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Rheumatology 1999; 38: 968-973
© 1999 British Society for Rheumatology

A systematic review of treatments for the painful heel

D. Atkins, F. Crawford1, J. Edwards and M. Lambert1

Department of Rheumatology, University College, London and
1 Department of Health Sciences and Clinical Evaluation, Alcuin College, University of York, Heslington, York YO10 5DD, UK

Correspondence to: F. Crawford.

Objective. To establish the efficacy for treatments of pain on the plantar aspect of the heel.

Methods. Systematic review of the published and unpublished literature. Electronic search of Medline, BIDS and the Cochrane database of clinical trials. An assessment of the quality of the reporting was made of studies included in the review. Main outcome measure: patients' pain scores. Study selection: randomized controlled trials, published or unpublished, that evaluated treatments used for plantar heel pain. Foreign language papers were excluded.

Results. Eleven randomized controlled trials were included in the review. These evaluated some of the most frequently described treatments (steroid injections and orthoses) and some experimental therapies (extracorporeal shock wave therapy and directed electrons). The methodological assessment scores of the published trials were low; small sample sizes and failure to conceal the treatment allocation from study participants prevents more definitive statements about the efficacy of treatments. In 10 of the included trials, patients in both the intervention and control arms reported improved pain scores at the final outcome measure.

Conclusions. Although much has been written about the treatment of plantar heel pain, the few randomized controlled trials involve small populations of patients and do not provide robust scientific evidence of treatment efficacy.

KEY WORDS: Heel, Pain, Treatment, Efficacy, Systematic review.


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