Fascia Thickness Research Articles

Effectiveness and tolerability of focal versus radial extracorporeal shock wave therapy in patients affected by plantar fascia enthesopathy

Plantar fascia enthesopathy is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is widely used in patients affected by this condition. The aim of this study was to compare efficacy and tolerability of ESWT modalities in the treatment of plantar fasciitis. We included 42 patients receiving 1 session of focused ESWT (f-ESWT group) or radial ESWT (r-ESWT group) per week for 3 weeks. Pain assessment was performed at baseline, before each session, and 1 month after the last session using brief pain inventory (BPI) severity index, and interference index (II). Tolerability was defined in terms of patient discomfort after treatment assessed by numeric rating scale at baseline and after each session. Plantar fascia changes in ultrasonography were further investigated. A significant reduction of BPI-II (P<0.001) was reported in both groups, although no between-group differences were found. Plantar fascia thickness showed significant reduction only in the f- ESWT group (P=0.028). Patient’s tolerability was significantly better in the r-ESWT group (P<0.05). Our study confirms that ESWT is effective for reducing pain and disability in patients affected by plantar fasciitis, although r- ESWT seems to be better tolerated.

Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain

The objectives of this study were (1) to investigate the passive stiffness of the medial gastrocnemius (MG) and lateral gastrocnemius (LG) in patients with and without plantar fasciitis (PF), (2) to explore the correlation between gastrocnemius stiffness and plantar fascia thickness (PFT) as well as the intensity of pain in patients with PF, (3) to detect optimal cut-off points for stiffness of the MG and LG for identifying patients with PF. Forty patients (mean age = 51.1 years ± 12.9) participated in this study. The elastic properties of the MG and LG were quantified using shear wave elastography ultrasound. The thickness of the plantar fascia was measured by B-mode imaging. The intensity of pain was assessed using a visual analogue scale. The results showed that when the ankle was in the relaxed position, patients with PF had increased passive stiffness in the MG (P < 0.05) but not in the LG. Significant correlations were found between pain and the stiffness of the MG (middle, distal; all P-values < 0.05) and no correlation was observed between pain and PFT (P = 0.416). The initial cut-off point for the stiffness of the MG was 29.08 kPa when the ankle was in the relaxed position. The findings from the present study show that an increase in muscle stiffness is not the same in the individual muscles of the gastrocnemius muscle. Traditional treatment of the whole gastrocnemius muscle might not be targeted at the tight muscle.

Sonographic Evaluation of Plantar Fasciitis and its Relation to Body Mass Index and Heel Pad Thickness

Introduction: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis (PFs) using both quantitative and qualitative parameters, and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT).&#x0D; Methods: In this case controlled analytical study, we sonographically evaluated 100 patients with clinical plantar fasciitis (unilateral: 90, bilateral: 10 with mean age 46.9yrs) and control group of 60 (120 heels) healthy volunteers with mean age 45.3yrs. Plantar Fascia Thickness (PFT), HPT, hypoechogenity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. PFT was measured 5mm distal to the calcaneal insertion of plantar aponeurosis. The unloaded HPT was measured from the skin surface to the nearest calcaneal tuberosity.&#x0D; Results: Mean Plantar Fascia Thickness (PFT) and Heel Pad Thickness (HPT) are greater on the symptomatic side for patients with unilateral and bilateral PFs than on the asymptomatic side for patients with unilateral PFs, and also control subjects (PFT values are 4.41 ± 0.59, 4.63 ± 0.55, 2.83 ± 0.36, 2.62± 0.37 mm, and HPT values 17.64 ± 1.07, 17.28 ± 1.10, 16.91 ± 1.06, 16.73 ± 1.13 mm, respectively) (p &lt;0.0001). Mean BMI values of the case and control groups are 26.14 ± 1.9 and 24.42 ± 0.89 Kg/m2, respectively (p &lt;0.05). We found hypoechogenicity of plantar fascia in 80 cases (72.7%), calcaneal spur in 69 cases (62.7%), biconvexity in 11 cases (10%) and perifascial fluid in 16 cases (14.5%) within the plantar fasciitis group (110 symptomatic heels).&#x0D; Conclusion: Increased plantar fascia thickness, increased heel pad thickness and hypoechogenicity of plantar fascia are consistent sonographic findings in plantar fasciitis. Its occurrence has significant relation to high BMI.

