Comparative Effectiveness of Iontophoresis vs. Low Dye Taping in Plantar Fasciitis: A Systematic Review

Vol.:(0123456789) Indian Jou nal o O hopaedics h ps://doi.o g/10.1007/s43465-025-01477-4 REVIEW ARTICLE Compa a i e E ec i eness o Ion opho esis s. Low Dye Taping inPlan a Fascii is: ASys ema ic Re iew Au o aCas o‑Méndez1· LucíaRoldán‑Fe nández2· Na aliaTo a uela‑Ca ión3 · ManuelPabón‑Ca asco4· JuanÁl a ez‑Co de o2· Ma íaVázquez‑Cas o2 Recei ed: 17 Feb ua y 2025 / Accep ed: 25 June 2025 © The Au ho (s) 2025 Abs ac Backg ound Plan a ascii is (PF) is a equen cause o heel pain, a ec ing app oxima ely 10% o he popula ion. Conse a- i e ea men s such as ion opho esis and low-dye aping (LDT) a e widely used o alle ia e symp oms, o en p o iding sho - e m pain elie . Objec i e This sys ema ic e iew aims o compa e he e icacy o ion opho esis (wi h 5% ace ic acid, 0.4% dexame hasone, dexame hasone and lidocaine, o placebo) e sus low-dye aping (LDT) in ea ing plan a ascii is. Addi ionally, i e alua es he combined e ec o ion opho esis and LDT applica ion. Me hods A sys ema ic sea ch was conduc ed in Scopus, PubMed, Web o Science, CINAHL, and he Coch ane Lib a y da abases, ollowing PRISMA guidelines and he Coch ane Handbook o Sys ema ic Re iews o In e en ions. Inclusion and exclusion c i e ia we e p ede ined. Two independen e iewe s sc eened and ex ac ed da a om eligible s udies, assessing hei quali y. Included s udies comp ised andomized con olled ials, non- andomized clinical ials, case–con ol s udies, sys ema ic e iews, and me a-analyses. The e iew p o ocol was egis e ed wi h PROSPERO ( egis a ion numbe : [blind o e iew]). Resul s Eigh s udies published be ween 1997 and 2018 we e included, p o iding a mode a e le el o e idence. Bo h ion- opho esis (wi h he speci ied agen s) and low-dye aping, alone o combined, we e associa ed wi h s a is ically signi ican educ ions in pain sco es compa ed o baseline. Conclusion Ion opho esis and low-dye aping a e e ec i e conse a i e in e en ions o plan a ascii is, wi h hei com- bined use also showing bene icial e ec s. These ea men s can be conside ed iable op ions o educe pain in pa ien s wi h plan a ascii is. Keywo ds Low-dye aping· Ion opho esis· Plan a ascii is· Foo · The apy * Na alia To a uela-Ca ión n o[email p o ec ed] Au o a Cas o-Méndez au o acas [email p o ec ed] Lucía Roldán-Fe nández oldan e [email p o ec ed] Manuel Pabón-Ca asco [email p o ec ed] 1 G upo de In es igación en Lide azgo He mes CTS-601, Depa amen o de Podología, Facul ad de En e me ía, Fisio e apia y Podología. Lide azgo DS-30 Bases biomédicas del pie que a ec an al apoyo y la ma cha, Ins i u o de Biomedicina de Se illa, IBiS/Uni e sidad de Se illa, 41009, Se illa, España 2 Independen Resea che s, Luis Mon o o S : 91, 41018, Se ille, Spain 3 G upo de In es igación He mes CTS-601, Depa amen o de Podología, Facul ad de En e me ía, Fisio e apia y Podología. G upo de In es igación DS-30 Bases biomédicas del pie que a ec an al apoyo y la ma cha, Ins i u o de Biomedicina de Se illa, IBiS/ Uni e sidad de Se illa, 41009, Se illa, España 4 CTS-1050 “Complex Ca e, Ch onici y andHeal h Ou comes” Resea ch G oup, Facul y o Nu sing, Physio he apy andPodia y, Uni e si y o Se ille, 41009, Se ille, Spain Indian Jou nal o O hopaedics Abb e ia ions PF Plan a Fascii is LDT Low dye ape echnique MFA Medial oo a ch PRP Pla ele - ich plasma AWB Au ologous whole blood In oduc ion Plan a ascii