Foot pain and osteopathy

Foot pain and Osteopathy: A Review of Mechanisms, Techniques, and Scientific Evidence

Abstract

Foot pain (podalgia) is a common reason for consultation in general medicine, podiatry, and osteopathy. While specific scientific evidence for osteopathic treatment remains limited, some clinical studies and reports suggest its effectiveness in managing mechanical and functional foot disorders. This article examines the mechanisms of action, osteopathic techniques employed, and current efficacy data, while highlighting limitations and future research directions.

Keywords: Osteopathy, foot pain, plantar fasciitis, hallux valgus, biomechanics, manual therapy.

1. Introduction

Foot pain affects approximately 20% of adults, with diverse etiologies:

• Structural disorders (hallux valgus, flat/cavus foot)

• Inflammatory conditions (plantar fasciitis, Achilles tendinopathy)

• Mechanical dysfunctions (joint restrictions, gait abnormalities)

Osteopathy—a manual therapy grounded in the structure-function relationship—proposes a holistic approach to alleviate such pain.

2. Proposed Mechanisms of Osteopathic Action

2.1. Biomechanical Balance Correction

• Restoring mobility in foot joints (subtalar, midtarsal, metatarsophalangeal)

• Rebalancing muscular chains (calf, plantar fascia, tibialis posterior)

2.2. Vascular and Neural Enhancement

• Manipulations may improve microcirculation and reduce local inflammation

2.3. Neurophysiological Effects

• Pain modulation via the central nervous system ("gate control" theory)

3. Osteopathic Techniques for Foot Pain

3.1. Structural Techniques

• HVLA (High-Velocity Low-Amplitude) thrusts:

  • For subtalar or metatarsal joint restrictions

• Gentle joint mobilizations:

  • Targeting midfoot kinematics

3.2. Myofascial Techniques

• Plantar fascia release (specific stretching protocols)

• Intrinsic foot muscle relaxation (flexor digitorum brevis, abductor hallucis)

3.3. Global Approach

• Ascending chain assessment:

  • Evaluation of pelvis, lumbar spine, and knee

• Postural corrections (e.g., valgus/varus foot alignment)

4. Scientific Evidence: Key Findings

4.1. Plantar Fasciitis

• López-Rodríguez et al. (2020):

  • Osteopathy vs. stretching → significant pain reduction at 6 weeks

• Franke et al. (2017) systematic review:

  • Positive outcomes but protocol heterogeneity

4.2. Hallux Valgus and Static Disorders

• Pilot study (Dufour et al., 2019):

  • Improved hallux mobility and pain relief

  • Limitation: No evidence of long-term structural correction

4.3. Chronic Pain (Neuropathic, Osteoarthritic)

• Insufficient data for definitive conclusions

5. Limitations and Criticisms

• Scarce randomized double-blind trials

• Potential placebo effects (therapist-patient interaction)

• Non-standardized treatment protocols

6. Clinical Recommendations

• Potential indications:

  • Plantar fasciitis (adjunct to orthotics/stretching)

  • Post-traumatic joint restrictions

• Contraindications:

  • Fractures, infections, acute arthritis

7. Conclusion and Perspectives

Osteopathy may serve as a valuable adjunct for functional foot disorders. Further controlled studies are needed to:

• Compare efficacy with physiotherapy for plantar fasciitis

• Investigate fascial biomechanics via MRI

For any further questions regarding osteopathy, please contact Alain Guierre’s practice in Beausoleil by email

Selected References

1. López-Rodríguez et al. (2020). J Am Osteopath Assoc

2. Franke et al. (2017). BMJ Open

3. Dufour et al. (2019). Foot Ankle Int