Effect of pilates exercises on patients with plantar fasciitis

INTERVENTION: Exercise Movement Techniques Other The 75 participants will be randomized into three treatment groups for plantar fasciitis: (1) Pilates Group (n = 25) and (2) Pilates Group + foot strengthening exercises (n = 25) and (3) Control Group ‐ Strengthening of the foot muscles (n = 25). The interventions will last for eight weeks, with a weekly frequency of two days (non‐consecutive), for approximately 40 to 50 minutes. (1) Pilates Group: Participants will perform the exercises of the pilates method on the four devices: Combo Chair or Chair, Cadillac, Reformer and Barrel, which works the various muscle groups of the body: abdominals, trunk, upper limbs (lower limbs) and lower limbs (LL), all associated with breathing. Each exercise will have 10 to 15 repetitions with a gradual increase in the levels (1, 2 and 3) of difficulty. If there is a limitation for the performance of a given exercise, they may be modified or adapted according to the evolution of each participant. (2) Pilates Group + foot strengthening exercises (Foot Core) will perform the pilates exercises described above in addition to the exercises for strengthening the stabilizers of the foot muscles (Foot Core). Participants will perform three sets of fifteen repetitions of the intrinsic foot muscle activation exercises: “short foot exercise”, Toe‐Spread‐out, Hallux extension and Lesser‐toe extension; for the extrinsic musculature of the foot the exercises: “towel curl exercise, catch and hold the ball, abductor and adductor of the toes. The exercises of abduction of the foot, flexion of the fingers and ankle, inversion of the ankle, will be resisted by an elastic band. Graduation will start with the lightest elastic resistance progressing to the heaviest resistance, based on the patient's ability to perform the exercise. Another proposed ex CONDITION: Fasciitis, Plantar M00‐M99 Plantar fasciitis ; Fasciitis, Plantar PRIMARY OUTCOME: The primary outcome the pain variable will be measured during the initial evaluation (T0), in the last evaluation after treatment (T1) (Follow up of eight weeks), and in the Follow up of three and six months. The pain perceived by the patient through a scale with gradations from zero to ten. 0 being classified as "no pain" and 10 "the worst pain he could feel". The intensity of the pain will be graded in the first three moments: (1) in the first step of the morning; (2) at the end of the day and (3) at the time of the evaluation. SECONDARY OUTCOME: Dynamic Balance Test of the lower limbs: Star Excursion Balance Test. The test assesses the dynamic balance of the lower limb, in unipodal support. Three lines are demarcated on the ground forming the design of the letter Y: the two posterior lines are 90 ° apart and 135 ° in relation to the previous one. The lower limb to be evaluated is positioned in the center of the markings, while the other limb reaches the maximum distance along each line. Six attempts for each direction are made to familiarize the patient, with the measurement of the seventh attempt recorded. The measurement is performed by means of a tape measure from the center of the Y to the maximum possible range achieved by the participant, in centimeters (cm). Foot Intrinsic Muscle Strength Test: Evaluation of the foot intrinsic muscle strength ‐ Manual Dynamometer. The measurement of the isometric strength of the intrinsic musculature of the foot will be carried out by hand dynamometer, Hand‐Held‐Dynamometer (HHD, in the acronym of the English term) of the Lafayette brand (Lafayette Instrument Company, Lafayette, IN). The manual dynamometer is a simple and objective tool, widely used in clinical practice, with good intra‐ and inter‐examiner reliability for measuring the strength of the ankle and foot muscles. Participants will be instructed to sit on a bench keeping their torso upright, arms crossed on their chest, knees and hips at 90 °, with their feet stripped of shoes and socks, positioned on a wooden box with dimensions: length 45 cm, width 40 cm and height 7 cm, containing the dynamometer inside, with the device (dynamometer load cell) to which the patient will apply the flexion force of the hallux, level to the surface of the box. The participant will be asked to make three attempts at maximum isometric contraction of hallux flexion. For data analysis, the average values ??of the 3 attempts will be used. The duration of each maximum isometric contraction will be standardized at 3 seconds, with a rest time of 10 seconds between them. After recording the muscular strength of a limb, a 1‐minute rest will be provided, so that the same evaluation can be performed on the contralateral side. The order of choice of members, right or left, to perform the test, will be made at random. When the examiner observes any compensation of