is (PF), also e e ed o as plan a asciosis, is he mos common cause o heel pain [1, 2], a ec ing app oxima ely 10% o he popula ion du ing hei li e ime [3]. The e iology o PF is conside ed mul i ac o ial and no ye ully unde s ood, wi h isk ac o s including obesi y, seden a y li es yle, epe i i e s ess, physical ac i i y, and male sex among o he s [4–9]. Acco ding o Ma dani e al., PF is ega ded as a degene a i e condi ion ( asciosis) when symp oms pe sis beyond 8 weeks, wi h he ch onic s age de ined a e his ime ame [10, 11]. The diagnosis o PF is p ima ily clinical [12–14], bu imaging echniques such as ul asound, elas og aphy, o sonoelas og aphy can con i m cha ac e is ic plan a ascia hickening [15, 16]. Typical ul asound indings include hypoechogenici y, inc eased issue igidi y, and dis up ion o he no mal ib illa pa e n [17, 18]. Conse a i e ea men is he i s -line app oach in man- aging PF, wi h su gical in e en ions ese ed o cases e ac o y o conse a i e he apies [19]. Common con- se a i e modali ies include o ho ics, d y needling, s e ch- ing, pha macological he apy, manual he apy, shockwa e he apy, nigh splin s, physical he apy echniques (ul a- sound, elec o he apy, phonopho esis), in insic oo muscle s eng hening, and aping [1, 20, 21]. Co icos e oid injec ions a e equen ly used o hei an i-in lamma o y and analgesic e ec s in PF [22]. C aw o d e al. epo ed pain elie up o one mon h pos -injec ion, al hough e ec s ypically diminish by h ee mon hs [23]. Howe e , injec ions can be pain ul and a e no sui able o all pa ien s, wi h po en ial ad e se e ec s including in ec- ion, skin a ophy, and plan a ascia up u e [22]. Ion opho esis is a non-in asi e echnique ha uses low- ol age elec ical cu en s o deli e co icos e oids o ace ic acid ansde mally in o so issues [24–26]. I is employed in app oxima ely 13.04% o PF cases [27]. S udies ha e demons a ed ha ion opho esis wi h 0.4% dexame hasone can es o e unc ion in musculoskele al condi ions and may se e as an al e na i e o co icos e oid injec ions [28]. Ace ic acid ( ypically 5%) deli e ed by ion opho esis o ms calcium ace a e, which binds and acili a es he emo al o calcium deposi s, making his echnique use ul in PF and o he calci ic endini is condi ions [29, 30]. Ad an ages o ion opho esis include p ese a ion o he skin ba ie and a oidance o needle- ela ed issue damage and pain. This minimizes isks such as plan a ascia up- u e and in ec ion commonly associa ed wi h co icos e oid injec ions [22]. Low-Dye aping (LDT) is a widely used aping echnique designed o p o ide empo a y ex e nal suppo o he medial oo a ch (MFA), add essing biomechanical ac o s con ib- u ing o PF [31, 32]. Among a ious aping me hods (e.g., X-a ch, High-Dye), LDT is conside ed he gold s anda d and is equen ly applied in ea ly PF managemen [32]. O ho- pedic de ices combined wi h aping ha e demons a ed enhanced e ec i eness compa ed o single modali ies [27]. Despi e ad ances in PF ea men , symp om managemen emains challenging. Co icos e oid injec ions o e ansien pain elie bu a e associa ed wi h po en ial complica ions and lack s anda dized guidelines o use [19, 26]. Thus, explo ing al e na i e o adjunc i e conse a i e ea men s is essen ial. This e iew speci ically compa es ion opho esis and LDT, gi en hei widesp ead use and po en ial complemen- a y mechanisms—ion opho esis deli e ing an i-in lamma- o y agen s di ec ly in o a ec ed issues and LDT p o iding mechanical