Cause Of Heel Pain Research Articles

Ayurvedic Intervention for Vatakantak with special reference to Plantar Fasciitis: A Case Study

Pain is a significant symptom that disrupts our daily activities and diminishes our quality of life. Heel pain is a particular type of discomfort that can hinder walking, thereby interfering with everyday routines. Among the various causes of heel pain in adults, plantar fasciitis is the most prevalent.[1] It is estimated that 1 in 10 people will develop Plantar Fasciitis during their life time.[2] As per Ayurveda it is mentioned by Acharya Sushruta[4] in the context of Vatavyadhi as a condition of heel due to improper placement of foot on the ground or by walking often correlated to a calcaneal spur which is a calcium deposit causing a bony protrusion on bone often frequently associated with plantar fasciitis, a painful inflammation of tissue. It is a common condition that affects normal routine work. Agnikarma, Snehna, Swedan, & Raktamokshana is the treatment choice of Vatakantaka. A 55-year-old female patient presented with primary complaints of pain in the left heel and sole of the foot which had persisted for one month. The pain intensified during the initial steps taken after rising from bed. The patient underwent Agnikarma treatment, consisting of five sessions at 5-days intervals, at the affected site, along with a regimen of Sinhanaad Guggulu at a dosage of 500 mg thrice daily for 30 days, and Mahavatavidhwansa Rasa 250 mg twice daily for 30 days. The patient’s condition was completely resolved without any recurrence. It is evident that plantar fasciitis can be effectively treated without recurrence through Ayurvedic interventions such as Agnikarma combined with Mruttika Shalaka.

Heel Pain After Landing in a Soccer Player: A Case of Abductor Hallucis Strain

BACKGROUND: Plantar heel pain is often attributed to the plantar fascia and calcaneal fat pad, both for athletes and sedentary individuals. Another potential cause of heel pain is Abductor Hallucis muscle (AbdH) strain. CASE PRESENTATION: The athlete jumped for a header during a league game, and after he landed on his left foot with a dorsiflexed ankle, he felt sudden pain and was not able to continue. The initial physical examination has overlapping features of AbdH and plantar fascia injury. Detailed physical examinations and radiological images revealed AbdH strain. OUTCOME AND FOLLOW-UP: Immobilization and cold therapy were started as the first line of treatment, then stretching and gradual loading were added. The patient was able to play after 3 weeks. DISCUSSION: AbdH strain is a rare cause of heel pain, but it should be kept in mind, especially when a suspected mechanism of injury occurs.

Evaluation of the impact of shockwave therapy on the functioning of a patient with a lower calcaneal spur

Introduction. A common cause of heel pain is the presence of a calcaneal spur. This condition may disrupt the posterior superficial fascia chain and can also lead to problems in distant areas of the body. Among the physical methods used, shockwave therapy is often applied. The aim of the study was to assess the effectiveness of shockwave therapy and its effect on the tension of the gastrocnemius muscle, which is part of the posterior fascia chain. Materials and Methods. A 52-year-old female patient diagnosed with a left lower calcaneal spur underwent a series of six radial shockwave therapy sessions, performed twice a week. The method for assessing the therapy’s effectiveness involved measuring pain on the Visual Analogue Scale (VAS) and changes in tissue temperature before, immediately after, and five minutes post-therapy. Electromyographic (EMG) examination was used to assess the tension of the gastrocnemius muscle. Results. An average decrease in temperature was observed immediately after the treatment (from 25.3°C to 24.45°C). After five minutes, the temperature increased to 27.05°C compared to the initial measurement. The resting tension of the gastrocnemius muscle, as measured by EMG, decreased as follows: channel 1: from 0.6 µV to 0.4 µV, channel 2: from 4.3 µV to 3.2 µV. Pain decreased from a level of 7 to 2 on the VAS scale. Conclusions. Shockwave therapy is an effective solution for alleviating pain in the case of a calcaneal spur. The reduction of resting tension in the gastrocnemius muscle leads to a decrease in elevated tension within the posterior myofascial chain, which may help reduce the risk of secondary pathologies in distant areas along the chain.

Efficacy of Autologous Platelet-Rich Plasma Injections for Treating Plantar Fasciitis.

