Heel Pain In Adults Research Articles

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

Effectiveness of corticosteroid injection vs platelet rich plasma (PRP) injection in the treatment of plantar fasciitis

Introduction: Plantar fasciitis is one of the most common causes for inferior heel pain in adults. Many noninvasive and invasive treatment modalities are available for its treatment. Local injection of corticosteroid and Platelet-rich plasma (PRP) is usually used in the treatment of chronic plantar fasciitis not responding to noninvasive conservative treatments. Objectives: To compare the efficacy of local injection of corticosteroids and platelet rich plasma (PRP) in the treatment of plantar fasciitis. Methodology: Patients diagnosed as plantar fasciitis and treated conservatively for at least 3 months and had no response to conservative treatment modalities were involved in this study and randomly allocated into 2 groups of 38 each (Group A and Group B). Patients were treated with local corticosteroid injection in group A and autologous PRP injection in group B. Clinical assessment was done prior to the injection and at 3 weeks and 3 months following the injection, which included visual analog pain scale (VAS), subjective rating using the modified Roles and Maudsley score (MRMS), functional outcome score by the Foot function Index (FFI). Results: The mean age, sex and body mass index was comparable for both groups. Postinjection, there was significant improvement (p &lt; 0.05) of visual analog score (VAS), modified Roles and Maudsley score (MRMS), Foot Function Index in both the groups. However, there was no significant difference (p &gt; 0.05) in improvement of VAS, MRMS and FFI when compared between the 2 groups. Conclusion: This study revealed that the treatment of plantar fasciitis with steroid or PRP injection was equally effective in patients who do not respond to conservative treatment.

Healthcare usage and cost for plantar fasciitis: a retrospective observational analysis of the 2010–2018 health insurance review and assessment service national patient sample data

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain in adults, and the number of patients and medical expenses are increasing annually. However, studies on this condition are lacking. There is a need to investigate universally administered PF treatment and the associated costs. Therefore we analyzed the South Korean Health Insurance Review and Assessment Service data to investigate the distribution and healthcare usage of patients with PF.MethodsA cross-sectional retrospective observational design was used in this study. Patients diagnosed with PF (ICD-10 code M72.2) between January 2010 and December 2018 in South Korea, of whom 60,079 had used healthcare at least once, were included in the study. We assessed healthcare usage and cost due to PF, treatment method, and visit route. All statistical analyses were performed with descriptive statistics using SAS 9.4 version.ResultsThe number of treated cases of PF and patients with PF was 11,627 cases and 3,571 patients in 2010, respectively, which increased annually to 38,515 cases and 10,125 patients by 2018, respectively. The 45-54-year-old age group had the highest number of patients; the patient population was predominantly women. Physical therapy was used frequently in Western medicine (WM) institutions, where > 50% of the medicines prescribed to outpatients were analgesics. In contrast, acupuncture therapy was most commonly used in Korean medicine (KM) institutions. A high percentage of patients who visited a KM institution, followed by a WM institution, and then returned to the same KM institution had visited the WM institution for radiological diagnostic examination.ConclusionThis study analyzed nine years of period data from a patient sample of claims data from the Health Insurance Review and Assessment Service to examine the current status of health service use for PF in Korea. We obtained information on the status of WM/KM institution visits for PF treatment, which could be useful for health policymakers. Study findings regarding treatments often used in WM/KM, the frequency of treatments, and their costs could be used as basic data by clinicians and researchers.

Use of combined shockwave therapy and platelet-rich plasma injection for management of chronic plantar fasciitis in runners: two case reports

Plantar fasciitis is one of the most common causes of foot and heel pain in adults. Extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) have each been described as effective treatments for plantar fasciitis; however, the combined use has not been adequately described. This report characterizes successful return to sport in two runners with plantar fasciitis who were treated with ESWT combined with PRP. Patient-reported outcomes were measured using the Foot and Ankle Ability Measure (FAAM). A 69-year-old female had 8 months of pain refractory to physical therapy (PT). A 73-year-old male presented with recent onset of 3 weeks of symptoms. Both runners had exam findings of plantar fasciitis and MRI confirmation. Each elected to complete ESWT along with PT using a foot core program and met functional improvements for both sport and ADL subscales of FAAM after initial ESWT treatment. However, each runner had worsening pain when attempting to run and both elected to proceed with a single leukocyte-poor PRP injection combined with ESWT. This allowed for successful return to running. Both cases highlight how combined ESWT and PRP with a foot core PT progression may be effective in managing plantar fasciitis in running athletes.

