ASTYM® TREATMENT AS AN ADJUNCT TO STANDARD PHYSICAL THERAPY CARE FOR CHRONIC HEEL PAIN: A MULTIPLE PATIENT CASE REPORT Shannon Hay, DPT, Mallory Mountz, DPT, Monika Thelen, DPT Benchmark Rehab Partners, Ooltewah, TN Case Reports Patient 1: Insidious onset of right heel pain located locally along the plantar surface of his calcaneus. Pain was aggravated with prolonged walking and eased with using medicated gel and wearing his orthotics. Pt was treated 2x/week for 4 weeks for a total of 8 visits. At conclusion of care, there were improvements in pain level, LEFS score, plantarflexion strength, and muscle extensibility of the gastrocnemius and soleus complex. Patient 2: Insidious onset of bilateral heel pain located on the plantar surface of the calcaneus and occasional sharp pain along the medial and lateral aspects of his foot. Pain was worse in the morning and following prolonged standing and walking; relief with rest. Pt was treated 2x/week for 6 weeks for a total of 13 visits. At conclusion of care, there were improvements in pain level, LEFS score, bilateral ankle dorsiflexion ROM, muscle extensibility of the gastrocnemius and soleus complex, and tenderness to palpation at the plantar calcaneus. Patient 3: Insidious onset of right heel pain that began in the plantar heel and progressively worsened to include the Achilles tendon. Pain was aggravated with walking and relieved with rest and use of an anti-inflammatory gel. Pt was treated 2x/week for 5 weeks for a total of 9 visits. At conclusion of care there were improvements in pain level, LEFS score, ankle ROM, plantarflexion strength, and muscle extensibility of the gastrocnemius and soleus complex. Background/Purpose Plantar heel pain is the most common diagnosis for foot & ankle pain, and approximately 1 in 10 individuals will experience plantar heel pain during the course of their life. Current research suggests that the underlying pathology behind chronic plantar heel pain is the result of a degenerative process, as opposed to inflammation, which has significant implications for its treatment. The use of Astym® therapy has been shown to promote cell regeneration and decrease presence of scar tissue resulting in improved ROM, decreased pain, and improved function in several tendinopathies and chronic soft tissue injuries. Currently, there is limited evidence for the effectiveness of Astym therapy as an adjunct to standard physical therapist services in the treatment of plantar heel pain. The purpose of this case report is to describe the outcome of three patients treated with the Astym soft tissue approach including exercise and stretching for plantar heel pain. Patient 1 Patient 2 Patient 3 Age 65 53 26 Sex Male Female Symptom duration 3 months 18 months Results Patients were treated for an average of 10 visits (SD, 2.6) over an average of 55 days (SD, 34.2). All three patients reported lower pain from an average of 5.7 (SD, 1.5) to 2.3 (SD, 0.6). In addition, each patient had an improved LEFS score averaging 58.3 (SD,4) at baseline and increasing to 64.7 (SD, 0.6) at conclusion of care. Methods Three patients with a referral for heel pain completed a numeric pain rating scale and a Lower Extremity Functional Scale (LEFS) which were administered at baseline and conclusion of care. Each patient was treated with Astym therapy using the lower extremity protocol 2 times a week over a span of 4-6 weeks. Astym treatment was used in conjunction with standard physical therapist services including manual therapy, therapeutic exercise, and education in a home program. Conclusions This study suggests Astym therapy is an effective treatment approach when combined with standard physical therapist services when treating patients with chronic plantar heel pain. References 1. Cleland J a, Abbott JH, Kidd MO, et al. 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