Comparison of Structural Diagnosis and Management (SDM) approach and Myofascial Release (MFR) for improving planter heel pain, ankle range of motion and disability: A Randomized Clinical Trial

Purpose This study compared the effect of Structural Diagnosis and Management (SDM) approach over Myofascial Release (MFR) on gastrocnemii, soleus and plantar fascia in patients with plantar heel pain. Subjects Sixty-four (n=64) subjects, aged 30-60 years, with a diagnosis of plantar heel pain, plantar fasciitis or calcaneal spur by a physician and according to ICD-10. Participants were equally allocated to MFR (n=32) and SDM (n=32) group by hospital randomization and concealed allocation. Methods In this assessor blinded randomized clinical trial, the control group performed MFR (three tissue specific stretching techniques) and the experimental group performed 2 tissue-specific interventions utilizing the Structural Diagnosis and Management (SDM) concept for 12 sessions over a 4-week period. In addition, both groups received strengthening exercises and other conventional treatments. Pain, activity limitations and disability were assessed as primary outcomes utilizing the foot function index (FFI) and range of motion (ROM) of the ankle dorsiflexors and plantar flexors were measured with a universal goniometer. Secondary outcomes were measured using the Foot Ankle Disability Index (FADI) and 10-point manual muscle testing process for the ankle dorsiflexors and plantar flexors. Result Both MFR and SDM groups exhibited significant improvements from baseline in all outcome variables, including: pain, activity level, disability, range of motion and function after the 12-week intervention period (p<.05), The SDM group showed more significant improvements than MFR for FFI pain (p=.001), FFI activity (p=.009), FFI (p= .001) and FADI (p=.002). Conclusion MFR and SDM approaches are both effective to reduce pain, improving function, ankle range of motion, and reduce disability in plantar heel pain. However, the SDM approach is significantly superior (for reducing pain, improving function and reducing disability (p<.05). ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial CTRI/2020/05/025151 ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of Bangladesh Health Professions Institute (BHPI) gave ethical approval for this work (CRP-BHPI/IRB/12/18/1285) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors