Heel Pain Research Articles

Penataklasanaan Fisioterapi pada Kasus Faciitis Plantaris Dextra dengan Modalitas Ultrasound dan Terapi Latihan di RS Cahya Kawaluyan

Plantar Fasciitis is heel pain caused by inflammation of the muscle membrane of the soles of the feet called the plantaris fascia. The plantar fascia is located on the surface of the sole of the foot, extending from the calcaneus towards the toes. To determine the implementation of Physiotherapy in reducing pain, increasing muscle strength, and increasing the Scope of Joint Movement in cases of Plantar Fasciitis Dextra using Ultrasound (US) modalities and exercise therapy. After 6 treatments using VAS, it showed a decrease in movement pain from T1 with a value of 3.5 to T6 with a value of 1, a decrease in tender pain from T1 with a value of 6 to T6 with a value of 2, while for silent pain T1 to T6 the value was 0. There was an increase in strength. T1 plantar flexion muscle is worth 4 to T6 is 5, T1 is 3 to T6 is 5, T1 eversion muscle is 3 to T6 5, T1 inversion muscle is 3 to T6 is 5. There is an increase in the range of motion of the ankle joint in the sagittal plane T1 : 150-00-200 becomes T6 : 200-00-350, in the rotation plane T1-T6 : 300-00-200.Ultrasound (US) can help reduce pain and reduce muscle tension. Exercise therapy can increase muscle strength, reduce stiffness and increase joint range of motion.

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.

PREVALENCE OF MEDIAL CALCANEAL NEUROPATHY,CAUSE HEEL PAIN IN GIRLS WHO WEARS HIGH HEELS

BACKGROUND :In this topic there is prevalence of calcanealneuropathy which causesPain in the plantar heel is a frequent issue that can be very uncomfortable chronic plantar heel pain has been linked to a number of neurological Etiology including entrapment neuropathy of the medial calcaneal nerve a branch of the posterior tibial nerve. One kind of tarsal tunnel syndrome is through to be medial calcaneal neuropathy.OBJECTIVE :The study was done to determine the prevalence of medial calcaneal neuropathy which causes heel pain.METHODS:The study was an observational study which include 357 girls in Karad which includes rural and urban area. Consent forms was explained and signed by the participants. The test performed was specific to neuropathy Tinel’s sign. RESULT :on the basis of the study 84.5 girls has pain and 15.5 girls is not having pain in both urban and rural area .CONCLUSION :The study concluded that there is a significant portion of individuals with persistent plantar heel pain have medial calcaneal neuropathy.

Diamondback Double-Row Reconstruction with Proximal Modification for the Treatment of Chronic Insertional Achilles Tendinosis

Chronic insertional Achilles tendinosis is a common source of posterior heel pain. When nonoperative treatment fails, surgical procedures include debridement of unhealthy tissue, enthesophytes, and Haglund’s deformity. This surgical procedure often entails detaching the Achilles tendon from its insertion, followed by a reconstructive procedure to re-attach the Achilles tendon to the bone. Most common double-row repairs involve 2 proximal and 2 distal anchors with crossing sutures. This technique may have several limitations, including the proximal portion of the tendon not being compressed to bone and the lack of complete coverage of the distal Achilles insertion. This paper describes a new double-row technique to address these potential shortcomings, aiming for a more biomechanically favorable repair with a quicker functional recovery. The method and 1-year outcomes from a series of 33 patients are described. Level of Evidence: Level IV.

Prevalence, characteristics, and associated risk factors of plantar heel pain in americans : The cross-sectional NHANES study

