A comparative study of passive stretching vs corticosteroid injection vs therapeutic ultrasound in plantar fasciitis

Abstract

Background and Objective: This study compares passive stretching, corticosteroid injection and therapeutic ultrasound in plantar fasciitis. Materials and Methods: A total of 75 patients (age range, 18-60 years; 38 females) with PF were randomly assigned to receive either passive stretching (n = 25) or corticosteroid injection (n = 25) or therapeutic ultrasound (n=25). Passive stretching included both plantar fascia specific stretching exercise and Achilles tendon stretching exercise each applied in 10 sets of 10-second stretch and a 10-second rest 3 times a day for 6 months and supervised two times per week for 4 weeks to ensure that patients were doing the passive stretching exercise properly as they were advised. The corticosteroid injection group received a single palpation guided mixture of 40 mg of methylprednisolone and 2 ml of 2% lignocaine injection at baseline. Therapeutic ultrasound group received continuous mode, base frequency of 1MHz, power 2 w/cm2, applied during three minutes each on calcaneus medial tuberosity and on the 2 cm distal to tuberosity three times a week, for four weeks duration (total 12 sessions). Also the patients in all the 3 groups were advised to use silicon heel pads as a common modality of treatment. The patients’ functional outcome was assessed using the Foot and Ankle Ability Measure (FAAM), and relief of pain was evaluated using the Visual Analog Scale (VAS). Outcomes of interest were recorded before the treatment and at 1 month, 3 month & 6 month follow-ups. Results: Age, sex and body mass index did not significantly impact pain relief or functional outcome (P > 0.05). Out of 75 planned subjects only 68 patients could be followed up. Planned pair-wise comparisons demonstrated significant improvements in pain relief and functional outcomes in terms of both VAS (P passive stretching >therapeutic ultrasound. But for the long term improvements (6 months), passive stretching was more effective than corticosteroid injection and therapeutic ultrasound was not effective. Hence passive stretching exercise is recommended as a primary line of treatment as it is a non-invasive modality, avoids complications associated with steroid injection and has long lasting effects.