suppo o he oo a ch. Addi ionally, he com- bined applica ion o bo h ea men s is assessed, as his may o e syne gis ic bene i s. The e o e, his e iew aims o compa e he e icacy o ion opho esis (wi h 5% ace ic acid, 0.4% dexame hasone, dexame hasone and lidocaine, o placebo) e sus LDT in he ea men o PF. Fu he mo e, i e alua es he combined e ec o ion opho esis and LDT applica ion. The guiding esea ch ques ion is: In he symp oma ic ea men (pain educ ion) o PF, which is mo e e ec i e—ion opho esis, LDT, o hei combined use? Me hods The sea ch s a egy was conduc ed be ween Feb ua y and Oc obe 2021 on he da abases: Scopus, PubMed, Web o Science, CINHAL, and he Coch ane Lib a y. This sys ema ic e iew was conduc ed ollowing he P e- e ed Repo ing I ems o Sys ema ic Re iews (PRISMA) guidelines and he Coch ane Guide o Sys ema ic Re iews o In e en ions. The sys ema ic e iew p o ocol was egis- e ed in he In e na ional P ospec i e Regis e o Sys ema ic Re iews PROSPERO (numbe : ‘‘[blinded o e iew]”). The esea ch ques ion ollowed he PICOS c i e ia (P— pa ien s: adul popula ion wi h PF; I—in e en ion: symp- oma ological ea men o PF wi h ion opho esis; C—com- pa ison wi h LD- ype bandage and wi h combined ea men wi h LDT- ype bandage wi h ion opho esis; and O—Ou - comes: pain educ ion). Indian Jou nal o O hopaedics To design he sea ch s a egy, index e ms and ee ex wo ds ela ed o keywo ds o he e iew objec i e we e used and connec ed wi h Bolean ope a o s (AND, OR and NOT). The ollowing wo common sea ch s a egies we e used o all da abases: (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND (‘‘ion opho esis’’ OR 'dexame hasone' OR ‘‘ace ic acid’’) NOT (‘‘injec ions’’ OR ‘‘su ge y’’) and (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND 'low dye aping'. The desc ip ion o he da abase is shown in Table1. A e emo ing duplica es (Check o duplica es o Men- deley oll), wo independen e iewe s (LRF and ACM) sc eened he i le and abs ac o all a icles o eligibili y. In case o disag eemen , a consensus was eached wi h he opinion o a hi d e iewe (EFG). The inclusion c i e ia o his e iew we e as ollows: s udies published in English, Spanish, F ench, o Ge man; in ol ing adul pa icipan s diagnosed wi h plan a ascii- is (PF), ei he unila e al o bila e al. Eligible s udies we e published wi hin he las 25yea s ( om 1996 o 2021) and included andomised con olled ials (RCTs), non- an- domised clinical ials, case–con ol s udies, coho s ud- ies, sys ema ic e iews, and me a-analyses. S udies we e equi ed o e alua e he e ec o ion opho esis (using dexa- me hasone and/o ace ic acid) in he ea men o PF. This included s udies compa ing ion opho esis wi h placebo, no ea men , Low-Dye aping (LDT), o he combined applica- ion o ion opho esis and LDT. Addi ionally, s udies had o epo ou comes using alida ed measu emen ools such as he Visual Analogue Scale (VAS), he Ma yland Foo Sco e (MFS), o he Foo Func ion Index (FFI). The exclusion c i e ia we e: s udies in ol ing animal models, and hose compa ing ion opho esis wi h su gical in e en ions, co icos e oid in il a ions, o o he conse a- i e ea men me hods no unde e iew in his s udy. Da a Ex ac ion The e iew was ca ied ou independen ly by wo esea ch- e s; s udy au ho s (LRC, ACM). The e e ences ound we e expo ed o he Mendeley bibliog aphic manage , and duplica e a icles we e dele ed. Subsequen ly, he e iew- e s ead he abs ac s o he p eselec ed esea ches, and inally he