Predicting the outcome of plantar heel pain in adults: a systematic review of prognostic factors

BackgroundPlantar Heel Pain (PHP) is a common disorder with many treatment pathways and is not self-limiting, hence prognostic information concerning recovery or recalcitrance is needed to guide practice. In this systematic review, we investigate which prognostic factors are associated with favourable or unfavourable PHP outcomes.MethodsMEDLINE, Web of Science, EMBASE, Scopus and PubMed electronic bibliographic databases were searched for studies evaluating baseline patient characteristics associated with outcomes in prospective longitudinal cohorts or after specific interventions. Cohort, clinical prediction rule derivation and single arms of randomised controlled trials were included. Risk of bias was evaluated with method-specific tools and evidence certainty with GRADE.ResultsThe review included five studies which evaluated 98 variables in 811 participants. Prognostic factors could be categorised as demographics, pain, physical and activity-related. Three factors including sex and bilateral symptoms (HR: 0.49[0.30–0.80], 0.33[0.15–0.72], respectively) were associated with a poor outcome in a single cohort study. The remaining four studies reported twenty factors associated with a favourable outcome following shockwave therapy, anti-pronation taping and orthoses. Heel spur (AUC = 0.88[0.82–0.93]), ankle plantar-flexor strength (Likelihood ratio (LR): 2.17[1.20–3.95]) and response to taping (LR = 2.17[1.19–3.90]) were the strongest factors predicting medium-term improvement. Overall, the study quality was low. A gap map analysis revealed an absence of research that included psychosocial factors.ConclusionsA limited number of biomedical factors predict favourable or unfavourable PHP outcomes. High quality, adequately powered, prospective studies are required to better understand PHP recovery and should evaluate the prognostic value of a wide range of variables, including psychosocial factors.

Effect of Extra-corporeal Shock-wave Therapy in the Management of Chronic Plantar Fasciitis

Plantar fasciitis is a progressive degenerative condition of the plantar fascia which is reported to be one of the most common causes of lower heel pain in adults. Extracorporeal Shock Wave Therapy is being used for the management of plantar fasciitis now a day. The aim of the study was to find out the effects of Extracorporeal Shock-wave therapy in patients with chronic plantar fasciitis. A randomized clinical trial was conducted from May to October 2015, on 60 patients aged more than 18 years with plantar fasciitis attending in the department of Physical Medicine and Rehabilitation (PMR) in the Dhaka Medical College Hospital (DMCH) to observe the effectiveness of Extracorporeal shock-wave therapy (ESWT) in the treatment of plantar fasciitis and its therapeutic outcomes.60 patients were allocated randomly into intervention group (Group A) and control group (Group B). Data were composed through face to face interview using a questionnaire based on 1.Visual analogue scale, 2.Modified Roles and Maudsley score, and 3.100-point Scoring System for Plantar Fasciitis. But after 8 weeks, score was found lower in Group A than Group B (p&lt;0.05).The usual total pain score was higher in 100-point Scoring System for Plantar Fasciitis (p&lt;0.001) after 8 weeks of treatment as well average function score (0.001) in Group A. Patient satisfaction was also found higher in Group A by using Modified Roles and Maudsley score. Extracorporeal shock-wave therapy showed effective, so it can be suggested for the patients. Bangladesh Med J. 2021 May; 50(2) : 1-8

The Efficacy of Instrumental Physical Therapy through Extracorporeal Shock Wave Therapy in the Treatment of Plantar Fasciitis: An Umbrella Review

(1) Background: Plantar fasciitis (PF) is the most common cause of heel pain in adults. Extracorporeal shockwave therapy (ESWT) is a minimally invasive treatments commonly used for treating PF. Our aim is to provide a complete overview of which treatments have been compared to ESWT, with a focus on the modalities that have been used. (2) Methods: A thorough search of the literature was performed on Medline via Pubmed, Cochrane Database of Systematic Reviews (CDSR) of the Cochrane Library and Physiotherapy Evidence Databases (PEDro) up to 18 November 2021. In the study were included only systematic reviews and meta-analysis in English language, published from 2010 to date. (3) Results: A total of 14 systematic reviews and meta-analysis were included in the umbrella review. A total of eight studies compared the efficacy of ESWT treatment with placebo, three studies compared ESWT with another therapy (two studies compared ESWT and corticosteroids, one study ESWT and ultrasound therapy), and three studies had more than one comparison. (4) Conclusions: When compared to placebo, ESWT demonstrated to be effective. More randomized trials with specific comparisons between different types and intensity of SW are needed to obtain more precise information on SW effectiveness.