Introduction Plantar fasciitis, a common cause of heel pain, is often treated conservatively. Platelet-rich plasma (PRP) injections have emerged as a promising treatment option. This study aimed to evaluate the efficacy of autologous PRP injections for plantar fasciitis. The objective of this study was to assess the effectiveness of autologous PRP injections delivered at the plantar fascia origin in reducing pain (measured by the Visual Analog Scale (VAS) pain intensity score) in patients with plantar fasciitis. Materials and methods A prospective cohort study was conducted at the Department of Orthopedics, Hayatabad Medical Complex, Peshawar. Patients with plantar fasciitis, a VAS pain score ≥ 7, and failure of conservative treatment were included. A single injection of autologous PRP was administered to the plantar fascia. Pain reduction was assessed using the VAS score at a 12-week follow-up. Result The study included 163 patients. Success was achieved in 80.3% of cases, showing that autologous PRP injection resulted in significant pain improvement in patients with plantar fasciitis (p≤0.05). An increased likelihood of successful treatment was observed in individuals with symptoms lasting less than 12 months. No other variables (gender, age group, residence, literacy) significantly impacted treatment efficacy. Conclusion Autologous PRP injections may be a promising treatment option for plantar fasciitis, particularly when administered early. Further research is needed to validate these findings and explore optimal patient selection criteria.

Exploring the Link Between Calcaneal Apophysis Maturation and Heel Pain in Youth Baseball Players.

Calcaneal apophysitis is the most common cause of heel pain in children and adolescents. However, the relationship between skeletal maturity and heel pain in the specific youth cohort is unclear. To clarify the relationship between the maturity stages of the calcaneal apophysis and heel pain in youth baseball players. Cross-sectional study; Level of evidence, 3. A total of 336 youth male baseball players participated in this study. Ultrasound scanning of the calcaneal apophysis was performed along the longitudinal line connecting the middle of the Achilles tendon, the middle of the calcaneus, and the second toe, between the proximal calcaneal edge and the medial calcaneal tubercle. The authors classified the maturity of the calcaneal apophysis into 5 stages, from nonpresence of the apophysis (stage 1) to complete fusion (stage 5). The diagnosis of heel pain was based on subjective report of feeling pain on the squeeze test. The relationship between the maturity stages and physical characteristics was investigated using 1-way analysis of variance or the Kruskal-Wallis test, and the relationship between the maturity stages and heel pain was investigated using the chi-square test. Of the 336 players, 49 had heel pain, for a prevalence of 14.6%. Eighteen (5.4%) players had unilateral heel pain, and 31 (9.2%) players had bilateral heel pain. There were no significant differences in the maturity stages of the calcaneal apophysis between the players with no heel pain and those with heel pain. However, no players had heel pain during stage 5, when the calcaneus had completed its maturation. The prevalence of heel pain was 14.6% in Japanese youth male baseball players. There was no relationship between the maturity stages of the calcaneal apophysis and heel pain. Heel pain that could be associated with calcaneal apophysitis did not occur during stage 5, when maturation of the calcaneal apophysis was complete.

Comparative Analysis of Platelet-rich Plasma and Triamcinolone Acetonide Injections in the Management of Plantar Fasciitis: A Prospective Study

Abstract Context: Plantar fasciitis, a prevalent cause of heel pain, poses challenges in treatment due to diverse therapeutic options and variable outcomes. Platelet-rich plasma (PRP) and triamcinolone acetonide (TA) injections have emerged as potential interventions, yet their comparative effectiveness remains debated. Aims: The aim of the study was to compare the effectiveness of PRP and TA injections in relieving pain, improving function, and promoting healing in individuals with plantar fasciitis. Settings and Design: The study design was a prospective, hospital-based, experimental study. Subjects and Methods: A 2-year prospective hospital-based experimental study was conducted, enrolling patients aged 30–60 years with plantar fasciitis. Patients received either PRP or TA injections. Preoperative assessments and 3 months of monitoring were performed. Foot and Ankle Outcome Score (FAOS) survey was utilized for outcome evaluation. Statistical Analysis Used: T-test was applied. Results: Ninety patients were included, with both treatment groups demonstrating significant improvement in foot symptoms. PRP administration showed superiority in descending and ascending stairs, rising from sitting, and walking on flat surfaces compared to TA. FAOS scores indicated significant improvement posttreatment in both groups, with PRP yielding better outcomes than TA. Conclusions: Both PRP and TA injections effectively alleviate foot symptoms in plantar fasciitis patients. However, PRP demonstrates superior outcomes in specific functional activities and quality-of-life components compared to TA. These findings suggest PRP as a preferred intervention in the management of plantar fasciitis.