ull ex s o he a icles ha s ill me he inclu- sion c i e ia we e analysed. Any disc epancy was esol ed by a join discussion and a hi d e iew. The ollowing da a we e ex ac ed: (1) i s au ho ; (2) s udy Ti le; (3) publica- ion yea ; (4) ype o design; (5) ype o in e en ion; (6) me hod and du a ion o in e en ion; (7) sample size; (8) age o s udy pa icipan s; (9) a ing scale(s) used; (10) main indings and conclusions. Table 1 Sea ch s a egies used in each da abase Da abase Sea ch s a egies Resul s Medline (Pubmed) 1s sea ch (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND (‘‘ion opho esis’’ OR ‘‘dexame hasone’’ OR ‘‘ace ic acid’’) NOT (‘‘injec ions’’ OR ‘‘su ge y’’) 8 2nd sea ch (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND ‘‘Low-Dye Taping’’ 5 CINAHL 1s sea ch (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND (‘‘ion opho esis’’ OR ‘‘dexame hasone’’ OR ‘‘ace ic acid’’) NOT (‘‘injec ions’’ OR ‘‘su ge y’’) 18 2nd sea ch (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND ‘‘Low-Dye Taping’’ 4 Web o Science 1s sea ch 2nd sea ch (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND (‘‘ion opho esis’’ OR ‘‘dexame hasone’’ OR ‘‘ace ic acid’’) NOT (‘‘injec ions’’ OR ‘‘su ge y’’) 15 17 2nd sea ch (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND (‘‘ion opho esis’’ OR ‘‘dexame hasone’’ OR ‘‘ace ic acid’’) NOT (‘‘injec ions’’ OR ‘‘su ge y’’) 17 Scopus 1s sea ch (‘‘plan a ascii is’’ OR ‘‘heel pain’’) AND ea men AND (‘‘ion opho esis’’ OR ‘‘dexame hasone’’ OR ‘‘ace ic acid’’) NOT(‘‘injec ions’’OR ‘‘su ge y’’) 5 2nd sea ch (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND ‘‘Low-Dye Taping’’ 17 Coch ane 1s sea ch (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND (‘‘ion opho esis’’ OR ‘‘dexame hasone’’ OR ‘‘ace ic acid’’) NOT (‘‘injec ions’’ OR ‘‘su ge y’’) 24 2nd sea ch (‘‘Plan a ascii is’’ OR ‘‘Heel pain’’) AND ea men AND ‘‘Low-Dye Taping’’ 2 Indian Jou nal o O hopaedics Da a Syn hesis andRisk o Bias Wi h he ool p o ided by Coch ane 'Re iew Manage ' o 'Re Man', was assessed he isk o bias o he selec ed s ud- ies ( e sion 5.4.1.was used). Quali y Assessmen Two esea che s (EFG, ACM) e iewed me hodological quali y based on he C i ical Assessmen Skills P og amme and a PRISMA Decla a ion Checklis (P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses). This p ocess was ca ied ou by he wo di e en esea che s o dec ease he p obabili y o isk o bias. Resul s Acco ding o he guidance o PRISMA guidelines, he i s sea ch gene a ed 70 a icles, while he second gene a ed 35 a icles, and inally whe e added he 3 a icles by snowball sampling, so he o al was o 108 a icles. A e using he ''check o duplica es'' op ion o he biblio- g aphic manage , we disca d hose documen s ha we ind in duplica e in se e al da abases. In his way, we a e le wi h 53 a icles om he i s sea ch, 26 om he second sea ch, and 3 o he a icles ob ained by snowball. A e disca ding duplica es, we p oceeded o make a mo e exhaus i e selec ion o he 82 a icles we had. To do his, we e iewed and ead he i les and abs ac s o all a icles and p oceeded o emo e hose ha we e no co ec ly classi ied by he da abases. By his me hod, we limi ed he selec ion o a icles o 23, o which he ull ex s we e assessed so ha hey me he equi emen s o ou PICO esea ch ques ion. A e ha only nine o he 23 a icles ully me he selec- ion c i e ia, so he emaining 14 we e elimina ed, among he main easons being language and no o