Plantar Fascia Thickness Research Articles

Musculoskeletal Ultrasound for the Diagnosis of Plantar Fasciitis: An Accuracy and Diagnostic Yield Study.

To evaluate the accuracy of musculoskeletal ultrasound measurement of plantar fascia thickness and shear wave elastography (SWE) calculation of Young's modulus in the diagnosis of plantar fasciitis (PFis), and to explore whether it will have any impact on clinical decision-making, rather than just using established diagnostic methods of clinical symptoms and signs. A diagnostic single-center study was conducted in 60 patients with PFis and 64 patients with other types of heel pain. The sensitivity and specificity of musculoskeletal ultrasound in the diagnosis of PFis were calculated according to the diagnostic criteria for PFis recommended by the Clinical Practice Guide for PFis of the American Physical Therapy Association (APTA) Orthopaedic Branch. The analysis of the receiver operating characteristic curve of the subjects was used to study the accuracy of the diagnosis of PFis by two indicators alone and two indicators jointly. The thickness of plantar fascia measured by musculoskeletal ultrasound and the area under the curve (AUCs) calculated by shear wave elastography for diagnosing PFis were 0.925 and 0.917, respectively, and the optimal cutoff values were 3.15 mm (sensitivity: 100.0%, specificity: 81.3%) and 63.24 kPa (sensitivity: 78.3%, specificity: 92.2%), respectively. The area under the curve (AUCs) for the combined diagnosis of the two is 0.973 (sensitivity: 93.3%, specificity: 93.8%). The thickness of plantar fascia measured by musculoskeletal ultrasound and Young's modulus calculated by SWE have high accuracy in diagnosing PFis, and the combined diagnosis of the two can improve the diagnostic accuracy of patients with PFis.

Plantar Fasciitis: An Updated Review.

Plantar fasciitis (PF) is a common musculoskeletal disease. Histologic findings of patients with PF showed mainly chronic degenerative processes rather than inflammation. In addition to mechanical factors, such as repetitive stress and reduced ankle dorsiflexion, PF is also linked to rheumatologic diseases and genetic factors. Ultrasound is becoming a standard imaging technique for assessing PF. Major sonographic findings included increased plantar fascia thickness and hypoechoic plantar fascia. In addition to traditional B-mode ultrasound, sonoelastography can also be utilized to diagnose PF. Ultrasound can also be used to guide therapeutic interventions. Over 80% of patients with PF improved under nonsurgical treatment. Treatment options for PF include physical therapy, modalities (laser, therapeutic ultrasound), extracorporeal shock wave therapy (ESWT), injections, transcatheter arterial embolization, and surgery. For injections, corticosteroid was mostly used in the past but has been replaced gradually by other techniques such as platelet-rich plasma or dextrose prolotherapy. There is also more and more evidence about ESWT in treating PF. Surgery serves as an option for recalcitrant PF cases, and endoscopic fasciotomy seemed to have good outcomes. Ultrasound plays an important role in diagnosing of PF and evaluating the treatment effect, and the use of sonoelastography in addition to traditional B-mode ultrasound may help in the early detection of PF and assessment of the treatment effect.

Ultrasound and Clinical Alterations in the Foot of Children with Obesity and Diabetes.