Effect of extracorporeal shockwave on gait parameters in patients with plantar fascitis: a randomized controlled trial

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain affecting both young active patients and older sedentary individuals. It most often arises as a result of degenerative changes in the proximal plantar fascia.AimThe purpose of this study was to investigate the effect of extracorporeal shockwave on gait parameters in patients with plantar fasciitis.DesignA randomized controlled clinical trial.SettingThe outpatient physiotherapy clinic of the teaching hospital Shibin El Kom.MethodsParticipants were randomly divided into two equal groups. Group (A) (study group): received extracorporeal shockwave therapy one session per week and traditional treatment (ultrasound, stretching exercises, and strengthening exercises) three sessions per week for 4 weeks. Group (B)(the control group): received traditional treatment (ultrasound, stretching exercises, and strengthening exercises) 3 sessions per week for 4 weeks. The pre- and post-treatment development of the patients was evaluated by visual analog scale (VAS) to measure pain, foot function index (FFI) to measure foot function, and Kinovea software to analyze gait parameters (stride length, stride time, walking speed, and cadence).ResultsBoth groups showed improvement in all study variables, but the study group showed more improvement. There was a statistically significant decrease in VAS (p = 0.001), a significant decrease in FFI (p = 0.001), a significant increase in stride length (p = 0.001), a significant decrease in stride time (p = 0.001), a significant increase in walking speed (p = 0.001), and a significant increase in cadence (p = 0.01) post-treatment compared to group (B).ConclusionExtracorporeal shockwave treatment is regarded as a useful treatment for improving gait parameters in patients with plantar fasciitis.Clinical rehabilitation impactExtracorporeal shockwave therapy improved gait parameters in patients with plantar fasciitis as it increases stride length, walking speed, cadence, and decreases stride time. So, it is recommended to be included in the rehabilitation program for patients with plantar fasciitis and gait disabilities.

Plantar Fascia Thickness and Stiffness in Healthy Individuals vs Patients With Plantar Fasciitis.

Plantar fasciitis is a major cause of heel pain, resulting from repetitive trauma to the plantar fascia and leading to structural changes within the fascia. It has been observed that plantar fascia thickness in plantar fasciitis patients exceeds that of normal individuals. However, the biomechanical properties of the plantar fascia in patients with plantar fasciitis remain unclear. Therefore, this study aimed to compare plantar fascia stiffness between healthy individuals and patients with plantar fasciitis across different areas. Fifty-eight participants were divided into 2 groups: 29 healthy individuals and 29 individuals with plantar fasciitis. B-mode ultrasonography was used to assess plantar fascia thickness, whereas shear wave elastography was employed to measure plantar fascia stiffness. The study focused on 3 distinct areas: calcaneal insertion, 1-cm distal area, and 2-cm distal area. Additionally, the most painful area reported by patients was marked in the plantar fasciitis group. The findings showed that the plantar fasciitis group exhibited significantly greater plantar fascia stiffness in almost all areas compared to the healthy group (P < .05). Moreover, the stiffness of the plantar fascia in the most painful area demonstrated the highest value compared with other areas within the plantar fasciitis group (P < .05). This study suggests structural and mechanical changes in the plantar fascia in patients with plantar fasciitis.

A concise review of plantar fasciitis: Diagnosis, treatment, and management

Plantar fasciitis is one of the most common causes of heel pain, marked by inflammation of the plantar fascia, a thick connective tissue structure that supports the arch of the foot. This condition can substantially affect quality of life, limiting mobility and daily activities. This review aims to provide a thorough overview of plantar fasciitis, including its etiology, clinical presentation, diagnostic procedures, treatment options, and preventive measures. Emphasis is placed on evidence-based practices and current research trends in the management of this prevalent condition.

Comparison of the Effectiveness of Platelet-Rich Plasma Injection Versus Plantar-Specific Calf Stretching Exercises in Patients With Plantar Fasciitis: A Randomized Controlled Trial.