SummaryBy analyzing data from NHANES, we aimed to evaluate the prevalence, characteristics, and associated factors of plantar heel pain in Americans aged 20 or above.IntroductionPlantar heel pain is a prevalent problem that affects a substantial number of adults and significantly impairing their quality of life.ObjectiveTo investigate the prevalence and characteristics of plantar heel pain, exploring the associated risk factors.MethodsThis is a cross-sectional study. We analyzed data from 4957 individuals aged 20 or above who participated in the 2009–2010 NHANES.ResultsAmong the total 4957 US participants ≥ 20 years of age, 549 (11.1%) participants reported plantar heel pain. There was a significant difference in distribution between female and male (p = 0.002). Furthermore, participants aged between 50 and 65 years had the highest plantar heel pain prevalence of 14.5% among the entire population, however, among the female participants, those aged ≥ 65 years demonstrated the highest prevalence (19.8%) of plantar heel pain. In addition, compared to those with BMI < 25 kg/m2, BMI with 25–30 kg/m2 had 1.5-fold risk of plantar heel pain(OR:1.50, 95%CI:1.10–2.05), while BMI with 30–35 kg/m2 had a 2.1-fold higher risk and those with BMI ≧ 35 kg/m2 had a 2.7-fold risk to experience plantar heel pain. Age, BMI, female (OR:1.35, 95%CI:1.07–1.70), kidney stones history (OR:1.52, 95%CI:1.09–2.11), hypertension (OR:1.54, 95%CI:1.20–1.96) and osteoporosis (OR:1.75, 95%CI:1.10–2.78) were independent risk factors for plantar heel pain. Further subgroup analysis indicated that osteoporosis is the independent risk factor for women (OR:2.00, 95%CI:1.19–3.37) but not men (OR:0.65, 95%CI:0.15–2.86) for plantar heel pain.ConclusionOur findings might offer evidences for the prevention and treatment of plantar heel pain. Further prospective studies are needed to confirm our findings.

Effect of Radial Extracorporeal Shockwave Therapy on Pain Intensity Level in Patient with Calcaneal Spur

Background: Heel pain is a common musculoskeletal issue that significantly impacts patient daily activities and, consequently, their quality of life. This clinical study aims to evaluate the effectiveness of radial extracorporeal shockwave therapy in reducing pain intensity in patients with calcaneal spurs.Objective: To investigate the effects of radial extracorporeal shockwave therapy on pain intensity in patient with calcaneal spur.Methods: A total of 60 patients diagnosed with calcaneal spurs based on clinical examination and lateral radiography between September 2022 and June 2023 were included in this study. Participants were randomly assigned to two groups: Group A (radial extracorporeal shockwave therapy) and Group B (traditional physical therapy). All participants followed an exercise program; however, those in Group A received six sessions of radial extracorporeal shockwave therapy (10 Hz, 2000 pulses, at 2.4 bar). The Visual Analog Scale (VAS) was used to assess pain intensity both before and after treatment in all participants.Results: No significant differences were observed between Group A and Group B regarding gender, affected side, condition distribution, age, weight, height, or BMI (p &gt; 0.05). Both groups experienced significant reductions in VAS scores post-treatment (p &lt; 0.001); however, Group A demonstrated a greater improvement, with a percentage reduction in pain of -50.65%, compared to -28.17% in Group B. Additionally, post-treatment VAS scores were significantly lower in Group A than in Group B (p = 0.003), indicating that shockwave therapy yielded a more substantial reduction in painConclusions: Both radial extracorporeal shockwave therapy and traditional physical therapy programs significantly reduced pain intensity in patients with calcaneal spurs, with a favorable effect observed for radial extracorporeal shockwave therapy. These methods can be considered effective, safe, and conservative treatment options for managing calcaneal spurs.

Efficacy and tolerability of extracorporeal shock wave therapy in patients with plantar fasciopathy: a systematic review with meta-analysis and meta-regression.

Plantar fasciopathy (PF) is a common musculoskeletal condition characterized by heel pain and functional impairment. Extracorporeal shock wave therapy (ESWT) has gained increasing interest in the treatment of PF, but the optimal ESWT program is still debated. Therefore, this systematic review with meta-analysis and meta-regression aimed at providing a comprehensive assessment of the efficacy and tolerability of ESWT in PF management. Randomized controlled trials (RCTs) published until February 2023 were systematically searched on PubMed/MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PEDro. Studies assessing adult patients with PF treated with ESWT were considered. The primary outcome was the tolerability of ESWT, measured by treatment adherence, dropouts, and safety. Secondary outcomes were pain intensity and functional outcomes. Meta-analysis and meta-regression were performed to examine the relationship between ESWT program characteristics and treatment outcomes. The quality of included studies was assessed using the Jadad scale and the Cochrane risk-of-bias tool. Eleven studies met the inclusion criteria and were included in the analysis. Our findings showed that ESWT is effective in reducing pain intensity assessed by Visual Analogue Scale [focal-ESWT: -2.818 (SE 0.803, -4.393, -1.244; P< 0.0001; radial-ESWT: -3.038 (SE 0.428, -3.878, -2.199; P<0.001)]. Meta-regression analysis indicated a positive relationship between specific ESWT parameters (frequency, number of pulses, energy flux density and frequency, and number of pulses, pressure) and pain intensity (all P<0.05) and dropout (all P<0.05). ESWT seems to be an effective and tolerable treatment for PF, albeit the peculiarity of parameters might affect both the efficacy in pain relief and the adherence to the treatment. Physicians should consider individual patient characteristics when selecting the ESWT parameters for PF treatment. Further high-quality studies are warranted to establish the optimal ESWT protocol to treat PF.