iginal esea ch a icles. Howe e , i should be no ed ha , a e conduc ing an in-dep h eading o he 9 a icles, we could obse e ha 2 o hem had exac ly he same me hodology and a i ed a exac ly he same esul s, despi e being published in di - e en scien i ic jou nals. Fo his eason, we included he o iginal a icle and emo ed he duplica e s udy, wi h eigh a icles inalising ou sys ema ic e iew. Finally, he eigh selec ed s udies we e analysed in de ail o co obo a e ha hei con en was in acco dance wi h he equi emen s p e i- ously es ablished o he PICO esea ch ques ion (Fig.1). Risk o bias in included s udies was assessed using he Re iew Manage so wa e (Re iew Manage ® o Re Man ool®), de eloped by The Coch ane Collabo a ion. This ool acili a ed a s uc u ed e alua ion o po en ial biases ac oss s udies, wi h esul s isually summa ized in Fig.2, indica ing a gene ally low isk o bias in he majo i y o included publica ions. Fu he mo e, a de ailed ma ix dia- g am (Fig.3) depic s he isk o bias le els o each s udy indi idually, ca ego ized by colo codes: g een o low isk, yellow o mode a e isk, and ed o high isk o bias. S a is ical Analysis o S udy Quali y The CASPe and PRISMA assessmen guidelines we e used and applied o he eigh a icles included in he sys ema ic e iew [33]. This p ocess was ca ied ou by wo di e en esea che s (LRF and ACM) o educe he p obabili y o isk o bias, and he sco e ob ained is shown in Table2. Resul s o Syn heses Table3 p o ides a comp ehensi e syn hesis o he objec- i es, me hodologies, esul s, and conclusions o all included s udies. Each s udy is subsequen ly analyzed indi idually, wi h de ailed desc ip ions o key cha ac e is ics, including me hodological quali y assessed using he Sacke e idence classi ica ion sys em [34]. Main Resul s Gudeman e al. published in 1997 was he i s known s udy in which he e ec s o ion opho esis wi h 0.4% dexame ha- sone we e s udied in he symp oma ic ea men o PF we e s udied. The esul s ob ained we e e y signi ican ; hey con- cluded ha he applica ion o ion opho esis wi h 0.4% dexa- me hasone educes pain and inc eases oo unc ionali y in he sho e m (2–3 weeks) in pa ien s wi h PF, and ecom- mended i insi ua ions whe e immedia e educ ion in symp- oms o PF was needed, o example, in eli e a hle es. As a limi a ion, his s udy only shows s a is ically signi ican di - e ences in he sho e m (2–3 weeks), wi h no di e ences in he one-mon h ollow-up [35]. Subsequen ly, Japou e al., 1999 s udied he e ec i eness o 5% ace ic acid in educ- ing ch onic heel pain, concluding ha applica ion o ion o- pho esis wi h 5% ace ic acid educes heel pain in he i s s ep o he day (a cha ac e is ic sign o PF) and is he e o e an e ec i e conse a i e ea men o acu e o ecalci an heel pain, al hough i is necessa y o con inue in es iga ing in his line o con i m hese esul s. In his s udy, i should be no ed as a limi a ion ha i lacks a con ol g oup [36]. In 2006 Osbo ne e al. conduc ed a s udy andomly di iding he sample in o 3 g oups: G oup 1 (G1) ecei ed LDT and ion opho esis wi h 0.4% dexame hasone as ea men , G oup 2 (G2) applied LDT and ion opho esis wi h placebo (0.9% NaCl) and G oup 3 (G3) ecei ed LDT as ea men oge he wi h ion opho esis wi h 5% ace ic acid. Fu he mo e, he h ee g oups ecei ed guidelines o s e ch he leg muscle [25]. Pain and mo ning s i ness we e measu ed using he Indian Jou nal o O hopaedics Fig. 1 PRISMA lowcha o s udy selec ion Fig. 2 Gene al analysis o he