Effect of preservation on the physical and chemical properties of the temporal fascia

ObjectiveThe temporal fascia has been widely used in tympanoplasty. In addition, the preserved fascia has been also used in the ear surgery. In this study, we planned the experiments to determine whether physical and chemical properties of the fascia preserved at a low temperature. MethodsPreserved temporal fasciae from 21 patients were used in this study. The thickness of the temporal fascia was measured under a 3D laser microscope. The tensile strength was evaluated using a tensile tester. In addition, the chemical property evaluated was the biologic antioxidative potential of samples. ResultsThe results showed that the strength of the fascia was not affected by the retention period. The thick fascia tended to show the less tensile strength. The intensity was highest in middle-aged donors when compared to young and older donor. The antioxidative potentials did not affect the preservation. ConclusionThe results suggested that the preserved temporal fascia could be safely used for tympanoplasty.

Evaluation of plantar fascia using high-resolution ultrasonography in clinically diagnosed cases of plantar fasciitis

PurposeThe aim of this study was to assess the efficacy of high-resolution ultrasonography in the assessment of plantar fascia in individuals with heel pain, before and after treatment.Material and methodsThis study was conducted from 2016 to 2019, during which time 44 clinically diagnosed patients of plantar fasciitis were compared to 50 normal volunteers. There were 25 males and 25 females in the control group and 42 females and two males in the study group. Thirty-eight patients had unilateral disease, and six patients had bilateral disease. The thickness of the plantar fascia was measured just anterior to its calcaneal attachment using ultrasonography. Body mass index (BMI) was also calculated in both groups.ResultsThe plantar fascia was 2-4 mm thick in the control group whereas it was > 4 mm thick in 48 heels in the study group. With cut-off of > 4 mm as diagnostic of plantar fasciitis, this study had a sensitivity of 96%, specificity of 100%, and accuracy of 98%. BMI was increased in 60% of female patients. All patients were treated with local infiltration of corticosteroid. In 37/42 patients (43 heels) who had improved clinically, the thickness of plantar fascia was reduced to < 4 mm when assessed after six weeks of corticosteroid injection.ConclusionsDiagnosis of plantar fasciitis can be easily verified by ultrasonography with plantar fascia thickness > 4 mm being suggestive of plantar fasciitis. Ultrasound can also be used to evaluate treatment response. Ultrasono-graphy helps the clinician in confirming the diagnosis of plantar fasciitis and also in assessing the response to treatment.

Evaluation of plantar fascia thickness in Egyptian patients with spondyloarthropathy

Purpose To measure plantar fascia (PF) thickness in Egyptian patients with spondyloarthropathy (SpA) using high-resolution musculoskeletal ultrasound and to assess its relationship with age, sex, BMI, and clinical and laboratory parameters of disease activity. Patients and methods PF thickness was measured in 50 patients with SpA (diagnosis based on Amor criteria), in addition to 100 healthy volunteers as a control group, using 7–13-MHz linear array transducer. Results The mean PF thickness in patients with SpA was 5.17±1.25 mm, whereas it was 3.06±0.65 mm in the control group, with significant difference (P Conclusion SpA is frequently associated with plantar fasciitis. Plantar fasciitis in patients with SpA may be clinically asymptomatic and early diagnosed with ultrasonography. PF mean thickness was found to be more than 4 mm in most patients with SpA. Its thickness is associated with disease activity and functional impairment.

A comparative prospective study of platelet rich plasma vs. corticosteroid injection in plantar fasciitis

