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2019 literature review part 3: knee, foot, and ankle pain

We distribute newsletters every week to educate you—our patients—on some of the most common injuries and conditions that we treat, and to explain why we always recommend seeing a physical therapist first when dealing with any type of pain. In working towards this goal, we also regularly summarize research studies that show how physical therapy typically leads to the best possible outcomes, and how it helps patients avoid surgery and other costly or unnecessary treatments in the process.

With the end of the year approaching, we’d like to look back at some of our favorite study summaries of 2019 in a four—part newsletter series with each one focusing on a different topic or region of the body. In part 3, we review research on physical therapy for knee pain, ankle pain, and foot pain.


The knee is one of the largest and most complex joints in the body. It’s also incredibly vulnerable to injury, with knee pain ranking behind just back pain as the second most common condition of the muscles and bones. Knee pain is the single greatest cause of disability in individuals who are 65 and older, and knee osteoarthritis is usually responsible in these cases. For more active individuals, injuries like runner’s knee, jumper’s knee, and tears of the ACL and other ligaments are most common.

How do the costs of physical therapy and arthroscopic partial meniscectomy compare? A trial—based economic evaluation of two treatments in patients with meniscal tears alongside the ESCAPE study (2019)

  • Background: tears of the meniscus—a crescent—shaped piece of cartilage in the knee that absorbs shock—are common in athletic populations; many patients with meniscus tears are treated by a surgical procedure called arthroscopic partial meniscectomy, but it’s not clear if surgery is the best approach, and physical therapy represents an alternative
  • How the study was conducted: 321 patients with meniscus tears were randomly assigned to undergo either an eight—week physical therapy treatment program—which featured stretching, strengthening, and balance exercises—or surgery; data on the effects and costs of these treatments was evaluated for up to two years to determine which led to better outcomes
  • What the results showed: there was a relatively high probability that physical therapy was more cost—effective than surgery, and a relatively high probability that it was superior to surgery for both knee function and quality of life
  • Take—home message: based on these findings, it appears that patients with a meniscus tear can experience better outcomes at a lower cost with physical therapy over surgery; these individuals are therefore urged to try a physical therapist program first before contemplating surgery

Foot and ankle pain

The feet and ankles have the tall task of withstanding the weight of the entire body, and as a result, injuries are quite common in this region. Foot and ankle issues are particularly common in active individuals, with ankle sprains being the single most prevalent injury sustained in sports. Other issues—like plantar fasciitis and Achilles tendinitis— typically occur in individuals who frequently do lots of running and/or jumping, but foot or ankle pain can strike anyone at any age.

Exercise, orthoses and splinting for treating Achilles tendinopathy: a systematic review with meta—analysis (2018)

  • Background: Achilles tendinopathy is defined as either tendinitis (inflammation) or tendinosis (micro—tears without inflammation) of the Achilles tendon, and it causes pain, swelling and impaired performance; treatment options for this condition include physical therapy with exercise, splints, and orthoses (shoe inserts)
  • How the study was conducted: a systematic review and meta—analysis was conducted, which collect and analyze research on the same topic; in this case, 22 studies were included, all of which evaluated either exercise, orthoses, or splints for Achilles tendinopathy to determine which is most effective
  • What the results showed: moderate—quality evidence showed treatments that included exercise reduced pain and improved function in patients with Achilles tendinopathy; adding a splint or orthoses to an exercise program did not significantly change these outcomes
  • Take—home message: exercise produced positive outcomes in Achilles tendinopathy, while splints and orthoses did not seem to have any notable impact; patients are therefore encouraged to see a physical therapist, where they can undergo an exercise—based treatment program and are likely to experience similar improvements

Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review (2018)

  • Background: plantar fasciitis is a common injury involving inflammation of the plantar fascia, a strong piece of tissue that supports the arch of the foot; manual therapy is a hands—on technique commonly administered by physical therapists for these patients, but more research is needed to support this intervention
  • How the study was conducted: a systematic review was conducted, which collects and analyzes data from research on the same topic; seven high—quality studies called randomized—controlled trials (RCTs) were included in this review, all of which evaluated manual therapy for plantar fasciitis
  • What the results showed: manual therapy was found to improve patients’ function and threshold for pain more effectively than the other treatments analyzed
  • Take—home message: since manual therapy appears to be a beneficial intervention for plantar fasciitis, patients with this condition should strongly consider seeing a physical therapist for a personalized treatment program that includes these techniques

In our next newsletter, we review our top summaries on studies of opioids for pain relief, sports injuries, and arthritis.

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