isks o bias in he s udies analyzed Indian Jou nal o O hopaedics Visual Analogue Scale (VAS), he Visual Analogue S i - ness Scale, and he Mo ning S i ness Du a ion Ques ion- nai e. These measu emen s we e aken a he beginning o ea men , a he end o i , and a e 4 weeks om he end o ea men . As a esul , all g oups showed signi ican imp o emen s in mo ning pain and s i ness. Howe e , o mo ning pain, he ace ic acid and bandage g oup showed a signi ican ly g ea e imp o emen han he es o he g oups. The esea che s concluded ha applying LDT oge he wi h ion opho esis and ace ic acid, dexame hasone, o placebo educes he pain and s i ness caused by PF. As indica ed in he i le o he s udy, he esul s shown a e sho - e m, so he conclusions a e limi ed o he pe iod obse ed, lacking long- e m esul s [25]. Following his line o esea ch, Goyal e al. compa ed he e ec i eness o LDT wi h he combina ion o his band- age and ion opho esis o educe oo pain and inc ease i s unc ionali y in PF, he au ho s concluded ha bo h LDT and combined bandage he apy and ion opho esis cause a signi ican dec ease in pain and disabili y in pa ien s wi h PF The e ec s o combina ion he apy a e mo e bene icial. As a limi a ion, since i is a s udy wi h a quasi-expe imen- al design, he s udy lacks andomiza ion o g oups, which inc eases he isk o bias and limi s he s eng h o causal in e ences. Di e ences be ween g oups a baseline could in luence he esul s [37]. In ela ion o combined ea - men s, Che i e al. concluded ha he combina ion o ion- opho esis wi h ace ic acid and conse a i e ea men s can p omo e he eco e y o oo unc ionali y and he educ ion o pain mo e e ec i ely compa ed o he use o ea men app oaches in which only one me hod is used. LDT is e y bene icial and e ec i e in he symp oma ic ea men o PF, and ace ic acid ion opho esis has shown p omising esul s [38]. Howe e , Kal a, 2016 concluded in his s udy ha he applica ion o ion opho esis wi h 0.4% dexame hasone and lidocaine hyd ochlo ide shows be e esul s in he symp o- ma ic ea men o PF compa ed o ion opho esis wi h dis- illed wa e (placebo) [39]. Rega ding he sys ema ic e iew by Podolsky e al., 2015 i concluded ha al hough se e al bandaging echniques ha e been shown o educe pain in PF, LDT has he bes e idence o he ea men o PF in he sho e m, al hough he long- e m e ec and e ec i eness o his echnique mus be in es iga ed. This e iew is limi ed by he quali y o he included s udies, since he indi idual limi a ions p esen ed by he included RCTs, c osso e s udies, and epea ed meas- u es clus e s udy a e ans e ed o he conclusions o he e iew [40]. Ve b uggen e al. In 2018, s udies in which he du a ion o ea men was longe (6 weeks ins ead o 2 o 3) p oduced he g ea es e ec s, sugges ing ha long- e m LDT ea men may be mo e bene icial in educing PF pain. This e iew is limi ed by he quali y o he included s udies and he sea ch pa ame e s (2005–2016) [41]. Fig. 3 Risks o bias acco ding o each s udy included in he sys em- a ic e iew Table 2 Sco e o each s udy analyzed acco ding o he c i ical app aisal guides S udy Scales Resea che 1 Resea che 2 Gudeman e al., 1997 CASPe 9/11 9/11 Japou e al., 1999 CASPe 7/11 8/11 Osbo ne e al., 2006 CASPe 9/11 10/11 Goyal e al., 2013 CASPe 9/11 9/11 Che i e al., 2016 CASPe 8/11 8/11 Kal a, 2016 CASPe 9/11 9/11 Podolsky e al., 2015 PRISMA 18/27 21/27 Ve b uggen e al., 2018 PRISMA 17/27 20/27 Indian Jou nal o O hopaedics Table 3 Main cha ac e is ics o he s