Volume 9, Issue 1, January 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Efficacy of Phonophoresis and Foam Roller
Stretching along with Intrinsic Muscle Activities in
Reducing Pain and Improving Function among
Patients with Plantar Fascitis
Subramani. T.; Kavith. K.; Usha Nandhini. M.
Abstract:- I. INTRODUCTION
BACKGROUND: Plantar fasciitis is a heel pain common
in middle-aged persons due to inflammation of the The routine activity of locomotion is provided by the
plantar fascia. The calcification at the fascia's connection extremes of ground reactive forces associated with
to the calcaneus is the result of recurrent microtrauma. extremities. As we have seen, people are moving around
It is imperative to intervene early. To manage the illness, quickly to meet their needs in daily life, which has made the
physiotherapy is crucial, involving foam roller stretching world too busy looking and moving.
and phonophoresis. The combination therapy known as
phonophoresis combines workouts aimed at In ambulation, the lower extremities do the majority of
strengthening muscles and employs ultrasound to deliver the work, with the foot becoming nearly obsolete for smooth
medicines into tissues. locomotion. It also acts as a powerful lever, propelling the
body forward and providing good body stability by keeping
OUTCOME MEASURES: The Foot Function Index and the foot arches in place.
Visual Analog Scale were used to assess pain severity and
impact on duties and activities. A score of 10 indicated More than half of middle-aged people get plantar
extreme pain or inability to function. Participants rated fasciitis as a result of this kind of recurrent stress. An
their pain on both scales. aseptic infection of the plantar fascia is what this plantar
fasciitis is. The most typical reason for heel pain is this.
METHODOLOGY: This study was conducted at Plantar fasciitis is a medical term that refers to "the bottom
Thangam Physiotherapy clinic in Perambalur, India, for of the foot, "fascia" is a kind of connective tissue, and
3 weeks. The population included patients aged 30 to 45 itisdenotes inflammation.
with plantar fasciitis for two months, free from
This is an overuse condition that, for unknown reasons,
psychological depression, and well-organized. 15 patients
results in a localized inflammatory response to stressors
were selected and assessed using an ultrasound
apparatus, diclofenal diethylamine, and Aquasonic gel. resulting from repeated microtrauma. This syndrome
develops when the tissue is overworked before it has had
PROCEDURE: The patient had phonophoresis, which is enough time to recover. Thus, the so-called "heel spur"—a
a continuous, ten-minute process that uses aquasonic gel calcification at the plantar fascia's attachment to the
and diclofenal diethylamine. The instructions given to calcaneus—continues to cause pain and inflammation over
the participants involved standing with the afflicted foot time.The term "heel pain syndrome" is frequently used to
on a foam roller and pressing down on the roller until describe this illness.
they experienced discomfort. In order to strengthen the
feet and ankles, intrinsic foot workouts were carried out, As it worsens, the discomfort could begin to interfere
such as toe curls and extensions. with everyday tasks. A lack of achilles tendon flexibility
combined with a history of increased stress on the plantar
RESULT: A three-week therapy trial for plantar fasciitis fascia can result in plantar fasciitis, an inflammation of the
revealed a statistically significant difference in the fascia. Physiotherapy, through its preventive, therapeutic,
patients' discomfort and function, indicating that these and restorative functions, is an important part of this
therapies can successfully lessen pain and enhance ankle patient's overall management because it allows the patient to
joint function. participate in daily activities more effectively.
CONCLUSION: Patients with plantar fasciitis who There is a lot of literature that supports phonophoresis
received intrinsic foot exercises, foam roller stretching, as a new upcoming technique in which medically useful
and phonophoresis showed considerable improvements drugs are driven into the tissues using ultrasound, which
in function and pain reduction. plays an important role in reducing pain in plantar fasciitis.
Plantar fasciitis is a significant issue that interferes with
daily activities. The importance of early intervention in
regaining optimal function cannot be overstated.
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Volume 9, Issue 1, January 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Plantar Fasciitis can be treated in a variety of ways. E. Selection Criteria
The Outcomes of various therapy methods differ depending
on the Clinical situation. Plantar fasciitis is routinely treated Inclusion Criteria
with Phonophoresis and foam roller stretching and intrinsic Age range: 30 to 45 years
foot activities, are the techniques utilised by Both sexes
physiotherapists. It is impossible to say that one modalityis The patient who has had plantar fasciitis for two months.
preferable to another. Free from psychological depression and well-organized.
Foam rolling has recently gained popularity as a self- Criteria For Exclusion
myofascial release (SMR) method. SMR is thought to Patients with plantar fascia rupture,
operate on the same therapeutic mechanism as conventional Diabetic mellitus,
“myofascial release.” Nevertheless, the person must exert leprosy,
pressure on themselves by using their own body weight. The tarsal tunnel syndrome,
motion of the foam roller in relation to the tissue structure fat pad syndrome,
applies both direct and sweeping pressure to the soft tissues. calcaneal spur.
