Pain relief in plantar fasciitis: phonophoresis versus iontophoresis in guards: a pilot study

Abstract

Purpose. Plantar fasciitis is a leading cause of heel pain, particularly among individuals engaged in prolonged standing and walking occupations such as security guards. It is now understood as a degenerative fasciosis of the plantar fascia rather than a purely inflammatory condition, involving collagen disorganization and microtrauma at the medial calcaneal 26 management due to their safety and clinical feasibility. Phonophoresis and iontophoresis are commonly used transdermal drug delivery modalities that enhance the local effects of topical agents such as diclofenac through ultrasonic energy and low-intensity electrical currents, respectively. Both techniques aim to provide targeted pain relief while minimizing systemic side effects. Additionally, Muscle Energy Techniques (MET) may further improve outcomes by enhancing flexibility, reducing muscle tightness, and optimizing foot biomechanics. However, evidence comparing the relative effectiveness of phonophoresis and iontophoresis, particularly when combined with MET in occupationally active populations, remains limited. This study, therefore, seeks to address this gap by comparing their effects on pain and quality of life in middle-aged security guards with plantar fasciitis. Objective: to determine Pain Relief in Plantar Fasciitis: Phonophoresis versus Iontophoresis in Guards.

Material & Methods. Thirty security guards with clinically diagnosed bilateral plantar fasciitis were recruited using convenience sampling and randomly allocated into two equal groups in a single-blinded manner using an odd–even allocation method. Group A received MET combined with phonophoresis using diclofenac potassium 6% gel, while Group B received MET combined with iontophoresis using diclofenac potassium 6% gel. Both interventions were administered daily for four weeks under physiotherapist's supervision. Pain intensity, foot function, and quality of life were assessed at baseline and post-intervention using the Visual Analog Scale (VAS), Foot Function Index (FFI), and SF-36 Health Survey Questionnaire, respectively. Data were analyzed using IBM SPSS Statistics version 26.0. (IBM Corp., Armonk, NY, USA) Descriptive statistics were expressed as mean ± standard deviation. Normality was assessed using the Shapiro–Wilk test, and as data were normally distributed, parametric tests were applied. Within-group changes were analyzed using paired t-tests, and between-group differences were evaluated using independent samples t-tests. A p-value <0.05 was considered statistically significant.

Results. Thirty participants were equally allocated to the phonophoresis + MET group (Group A, n=15) and the iontophoresis + MET group (Group B, n=15). Baseline demographic characteristics and pre-treatment outcome measures were comparable between groups (p>0.05). Both groups demonstrated significant within-group improvements in pain (VAS), foot function (FFI), and quality of life (SF-36) following the 4-week intervention (p<0.001). However, post-intervention comparisons revealed significantly greater improvements in Group A compared with Group B across all primary and secondary outcomes. Group A showed a larger reduction in VAS scores (2.58±1.07 vs. 4.75±1.48; p<0.001) and markedly lower post-treatment FFI pain, disability, and activity limitation scores (p<0.001 for all). Quality-of-life outcomes also favored Group A, with greater percentage improvements across all SF-36 domains, particularly physical health limitation and physical functioning. These findings indicate that diclofenac potassium phonophoresis combined with MET was more effective than iontophoresis with MET in reducing pain, improving foot function, and enhancing quality of life in patients with plantar fasciitis.

Conclusions. Diclofenac potassium phonophoresis combined with muscle energy techniques appears to be more effective than iontophoresis in reducing pain and improving foot function and quality of life in middle-aged individuals with plantar fasciitis, particularly those exposed to prolonged occupational standing. The superior improvements observed across physical, emotional, and functional domains support phonophoresis as a promising, non-invasive adjunct in the conservative management of chronic heel pain. Further large-scale, long-term randomized trials are warranted to confirm these findings and optimize treatment protocols for occupational populations.