Abstract
IntroductionPlantar fasciopathy, characterised by plantar heel pain, affects one in ten in a lifetime. Heavy-slow resistance training (HSR) is an emerging treatment, but it often takes considerable time before the effect starts to manifest. Combining HSR with a corticosteroid injection (known for its short-term pain relief) could potentially improve outcomes in both short and long term. As this combination is yet to be investigated, we aimed to evaluate the feasibility of combining HSR with a corticosteroid injection for individuals with plantar fasciopathy before investigating the efficacy in a clinical trial.Materials and methodsWe recruited 20 participants with plantar fasciopathy for this prospectively registered feasibility study (ClinicalTrials.gov: NCT03535896). Participants received an ultrasound-guided injection and performed heel raises on a step every second day for 8 weeks. To assess participant acceptability of the combined interventions and exercise compliance, we used a 7-point Likert scale dichotomised to “unacceptable” (categories 1–2) or “acceptable” (categories 3–7) and training diaries. Greater than or equal to 10/20 had to rate the combination “acceptable”, ≥ 15/20 had to perform ≥ 20 training sessions, and ≥ 15/20 had to start exercising ≤ 7 days after injection to confirm feasibility.ResultsEighteen out of 20 rated the combination acceptable. Five training diaries could not be retrieved. Ten out of 15 participants performed ≥ 20 training sessions, and 15/15 started exercising ≤ 7 days after injection.ConclusionsBased on participant acceptability and time to exercise start, combining HSR with corticosteroid injection is feasible and the efficacy should be investigated in a future trial. Due to loss of 5/20 training diaries, firm conclusions regarding exercise compliance could not be drawn.Trial registrationClinicalTrials.gov, NCT03535896
Highlights
Plantar fasciopathy, characterised by plantar heel pain, affects one in ten in a lifetime
Based on participant acceptability and time to exercise start, combining Heavy-slow resistance training (HSR) with corticosteroid injection is feasible and the efficacy should be investigated in a future trial
A corticosteroid injection has been found to be a safe option for plantar fasciopathy and has a good shortterm effect compared with placebo, but there is no added benefit after 1 month [11,12,13]
Summary
Plantar fasciopathy, characterised by plantar heel pain, affects one in ten in a lifetime. Combining HSR with a corticosteroid injection (known for its short-term pain relief) could potentially improve outcomes in both short and long term. As this combination is yet to be investigated, we aimed to evaluate the feasibility of combining HSR with a corticosteroid injection for individuals with plantar fasciopathy before investigating the efficacy in a clinical trial. A recent systematic review and network meta-analysis compared the effect of several treatment options for plantar fasciopathy. It concluded that no single treatment was superior to others and that different treatments may take different time to work [10]. HSR is a frequently used treatment option in the rehabilitation of both upper and lower limb tendinopathies and has been found to be superior to stretching in plantar fasciopathy, but its effects usually take several weeks to manifest [14,15,16,17]
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