By breaking adhesions, this generates an increase in tissue
extensibility and lubrication of the fascial layer. III. METHODOLOGY
Intrinsic muscle strengthening exercises include short Using a practical selection technique, 15 patients with
foot exercises, heel raises, toe curls, and toe extensions. The plantar fasciitis were selected, and they completed an
Foot Function Index comprises 17 questions regarding the assessment proforma with subjective ratings of the type,
impact of pain on various duties and activities. Using the degree, and medical history of their pain. An explanation of
same scale as the patient assessment, the questionnaire’s each participant's ailment and the intended treatment plan
pain severity was determined; a score of 10 indicated was provided. Test pain scores were gathered using a visual
extreme pain or an inability to function. analog scale, and data was documented.
Visual Analog Scale: Participants were asked to rate A. Materials Used
their level of pain on a horizontal scale ranging from 1 to 10, Ultrasound apparatus
as well as on a 10 cm scale with 0 to 10 markings. They Diclofenal diethylamine (Voveran)
were then asked to indicate which mark on the scale best Coupling medium (Aquasonic gel)
described their level of pain.
B. Phonophoresis
Therefore, the goal of this study was to ascertain which The patient received the phonophoresis at first. The
combination of phonophoresis and exercise routine would patient was lying prone. The foot was raised by placing the
be the most successful course of treatment. Phonophoresis is pillow on the ankle. On the heel, diclofenal diethylamine
the term for the drug's passage through the skin and into the and the coupling media aquasonic gel were administered.
subcutaneous tissue while sound waves are present. Due to After the transducer was positioned, it was turned in tiny,
the fact that it combines medication with ultrasonic therapy, concentric circles.
it falls under the category of combination therapy. Any
Mode: Continuous
movement, skill, or manoeuvre that requires the use of
Intensity : 0.25 watt/cm².
muscles and is repeated in order to develop or strengthen the
body or any of its parts. Therefore, the goal of this study was Duration : 10 minutes.
to assess the effects of phonophoresis, foam rolling, Frequency : 1MHz
stretching, and intrinsic foot exercises on individuals with
C. Foam Roller Stretching
plantar fasciitis' range of motion and discomfort.
Standing with the injured foot on the foam roller and the
II. DESIGN AND METHODOLOGY unaffected foot on the floor was the recommended position
for the participants. The next step was to tell them to keep
A. Study Design pushing against the foam roller while moving their foot
Experimental study design was selected to conduct this repeatedly from heel to toe. When they reached their point
study. of greatest discomfort, they were instructed to halt. The
participants foam-rolled for 45 seconds, took a 15-second
B. Study Setting break, and then repeated five times.
The study took place at Thangam Physiotherapy clinic,
Perambalur. D. Intrinsic Foot Activities
Foot exercises involve pressing the tip into the ground,
C. Study Duration lifting heels, and holding the upper position for 5 seconds.
The study was conducted for about total of 3 weeks. Toe curls involve scrunching toes on a towel, while toe
extensions involve lifting toes and spreading them apart to
D. Sampling Method achieve the same height. These exercises help strengthen the
The population under research consisted of all subjects muscles in the feet and ankles.
who met the inclusion criteria and were between the ages of
30 and 45 for both sexes.
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Volume 9, Issue 1, January 2024 International Journal of Innovative Science and Research Technology
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E. Statistic Analysis The investigation's end measures were the ankle joint's
Each patient had a three-week course of treatment. The range of motion and discomfort. We measured pain and
pre and post intervention ratings were recorded on a unique function using the visual analog scale (VAS) and the foot
proforma for each and every individual subject. function index (FFI).
Table 1: Pre test and Post test value of Visual analog scale (VAS)
Pre test Post test P value
8.32 3.2 <0.001
VAS
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
pre test post test
Graph 1: Comparison of pre test and Post test core of Visual analog scale (VAS)
Table 2: Pre test and Post test value of foot function index (FFI)
Pre test Post test P value
O.79 0.32 <0.001
VAS
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
pre test post test
Graph 2: Comparison of pre test and Post test of foot function index (FFI)
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Volume 9, Issue 1, January 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
IV. RESULT For subjects who will be in the research longer than
two months, a comparable investigation may be conducted.
Patients with plantar fasciitis who underwent A larger sample size could be used for a comparable
phonophoresis, foam roller stretching, and intrinsic foot investigation. A comparable investigation might be carried
exercises showed a statistically significant difference out for the age range of under thirty to over forty-five years.
(p<0.001) in all the outcome measures in terms of pain relief Future research might examine the comparative and long-
and function. term effects of intrinsic foot exercises, foam rolling, and
phonophoresis in the treatment of plantar fasciitis.
V. DISCUSSION
VI. CONCLUSION
The following are the notable reductions in pain that
the various therapy approaches have brought about. Plantar fasciitis patients who received phonophoresis,
foam roller stretching, and intrinsic foot exercises improved
Rather than being a direct result of ultrasound, the significantly in terms of pain relief and improvement in
penetration of hydrocortisone is caused by the skin being function.
heated by conduction from the warm ultrasound head.
Conflicts Of Interest: We have no conflict of interest to
Both thermal and non-thermal impacts of ultrasound
declare.
can alter the stratum corneum's permeability. Because the
Source of Fundings: We did not receive support from
stratum corneum contracts differently on either side of the
any organization for the submitted work.
skin, the medication will spread across it when its
permeability is enhanced. The tissue absorbs the ultrasonic Ethical Clearance: Approval was obtained from local
frequencies and transforms them into heat. The insonate ethics committee.
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