Background Plantar fasciitis is a common foot condition with multifactorial etiology. It is the most frequent cause of heel pain and has been categorized as an overuse syndrome. A clinical examination and history are crucial for diagnosis. There are several different forms of treatment available, two of which are frequently used: physical therapy and steroid injections. Recent research on platelet-rich plasma (PRP) has demonstrated encouraging outcomes and fewer side effects when compared to steroid injections. Methods A randomized controlled trial was conducted and randomization was done of indoor patients into two groups. Group 1, ending with odd numbers, was given PRP injections, and Group 2, ending with even numbers, was advised plantar-specific calf stretching exercises. Visual analog scale (VAS) scores were evaluated before and after the intervention and follow-up was done on the second, sixth, and 12th weeks. Results Comparing the VAS scores between the two groups, we found that in the pre-intervention phase, the VAS score of Group 1 was 5.4±0.56 and that of Group 2 was 5.4±0.59. In the post-intervention phase, the VAS score in Group 1 was 4.6±0.89, while in Group 2 it was 5.2±0.62. In the second week after intervention, the VAS score was observed to be 3.3±0.97 in Group 1, while in Group 2, it was 3.3±0.80. After the sixth week of intervention, the observed VAS score was 2.7±0.78, while in Group 2 it was 2.9±0.82. The mean VAS score after 12weeks of intervention was observed to be 2.3±0.91 in Group 1, while in Group 2, it was 2.2±0.80. Conclusion PRP injections and plantar-specific calf stretching exercises are equally effective in providing pain relief in plantar fasciitis. PRP injections have complications and problems which have been discussed. Exercises are devoid of such complications. No recurrences occurred in the exercise group and four cases had recurrence in the PRP group.

Randomized placebo controlled trial of phytoterpenes in DMSO for the treatment of plantar fasciitis

Plantar fasciitis is the most common cause of heel pain in adults with an overall prevalence of 0.85% in the adult population of the US, affecting over 2 million adults annually. Most current treatment modalities are not supported by sufficient evidence to recommend one particular strategy over another. Topical application of analgesics for soft tissue pain is well established, however the plantar fascia presents challenges in this regard due to thick skin, fibrotic tissue, and an often thickened fat pad. Sixty-two patients with plantar fasciitis were randomized to a placebo controlled trial testing the efficacy of a topical solution of plant terpenes containing camphor, menthol, eugenol, eucalyptol, and vanillin. Skin permeation of the mixture was enhanced with 15% dimethylsulfoxide (DMSO), 1% limonene, and rosemary oil. One ml of solution was applied topically twice daily, and pain scores evaluated on Day 0, Day 1, Day 3, and Day 10. Using the validated foot function index 78.1% of patients reported an 85% or greater decrease in their total pain score by day 10 while placebo treatment was without effect (One Way ANOVA, P < 0.01). This study adapts the treatment modality of topical analgesia for soft tissue pain to a problematic area of the body and shows therapeutic promise.ClinicalTrials.gov Identifier: NCT05467631

[Translated article] Medial gastrocnemius proximal fasciotomy in patients with chronic plantar fasciitis: A systematic review

IntroductionPlantar fasciitis is the main cause of heel pain in middle-aged patients. In chronic cases, limited ankle dorsiflexion caused by isolated gastrocnemius contracture is considered the main risk factor for suffering it. Therefore, in recent years the number of patients operated on by proximal fasciotomy of the medial gastrocnemius (FPGM) has increased to treat chronic plantar fasciitis. Material and methodsSystematic review following the PRISMA guidelines. We have carried out a bibliographic search in Pubmed, Science Direct, Cochrane Library and Web of Science databases. One hundred and eighty-four articles were found. Data extraction was performed using the Covidence software, and a quality and risk of bias analysis of the included articles was performed based on the Cochrane risk of bias Tool 2.0. ResultsThree articles were included in the review: two randomised clinical trials and one cohort study with a total of 138 patients. In the analysed studies, patients after proximal fasciotomy of the medial gastrocnemius showed significant improvements in pain and in the AOFAS score with high levels of patient satisfaction. Increases in ankle dorsiflexion angle were found after 12 months of follow-up, with no loss of gastrocnemius strength. The complication rate was low and fewer occurred in the proximal fasciotomy compared to plantar fasciotomy. ConclusionProximal fasciotomy of the medial gastrocnemius provides clinical benefit in patients with chronic plantar fasciitis, with a low probability of complications and high patient satisfaction.

