BACKGROUND: A lack of data exist about the effectiveness of active treatments for persistent plantar heel pain (PPHP). OBJECTIVES: To compare short-term functional and clinical effects of a 4-week barefoot or shod treadmill walking program for people with PPHP. METHODS: A single-blinded clinical trial randomized 52 participants with PPHP into either a barefoot walking group (BWG), or a shod walking group (SWG). All participants received therapeutic ultrasound. Outcomes were measured at baseline (t0), following 4 weeks of treatment (t1), and at 1-month follow-up (t2). The SF-36 functional questionnaire score was the main outcome. Secondary outcomes were self-reported and clinically-assessed pain provocation levels, pressure pain thresholds and pain tolerance. Treadmill walking time and speed were measured at t0 and t1; people also recorded the time spent walking each day in a diary. RESULTS: The BWG exhibited significant improvements in all SF-36 items (except "emotional well-being") (p < 0.05), whereas the SWG exhibited improvements only in "pain" and "health change" items (p = 0.0001; effect size 0.13 to 0.94). Greater improvements were observed in the BWG than the SWG for "physical function" (p = 0.019) and "role limitations due to physical health" items (p = 0.035). Both groups demonstrated significant improvements in pain, with greater improvements in the BWG (p = 0.0001; effect size 0.89). Only the BWG showed significant improvements in pain pressure thresholds (p < 0.05; effect size 0.70) and pain tolerance (p < 0.001; effect size 0.67). Both groups significantly increased their speed and time spent walking on the treadmill (BWG delta = 19.7 min and delta = 1.7 km/h; SWG delta = 16.7 min and delta = 1.1 km/h) and time outdoors (SWG = 38.2 min/week; BWG mean = 48.5 min/week) (p < 0.001). All clinical tests of pain were significantly less positive in the BWG at all time points (p < 0.05). CONCLUSIONS: Both walking programs benefited people with PPHP by alleviating pain and improving function and quality of life. Greater improvements were observed in the BWG than the SWG overall.

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