Objective To develop a best practice guide for managing people with plantar heel pain (PHP). Methods Mixed-methods design including systematic review, expert interviews and patient survey. Data sources Medline, Embase, CINAHL, SPORTDiscus, Cochrane Central Register of Controlled Trials, trial registries, reference lists and citation tracking. Semi-structured interviews with world experts and a patient survey. Eligibility criteria Randomised controlled trials (RCTs) evaluating any intervention for people with PHP in any language were included subject to strict quality criteria. Trials with a sample size greater than n=38 were considered for proof of efficacy. International experts were interviewed using a semi-structured approach and people with PHP were surveyed online. Results Fifty-one eligible trials enrolled 4351 participants, with 9 RCTs suitable to determine proof of efficacy for 10 interventions. Forty people with PHP completed the online survey and 14 experts were interviewed resulting in 7 themes and 38 subthemes. There was good agreement between the systematic review findings and interview data about taping (SMD: 0.47, 95% CI 0.05 to 0.88) and plantar fascia stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term. Clinical reasoning advocated combining these interventions with education and footwear advice as the core self-management approach. There was good expert agreement with systematic review findings recommending stepped care management with focused shockwave for first step pain in the short-term (OR: 1.89, 95% CI 1.18 to 3.04), medium-term (SMD 1.31, 95% CI 0.61 to 2.01) and long-term (SMD 1.67, 95% CI 0.88 to 2.45) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). We found good agreement to ‘step care’ using custom foot orthoses for general pain in the short term (SMD: 0.41, 95% CI 0.07 to 0.74) and medium term (SMD: 0.55, 95% CI 0.09 to 1.02). Conclusion Best practice from a mixed-methods study synthesising systematic review with expert opinion and patient feedback suggests core treatment for people with PHP should include taping, stretching and individualised education. Patients who do not optimally improve may be offered shockwave therapy, followed by custom orthoses.

中文翻译：

---

足跟痛的管理：系统评价、专家临床推理和患者价值观的最佳实践指南

目的 制定管理足跟痛 (PHP) 患者的最佳实践指南。方法采用混合方法设计，包括系统评价、专家访谈和患者调查。数据来源 Medline、Embase、CINAHL、SPORTDiscus、Cochrane 对照试验中央注册、试验注册、参考列表和引文跟踪。与世界专家的半结构化访谈和患者调查。资格标准 随机对照试验 (RCTs) 以任何语言评估对 PHP 患者的任何干预，均符合严格的质量标准。样本量大于 n=38 的试验被认为是疗效证明。使用半结构化方法采访了国际专家，并对使用 PHP 的人进行了在线调查。结果 51 项符合条件的试验招募了 4351 名参与者，有 9 项 RCT 适合确定 10 种干预措施的有效性证明。40 名 PHP 用户完成了在线调查，采访了 14 位专家，得出了 7 个主题和 38 个子主题。关于短期内第一步疼痛的贴敷（SMD：0.47, 95% CI 0.05 至 0.88）和足底筋膜拉伸（SMD: 1.21, 95% CI 0.78 至 1.63）的系统评价结果与访谈数据有很好的一致性. 临床推理主张将这些干预措施与教育和鞋类建议相结合，作为核心的自我管理方法。专家一致同意系统评价结果建议在短期（OR：1.89, 95% CI 1.18 至 3.04）、中期（SMD 1.31, 95% CI 0.61 至2.01) 和长期 (SMD 1.67, 95% CI 0.88 to 2. 45）和径向冲击波用于短期（OR：1.66，95% CI 1.00 至 2.76）和长期（OR：1.78，95% CI 1.07 至 2.96）的第一步疼痛。我们发现在短期（SMD：0.41, 95% CI 0.07 至 0.74）和中期（SMD: 0.55, 95% CI 0.09 至 1.02）中，使用定制足部矫形器进行“阶梯护理”非常一致。结论 综合系统评价与专家意见和患者反馈的混合方法研究的最佳实践表明，PHP 患者的核心治疗应包括贴敷、拉伸和个性化教育。没有最佳改善的患者可能会接受冲击波治疗，然后是定制矫形器。我们发现在短期（SMD：0.41, 95% CI 0.07 至 0.74）和中期（SMD: 0.55, 95% CI 0.09 至 1.02）中，使用定制足部矫形器进行“阶梯护理”非常一致。结论 综合系统评价与专家意见和患者反馈的混合方法研究的最佳实践表明，PHP 患者的核心治疗应包括贴敷、拉伸和个性化教育。没有最佳改善的患者可能会接受冲击波治疗，然后是定制矫形器。我们发现在短期（SMD：0.41, 95% CI 0.07 至 0.74）和中期（SMD: 0.55, 95% CI 0.09 至 1.02）中，使用定制足部矫形器进行“阶梯护理”非常一致。结论 综合系统评价与专家意见和患者反馈的混合方法研究的最佳实践表明，PHP 患者的核心治疗应包括贴敷、拉伸和个性化教育。没有最佳改善的患者可能会接受冲击波治疗，然后是定制矫形器。