the surrounding segments during a test, the values ??will be disregarded and the test will be repeated after 20 seconds of rest. Strength data will be measured in kilograms and normalized by body weight, also in kilograms, using the following formula: (strength (Kg) / body weight (Kg) X 100. Foot mobility: Navicular Drop: The navicular drop test (TQN) is considered a validated, non‐invasive, reliable method and a good indicator of anthropometric parameters of the foot structure. The test measures the height of the tuberosity from the navicular bone to the ground, with and without weight bearing, indicating the pronation of the subtalar joint. The assessment is initially carried out with the participant in the sitting position (without weight bearing) and then in the standing position (with weight bearing). The difference between the two measurements will be measured in millimeters. The difference in seated to standing height indicates the amplitude of distal dislocation of the navicular bone. The classification is obtained through five levels: (0 to 1) highly supinated foot, (2 to 4) supinated foot, (5 to 9) normal foot, (10 to 12) pronated foot and (> 13) highly pronounced foot . Foot posture: Foot Posture Index (FPI): FPI is a multidimensional assessment of the foot used to quantify your posture, in three dimensions, quickly and easily in the clinical environment. It consists of six items evaluated in three views (anterior, medial and posterior): 1‐ palpation of the talar head; 2‐ supra and infra‐malleolar curvature; 3‐ inversion / eversion of the calcaneus; 4‐ position of the calcaneus in the frontal plane; 5‐ height and congruence of the medial longitudinal arch and 6‐ abduction adduction of the forefoot in relation to the hindfoot. Each of these items is scored using a five‐point Likert scale, ranging from ‐2 (hyper supine) to +2 (hyper pronate). The neutral position of the foot is scored as zero. Function: Foot Function Index (FFI) questionnaire. The Brazilian version of the questionnaire assesses the function of the foot complex in patients with plantar fasciitis. It consists of 23 items divided into three domains, as follows: disability (5 items), difficulty (9 items) and pain (9 items). To obtain the value of each item, the participant is asked to mark the score from zero to 100%, who must choose the number that best fits their condition. The higher the percentage, the greater the functional change presented. ; To obtain the score for each domain, the following formula was applied: sum of the score obtained from all items answered by the patient in each domain x 100. Since the patient does not perform the task related to one of the items in the domains, this score will not be applied. That is, these items will not be considered in the total sum of the domain. The total score of the questionnaire is calculated using the formula: sum of the final percentages of all domains / per three (total number of domains). Global Perception Test: The Global Effect Perception Scale compares the beginning and end of symptoms, assessing whether there was a clinical change perceived by the patient. It is an 11‐point Likert Scale, ranging from ‐5 ("extremely worse"), zero "without modification" and + 5 ("completely recovered"). The higher the score result, the better the recovery of the patient's condition. The use of the global perception effect. In clinical trials it is recommended as a measure of improvement in the overall treatment assessment. This Scale is available in the Portuguese‐Brazilian version and its measurement values are similar to those of the original version. Intrinsic Muscle Assessment Test: This is a qualitative test, in order to assess the ability to maintain the height of the medial longitudinal arch in unipodal support. The test begins with the participant in an orthostatic position in front of a wall, with feet shoulder‐width apart. The foot to be evaluated will be kept on the ground while the other will perform the flexion of the hip and knee at 90 degrees, thus maintaining unipodal support. If necessary, the participant is allowed to lightly place his hands on the wall. In order to maintain the medial longitudinal arch, the participant will receive the verbal command to bring the head of the first metatarsus towards the heel, without flexing the fingers. The test will be maintained for 30 seconds and during this time, postural compensations will be identified. It will be classified as “good” when the participant is able to maintain the height of the navicular bone and ALM without changes; “Failure” when there is instability of the ankle and foot and postural compensations in an attempt to maintain the position; “Poor” when the patient is unable to maintain the height of the navicular bone and the ALM. Muscle endurance tests of core stabilizers: Muscle endurance tests will be carried