Objective: To compare the relative effectiveness of intralesional Steroid versus Platelet- Rich Plasma injection among 80 patients in plantar fasciitis.Methods: A total number of 80 patients with plantar fasciitis were divided into 2 groups (Group A and B). Group A with 30 patients received intralesional Platelet Rich Plasma (PRP) and Group B received intralesional methyl prednisolone acetate injection. Pre and post intervention Visual Analogue Score (VAS), Foot and Ankle Ability Measure (FAAM) score and PF (plantar fascia) thickness for assessment of pain relief in two groups were recorded at 6 months.Results: The mean VAS scores for heel pain measured after 6 months of treatment were 1.460+0.6911in PRP group and 3.024+0.9572in steroid group. The decrease in mean VAS score in both the groups was statistically significant when compared with pre-treatment values (8.38+0.6820in PRP group and 8.44+0.6021in steroid group). The mean FAAM score measured after 6 months of treatment increased in both the groups (83.43±5.661in PRP group and 69.12±5.795 in steroid group)when compared with pre-treatment value (29.97±5.997in PRP group and 31.68±6.297 in steroid group)and it was statistically significant.There was 35.90% reduction in mean plantar fascia thickness in PRP group and 28.67% reduction in Steroid groupas compared to baseline values after 6 month of injection.Conclusion: Intralesional injection of both the PRP and steroid are effective and safe modalities of treatment for plantar fasciitis. Steroid is better for short term treatment of plantar fasciitis but in long term follow up platelet rich plasma therapy is better than steroid. Both the treatment methods have caused significant reduction in PF(Plantar fascia) thickness.

Short-Term Efficacy of Kinesiotaping versus Extracorporeal Shockwave Therapy for Plantar Fasciitis: A Randomized Study.

Background:Plantar fasciitis is a degenerative condition that is one of the most common causes of heel and foot pain. Among noninvasive management of plantar fasciitis, extracorporeal shockwave therapy (ESWT) has been extensively studied and found to be effective, but few studies have assessed the effectiveness of kinesiotaping (KT) method.Objective:This study aimed to show the effectiveness of KT compared with ESWT in the management of plantar fasciitis.Methods:A total of 84 patients with plantar fasciitis were enrolled from a single center and randomized into KT and ESWT treatment groups in a 1:1 ratio (i.e., 42 patients in each group); only one foot was considered for each patient. Both KT and ESWT were applied once a week for 6 weeks. Patients' pain, functional status and quality of life were evaluated with the visual analog scale (VAS), Foot Function Index (FFI) and the Short-Form-36 (SF-36) health survey, respectively. Patients' fat pat and plantar fascia thickness were measured using ultrasonography. All evaluations were performed before and immediately after the 6-week intervention.Results:In the KT group, six patients were lost to follow-up; therefore, the final analysis only included 36 patients. After the intervention, there was a statistically significant improvement in the VAS and SF-36 scores of both groups (P = 0.001), but the FFI score improvement was statistically significant only in the KT group (P = 0.001). In both groups, the mean thickness of plantar fascia decreased after treatment and the mean thickness of the fat pat increased; however, the change was not statistically significant (P = 0.935 and P = 0.832, respectively).Conclusion:Both KT and ESWT treatments improved pain levels and quality of life in patients with plantar fasciitis, but KT also improved functionality. Multicentered studies with larger sample size and longer follow-ups are required to further validate these findings.

Foot exercise plus education versus wait and see for the treatment of plantar heel pain (FEET trial): a protocol for a feasibility study

BackgroundPlantar heel pain (PHP) is present in a wide range of individuals and creates significant burden to quality of life and participation in physical activity. The high recurrence rates and persistence of PHP suggests current management options may not address all potentially modifiable factors associated with the condition. Reports of intrinsic foot muscle (IFM) atrophy in individuals with PHP, together with biomechanical evidence of their important contribution to optimal foot function, suggests that an intervention focused on IFM training may be beneficial in managing PHP. We will test the feasibility of a prospective, assessor-blinded, parallel-group, randomised clinical trial that compares foot exercise plus education to brief advice in individuals with PHP.MethodsTwenty participants with PHP will be randomly allocated to one of two groups for a 12-week intervention period: (i) foot exercise plus education, or (ii) brief advice. The foot exercise plus education group will attend eight sessions with a physiotherapist and receive detailed education on self-management strategies as well as a progressive exercise program for the IFMs. The brief advice group will attend one session with a physiotherapist and receive brief information about self-management strategies and reassurance. Outcome measures will be obtained at baseline and the primary end-point of 12 weeks. Primary outcomes will be the feasibility of conducting a full-scale randomised clinical trial (RCT), and the credibility and acceptability of the foot exercise plus education intervention. Secondary outcomes will explore treatment effects, which will consist of pain, physical function, physical activity level, pain self-efficacy, perceived treatment effect, magnetic resonance and ultrasound image measurement of IFM morphology, ultrasound imaging measurement of plantar fascia thickness, IFM motor performance, foot posture, foot mobility, ankle dorsiflexion range of motion, toe flexor and plantar flexor strength/endurance.DiscussionTo reduce the burden of PHP on individuals and society, there is a need to establish effective treatments that are feasible and accepted by patients and health professionals. This trial will be the first to evaluate the feasibility of conducting a full-scale RCT, as well as the credibility, acceptability, and treatment effects, of education and foot exercise for PHP. The findings of this study will inform the development of a full-scale RCT.Trial registrationThe trial protocol was prospectively registered with the Australia and New Zealand Clinical Trial Registry (ACTRN12619000987167) on 11th July 2019.