Cadaveric Analysis of Plantar Fascia Tension and Windlass Mechanism and Development of Plantar Fascia-Specific Stretching Device

Category:OtherIntroduction/Purpose:Plantar fasciitis is the most common cause of heel pain in adults, affecting 1 out of 10 of the population at some point during their lifetime. Plantar specific stretching programs are popularity among foot and ankle surgeons consisting of passively dorsiflexing foot and using thumb to apply pressure. This technique is not without limitations. Certain patients are unable to properly perform the stretching techniques, such as limited mobility from advanced age, disability, or simply from performing stretching exercises incorrectly. The aims of this study are; first, identify what configuration of plantar-specific stretching combined with applied pressure to the plantar aponeurosis generates the greatest tensional force in the plantar fascia. And second, to construct a prototype device that could simulate these forces in a hands-free technique.Methods:Six (will be 10) fresh-frozen, morphologically normal cadaver feet (Medcure, RI) were utilized. Plantar fascia was exposed, ankle was fixed at 90-degree dorsiflexion using Calcaneo-Tibial Schanz Pin, specimen was then inverted and potted in a custom-made box (Smooth-Cast 300q, PA). Using an electromagnetic motion tracking system (Liberty, Polhemus, VT), the motion of sensors was recorded at 120 Hz. Utilizing tissue adhesive glue (Vetbond, 3M, Minnesota), the first sensor was attached to medial calcaneal tuberosity, and the second sensor was placed 5 cm distal to the first sensor on the plantar aponeurosis. Custom- built testing apparatus was made for induction of MTP dorsiflexion application of pressure on the plantar aponeurosis to mimic current conservative treatments. Weights were added to the custom build stretcher device in 10Lb increments. Strain percentage was calculated as the change in length divided by the baseline length position (condition 1) using the formula: ([L − Lo]/Lo) × 100Results:Dorsiflexion of 2nd-5th MTPs increases strain percentage more in comparison with 1st MTP dorsiflexion (Condition 3>4>2). This might show that dorsiflexing of 1st metatarsal is less effective at straining the plantar fascia because of the midfoot motion. By adding thumb pressure, strain percentages go higher, up to a point that in condition 7 (dorsiflexing all MTPs in combination of thumb pressure) it is significantly higher than our baseline condition (P=0.0385). It is noteworthy that, stretcher device itself (condition 8), cannot replicate conditions 4 or 7 strain percentages. When adding direct pressure and weight to the stretcher device (conditions 12 and 13), strains are even higher than condition 7 and also are significantly higher than the baseline (P= 0.0090 and 0.0291 respectively).Conclusion:The stretcher device itself is insufficient for stretching the plantar fascia, supporting the hypothesis of this study that we need a direct forceful pressure on the plantar aponeurosis as well. Our customized plantar stretcher not only can replicate the conventional stretching program, but also can produce higher strains on the plantar aponeurosis than the current manual application of plantar specific stretching. This device may impact the rehabilitation process in patients with advanced age as well as patients with spine mobility limitation who cannot perform manual stretching programs.

Prevalence for plantar fasciitis of neural origin in community-dwelling adults

Introduction: Plantar fasciitis (PF) is one of the most common causes of heel pain in adults. Common causes of PF include prolonged standing, obesity, flat foot, and nerve entrapment. PF caused due to nerve entrapment is often left unnoticed when making a diagnosis or management for PF. Lateral and medial plantar nerves are the common nerves to get entrapped causing pain and tingling in the foot ultimately leading to PF. Aims: This study aimed to come up with the prevalence of PF of neural origin in community-dwelling adults. Settings and Design: A cross-sectional study was conducted on fifty patients with PF attending Department of Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune, over a 6 months period. Subjects and Methods: Patients were assessed based on their symptoms and whether they meet the criteria for diagnosing the condition as PF. Assessment for classifying PF of neural origin was done using Standard Neurodynamic Testing for Plantar nerves branch of tibial nerve. Statistical Analysis Used: Descriptive statistics was presented as frequency percentage. Results: The prevalence of neural origin PF among fifty patients was 54%. Forty-eight percent of them were females and 6% were males. Conclusion: This study concludes that the burden of PF of Neural Origin is more in Community Dwelling Adults yet goes undiagnosed due to the tendency of following a set battery of physical examination by physiotherapists which does not include neurodynamic tests.