Comparison between the effect of Steroid Injection, Prolotherapy Local Injection and Extracorporal Shock Wave Therapy in Treatment of Symptomatic Calcaneal Spur

Abstract Background Calcaneal spurs are common cause of heel pain occurring anywhere along the calcaneal tuberosity and most frequently found at the insertion of the plantar fascia. They are usually asymptomatic, but when they are painful, the condition is generally the result of inflammation of the insertional fibers of the plantar fascia at the medial tuberosity. Symptomatic calcaneal spurs are often found in association with plantar fasciitis. Like plantar fasciitis, calcaneal spurs can occur alone or may be part of a systemic inflammatory condition such as rheumatoid arthritis or gout. In some patients, the cause seems to be entirely mechanical, and such patients often exhibit an abnormal gait with excessive heel strike. Objective To compare the effectiveness of dextrose prolotherapy injection, corticosteroid injection and extracorporal shockwave in symptomatic calcaneal spur, based on clinical and functional outcome measures. Patients and Methods This study was conducted on forty-five patients diagnosed with symptomatic calcaneal spur (plantar fasciitis) for more than 6 months. The patients were recruited from Physical Medicine, Rheumatology and Rehabilitation department at Ain Shams University Hospitals. Diagnosis was based on detailed history taking, full clinical examination, pain and functional assessments of the foot using visual analogue scale (VAS score) and foot function index (FFI). Results Eight weeks after treatment, the pain score by VAS was significantly improved at ESWT group mostly, less extent at prolotherapy group and least at corticosteroid group. Also the percentage of improvement in ESWT group was found higher than the other groups indicating the long term analgesic effect of ESWT. Eight weeks after treatment, the FFI subscales (pain, disability and activity limitation)and total FFI score significantly improved mostly at ESWT group, less extent at prolotherapy group and least at corticosteroid group indicating the long term beneficial effect of ESWT on the function in patients with chronic PF. Conclusion Although ESWT, dextrose prolotherapy injection, and local corticosteroid injection were all effective in the treatment of symptomatic calcaneal spur during 8weeks of follow-up but, ESWT was superior to all other modalities in its effect on pain intensity and function during daily life activities at long term follow up.

Ultrasound imaging and shear wave elastography for the differential diagnosis of heel pain: a comparative cross-sectional study.

In correlation with magnetic resonance imaging (MRI), this study attempts to assess the effectiveness of the diagnostic of ultrasonography (US) features and shear wave elastography (SWE) in determining the different causes of heel pain. 55 heels with a mean age of 38.33 ± 10.8 were included in the study (10 control cases and 41 cases, 4 of which had bilateral heel pain). There were 23 female cases (56.1%) and 18 male cases (43.95%). Examinations using shear wave elastography (SWE) and ultrasound (US) were done in different positions. MRI and the obtained data were correlated. When used to diagnose different heel pain causes, ultrasound demonstrated great sensitivity and specificity. SWE demonstrated a good correlation with MRI findings and enhanced the ultrasound's diagnostic precision in identifying plantar fasciitis early on (increased accuracy from 88.9 to 93.33% with 100% sensitivity and 83.3% specificity) and Achilles tendinopathy (increased accuracy from 88.9 to 97.8 with 94.7% sensitivity and 100% specificity). In summary, we concluded that heel pain can be efficiently examined by both ultrasound (US) and shear wave elastography (SWE) with the former being used as the primary effective tool and the latter being done to increase diagnostic accuracy. We also concluded that SWE improved the ultrasound's diagnostic precision in identifying patients with early plantar fasciitis and Achilles tendinopathy and showed a robust relationship with clinical outcomes, enhancing patient evaluation and follow-up.

Conceptual study of vatakantaka

Pain is that one feature which can interfere with daily activities such as working, having a social life, taking care of oneself and others. Several problems can cause pain to develop in the back of the heel.Plantar fasciitis is one of the most common causes of heel pain. Plantar fasciitis is estimated to affect 1 in 10 people at some point during their lifetime and most commonly affects people between 40 and 60 years of age.Vatakantaka is a Sanskrit compound consisting of the terms vata and kantaka which means a particular pain in the ankle.Walking in irregular or uneven ground, the structural deformity of foot or excessive strain on foot lead to provocation of vata and brings about severe pain in ankle joint which is referred to as Vatakantaka.Through this article an attempt is made to understand the nidana, samprapti, purvarupa, lakshana of vatakantaka which contributes in its manifestation.Snehana, swedana, virechana, raktamokshana, agnikarma are line of treatment explained in ayurveda.