Platelet rich plasma injection versus extracorporeal shock-wave therapy in treatment of plantar fasciitis

Objective The aim of this study was to determine the efficacy of local platelet-rich plasma (PRP) injection compared with extracorporeal shock-wave therapy (ESWT) for treatment of plantar fasciitis. Background Plantar fasciitis is an important cause of heel pain. ESWT and PRP have emerged as new management options, alternative for surgery. Patients and methods This comparative study included 60 patients, comprising 48 female and 12 male patients with plantar fasciitis diagnosed clinically and by ultrasound. The patients were divided into two groups: 30 patients received single local PRP injection and 30 patients received three sessions of ESWT weekly. All patients were assessed using pain visual analog scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale, and plantar fascia thickness by ultrasound before treatment and at 1 and 3 months after treatment. Results VAS, AOFAS ankle-hind foot score, and plantar fascia thickness improved significantly in both groups. The AOFAS ankle-hind foot scale shows more improvement in the ESWT group at 1 month after treatment (P = 0.009). Significant improvement in plantar fascia thickness was seen clearly in PRP group at 1 and 3 months after treatment (P Conclusion Local PRP injection and ESWT improve pain and function in patients with plantar fasciitis. ESWT showed early improvement if plantar fasciitis is associated with calcaneal spur.

Predictors of response to foot orthoses and corticosteroid injection for plantar heel pain

BackgroundFoot orthoses and corticosteroid injection are common interventions used for plantar heel pain, however few studies have investigated the variables that predict response to these interventions.MethodsBaseline variables (age, weight, height, body mass index (BMI), sex, education, foot pain, foot function, fear-avoidance beliefs and feelings, foot posture, weightbearing ankle dorsiflexion, plantar fascia thickness, and treatment preference) from a randomised trial in which participants received either foot orthoses or corticosteroid injection were used to predict change in the Foot Health Status Questionnaire foot pain and foot function subscales, and first-step pain measured using a visual analogue scale. Multivariable linear regression models were generated for different dependent variables (i.e. foot pain, foot function and first-step pain), for each intervention (i.e. foot orthoses and corticosteroid injection), and at different timepoints (i.e. weeks 4 and 12).ResultsFor foot orthoses at week 4, greater ankle dorsiflexion with the knee extended predicted reduction in foot pain (adjusted R2 = 0.16, p = 0.034), and lower fear-avoidance beliefs and feelings predicted improvement in foot function (adjusted R2 = 0.43, p = 0.001). At week 12, lower BMI predicted reduction in foot pain (adjusted R2 = 0.33, p < 0.001), improvement in foot function (adjusted R2 = 0.37, p < 0.001) and reduction in first-step pain (adjusted R2 0.19, p = 0.011). For corticosteroid injection at week 4, there were no significant predictors for change in foot pain or foot function. At week 12, less weightbearing hours predicted reduction in foot pain (adjusted R2 = 0.25, p = 0.004) and lower baseline foot pain predicted improvement in foot function (adjusted R2 = 0.38, p < 0.001).ConclusionsPeople with plantar heel pain who use foot orthoses experience reduced foot pain if they have greater ankle dorsiflexion and lower BMI, while they experience improved foot function if they have lower fear-avoidance beliefs and lower BMI. People who receive a corticosteroid injection experience reduced foot pain if they weightbear for fewer hours, while they experience improved foot function if they have less baseline foot pain.

