. 3 The incidence and prevalence of plantar heel pain are uncertain. However, it has been estimated that 7% of people aged over 65 years report tenderness in the region of the heel, that plantar heel pain accounts for a quarter of all foot injuries relating to running, and that the diagnosis and treatment of plantar heel pain accounts for over 1 million. The condition affects both athletic and sedentary people, and does not seem to be influenced by gender. 1 Clinical features include pain on the medial aspect of the heel. Initially it is worse in the morning and decreases with activity. There may be a history of other leg or foot problem in patients with abnormal biomechanics. 3 Ultrasound therapy is the usual first choice of treatment for reducing pain and inflammation in plantar fasciitis. There is a variety of other treatments available for the plantar fasciitis such as Avoidance of aggravating activity, Cryotherapy, NSAIDs, Stretching of the plantar fascia, gastronomies & soleus, self-massage with a frozen bottle or golf ball, strengthening exercises of the intrinsic muscles of the foot to improve the longitudinal arch. Decrease stress on the plantar fascia taping. 4-7 There are various types of taping available to treat plantar fasciitis, commonly used taping are calcaneal taping 8 plantar fasciitis taping 8 low dye taping 9,10. There are no evidences and studies done to compare the efficacy of Calcaneal taping and Low dye taping in treatment of plantar fasciitis. In this study therapeutic ultrasound is used along with Calcaneal taping and Low dye taping to find the better treatment for plantar fasciitis. Materials and methods A randomised clinical trial was conducted in Out Patient Department of Alva s College of Physiotherapy, Moodbidri and Alva s Physiotherapy clinic, Karkala. Ethical clearance was obtained from institutional review board. 52 subjects with plantar fasciitis pain were recruited for study. They acknowledged their participation through signing the informed consent. 18 to 65 years of age of group were included for this study. Subjects who clinically diagnosed cases of plantar fasciitis, plantar heel pain for >1 month and pain located at the heel or plantar surface of the mid foot consistent with plantar fasciitis were selected for the study. Subjects having clinical disorder where therapeutic ultrasound is contraindicated, traumatic heel pain (including use of pain or anti-inflammatory medication), history of ankle or foot fractures, congenital deformities of foot or ankle, impaired circulation to lower extremities and referred pain due to sciatica & other neurological disorders were excluded from study. With simple random sampling technique they were allotted alternatively to group A and group B respectively) who were blinded of the group they belonged to. Group A includes 26 (15 males, 11 females) subjects with plantar heel pain receiving Calcaneal taping and UST and group B 26 (12 males, 14 females) subjects with plantar heel pain receiving Low dye taping and UST. The pre &post test evaluation was conducted by the main investigating physiotherapist. The subjects were evaluated for their current level of pain at the plantar aspect of foot during weight bearing using Visual Analogue Scale (VAS) and Foot Function Index Questionnaire (FFI) was filled by the subjects respectively. The interventions were provided to the subjects assigned to the respective groups. Group A received UST (continuous mode, intensity of 1 W/cm 2 with frequency of 1 MHz for five minutes in prone lying for 7 sittings, 1 sitting per day) 8 followed by Calcaneal taping. Group B received UST (continuousmode, intensity of 1 W/cm 2 with frequency of 1 MHz for five minutes in prone lying for 7 sittings, 1 sitting per day) 9 followed by Low-dye taping. The physical therapy treatment was given to the patients of both groups for 7 consecutive days and the pain measurement using VAS and FFI is taken on the 1 st day before treatment and then on the 7 th day after the both group physical therapy interventions. The pre &post test evaluation was conducted by the main investigating physiotherapist. The subjects were evaluated for their current level of pain at the plantar aspect of foot during weight bearing using Visual Analogue Scale (VAS)

3 and Foot Function Index Questionnaire (FFI) was filled by the subjects respectively. The data collected was taken for statistical analysis to compare the effectiveness of intervention between these two groups. Results First the demographic data like age and sex of the subjects in both groups were tabulated to know about the distribution and later the significance was analyzed. The data were analyzed by using Statistical Package for Social Sciences, Version-13 (SPSS-13). The collected data was analysed by Frequency, Percentage, Mean, Standard Deviation, Unpaired t-test, Paired t-test and Chi-square test. Table 1 shows mean age of group A and B. It proves that there is no significant difference between Group A and Group B with respect to age as p = > In Group A 42.3% were Females and 57.7% Males. In Group B 50% were Table-1: Age wise comparison of Group A and Group B Females and 50% Males. It shows there is no significant difference in Group A and Group B with respect to gender as p =0.578, >0.05. Paired t-test was used for finding within group difference (Table 2). Level of FFI before and after treatment in Group A was 71.5 ± 1.73 and ±2.93. Level of FFI before and after treatment in Group B was ± 1.09 and ±1.45. Both group shows decreased in FFI level after the treatment, which is statistically highly significant as p = < Unpaired t-test for between group comparisons before and after intervention with significance set at p value less than 0.05 (table 3). FFI level decreased in group A showed 49.37% and group B showed 55.02% which prooves low dye taping is more effective treatment than calcaneal taping in reducing pain in planter fascitis (p = < 0.01). Effects of age and gender has also been scrutinize in table 4 and 5. Minimum Maximum Mean SD t-value p-value Groups N Group A Group B Table-2: Comparison of before treatment and after treatment within Group A and B Groups Minimum Maximum Mean SD t-value p-value A BEFORE B AFTER BEFORE AFTER Table-5: Effect of gender on treatment Group Gender Mean Standard t value p value Deviation Group A F 49.69% 3.15% difference M 49.13% 4.06% Group B F 54.95% 1.77% difference M 55.08% 1.97%

