Assessing Comparator Interventions in Trials in People With Plantar Heel Pain: A Scoping Review of Usual Care and Guideline Concordance

OBJECTIVE: To summarize comparator interventions labeled as usual care or related terms in trials that included people with plantar heel pain, and to determine the alignment with recommendations made by contemporaneous and current clinical practice guidelines (CPGs) for plantar heel pain. DESIGN: Scoping review. LITERATURE SEARCH: This review was conducted according to JBI methodology. The CINAHL, Embase, Ovid MEDLINE, SPORTDiscus, and Cochrane CENTRAL databases were searched from inception to June 2026. STUDY SELECTION CRITERIA: Eligible studies were prospective randomized trials or quasi-experimental studies that recruited people with plantar heel pain and used a “usual care” comparator intervention. DATA SYNTHESIS: Comparator interventions were mapped to recommendations from the American Physical Therapy Association (APTA) CPGs for Heel Pain/Plantar Fasciitis. RESULTS: Eighty-seven studies were eligible. Comparator interventions were highly heterogeneous, though stretching appeared in 68 (78%) studies. Among studies initiated after publication of the 2008 CPG, 17 (22%) included the single Grade A recommendation. Between the 2014 and 2023 CPGs, 8 (13%) included zero of five contemporaneous Grade A recommendations; none included more than three. When studies were mapped to the 2023 CPG, 6 (7%) included zero of five current Grade A recommendations, 23 (26%) included one, 50 (58%) included two, and 8 (9%) included three; none included more than three. CONCLUSION: “Usual care” comparators that were used in trials of interventions for managing plantar heel pain were highly heterogenous. The usual care comparators only partially aligned with guideline-based best practice, which limited interpretability and complicates translation to clinical practice.