The evalaution of the foot core system in individuals with plantar heel pain

ObjectiveTo compare foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance, and abductor hallucis morphology in individuals with and without plantar heel pain (PHP). DesignCross-Sectional. SettingLaboratory. ParticipantsSixteen individuals with PHP and sixteen matched healthy participants. Main outcome measuresStatic foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance and abductor hallucis morphology were evaluated. Foot posture was assessed with the Foot Posture Index-6. Abductor hallucis morphology and plantar fascia thickness were measured utilizing diagnostic ultrasound. Plantar foot sensation was assessed at the head of the first metatarsal and medial longitudinal arch using Semmes-Weinstein Monofilaments. Intrinsic foot muscle performance was assessed using the intrinsic foot muscle test (IFMT). Mann-Whitney U and independent t-tests were used to examine between group differences. ResultsIndividuals with PHP exhibited a more pronated foot posture and greater plantar fascia thickness at the proximal insertion compared to healthy controls. Plantar sensation thresholds were higher in the PHP compared to healthy controls at the head of the first metatarsal. There were no group differences in abductor hallucis morphology or IFMT performance. ConclusionsIndividuals with PHP exhibited a more pronated foot posture, thicker plantar fascia, and diminished plantar tactile sensation.

Effect of Dextrose Prolotherapy on Pain Intensity, Disability, and Plantar Fascia Thickness in Unilateral Plantar Fasciitis: A Randomized, Controlled, Double-Blind Study.

The aim of the study was to evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis through comparison with a control group. In this double-blind, randomized, controlled study, the patients were divided into two groups. The prolotherapy group (n = 30) was administered 5 ml of 30% dextrose, 4 ml of saline, and 1 ml of 2% lidocaine mixture (15% dextrose solution) and the control group was given 9 ml of saline and 1 ml of 2% lidocaine mixture twice at a 3-wk interval. During the 15-wk follow-up period, pain intensity was measured using the visual analog scale during activity and at rest. The foot function index was used to measure pain and disability. The plantar fascia thickness was measured by ultrasonography. The measurements were undertaken before treatment and at posttreatment weeks 7 and 15. Improvements in visual analog scale during activity, at rest, foot function index (all subgroups), and plantar fascia thickness measured at the 7th and 15th weeks were significantly higher in the prolotherapy group compared with the control group (P < 0.001). Dextrose prolotherapy has efficacy up to 15 wks and can be used as an alternative method in the treatment of chronic resistant plantar fasciitis.

Is Platelet-rich Plasma Injection more Effective than Steroid Injection in the Treatment of Chronic Plantar Fasciitis in Achieving Long-term Relief?

Introduction: Plantar fasciitis is characterised by pain in the heel, which is aggravated on weight bearing after prolonged rest. Many modalities of treatment are commonly used in the management of plantar fasciitis including steroid injection. Many studies show that steroid injection provides pain relief in the short term but not long lasting. Recent reports show autologous platelet-rich plasma (PRP) injection promotes healing, resulting in better pain relief in the short as well as long term. The present study was undertaken to compare the effects of local injection of platelet-rich plasma and Corticosteroid in the treatment of chronic plantar fasciitis.Materials and methods: Patients with the clinical diagnosis of chronic plantar fasciitis (heel pain of more than six weeks) after failed conservative treatment and plantar fascia thickness more than 4mm were included in the study. Patients with previous surgery for plantar fasciitis, active bilateral plantar fasciitis, vascular insufficiency or neuropathy related to heel pain, hypothyroidism and diabetes mellitus were excluded from the study. In this prospective double-blind study, 60 patients who fulfilled the criteria were divided randomly into two groups. Patients in Group A received PRP injection and those in Group B received steroid injection. Patients were assessed with visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score. Assessment was done before injection, at six weeks, three months and six months follow-up after injection. Plantar fascia thickness was assessed before the intervention and six months after treatment using sonography.Results: Mean VAS in Group A decreased from 7.14 before injection to 1.41 after injection and in Group B decreased from 7.21 before injection to 1.93 after injection, at final follow-up. Mean AOFAS score in Group A improved from 54 to 90.03 and in Group B from 55.63 to 74.67 at six months’ follow-up. The improvements observed in VAS and AOFAS were statistically significant. At the end of six months’ follow-up, plantar fascia thickness had reduced in both groups (5.78mm to 3.35mm in Group A and 5.6 to 3.75 in Group B) and the difference was statistically significant.Conclusion: Local injection of platelet-rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effect.