Alterations in plantar soft tissues are often reported in adults with diabetes, whereas data on children are conflicting. Also, the extent of foot damage caused by excess body fat in children has not been fully characterized yet. This study aimed to address the relationship between body mass and structural changes of the foot in children and adolescents with and without diabetes. In a case-control study, 43 participants (age 13 ± 2.6 years) were recruited, 29 (67%) with type 1 diabetes (T1D) and 14 (33%) controls. Anthropometric parameters [body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR)], foot posture index-6 (FPI-6) for static foot posture, and navicular drop test (NDT) for medial longitudinal arch height (MLA) were measured in all participants. The thickness of the midfoot plantar fascia (MPF) and medial midfoot fat pad (MMFP) were quantified using ultrasound. No differences in clinical and ultrasonographical parameters were observed between the study groups. MMFP thickness was correlated with MPF thickness (p = 0.027). MMFP and MPF thicknesses were positively associated with BMI (p < 0.001 and p = 0.013, respectively), WC (p < 0.001 and p = 0.013), and WHtR (p < 0.001 and p = 0.026). The NDT measured on the right and left foot correlated with WHtR (p = 0.038 and p = 0.009, respectively), but not with WC and BMI. Children with T1D show structural alterations of plantar soft tissues which seem related to body mass increase rather than diabetes pathology. Ultrasound is a valuable tool to assess early structural changes of the foot in young people with an elevated BMI.

Effectiveness of Dextrose Prolotherapy in Chronic Plantar Fasciitis: A Cross-Sectional Study

&#x0D; Introduction: Plantar fasciitis is a very common musculoskeletal condition encountered in the outpatient department of orthopedics. It's the most common cause of heel pain. Patients have pain on weight-bearing, which limits their activities. Usually, plantar fasciitis is diagnosed on the basis of history and clinical examination; however, X-ray and USG can be helpful in atypical presentations. Mostly, plantar fasciitis is managed conservatively, which includes stretching exercises, footwear modification, ultrasonics, and injections. Prolotherapy is a very cost-effective, and OPD-based procedure that has shown promising results in many tendinopathies. There are no other risks involved in this procedure, and patients can start light activities immediately after the injection.&#x0D; Objective: To evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis (PF).&#x0D; Methodology: This prospective, cross-sectional study, was conducted from July 2021 to December 2021 at Birat Medical College and Teaching Hospital after taking permission from the Institutional Review Committee (IRC). Patient selection was done using inclusion and exclusion criteria. A total of 66 patients were included in the study, who received two prolotherapy injections in a gap of two weeks and were followed up after 12 weeks. Patient’s clinical (Visual Analogue Score for pain at rest and activities), functional (Foot Function Index), and ultrasonograhic (plantar fascia thickness) findings were noted pre- and post-test and were evaluated.&#x0D; Results: There were 66 adult patients included in the study, out of which 39 patients (59.1%) were female and 27 patients (40.1%) were male. Their age ranged from 26 to 68 years, with a mean age of 43.91 and a standard deviation (SD) of 10.225. The mean BMI was 25.758 with an SD 2.69 (range: 19.6-33.2). The clinical score (VAS-R and VAS-A), functional score (FFI), and ultrasonographic findings (PF thickness) yielded significant outcomes following prolotherapy.&#x0D; Conclusion: Prolotherapy is a safe, economical, and effective treatment module for plantar fasciitis that has shown significant improvement in pain, functional outcomes, and patient satisfaction.

Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study-An Evidence of Fascial Continuity.

Crural fascia (CF) and plantar fascia (PF) are biomechanically crucial in the gait and in the proprioception, particularly in the propulsion phase of the foot during the gait cycle and in the dissipation of forces during weight-bearing activities. Recent studies have revealed an association between increases in PF thickness and diabetes. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the CF and PF at different regions/levels in chronic Charcot diabetic foot patients (group 1) and in healthy volunteers (group 2). A cross-sectional study was performed using US imaging to measure the CF with Pirri et al.'s protocol and PF with a new protocol in a sample of 31 subjects (15 patients and 16 healthy participants). The findings for CF and PF revealed statistically significant differences in the poster region of CF (Post 1: group 1 vs. group 2: p = 0.03; Post 2: group 1 vs. group 2: p = 0.03) and in PF at two different levels (PF level 1: group 1 vs. group 2: p < 0.0001; PF level 2: group 1 vs. group 2: p < 0.0001). These findings suggest that chronic Charcot diabetic foot patients have CF and PF thicker compared to healthy volunteers. The US examination suggests that fascial thicknesses behavior in these patients points out altered fascial remodeling due to diabetes pathology and biomechanical changes.