Prevalence of Plantar fasciitis in academic physical therapists of KMU affiliated Institutes and clinical physical therapists in tertiary care hospitals: A cross sectional study

Background: Plantar fasciitis is the most common cause of heel pain affecting both academic and clinical physical therapists. Risk factors for developing PF are; prolong standing, BMI &gt;40, age, gender and inappropriate footwear. Its symptoms particularly aggravates in the morning while taking few steps. In general, PF is a self-limiting condition because of it resolves quickly. Aims: The aim of this study is to find the prevalence of plantar fasciitis and its association in academic and clinical physical therapists. Methods: This was cross sectional study to explore association of plantar fasciitis between academic and clinical physical therapists. 197 physical therapists were examined for plantar fasciitis by PFPS tool for plantar fasciitis pain. Plantar fasciitis Pain Scale questionnaire was filled by physical therapists for checking plantar fasciitis pain in physical therapists. Results: Individuals of mean age 25-28 were more prone to develop plantar fasciitis. Out of 197, 102 (53%) females and 92 (47%) males were likely to develop plantar fasciitis.28.9% of people with plantar fasciitis felt pain at the bottom of the heel. According to our study; regarding the relation between academic PT's, clinical PT's and VAS, data was gathered from PT's in the institutes and hospitals. The results were analyzed using chi-square test. The results of chi-square test revealed that there is a strong positive correlation (p &lt;0.05) between two variables (p = 0.00). When academic and clinical PT's were associated with VAS, for both the percentage of moderate pain was 58.9% as they are more exposed to weight bearing so, there are more chances of plantar fasciitis development. Conclusion: Plantar fasciitis was mostly found among clinical physical therapists commonly affecting bottom sole area of the foot. Plantar fasciitis was positively associated with age, gender; however, PFPS was not associated with it.

The Heel Complex: Anatomy, Imaging, Pathologic Conditions, and Treatment.

The differential diagnosis for heel pain is broad but primarily involves abnormalities of the Achilles tendon, calcaneus, and plantar fascia. Achilles tendon disorders include tendinosis, tendinitis, and partial or complete tears. Tendinosis refers to tendon degeneration, while tendinitis is inflammation after acute overload. Untreated tendinosis can progress to partial or complete tears. Tendon disorders can be accompanied by paratenonitis or inflammation of the loose sheath enclosing the tendon. Initial management involves rehabilitation and image-guided procedures. Operative management is reserved for tendon tears and includes direct repair, tendon transfer, and graft reconstruction. The calcaneus is the most commonly fractured tarsal bone. The majority of fractures are intra-articular; extra-articular fractures, stress or insufficiency fractures, medial process avulsion, and neuropathic avulsion can also occur. Posterosuperior calcaneal exostosis or Haglund deformity, retrocalcaneal bursitis, and insertional Achilles tendinosis form the characteristic triad of Haglund syndrome. It is initially managed with orthotics and physiotherapy. Operative management aims to correct osseous or soft-tissue derangements. The plantar fascia is a strong fibrous tissue that invests the sole of the foot and contributes to midfoot stability. Inflammation or plantar fasciitis is the most common cause of heel pain and can be related to overuse or mechanical causes. Acute rupture is less common but can occur in preexisting plantar fasciitis. Conservative treatment includes footwear modification, calf stretches, and percutaneous procedures. The main operative treatment is plantar fasciotomy. Plantar fibromatosis is a benign fibroblastic proliferation within the fascia that can be locally aggressive and is prone to recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Evaluation of the efficacy of trigger points combined with extracorporeal shock waves in the treatment of plantar fasciitis: heel temperature and plantar pressure