Comparación de la terapia de ondas de choque extracorpóreas focales y presión radiales en la fascitis plantar

ObjectivePlantar fasciitis is a common cause of heel pain. The aetiology of this condition remains unclear. Patients typically have pain upon palpation of the medial plantar calcaneal region. Extracorporeal shockwave therapy has shown favourable outcomes in various studies. The aim of this study was to compare the effect of focused extracorporeal shockwave therapy with radial pressure wave therapy. Patients and methodsSeventy-nine non-randomised patients diagnosed with plantar fasciitis were included between January 2017 and June 2018. Patients from the Arnau de Vilanova Hospital in Valencia were treated with focused extracorporeal shockwave therapy, and patients from Llíria Hospital with radial pressure wave therapy. Measured outcome variables were: visual analog scale; ultrasonographic measurement of plantar fascia thickness; self-reported foot-specific pain and disability using the Foot Function Index; self-reported health-related quality of life using the Euroqol-5D; self-reported pain and limitations of activity using the Roles & Maudsley Scale. ResultsAt inclusion, the 2groups showed no significant differences in demographic or clinical characteristics. Three months after treatment completion, both groups showed improvement in all outcome variables, without statistically significant differences between the 2groups. No adverse effects or complications were observed. ConclusionsBoth extracorporeal shockwave therapy and radial pressure wave therapy are effective treatments for plantar fasciitis.

WITHDRAWN: Ultrasonographic detection of normal plantar fascia thickness in healthy Egyptian adults

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Clinical characteristics of 57 patients with polyarteritis nodosa and renal involvement

Objective: To investigate the clinical characteristics of polyarteritis nodosa (PAN) patients with renal involvement. Methods: PAN patients admitted to the department of rheumatology, department of pediatrics, department of nephrology, general internal medicine department and department of vascular surgery at Peking Union Medical College Hospital from June 2012 to August 2018 were enrolled in this study and were divided into two groups according to renal involvement or not. The clinical characteristics were analyzed. Results: A total of 94 PAN patients were finally enrolled and 57 (60.64%) presented kidney manifestation. The mean age of onset was (37.76±17.40) years old and the interval from onset to diagnosis was 10 (0 to 240) months. Forty patients were misdiagnosed once or more times. In patients with renal involvement, 9 cases suffered from renal ischemia or infarction, 31 with microscopic haematuria, 26 with proteinuria, renal artery or its branch involved in 17 cases, renal vein thrombosis in 1 case, 4 cases with pyeloureterectasis, one case with renal fascia thickening, 33 cases with impaired renal function (serum creatinine>84 μmol/L) including creatinine>140 μmol/L in 10 patients. Renal artery branch stenosis was the most common presentation [9 cases (52.94%)] of renal vascular involvement, other abnormalities including nodular dilatation [4 cases (23.53%)], occlusion [3 cases (17.65%)]. There were significant differences (P<0.05) in the PAN patients with and without renal involvement in the following: age of onset [(33.72±16.13) years vs. (43.97±17.66) years, t(2)=2.901, P=0.005], weight loss(≥4kg since PAN onset) [25(43.86%) vs. 7(18.92%), χ(2)=6.216, P=0.013], elevation of diastolic blood pressure [22(38.60%) vs. 7(18.92%), χ(2)=4.072, P=0.044], acromegaly gangrene [18(31.58%) vs. 21(56.76%), χ(2)=5.859, P=0.015], and gastrointestinal artery involvement [20(35.09%) vs. 6(1.22%), χ(2)=3.993, P=0.046]. Laboratory parameters and the application of glucocorticoid and cyclophosphamide therapies were similar in two groups (all P>0.05). Conclusion: Young PAN patients are more likely to be associated with renal involvement, especially gastrointestinal arteries.

Local hyperalgesia, normal endogenous modulation with pain report beyond its origin: a pilot study prompting further exploration into plantar fasciopathy.