A Clinical Study to Evaluate the Effectiveness of Kokilakshadhi Kwatha in the Management of Vatakantaka (Plantar Fasciitis)

Pain is a symptom which alters our day to day activities, affecting the quality of life. One among such pain is, pain in the heel, which causes difficulty in walking and in turn disturbs daily routines. Plantar fasciitis is most common cause of heel pain in adults. It is estimated that 1 in 10 people may experience inferior heel pain during their life time. Signs and symptoms of Vatakantaka resembles with Plantar fasciitis according to modern paralines.&#x0D; Treatment Modalities according to modern science is NSAIDS, toe stretching, corticosteroid injections, extracorporeal shock wave therapy and surgical correction are the indicated treatments. Analgesics have been used in practice by modern practitioners to give immediate relief to patients from pain. And modern medicine has a huge number of the drug for pain management but they impact body with serious side effects. Therefore there is a large scope of finding a treatment for Vatakantaka So in this study Kokilakshadi Kwatha explained in Yogaratnakara is considered. The study is divided into four sections as Disease review, Drug review, Pharmaceutical study and clinical study.&#x0D; Methods: The outcome of Kokilakshadi kwatha is evaluated clinically on minimum of 30 patients. Kokilakshadi kwatha was given for 21 days. The lab test and clinical analysis were done as per requirement for the assessment. Evaluation of parameters of the disease like Pain and Tenderness were done before treatment, after 11 days and after 21days.&#x0D; Results: As a result, Out of 30 patients, highly significant results (p&lt;0.001) were obtained with respect to pain (93.3%) and tenderness (60%).&#x0D; Conclusion: Kokilakshadi Kwatha showed good results in reduction of signs and symptoms of Vatakantaka. The statistical analysis also supported this by concluding that the improvement after treatment is highly significant.

A problem-based approach in musculoskeletal ultrasonography: heel pain in adults.

Musculoskeletal ultrasonography (US) has unique advantages, such as excellent spatial resolution for superficial structures, the capability for dynamic imaging, and the ability for direct correlation and provocation of symptoms. For these reasons, US is increasingly used to evaluate problems in small joints, such as the foot and ankle. However, it is almost impossible to evaluate every anatomic structure within a limited time. Therefore, US examinations can be faster and more efficient if radiologists know where to look and image patients with typical symptoms. In this review, common etiologies of heel pain are discussed in a problem-based manner. Knowing the common pain sources and being familiar with their US findings will help radiologists to perform accurate and effective US examinations.

Plantar Fasciitis: Orthobiologics

Plantar fasciitis (PF) is characterized by plantar medial heel pain, usually present in the morning at the first few steps. Obese individuals, who stand for prolonged periods and who walk on hard surfaces, typically suffer from PF, the most common cause of plantar heel pain in adults. The diagnosis can be achieved through patient clinical history and clinical findings. Stretching exercises, activity modification, and use of several analgesics resolve symptoms in over 80% of patients, while biomechanical factors can be corrected by insoles or various kinds of orthotics or night splints. In the outnumbered group of patients who develop intractable PF, other available strategies are extracorporeal shock wave therapy and corticosteroid injections. Surgical management of PF consists of plantar fascia release, but efficacy is still debated. In recent years, biological treatments have been getting popularity in many orthopedic conditions. How to cite this article: Tarulli FR, Aletto C, Maffulli N. Plantar Fasciitis: Orthobiologics. J Foot Ankle Surg (Asia Pacific) 2021;8(1):24–27.