Reliability of Ultrasound Measurement of Plantar Fascia Thickness: A Systematic Review.

Because ultrasound measurement of plantar fascia thickness is widely used in the diagnosis and evaluation of plantar fasciitis, it is important to understand and minimize the errors that occur with this measurement. The aim of this systematic review was to identify and synthesize studies reporting on intrarater and interrater reliability of ultrasound measurement of plantar fascia thickness. After comprehensive searches in the MEDLINE, Embase, and Cochrane Library databases, 11 studies involving 238 healthy participants and 68 patients with pathologic foot disorders were included. Seven of 11 studies revealed a low risk of bias. Most of the studies reported good to excellent intrarater and interrater reliability for ultrasound measurement of plantar fascia thickness (intrarater intraclass correlation coefficient [ICC], 0.77-0.98; interrater ICC, 0.76-0.98). In addition, two studies on intrarater reliability and one study on interrater reliability showed moderate reliability (ICCs, 0.65, 0.67, and 0.59, respectively). Overall, the standard error of measurement was less than 5% and did not exceed 7%. The findings of this review suggest that ultrasound measurement of plantar fascia thickness is reliable in terms of both relative and absolute reliability. Reliability can be optimized by using the average of multiple measurements and an experienced operator.

Chronic Plantar Fasciitis Treatment: A Randomized Trial Comparing Corticosteroid Injections Followed by Therapeutic Ultrasound with Extracorporeal Shock Wave Therapy

This study aims to compare the effect of corticosteroid injection (CSI) followed by therapeutic ultrasound (TUS) with that of extracorporeal shock wave therapy (ESWT) in patients with chronic plantar fasciitis (PF) and to explore the impact of a sedentary lifestyle and obesity on treatment outcomes. Female patients with PF were randomly allocated to receive ESWT (group A, n = 25) or CSI + TUS (group B, n = 25). Interventions: Group A received four once-weekly sessions of ESWT (2000 shocks, 2.5 bar pressure, 10.0 Hz frequency). Group B received a local injection of 40 mg triamcinolone acetonide with 2 mL 1% xylocaine, followed by three sessions of TUS per week for two weeks. Pain visual analog scale (VAS pain), plantar fasciitis pain and disability scale (PFPDS), and fascia thickness using musculoskeletal ultrasound were all measured at baseline, 4 weeks, and 12 weeks after the end of treatment. VAS pain and PFPDS improved significantly in both groups after 4 and 12 weeks. In the ESWT group, the pain improved significantly more at 12 weeks (p = 0.004). In obese patients (BMI &gt; 29.9 kg/m2), ESWT gave more long-term pain relief at 12 weeks follow-up. In both the ESWT and CSI + TUS groups, after 12 weeks, the VAS pain improved more in patients with a sedentary daily life than in those with active life (p = 0.021 and p = 0.014, resp.), as well as the PFPDS (p = 0.014 and p = 0.019, resp.). Plantar fascia thickness decreased in both groups at 12 weeks. In both groups, improvements in function (PFPDS) correlated significantly with decreased plantar fascia thickness at 4 and 12 weeks. In the CSI + TUS group only, the decrease in plantar fascia thickness was correlated with pain improvement at both follow-up visits. Echogenicity changed from hypoechoic to iso- or hyperechoic and improved significantly in both groups at 12 weeks follow-up, but changes were not different between the groups (p = 0.208). Both CSI + TUS and ESWT are effective treatments for female patients with chronic plantar fasciitis resulting in pain relief and improved function and fascia thickness. ESWT gave more pain relief at 12 weeks follow-up. CSI + TUS is effective as a rapid and short-term modality for relieving PF pain. According to previous studies, the addition of TUS does not appear to make CSI much more effective.