Background and aims Persistent tendinopathies were previously considered solely as peripheral conditions affecting the local tendinous tissue until quantitative sensory testing identified involvement of altered pain processing. In similar fashion, pain in patients with persistent plantar fasciopathy may also involve more than local tissue. The aim of this pilot study was to investigate potential differences in conditioned pain modulation and pressure and thermal pain thresholds, between individuals with PF and healthy pain-free controls, as a precursor to a larger-scale study. Methods We assessed 16 individuals with plantar fasciopathy and 11 pain-free controls. Plantar fasciopathy diagnosis was: palpation pain of the medial calcaneal tubercle or the proximal plantar fascia, duration ≥3 months, pain intensity ≥2/10, and ultrasound-measured plantar fascia thickness ≥4 mm. Quantitative sensory tests were performed locally at the plantar heel and remotely on the ipsilateral elbow. Assessments included pain thresholds for pressure, heat and cold, and conditioned pain modulation measured as change in local resting pressure pain threshold with cold water hand immersion. Participants rated pain intensity at pain threshold. Additionally, the area and distribution of plantar fasciopathy pain was drawn on a digital body chart of the lower limbs. Descriptive analyses were performed and between-group differences/effects expressed as standardised mean differences (d). Results There was no conditioned pain modulation difference between participants with plantar fasciopathy and controls (d = 0.1). Largest effects were on local pressure pain threshold and reported pain intensity on pressure pain threshold (d > 1.8) followed by pain intensity for heat and cold pain thresholds (d = 0.3-1.5). According to the digital body chart, pain area extended beyond the plantar heel. Conclusions The unlikelihood of a difference in conditioned pain modulation yet a pain area extending beyond the plantar heel provide a basis for exploring altered pain processing in a larger-scale study. Implications This was the first study to investigate the presence of altered pain processing in individuals with plantar fasciopathy using a conditioned pain modulation paradigm and thermal pain thresholds. We found no indication of an altered pain processing based on these measures, however, patients rated pain higher on thresholds compared to controls which may be important to clinical practice and warrants further exploration in the future.

Comparing effectiveness of polydeoxyribonucleotide injection and corticosteroid injection in plantar fasciitis treatment: A prospective randomized clinical study

BackgroundThis study aimed to compare the efficacy and safety of polydeoxyribonucleotide (PDRN) injection and corticosteroid injection for plantar fasciitis. MethodsThis study included 44 patients with plantar fasciitis, randomly allocated to the PDRN and corticosteroid groups. Evaluation using the visual analogue scale (VAS) pain score and Manchester-Oxford foot questionnaire (MOXFQ) was conducted at baseline, 1, 2, 6weeks and 6months. The thickness and echogenicity of the plantar fascia in ultrasonography and complications were recorded. ResultsCorticosteroid injection elicited more pain relief than did PDRN injection at 2 (p=0.010) and 6weeks (p=0.016); however, it showed no superiority at 6months (p=0.523). MOXFQ showed similar outcomes. The thickness and echogenicity did not differ between groups and no complications were reported in either group. ConclusionsWe demonstrated that PDRN injection could be an effective and safe option for plantar fasciitis and was comparable to corticosteroid injection after 6months follow up. Level of evidenceII, comparative study.

Assessment the reliability of ultrasonography in the imaging of the plantar fascia: a comparative study

BackgroundImaging methods for the plantar fascia have included radiography, ultrasound and magnetic resonance imaging (MRI), all of which have provided valuable information. This study assessed the reliability of ultrasonography examinations of the plantar fascia using a comparative study.MethodsFifty healthy adult volunteers (25 males and 25 females, mean age 31.6 ± 3.5 years) were included in this study. Images of the plantar fascia from 100 ft were acquired with ultrasonography, CT and MRI. Ultrasound was used to measure the thickness of the plantar fascia. Imaging data from CT and MRI in a DICOM format were transformed into the Materialise Mimics Innovation Suite 16.0 software for digital analysis. SPSS software (SPSS, USA) was used for statistical analysis. The reliability was established by a t-test. Moreover, 42 patients with unilateral plantar fasciitis were examined by ultrasonography.ResultsThere were no significant differences between the three imaging modalities for patients of the same sex (P > 0.05). There were no statistically significant differences between the left and right sides for patients of the same sex (P > 0.05), but the difference between males and females was statistically significant (P < 0.01). There were no significant differences between US, CT and MRI in the normal group, but there were significant differences in the plantar fasciitis group evaluated with ultrasound. The plantar fascii of normal male subjects are significantly thicker than those of the normal female.ConclusionUltrasonography can be a relatively simple and reliable method for the measurement of plantar fascia thickness.