udies included in his sys ema ic e iew Au ho /s, yea s S udy i le Design ype Type o in e en- ion Me hod and du a ion Sample size and age Le el o e i- dence (Sacke Assessmen scale/s Resul s Conclusions Gudeman e al., 1997 T ea men o Plan a Fascii- is by Ion opho- esis o 0.4% Dexame hason e. A andomized, double-blind, placebo- con- olled s udy RCT, double blind GC: s e ching, heel suppo , exe cises and placebo ion o- pho esis GExp: s e ching, heel suppo , exe cises and ion opho esis wi h 0.4% dexa- me hason e 2weeks 6ion opho esis sessions (pla- cebo o wi h dexame hason e), each las ing 20min wi h a cu en o 40mA N = 39 pa ien s (40 ee ), mean age 42.1 yea s G ade Ib (A) Ma yland Foo Sco e (meas- u es he pain and unc ional- i y o he oo , whe e 100 poin s implies maximum independence and < 45 poin s g ea depend- ence G1 had a much mo e signi i- can imp o e- men (6.8 ± 5.6 inc ease in he MFS scale) han he GC (3.1 ± 4.1 inc ease). (P = 0.022) 1-mon h ollow- up: he e was no signi ican di e ence. (P = 0.434) The applica ion o dexame hasone ion opho esis educes pain and inc eases oo unc ionali y in he sho e m (2–3weeks) in pa ien s wi h PF Japou e al., 1999 Managemen o Heel Pain Synd ome wi h Ace ic Acid Ion opho esis Quasi- expe im en al s udy (no con ol g oup) Exp:ion opho esis wi h 5% ace ic acid 3weeks 2–3 sessions o ion opho esis wi h ace ic acid pe week o 20min N = 35 pa ien s, mean age 58.6 yea s G ade II-b (B) Pain scale om 0 o 10, whe e 0 ep- esen s no pain and 10 ep esen s maximum pain P e- ea men pain: 7.5/10 Pos - ea men pain: 1.8/10 The applica ion o ion opho esis wi h ace ic acid educes pain in PF Osbo ne e al., 2006 T ea men o plan a ascii is by LowDye aping and ion opho esis: sho e m esul s o a double blinded, andomized, placebo con olled clini- cal ial RCT, double blind G1: Low-Dye bandage, s e ch- ing and ion o- pho esis (0.4% dexame hason e) G2: Low-Dye bandage, s e ching and ion opho esis (placebo) G3: Low-Dye bandage, s e ching and ion opho esis (5% ace ic acid) 2weeks 6 ion opho esis sessions (wi h placebo, dexame hason e o ace ic acid) wi h 40 mA cu en and Low-Dye band- age N = 31 pa ien s (42 ee ), age be ween 18 and 75yea s G ade Ib (A) Visual Analogue Scale (VAS), Visual Ana- logue Scale o s i ness and mo ning s i - ness du a ion ques- ionnai e All g oups showed signi i- can imp o e- men s in mo ning pain, mean pain, and mo ning s i - ness. Howe e , o mo ning pain, he ace ic acid + bandage g oup showed g ea e imp o emen Low-dye ap- ing applica- ion + ion opho- esis wi h ace ic acid, dexame ha- sone, o placebo educes pain and s i ness caused by PF. Fo bes esul s a 4weeks, he bandage combined wi h ace ic acid is p e e ed Indian Jou nal o O hopaedics Table 3 (con inued) Au ho /s, yea s S udy i le Design ype Type o in e en- ion Me hod and du a ion Sample size and age Le el o e i- dence (Sacke Assessmen scale/s Resul s Conclusions Goyal e ., al., 2013 T ea men o Plan a Fascii is by Taping s. Ion opho esis: A Randomized Clinical T ial Quasi- expe im en al s udy (no andomi za ion o g oups) GExp: LDT and ion opho esis wi h 0.9% NaCl G2: LOD 1week 1 session pe day o aping + ion opho esis wi h NaCl wi h a cu en o 40mA, o only bandage N = 30 pa ien s, age be ween 24 and 58yea s G ade II-b (B) Visual analogue scale (VAS) and Foo Func ion Index (FFI) A e one week, he e was a signi ican di - e ence in VAS and FFI in bo h g oups, bu he imp o e- men was mo e signi ican