4 Table-3: Comparison of effect of treatment between group A and group B Group N Mean SD t- p- difference value value Group A Group B Table-4: Effect of age on treatment Groups Age With Difference Group A Group B Karl Pearson p value correlation coefficient r value Discussion The purpose of this study was to compare the effectiveness of Calcaneal taping along with UST versus Low dye taping along with UST in subjects with plantar fasciitis. This comparison demonstrated that treatment of plantar fasciitis with a seven sitting of Low dye taping along with UST was efficacious in reducing pain and improving the foot function. The outcome measure used is FFI. The groups were synchronized with age, sex and pre treatment scores of FFI (p< 0.01). Beneficial effects were significantly greater in Low dye taping in reducing pain than that of Calcaneal taping. Plantar fasciitis can be managed by various physical therapy modalities such as UST, exercises, taping, stretching, massage with a golf ball, transverse friction, etc 4-6,11. It can also be managed by Low dye taping 9-11, extracorporeal shockwave therapy, magnetic insole, acupuncture, strapping, heel cups 6, Calcaneal taping and stretching of plantar fascia. 12,13 In this study Calcaneal taping along with UST and Low dye taping along with UST is used in treating plantar fasciitis. Seven sessions of treatment, one sitting per day was given to subjects of both groups and pre and post intervention outcome measure were taken. The result of this study shows that there was a significant reduction in pain in both the groups. In groupa, it may be due to that it corrects the positional fault of the calcaneus and supports the arch 12. The benefits of the taping system may lie in its ability to simply reduce tension in the plantar fascia, thus reducing symptoms and allowing the injury to recover more readily. The results of this study may be applied to the general population with plantar fasciitis. This study did not include follow-up period and therefore no conclusions can be drawn about the long term benefits of the interventions. The greater effect of Low dye taping may be due to the fact that taping limits unwanted joint movement, to protect from further injury by supporting ligaments, tendons and muscles, to allow healing without stressing the injured structures. 9 However UST help in relieving the pain temporarily and the taping maintains the correction of the positional fault.finally this comparative study provides an evidence to support the use of Low dye taping in the short term management of plantar fasciitis. Further studies could focus on the long term benefits of physical therapy for this condition and the relative effectiveness of these treatment regimens compared with other approaches. The long term effects of Calcaneal taping and Low dye taping with ultrasound can be evaluated for plantar fasciitis with large scale groups Conclusion The study led to the conclusion that Low dye taping is significantly more effective than Calcaneal taping in reducing pain and increasing the foot function in patients with plantar fasciitis. Conflict of Interest: None. References 1. Plantar heel pain and fasciitis Search date January 2007 Karl B Landorf and Hylton B MenzBMJ Publishing Group Ltd Clinical Evidence 2008;2: Middleton J.A. Kolodin E.L. Plantar Faciitis-Heel Pain in Athletes. Journal of Athletic Training. 1992; 27(1): Brukner P. Khan K. Clinical sports Medicine. ed 6 th ; Sydney. McGraw-Hill book Company PP The journal of foot and ankle surgery,clinical Practice Guideline The Diagnosis and Treatment of Heel Pain, Clinical Practice Guideline Heel Pain Panel: James L. Thomas, DPM, Chair; Jeffrey C. Christensen, DPM, Board Liaison; Steven R. Kravitz, DPM; Robert W. Mendicino, DPM, John M. Schuberth, DPM; John V. Vanore, DPM; Lowell Scott Weil, DPM;Howard J. Zlotoff, DPM; and Susan D. Couture2001;40(5). 5. Hertling D. Kessler R.M. Management of Common Musculoskeletal Disorders Physical Therapy Principles and Methods. Ed 3 rd. Lippincot Williams & Wilkins. PP 426.

5 6. Mario Roxas ND. Plantar Fasciitis: Diagnosis and Therapeutic Consideratio, March Ahmad H. Alghadir, A conservative treatment of plantar fasciitis with dorsiflexion night splint and medial arch support: A prospective randomized study.2006;pp Vishal B. Santosh M. Ganesh B.R. Effectiveness of plantar fasciitis taping and calcaneal taping in plantar heel pain-a randomized clinical trial. Indian Journal of Physiotherapy & Occupational Therapy. 2010; 4(3): Saxley J. Betts R.P. Bygrave C.J. Low-Dye taping on the foot in the management of plantar-fasciitis. The Foot. 1997;7: Holmes CF, Wilcox D, Fletcher JP. Effect of a modified, low-dye medial longitudinal arch Taping procedure on the subtalar joint neutral position before and after light exercise. J Orthop Sports PhysTher. 2002;32: Joshua Dubin.Sports therapy, Evidence Based Treatment for Plantar Fasciitis- Review of Literature Matthew R. Hyland.Randomized Controlled Trial of Calcaneal Taping, Sham Taping, and Plantar Fascia Stretching for the Short-Term Management of Plantar Heel Pain Journal of Orthopaedic & Sports Physical Therapy. 2006;36(6): Garvit Shukla, Jagatheesan Alagesan, Iyyappan Manickavasagam. Effect of Fibular Repositioning Tapingamong Intercollegiate Athletes with Acute Ankle Inversion Sprain-Double Blinded Randomized Controlled Trial. International Journal of Scientific Research. 2015;4(3):

EFFECT OF KINESIO TAPING VERSUS MULLIGAN TAPING IN TREATMENT OF HEEL PAIN

Original Research Article Physiotherapy International Journal of Pharma and Bio Sciences ISSN 0975-6299 EFFECT OF KINESIO TAPING VERSUS MULLIGAN TAPING IN TREATMENT OF HEEL PAIN Dr. SHEFALI MEHTA 1*, Dr.SOUMIK