Treating Heel Pain in Adults: A Randomized Controlled Trial of Hard vs Modified Soft Custom Orthotics and Heel Pads

ObjectivesThis study compared the effectiveness of soft vs hard orthotics in treating heel pain and plantar fasciitis in adults. It also compared the level of function after orthotic use, cost, and number of visits for orthotics and explored whether age was a factor in orthotic effectiveness. DesignRandomized controlled trial. Before randomization, patients were stratified by age (younger vs older adults) in blocks of 4 to ensure that there were an equal number of participants in each group (soft vs hard orthotics). SettingAn orthotic clinic in a community-based hospital and a private orthotic clinic. ParticipantsThe participants were adults aged 18 years or older (N=44) with heel pain and plantar fasciitis. InterventionParticipants received hard or soft customized orthotics. Main Outcome MeasuresParticipants rated their pain intensity and pain interference before and after orthotic use using subscales from the Brief Pain Inventory. Function was similarly measured using the Late Life Function and Disability Instrument: Function component. Analyses of age, cost, and number of visits were also compared. ResultsThere was a reduction in pain intensity (P=.010) and pain interference (P<.001) but no change in function over time (P=.333), and no difference between the groups who received hard vs soft orthotics. Age had no effect on orthotic effectiveness. Soft orthotics were less expensive (P<.0001) and required fewer visits for fabrication (P<.0001). ConclusionBoth soft and hard orthotics provided effective pain relief, but soft orthotics are less expensive.

Effectiveness of combined shockwave therapy and plantar fascia stretching interventions in treating plantar heel pain: a systematic review and meta-analysis protocol.

The objective of this review is to synthesize the best available evidence on the effectiveness of interventions that have used a combination of extracorporeal shockwave therapy and plantar fascia-specific stretching to treat plantar heel pain compared to any other non-surgical intervention. Recent evidence suggests combining shockwave therapy and plantar fascia stretching may be more effective than other treatments for plantar heel pain. However, no systematic reviews have been conducted on the topic and optimal treatment protocols and clinical recommendations are lacking. Randomized controlled trials assessing the effectiveness of combined shockwave therapy and plantar stretching for plantar heel pain in adults will be included. The authors will search a wide range of sources to identify both published and unpublished studies via EBSCOhost, including, but not limited to MEDLINE, SPORTDiscus, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and Allied and Complementary Medicine Database (AMED). Studies published in a language other than English will only be considered if a translation is available. The JBI systematic review methodology will be followed when conducting the review. Data synthesis will be conducted using meta-analysis or narrative synthesis, where appropriate. PROSPERO CRD42020171538.

Prevalence and Risk Factors of Plantar Fasciitis Among Middle Aged Male and Female Population - A survey Based Study

Plantar fasciitis (PF) is a commonly reported cause of plantar heel pain. The purpose of this study is to create awareness of the risk factors and/or events that leads to the development of plantar fasciitis. The identification of musculoskeletal factors related to plantar heel pain could lead to the development of intervention strategies and improve clinical outcomes. The aim of the study is to know the prevalence and risk factors of plantar fasciitis among middle-aged male and female population – a survey based study. A self-administered questionnaire containing about 16 questions was prepared and circulated through online survey google forms link. About 129 middle aged people responded to the survey. The responses were collected, tabulated and statistically analysed using SPSS software. Out of which 47.33% were females and 52.67% where males. 45.80% of the total population have a stabbing pain in the heel early in the morning and also with the long-standing while 54.20% of the population do not have this condition. 41.22% of the population experience mild pain early in the morning, 42.75% experience moderate pain,13.74% experience severe pain and 2.29% experience very severe pain early in the morning. Plantar fasciitis is one of the causes of inferior heel pain in adults. The patient has a gradual occurrence of pain along the medial side of the heel. The pain is worse when arising in the morning, which becomes less severe after a few steps.

Evaluating the efficacy of platelet rich plasma injection for the treatment of chronic plantar fasciitis

Background: Plantar fasciitis is a common and recurring cause of heel pain in adults. Platelet-rich plasma (PRP) derived from autologous blood contains a high concentration of growth factors necessary for tissue healing and offer potential treatment for plantar fasciitis. Materials and Methods: The study was conducted in Coimbatore medical college hospital as a day care procedure. Between May and September 2017, 100 patients with chronic plantar fasciitis with a mean age of 40 years were included in this prospective study and were treated with single autologous PRP injection. All patients were assessed for the pain on the visual analog scale (VAS) and the American orthopedic foot and ankle score (AOFAS) both preinjection and postsingle injection of PRP. Results: The average pain perception before injection as assessed using VAS was observed to be 9.1. Before PRP injection, 72% of patients had severe limitation of activities and 28% of patients had moderate limitation of activities. Following the administration of PRP, VAS decreased to 1.6. Eighty-eight patients were completely satisfied; eight patients were satisfied with reservation, whereas four patients were unsatisfied with the treatment outcome. AOFAS improved from 52 to 90, thus establishing its therapeutic efficacy both at 8 weeks and 3 months posttreatment. Conclusion: The results of this study support that injection of autologous PRP is safe, does not affect the biomechanical function of the foot and is efficacious in improving plantar fasciitis.