in G1 han in G2 (p < 0.05) The combined he apy o aping and ion opho- esis causes a signi ican dec ease in pain and disabili y in pa ien s wi h PF Podolsky e al., 2015 Taping o plan- a ascii is Sys ema ic e iew The e ec s o a ious ypes o bandage in he ea men o PF we e analyzed in 5 RCTs, 2 c osso e s udies and 1 epea ed measu es clus e s udy We sea ched PubMed, CINAHL, PED o, ISIWeb o Science, and Google Schola in 2012. S ud- ies published be ween 2004 and 2012 we e included N = 8 s udies analyzed G ade Ia (A) The me hodolog- ica l quali y o he s udies was assessed using he PED o a - ing scale All 8 s udies a o ed he use o di e en bandaging echniques. The mos common echnique was he LDT The LDT has he bes e idence o he ea men o PF in he sho e m. The long- e m e ec and e ec i eness o his echnique needs o be in es iga ed Che i e al., 2016 A compa a- i e s udy on e ec i eness o apping wi h ion opho esis and aping alone in ch onic plan a ascii is RCT GExp: bandage, s e ching and ion opho esis wi h 5% ace ic acid GC: bandage and s e ching 2weeks 6 ea men sessions wi h ion opho esis + bandage, o only bandage N = 50 pa ien s, age be ween 30 and 60yea s G ade Ib (A) Visual analogue scale (VAS) and Foo Func ion Index (FFI) The VAS and FFI sco es showed a signi ican imp o emen (p < 0.05) in bo h g oups, bu g ea e in G1 Ion opho esis oge he wi h aping and s e ching ga e addi ional ben- e i compa ed o aping and s e ching alone in educing pain in PF Indian Jou nal o O hopaedics Table 3 (con inued) Au ho /s, yea s S udy i le Design ype Type o in e en- ion Me hod and du a ion Sample size and age Le el o e i- dence (Sacke Assessmen scale/s Resul s Conclusions Kal a, 2016 T ea men o plan a ascii is wi h dexame hason e wi h lidocaine hyd ochlo ide RCT G1: ul asound, s e ching and ion opho esis wi h 0.4% dexa- me hason e + 4% lidocaine hyd o- chlo ide GC: ul asound, s e ching and ion opho esis wi h placebo 2weeks 3 ion opho esis sessions (pla- cebo o wi h dexame hason e + lidocaine hyd ochlo ide) pe week wi h a cu en o 40mA N = 40 pa ien s, age: be ween 30 and 40yea s G ade Ib (A) Visual analogue scale (VAS) and Foo Func ion Index (FFI) G1 had a g ea e imp o emen ( om 7 poin s o 3′17 on he EVA scale and om 44′17 o 30′17 on he FFI) han he GC ( om 5.8 poin s o 4′40 on he EVA scale and om 43 ′40 o 37 in he FFI) The applica ion o ion opho esis is e ec i e in he ea men o PF, bu i i is admin- is e ed wi h dexame hasone and lidocaine hyd ochlo ide, i is signi ican ly mo e e ec i e Ve b uggen e al., 2018 The E ec i e- ness o LDT in Reducing Pain Associa ed Wi h Plan a Fascii is Re i e sys ema ic ision The e ec s o a ious ypes o bandaging (alone o combined wi h o he ea - men s) in he ea men o PF we e analyzed in 5 s udies: 4 le el 2 RCTs and 1 le el 2 con olled clinical ial Sea ches we e made inPubMed, EBSCOhos , Spo Discus, Medline, and Google Schola A icles pub- lished be ween 2005 and 2016 we e selec ed N = 5 s udies analyzed G ade Ia (A) The me hodolog- ica l quali y o he s udies was assessed using he PED o a - ing scale Compa ed wi h o he aping echniques o PF, LDT aping (alone o combined wi h o he ea men s) was ound o be he mos e ec i e in educ- ing pain and inc easing oo unc ion in PF S udies whe e he du a ion o ea men was longe p oduced he la ges e ec sizes: long- e m LDT ea men may be mo e bene icial in educing PF pain Cu en e idence suppo s i s use as pa o a mul imodal in e - en ion scheme