out, which involve the front and left and right side plank tests. For each of the tests performed, in the three positions, the volunteer will be instructed to remain in the position for as long as possible. The time will be recorded in seconds, using a stopwatch. For the frontal plank test, the participant in the ventral position keeps the forefoot and forearm in contact with the ground, flexed at 90 ° and aligned to the shoulder, with hands flat, while suspending the hips, knees and ankles. The lateral plank test will be performed in the lateral decubitus position with the knees extended. For the lower hemibody, the participant will be instructed to keep the elbow flexed at 90 °, support the forearm on the ground and keep the foot in contact with the ground; elevate the hip so that it is aligned with the trunk; keep your knees straight. This test will be performed bilaterally. Scale of Catastrophic Thoughts (PCS) about Pain: To investigate the presence of catastrophic thoughts about pain, the PCS, from the original The Pain Catastrophizing Scale, will be used. The PCS on pain was developed to quickly identify patients at risk of psychological impairment in pain management. The scale consists of 13 questions, which are used for the patient to express, on a five‐point scale, the degree of experience with each of the thoughts or sensations described on the scale. The PCS assesses three specific domains: rumination (4 items), magnification (3 items) and helplessness (6 items), with a total score ranging from 0 to 52 points, the higher the score the greater the amount / magnitude of catastrophic thoughts. It has been validated and translated into Portuguese, has good internal consistency (total Cronbach's alpha, helplessness, magnification and rumination subscales equal to 0.91, 0.93, 0.88 and 0.86 respectively) and reliability ranging from 0.91 to 0.94. Tampa Kinesiophobia Scale: To assess the presence of kinesiophobia, the Tampa Kinesiophobia Scale (TSK), of the English Tampa Scale of Kinesiophobia, will be used. TSK consists of 17 items that are used to subjectively measure kinesiophobia or fear of movement in patients with musculoskeletal pain. Each TSK item provides a score ranging from strongly agree to strongly disagree, on a scale of 1 to 4 points per item, which provides a result of a minimum of 17 and a maximum of 68 points. The scoring of four items (items 4, 8, 12 and 16) is done in reverse. The TSK showed good internal consistency (Cronbach's ? = 0.89) and good reliability (0.80) when the score was performed with all items, including the four items that score inversely. Thermographic Evaluation: Infrared thermography (TI) is a fast, portable, accurate method, does not emit radiation, is non‐invasive. The goal is to measure the skin temperature of the feet. When there is an inflammatory response, there is an increase in the permeability of blood vessels, leading to an increase in blood flow, changing the heat pattern of the affected region. To perform the examination of infrared images (IR) of the skin surface, the patient will remain seated, with the lower limbs extended, the feet naked, immobile and positioned one meter away from the thermal imager. It will be waited 10 minutes to stabilize the body temperature with the laboratory climate. The evaluated regions of the feet will be: hallux, smaller fingers, forefoot, medial arch, lateral side and heel. To perform the exam, patients will be instructed not to engage in vigorous physical activity in the 24 hours prior to the exam, not to drink stimulating food or drinks, and not to apply cosmetics in the last 6 hours. The thermographic images will be recorded by the Flir E8 infrared camera positioned on a tripod adjusted to a height where the center of the camera lens is level with the middle third of the foot, at a horizontal distance of 0.5m (1.6 ft) between the lens and the focus. The temperature measurement range will be calibrated between 20 degrees celsius and + 25 degrees celsius and the measurement accuracy will be within ± 2 percent of the reading for room temperature. The sensitivity of the device will be less than 0.06 degrees celsius (0.11 ° F) / <60mK and the infrared resolution will be 320 x 240 pixels. The thermal sensitivity of 0.07 degrees celsius will be used as a calorimetric scale (color palette). INCLUSION CRITERIA: Women between 40 and 65 years of age diagnosed with chronic plantar fasciitis, with symptoms lasting more than 12 weeks; Unilateral or bilateral pain (in bilateral cases the lower limb with the greatest pain complaint will be included) according to the numerical pain scale Pain of at least three and a maximum of seven on the numerical pain scale (0‐10); Pain after a period of inactivity; Pain in the plantar fascia after a recent increase in activities transmitted with body weight support; Positive Windlass test.