IMMEDIATE EFFECT OF FOAM ROLLING ON PAIN AND WEIGHT DISTRIBUTION IN PATIENTS WITH PLANTAR FASCIITIS: A PILOT STUDY

IMMEDIATE EFFECT OF FOAM ROLLING ON PAIN AND WEIGHT DISTRIBUTION IN PATIENTS WITH PLANTAR FASCIITIS: A PILOT STUDY Ishita Rambhia 1, Neeraj Athavale *2, Ashok Shyam 3, Parag Sancheti 4. 1 BPTh student, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India. *2 PT, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India. 3 MS ORTHO, Research officer, Sancheti Institute of Orthopedics And Rehabilitation, Pune, Maharashtra, India. 4 MS ORTHO, Chairman, Sancheti Institute of Orthopedics And Rehabilitation, Pune, Maharashtra, India.

Plantar fascia is a connective tissue aponeurosis which attaches from the calcaneal tuberos-ity to the proximal phalanges. The posterior tuberosity of calcaneum has medial and lateral processes. The flexor digitorum brevis, abductor hallucis, medial head of quadrates plante and central band of plantar fascia. The plantar fascia is attached to the calcaneum by a fibrocartilage. It is triangular in shape. Proximally, it attaches to the calcaneal tuberosity and distally diverges to attach at the mid-tarsal level. The function of the plantar fascia is to provide longitudinal arch support statically and for shock absorption dynamically [1]. Plantar fasciitis is an inflammatory condition of the plantar fascia usually caused due to repetitive micro-trauma. The risk factors include excessive running, wearing faulty shoes, running on unyielding surfaces, having a pes cavus (high arched foot) and shortened Achilles tendon [2]. The classical sign of plantar fasciitis is that the worst pain occurs with the first few steps. The pain begins at the beginning of the activity and reduces after warm up. The pain increases on prolonged standing and may worsen at the end of the day. There is a biomechanical problem related to reduced intrinsic strength and reduced force distribution secondary to acquired flat feet or high arch. The usual treatment includes ultrasound, NSAIDS, cortisone injection, arch taping, heel cups, orthotics, shoes, stretching and strengthening and surgery [3]. There is a problem with the alteration in the load bearing status of the foot. This leads to increased tensile stress on the fascia leading to degeneration [4]. In normal activities like walking and sports, the human body is subjected to various loads which can be measured by ground reaction forces. Clinically, it is important to compare the various loads in injured and non-injured, pre and postoperative or between patient and control groups. By measuring the plantar pressure distribution, it gives information about the pressures and force loads of the different regions of the foot. The whole foot can be divided into fore foot, mid foot, hind foot, medial and lateral parts of the foot. It also provides information on the weight bearing areas of the foot. Various systems are available which measures the distribution of the foot. Each system is specific to the technical specification and application. These systems are available in various forms.

MATERIALS AND METHODS
and piezoelectric) and devices (platform, insole, single transducer system). Platform systems are used for barefoot measurements and in laboratory settings only. Insole and single transducer systems are embedded in shoes and hence are easier to measure the differences in the pressure distribution. The information provided can be used clinically for shoe construction or modifications in orthotics. Clinically, many problems related to foot pressures can be diagnosed, prevented and be treated [5].
These devices provide information about the foot functions before and after therapeutic intervention which can be used to enhance studies, research and improve the way we practice.
Effective clinical utilization of these devices or systems depends on their scientific basis, capabilities and limitations [6].
Purpose: This study will compare the effect of foam rolling and conventional physiotherapy for pain and weight distribution in patients with plantar fasciitis. An objective biomechanical method like foot-scanner is useful as a diagnostic aid, to identify individuals predisposed to this condition and for evaluating the efficiency of various treatments.
Total 12 subjects in between age group 45-65 years with plantar fasciitis, unilateral involvement, pain score above 5/10 and patients under medications were included in the study and those with any traumatic injuries, foot deformities or any other diseases were excluded from the study. This study design includes Randomized Controlled Trial (convenient sampling). The subjects were explained their role in the study and a written consent was taken from the patients. The outcome measures used were-1) Pain-Numerical Rating Scale (NRS) and 2) Weight Distribution-PODOTECH foot scanner. The subjects were divided into 2 groups: Control group: The intervention included conventional physiotherapy. Conventional physiotherapy includeda) Plantar fascia towel stretch-3 reps, 30 sec hold b) Plantar fascia standing stretch-3 reps, 30 sec hold c) Towel crumple-3 reps, 30 times Experimental group: The intervention included conventional physiotherapy and foam rolling with flexbar for 3 minutes.

RESULTS AND DISCUSSION
Intra group analysis was done by the Wilcoxon Signed Rank test for pain and paired t test for weight distribution. Inter group analysis was done by the Mann Whitney U test for pain and unpaired t test for weight distribution.
The p values for pain scores in both the control and experimental group each were significant.
The p values for experimental group were more significant than the control group in case of pain scores. The earlier studies by Young and Rutherford have proven that conventional treatment is effective for plantar fasciitis. They have also suggested that the treatment given is more effective when the time span between the onset of symptoms and the treatment given is less [3].
The current study proves that the experimental as well as the control group were effective in reducing pain in patients with plantar fasciitis. When the differences in the pain values of both the group were considered, the experimental group which included intervention by foam roller and conventional treatment proved to be more significant than the control group. H.S. Bedi and Bruce Love, used Tekscan's F-scan system to determine the impulse distribution of fore, mid and hind foot based upon vertical footfloor reaction forces and time. The study was performed on individuals with plantar fasciitis. A greater proportionate of load was borne by the forefoot as compared to mid and hind foot [4].
In the current study, assessment for weight distribution was done in a static position as well as during dynamic state i.e. during walking. During the static position, the affected foot showed significant changes in the average pressure and thrust in the control group. The thrust is the force loaded by the foot on the ground. P=F/A Where, P= pressure, F= force (thrust) A= area\ . . . F=P×A The thrust of the foot is proportional to the average pressure of the foot and the area covered by the foot. Also, the average pressure and thrust of the normal foot showed significant changes in the control group. During walking, the affected foot presented significant changes in the area, average pressure and maximal pressure in the control group. Thus the changes observed in static position reflected in the dynamic state also in the control group. The foot was also evaluated for fore foot, mid foot and hind foot pressures. But there was no significant changes seen in these values. A longer interventional period on more number of subjects would have been more effective to show changes in these values. Since foam rolling has been proven to be more effective for reducing pain with the conventional treatment, its usage in clinical scenarios would be effective. Further studies can be done to prove the longer interventional period of foam rolling on weight distribution in patients with plantar fasciitis. Smaller sample size was a limitation for the study. CONCLUSION This study concludes that foam rolling is effective for pain reduction and the conventional treatment given was effective for changes in the weight distribution.
awf -avg p: affected whole foot-average pressure awf-th: affected whole foot-thrust daf -area: dynamic whole affected foot-area daf -avg p: dynamic whole affected foot-average pressure daf -max p: dynamic whole affected footmaximal pressure nwf -avg p: normal whole foot-average pressure nwf -th: normal whole foot-thrust