Document Type
Article
Publication Date
11-2025
Publisher
Oxford University Press
Source Publication
Physical Therapy & Rehabilitation Journal (PTJ)
Source ISSN
0031-9023
Original Item ID
DOI: 10.1093/ptj/pzaf119
Abstract
Importance
Plantar heel pain (PHP) contributes to reduced quality of life and is costly to manage. Persons with PHP are infrequently referred to a physical therapist after presenting to primary care or podiatry.
Objective
The study objective was to compare the cost-effectiveness of usual podiatry care (uPOD) plus physical therapist treatment with that of uPOD alone in the management of PHP.
Design
A cost-effectiveness analysis from societal and health care sector perspectives and a 3-year time horizon was performed alongside a randomized clinical trial. Intention to treat was used as the base case, and sensitivity analyses were used to assess the impact of adherence to treatment (ie, per protocol) and PHP-specific costs.
Setting
The setting was a multidisciplinary outpatient clinic in the United States.
Participants
Participants were 95 eligible patients with PHP.
Interventions
uPOD consisted of a stretching handout, medication, injections, and orthotics; uPOD plus physical therapist treatment also included physical therapist intervention consisting of manual therapy, exercise, foot taping, and iontophoresis.
Main Outcomes and Measures
Cost-effectiveness was determined by between-group differences in costs relative to quality-adjusted life-years (QALYs). Cost-effectiveness at different thresholds of decision maker willingness to pay was illustrated using the cost-effectiveness acceptability curve.
Results
uPOD plus physical therapist treatment reduced societal costs by $2708 (95% CI = −$294 to $5709) relative to uPOD and increased QALYs by 0.09 (95% CI = −0.01 to 0.18). The cost-effectiveness acceptability curve demonstrated 98%, 99%, and 97% probabilities of cost-effectiveness of uPOD plus physical therapist treatment in the base-case, per-protocol, and PHP-specific cost analyses using a willingness-to-pay threshold of $50,000 per QALY.
Conclusions
Adding physical therapist treatment to uPOD lowered total costs and improved quality of life despite increased short-term health care utilization. Results were not altered when considering adherence to treatment or PHP-specific costs.
Relevance
This study informs shared decision-making between providers and patients with PHP about the costs and benefits of adding physical therapist treatment and provides support for the economic value of physical therapist treatment for PHP.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
McClinton, Shane M.; Heiderscheit, Bryan C.; Flynn, Timothy W.; and Pinto, Daniel, "Cost-Effectiveness of Physical Therapist Treatment in Addition to Usual Podiatry Management of Plantar Heel Pain: Economic Evaluation of a Randomized Clinical Trial" (2025). Physical Therapy Faculty Research and Publications. 268.
https://epublications.marquette.edu/phys_therapy_fac/268
Comments
Published version. Physical Therapy & Rehabilitation Journal (PTJ), Vol. 105, No. 11 (November 2025): pzaf119. DOI. © The Author(s) 2025. Published by Oxford University Press on behalf of the American Physical Therapy Association. Used with permission.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/ by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.