Effectiveness of joint mobilization on heel fat pad syndrome among obese patient in geriatric population

Objective. To determine the effect of joint mobilization on Heel Fat Pad Syndrome among obese geriatrics. Methods. The randomized controlled study was performed at the Saveetha Physiotherapy OPD, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India. 202 samples aged above 60 years were collected based on the criterion for inclusion and exclusion. Interventions. The experimental Group (101Subjects) was treated with Ultrasound and Joint Mobilization. The Control Group (101 Subjects) was treated with Ultrasound and conventional Exercises. The lifestyle and Balance Assessment used the Foot Function Index and Berg balance scale. A numeric Pain Rating Scale was used to measure Pain. Results. The Wilcoxon Signed Rank Test revealed a significant difference (p &lt; 0.001) in the experimental Group between the pre-test and post-test values of NPRS, FFI, and BBS. Similarly, the Control Group showed a significant difference (p &lt; 0.001) in the pre-test and post-test values of NPRS, FFI, and BBS. The comparison of post-test scores between the Experimental Group and the Control Group also showed a significant difference (p &lt; 0.001), indicating significant improvements in the experimental group. As a result, the effects of Joint Mobilization on Heel Pad Syndrome minimize the symptoms of heel fat pad syndrome, Improve Foot Function and balance and reduce pain. Conclusion. The study provided evidence that ultrasound and joint mobilization used in this study show a significant reduction in pain and balance with non-specific heel pain.

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.

Inflammatory back pain as an unusual manifestation of Takayasu arteritis: a case report.

Takayasu arteritis and spondyloarthritis are two rheumatological diseases whose co-existence is well-documented in the literature. Data on the presence of inflammatory back pain in Takayasu arteritis without a diagnosis of spondyloarthritis, however, is scarce. Here, we present a 33-year-old man who was admitted to the emergency department with acute-onset chest pain associated with left carotidynia, carotid bruit, and left arm claudication, normal electrocardiogram and computed tomography angiographic features suggesting Takayasu arteritis, including stenosis and occlusion of the aorta and its branches. Two years prior, he had undergone a clinical work-up for an inflammatory back pain accompanied by alternating buttocks pain, morning stiffness lasting more than half an hour, and heel pain. HLA-B27 status and magnetic resonance imaging of the sacroiliac joints were both negative. He was prescribed non-steroidal anti-inflammatory drugs and was placed on adalimumab 40 mg SC every two weeks but had to switch to etanercept two months before his emergency admission due to supply issues. Oral prednisolone was initiated at a dose of 60 mg/day with symptomatic improvement in both his inflammatory back pain and his chest pain, but he had to be switched to methotrexate and infliximab due to steroid side effects. Inflammatory aortitis should be considered as a possibility during the assessment of inflammatory back pain to mitigate the risks of delayed diagnosis.

Treatment Options for Plantar Fasciitis: Surgical Release vs. Conservative Therapy

Introduction Plantar fasciitis is one of the most common reasons for visits to orthopedic clinics. This tendinopathy can cause medial heel pain, stiffness, and tenderness on the plantar surface of the foot. Both conservative and surgical methods are employed in its treatment. Aim The aim of this study is to evaluate selected conservative treatment methods, such as stretching, the use of orthotic insoles, splints, injections, extracorporeal shockwave therapy, and taping, as well as surgical treatment options. The study presents a comparison of these methods in terms of their effectiveness, advantages, and disadvantages. State of Knowledge The plantar fascia is a stiff, connective tissue structure extending along the plantar surface of the foot. Biomechanical load on the fascia, which supports the medial longitudinal arch, can lead to degenerative changes that underlie plantar fasciitis. Symptoms include pain, particularly in the mornings and late evenings, which intensifies with palpation of the heel area. Summary (Conclusions) Conservative treatments for plantar fasciitis are effective in 90% of patients. There are no studies that conclusively demonstrate the superiority of one treatment method over another. Thus, the choice of therapy should be tailored to the patient's lifestyle, activity level, and financial capability. Surgical intervention is necessary in cases of chronic plantar fasciitis which remains resistant to conservative treatments.