A Comparative Study on Effectiveness of Paraffin Wax Bath Versus Ultrasound in Plantar Fasciitis

Plantar fasciitis is the most common cause of inferior heel pain in adults. Amongst various options available for the treatment of planter fasciitis, purpose of this study was to compare effectiveness of two different electrotherapy modalities, Paraffin wax bath and Ultrasound, in the treatment of plantar fasciitis and to know which modality is better in relieving pain and improve function in patients with plantar fasciitis. Study included 30 (Thirty) subjects with plantar fasciitis who fulfill inclusion and exclusion criteria. The subjects were divided into 2 groups: group A who were given Paraffin wax bath along with conventional exercises and group B who were given Ultrasound along with conventional exercises. The subjects were treated for a period of 10 days. Pain was assessed by Visual Analogue Scale, Pressure Pain Threshold assessed by Pressure Algometer and functional disability by Foot Functional Index. In this study we found that there is no statistical significant difference between these two modalities in relieving pain and alleviate disability. it can be concluded that both Paraffin wax bath and Ultrasound are equally effective in plantar fasciitis.

Evaluation and Treatment of Chronic Plantar Fasciitis.

Plantar fasciitis is the most common cause of chronic heel pain in adults, affecting both young active patients and older sedentary individuals. It results from repetitive stress to the plantar fascia at its origin on the medial tubercle of the calcaneus and is often associated with gastrocnemius tightness. The diagnosis can be made clinically with a focused history and physical examination; imaging is reserved for atypical presentations and those that do not respond to initial treatment. The most common presenting symptom is aching plantar heel pain, which is worst with first step in the morning or after periods of rest. Diagnosis is confirmed with point tenderness at the origin of the plantar fascia on the medial tubercle of the calcaneus. Initial treatment consists of activity modification, anti-inflammatory medication, gastrocnemius and plantar fascia stretching, and an in-shoe orthosis that lifts and cushions the heel. These nonoperative treatments lead to complete resolution of pain in 90% of patients but can take 3-6 months. Patients who remain symptomatic despite a 6-month trial of nonoperative therapy may be considered for minimally invasive treatment or surgery. Platelet-rich plasma injections and therapeutic ultrasound are among a number of minimally invasive treatments that stimulate the body’s healing response. Corticosteroid injections temporarily relieve pain, but may increase the risk of plantar fascia rupture and fat pad atrophy. Botulinum toxin injections relax the calf muscles, which decreases the stress in the plantar fascia. Operative treatments include gastrocnemius recession and medial head of gastrocnemius release, which decrease the stress on the plantar fascia and partial planter fasciotomy, which stimulates a healing response.Level of Evidence:Level V, expert opinion.

Effect of agnikarma on chronic plantar fasciitis- A case report

Plantar fasciitis is the most common cause of heel pain in adults. It usually results when plantar fascia is got injured from too much pressure or activity. However in most of the cases, the exact cause or triggering event is missing. Although it is a self-limiting condition but due to severity of pain, medical attention is sought. Its management includes use of anti-inflammatory drugs, analgesics, local injections of steroids, physiotherapy, foot wear correction, use of heel pads, cold and hot water fomentations etc. Despite of adequate treatment, the symptoms recur or persist for a long time. Surgical intervention is rarely adopted. The clinical features of this disease simulate with Snayu- Asthi- Sandhigata Vyadhi termed as Vatakantaka by Acharya Sushruta in which the recommended treatment includes local application of Taila (medicated oils), Upnaha (poultice), Agnikarma (therapeutic burning) and Bandhana Karma (bandaging) etc. Here is a case report of a patient who was managed with Agnikarma.

Acupuncture and related interventions for treating plantar heel pain in adults

Acupuncture and related interventions for treating plantar heel pain in adults