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain. Among conservative treatments, extracorporeal shock wave therapy (ESWT) is considered effective for refractory PF. Studies have shown that applying ESWT to the trigger points (TrPs) in the triceps surae may play an important role in pain treatment in patients with PF. Therefore, the purpose of this study was to combine the concept of trigger points and ESWT to explore the effect of this combination on plantar temperature and pressure in patients with PF.MethodsAfter applying inclusion and exclusion criteria, 86 patients with PF were recruited from the pain clinic of Huadong Hospital, Fudan University and randomly divided into experimental (n = 43) and control groups (n = 43). The experimental group was treated with extracorporeal shock waves to treat the medial heel pain point and the gastrocnemius and soleus TrPs. The control group was only treated with extracorporeal shock waves at the medial heel pain point. The two groups were treated twice with an interval of 1 week. Primary measurements included a numerical rating scale (NRS) score (overall, first step, heel pain during daily activities), and secondary measurements included heel temperature, Roles–Maudsley score (RMS), and plantar pressure. All assessments were performed before treatment (i.e., baseline) and 6 and 12 weeks after treatment.ResultsDuring the trial, 3 patients in the experimental group withdrew from the study, 2 due to interruption of the course of treatment by the COVID-19 epidemic and 1 due to personal reasons. In the control group, 3 patients fell and were removed due to swelling of the heel. Therefore, only 80 patients with PF were finally included. After treatment, the two groups showed good results in NRS score (overall, first step, heel pain during daily activities), RMS, and plantar temperature, especially in the experimental group, who showed a significantly better effect than the control group.ConclusionESWT of the heel combined with the triceps trigger point of the calf can more effectively improve the pain, function and quality of life of refractory PF than ESWT of the heel alone. In addition, ESWT of the heel combined with the triceps trigger point of the calf can effectively reduce the skin temperature of the heel on the symptomatic side, indicating that the heel temperature as measured by infrared thermal imaging may be used as an independent tool to evaluate the therapeutic effect for patients with chronic PF. Although extracorporeal shock waves combined with TrPs treatment can cause changes in the patients’ gait structure, plantar pressure is still difficult to use as an independent tool to evaluate the therapeutic effect for PF.Trial registrationRegistered in the Chinese Clinical Trial Registry (www.chictr.org.cn) on 12/17/2021 with the following code: ChiCTR-INR-2,100,054,439.

Consensus statements and guideline for the diagnosis and management of plantar fasciitis in Singapore.

Plantar fasciitis (PF) is a common cause of heel pain among the general population. The lack of standard practice guideline in Singapore presents challenges in education and clinical practice for this painful condition. These consensus statements and guideline were developed to streamline and improve the management of PF, covering key aspects such as diagnosis, investigations, risk factors, treatment modalities, monitoring and return to work/play. A multidisciplinary expert panel consisting of 6 sports physicians, 2 orthopaedic surgeons, 2 podiatrists and 1 physiotherapist from SingHealth Duke-NUS Sport & Exercise Medicine Centre (SDSC) was convened based on their clinical and academic experience with PF. The Grading of Recommen-dations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of the evidence and subsequently prepare a set of clinical recommen-dations pertaining to the manage-ment of PF. A modified Delphi process was used to reach consensus. Eighteen consensus statements were developed to cover key components of PF management, from initial diagnosis to treatment modalities and finally, clinical progression. They were subsequently consolidated under a proposed treatment pathway guideline for PF. The SDSC consensus statements and guideline provide concise recommendations for the management of PF in Singapore.

Conservative Treatment of Sever's Disease: A Systematic Review.

Background: Sever's disease, or calcaneal apophysitis, stands as the most prevalent cause of heel pain in children, often linked to sports like soccer, Australian football, and basketball. While various therapies are documented in the scientific literature, the standard choice is conservative treatment. Thus, the objective of this research was to assess the effectiveness of diverse conservative methods and techniques in alleviating Sever's disease symptoms. Methods: Systematic searches were conducted in October 2023 in PubMed, Web of Science, Scopus, SportDiscus, and PEDro, using terms like Osteochondritis, Osteochondrosis, Apophysitis, Sever's disease, Calcaneus, Adolescent, Child, and Childhood. The PEDro scale gauged methodological quality, and the Cochrane Risk of Bias tool evaluated the risk of bias. Results: Eight randomized controlled studies were included, featuring commonly used treatments such as insoles, therapeutic exercises, Kinesio taping, and foot orthoses. The methodological quality was generally good, with an average PEDro score of 6.75 points. Regarding bias, four articles had low risk, three had high risk, and one had some concern. Conclusions: Conservative treatment emerges as an effective option for alleviating symptoms associated with Sever's disease.