Effectiveness of Cross Friction Massage, Manual Therapy, Gastro Soleus Complex Stretch on Foot for Heel Pain in Menopause Women

Plantar fasciitis is a common musculoskeletal problem and is a frequent source of heel discomfort. Plantar fasciitis is a widespread ailment, but its exact mechanism and aetiology are yet unknown. Most people agree that it is related to recurrent micro-trauma. However, because of the hormonal changes that follow menopause, it is more common in postmenopausal women. Because estrogen maintains the suppleness and length of the plantar fascia, the decrease in oestrogen levels is important. The inferior heel area, especially in the vicinity of the medial plantar process, as well as the medial, lateral, and lower posterior parts of the calcaneus are frequently affected by heel pain. Weight-bearing activities are usually when the patient experiences the most severe pain, and the majority of the time, a shift in the quantity or intensity of physical activity occurs before the patient experiences symptoms. This study aims to show the effectiveness of three treatment protocols for plantar fasciitis: foot and ankle manipulation combined with cross-friction massage and gastrocsoleus complex stretching.

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.

Ultrasound-Guided Approach to the Distal Tarsal Tunnel: Implications for Healthcare Research on the Medial Plantar Nerve, Lateral Plantar Nerve and Inferior Calcaneal Nerve (Baxter's Nerve).

The tibial nerve, commonly misnamed the "posterior tibial nerve", branches into four key nerves: the medial plantar, lateral plantar, inferior calcaneal (Baxter's nerve), and medial calcaneal branches. These nerves are integral to both the sensory and motor functions of the foot. Approximately 15% of adults with foot issues experience heel pain, frequently stemming from neural origins, such as tarsal tunnel syndrome (TTS). TTS diagnosis remains challenging due to a high false negative rate in neurophysiological studies. This study aims to improve the understanding and diagnosis of distal tarsal tunnel pathology to enable more effective treatments, including platelet-rich plasma, hydrodissections, radiofrequencies, and prolotherapy. Ultrasound-guided techniques were employed to examine the distal tarsal tunnel using the Heimkes triangle for optimal probe placement. The results indicate that the tunnel consists of two chambers separated by the interfascicular septum, housing the medial, lateral plantar, and inferior calcaneal nerves. Successful interventions depend on precise visualization and patient positioning. This study emphasizes the importance of avoiding the calcaneus periosteum to reduce discomfort. Standardizing nerve involvement classification in TTS is difficult without robust neurophysiological studies. The accurate targeting of nerve branches is essential for effective treatment.

Open Dorsal Closing-Wedge Calcaneal Osteotomy for Haglund Exostosis-Related Heel Pain.

Dorsal closing-wedge calcaneal osteotomy (DCWCO) is a treatment option for persistent Haglund exostosis-related heel pain after failed conservative management. In modifying the orientation of the calcaneal tendinous insertion site and reducing mechanical stress, the consequences of DCWCO-associated biomechanical changes on everyday foot function remain unknown. This retrospective cohort study analyzed routinely collected clinical data as well as data from our foot and ankle registry. One hundred twenty patients (66 males, 54 females, 17-77 years) who underwent DCWCO from January 2016 to December 2019 were included. Adverse events were collected from the patient files. Foot Function Index (FFI) scores were collected before (baseline) and at 6, 12, and 24 months postsurgery. Radiographic parameters including the Achilles tendon moment arm and X/Y ratio were evaluated from standard preoperative and 6-week postoperative radiographs. Correlations between FFI and biomechanical changes were calculated for men and women separately with the Pearson correlation coefficient and Bonferroni correction. One intra- and 18 postoperative adverse events were documented. Mean baseline FFI pain decreased from 47.9 ± 17.2 to 12.0 ± 17.5 points at 24 months with an average decrease of -21.8 ± 21.3 points occurring within the first 6 months postsurgery. A similar trend was also seen with the FFI disability score (49.6 ± 20.3 to 12.8 ± 17.6 points). The mean decrease in Achilles tendon moment arm was -8.1 ± 3.8 mm and mean X/Y ratio increased from 2.6 ± 0.3 to 3.8 ± 1.0. There were no significant correlations between the FFI score and radiographic changes. DCWCO effectively alleviates exostosis-related heel pain and associated disabilities. Improvements can still be expected up to 2 years after surgery. Radiographic changes of the foot and ankle are significant but do not correlate with patient-reported outcome measures.

