What are the management options for frozen shoulder and plantar fasciitis in the Outpatient Department (OPD)?

Management of Frozen Shoulder and Plantar Fasciitis in OPD

Frozen Shoulder Management

For frozen shoulder, physical therapy including stretching exercises and acupuncture are the most effective first-line treatments, while plantar fasciitis should be initially managed with plantar fascia-specific stretching, appropriate orthotics, and night splints. 1

First-line Interventions:

• Physical Therapy:

  • Stretching exercises focused on improving range of motion
  • Regular weight-bearing exercises
  • Referral to physical rehabilitation specialist for supervised therapy 1

• Pain Management:

  • Acupuncture (strongly recommended based on evidence) 1, 2
  • NSAIDs for short-term pain relief

Second-line Interventions:

• Mobilization techniques - strongly recommended for reducing pain and improving range of motion in stages 2 and 3 of frozen shoulder 2
• Low-level laser therapy - strongly recommended for pain relief and moderately for improving function 2
• Deep heat therapy - can be used for pain relief and improving ROM 2

Cautions:

• Ultrasound therapy is not recommended for pain relief, improving ROM or function 2
• Continuous passive motion is only recommended for short-term pain relief, not for improving ROM or function 2

Plantar Fasciitis Management

First-line Interventions:

• Stretching Exercises:

  • Plantar fascia-specific stretching (most effective) 3, 4
  • Calf stretching exercises 3
  • Ice massage to the affected area 4, 5

• Supportive Devices:

  • Appropriate orthotics to correct biomechanical abnormalities 3
  • Night dorsiflexion splinting 3

• Activity Modification:

  • Decrease cyclical repetitive loading of the plantar fascia 3
  • Rest and avoid prolonged standing/walking 4

• Medication:

  • NSAIDs for pain management 4, 5

Second-line Interventions (for persistent cases after 3 months):

• Corticosteroid Injections:

  • Can provide short-term pain relief
  • Must be weighed against risks of fat pad atrophy and plantar fascia rupture 3

• Diagnostic Imaging:

  • Ultrasonography for cases persisting beyond 3 months 5

Refractory Cases (6+ months):

• Extracorporeal Shock Wave Therapy:

  • Recommended for chronic, recalcitrant plantar fasciitis 3, 4, 5
  • Should be ultrasonography-guided and focal 3

• Surgical Options:

  • Endoscopic fasciotomy for patients with persistent pain limiting activity despite exhausting non-operative options 5
  • Surgical intervention is typically only needed in about 10% of cases 4, 6

Treatment Success Rates

• With proper conservative treatment, 80% of plantar fasciitis patients improve within 12 months 5
• Approximately 90% of frozen shoulder cases respond to conservative management 2
• Non-surgical treatment is ultimately effective in approximately 90% of plantar fasciitis patients 6

Key Pitfalls to Avoid

1. Delaying treatment of frozen shoulder, which can lead to prolonged disability
2. Overreliance on ultrasound therapy for frozen shoulder, which lacks evidence of effectiveness 2
3. Failing to address biomechanical factors in plantar fasciitis (obesity, foot pronation, tight Achilles tendon)
4. Premature use of corticosteroid injections before trying conservative measures for plantar fasciitis
5. Not emphasizing the importance of consistent stretching exercises, which are fundamental to recovery for both conditions