Biomechanical Changes to the Hindfoot After Zadek Osteotomy.

Insertional Achilles tendinopathy (IAT) is a common source of heel pain in active adults and athletes. The Zadek osteotomy (ZO) is a calcaneal dorsal closing wedge osteotomy that has demonstrated clinical success as a treatment for IAT, purported to favorably improve tendon mechanics, decrease impingement, and decrease pressure within the retrocalcaneal bursa. The present study aims to evaluate the biomechanical effects of ZO on Achilles strain, position of the Haglund prominence relative to the Achilles insertion, and retrocalcaneal pressure. The ZO was performed on 10 fresh-frozen foot and ankle mid tibia-fibula cadaveric specimens. An osteotomy was performed using a 1-cm dorsal closing wedge procedure secured with a 7.0 mm cannulated screw. Point pressure sensor catheters and differential variable reluctance transducers were used to measure the retrocalcaneal pressure and Achilles strain, respectively, pre- and postosteotomy. Paired t-tests were utilized to detect statistical differences (P < .05). After the ZO, the Haglund prominence was translated 9.9 mm anteriorly with respect to the insertion of the Achilles (P < .05) and the Achilles tendon insertion was translated 3.4 mm proximally (P < .05). The ratio of calcaneal length to greater tuberosity length, the X/Y ratio, increased from 2.56 to 3.52 with the osteotomy (P < .05). At maximum dorsiflexion, retrocalcaneal pressure decreased from 117 to 66 mm Hg (44%, P = .018). The Achilles strain changed from 0.00362 to 0.00436 in the anterior fibers (P = .484) and changed from 0.00467 to 0.00283 in the posterior fibers (P = .088). Biomechanical testing in a cadaveric model demonstrates that the ZO decreased retrocalcaneal pressure, shifted the Achilles tendon insertion proximally, increased the X/Y ratio of the calcaneus, and did not significantly change the strain of the Achilles tendon. Despite the clinical success demonstrated in recent literature, there are no biomechanical studies describing the effect of the ZO on the biomechanics of the hindfoot, and the mechanism of symptom relief of the ZO for IAT is not well understood. The present study measures two potential ZO effects relative to Haglund prominence by measuring retrocalcaneal pressure and displacement of the Achilles tendon with respect to the Haglund prominence, and measures one ZO effect relative to calcification of the tendon by measuring the Achilles tendon strain.

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.

Comparing different session regimens of electroacupuncture for chronic plantar fasciitis: study protocol for a randomized clinical trial

BackgroundPlantar fasciitis (PF) is one of the most common causes of plantar heel pain, and previous studies found that acupuncture is effective for relieving pain in patients with PF. Nevertheless, the impact of different sessions of electroacupuncture on PF has not been investigated through randomized, controlled trials. Methods/design: This is a two parallel-group, assessor-blinded, randomized controlled trial, consisting of a four-week treatment phase followed by a 12-week follow-up. Eighty patients with chronic PF will be recruited and randomly allocated to receive 12 (three sessions per week; the multiple electroacupuncture weekly treatment group (group M)) or four (one session per week; single electroacupuncture weekly treatment group (group S)) sessions of electroacupuncture treatment in a 1:1 ratio. The primary outcome to be studied is the response rate, defined as a minimum of 50% improvement in most severe pain intensity with first steps in the morning, compared with baseline. We will perform all analyses based on the intention-to-treat principle, with differences considered significant when the P value < 0.05 on a two-sided basis. DiscussionThis prospective trial will provide high-quality evidence on evaluating the efficacy and safety of different electroacupuncture sessions (one session per week versus three sessions per week) for chronic PF. This study aims to contribute in produce up-to-date, rigorous evidence on the most effective frequency of electroacupuncture in managing chronic PF.Trial registration Clinicaltrials.gov Identifier: NCT06284993. Registered on February 17, 2024.

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.