A comparative prospective study of platelet rich plasma versus corticosteroid injection in chronic plantar fasciitis

Background: The Plantar fasciitis is a common reason for heel pain which manifests as pain at medial process of calcaneal tuberosity. Patients are mostly diagnosed clinically on the basis of history. Conservative treatment in the form of stretching, non-steroidal anti-inflammatories, night splinting, ice packs, strapping, orthosis, and shoe modifications have been in use traditionally. Recently, the use of injectables like corticosteroids and platelet rich plasma (PRPs) has increased. This study aims at comparing the clinic-radiological outcomes of the two injectables in the treatment of chronic plantar fasciitis. Methods: This was a Prospective, Comparative, Randomized, Hospital-based clinical case study conducted in the Department of Orthopaedics, Sawai Man Singh Medical College, Jaipur, Rajasthan. 60 patients of chronic plantar fasciitis were taken and divided randomly into group A (PRP) and group B (corticosteroids) and the results were assessed based on the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and the plantar fascia thickness. Results: Mean VAS in Group A decreased from 8.07 before injection to 2.9 after injection and in Group B decreased from before 8.33 injection to 3.13 after injection, at the final follow-up. Mean AOFAS score improved from 54.06 to 90.60 and from 54.86 to 75.13 in the respective groups at the 6-months follow-up. Plantar fascia thickness (as measured using ultrasonography) decreased from 5.77 to 3.32 and from 5.6 to 3.73 in the respective groups. The improvements observed were statistically significant. Conclusions: Local injection of platelet rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effects.

Analgesic efficacy and functional outcome in refractory cases of plantar fasciitis treated with platelet-rich plasma: randomized comparative study with corticosteroids injection

ABSTRACT Background Steroid injection is a widespread treatment for plantar fasciitis but seems to be useful to a lesser extent, Platelet-rich Plasma (PRP) injections into the plantar fascia start the healing process required to stop the degeneration of the plantar fascia at its root. Aim of the study To compare analgesic efficacy, functional outcome, degree of satisfaction and improvement of fascial thickness and echogenicity after platelet-rich plasma injection versus corticosteroids injection in refractory cases of plantar fasciitis. Patients & method 60 patients with refractory plantar fasciitis who were resistant to conservative treatment were randomized to receive either PRP or steroid injection. All patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual Analogue Score (VAS) for pain, the Roles-Maudsley (RM) Score and plantar fascia thickness and echogenicity. Data were collected prospectively, pre-treatment, at 3, 6, 12 week, and 6 months post-injection. Results There was significant improvement in both groups as regards the clinical outcome measures involving (VAS & AOFAS) and radiological outcome measures including (thickness and echogenicity) in all post-injection times. However, steroid group showed early improvement (at 3rd week post-injection) with short duration while PRP group showed improvement at 12 weeks post-injection till the end of the study. Conclusion The use of PRP injection is safer with better analgesia and functional outcome than steroid therapy for treating chronic plantar fasciitis.

High-resolution Ultrasonographic Diagnosis of Plantar Fasciitis: An Association of Magnetic Resonance Imaging and Ultrasound

Objective: To assess the role played by ultrasound in evaluating plantar fasciitis and associate the findings with Magnetic resonance imaging.&#x0D; Study Design: Case series.&#x0D; Place and Duration of Study: Department of Radiology, Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Nov 2020 to Apr 2021.&#x0D; Methodology: All the patients underwent ultrasonography and magnetic resonance imaging scanning. The study and control Groups consisted of 38 patients. &#x0D; Results: Out of 38 patients, plantar fascia thickness in symptomatic feet was measured with ultrasound for both the Study and Control Groups. The Control Group had slightly thinner plantar fasciitis (1.1-2.4 mm, 1.7 ± 0.06 mm; p =0.03) compared to the Study Group (2.9-6.9 mm; 4.9±1.4 mm). In addition, this study compared other plantar fasciitis diagnostic signs on sonography with the magnetic resonance imaging findings. The diagnostic accuracy of plantar fascia pathological focal echogenicity, plantar fascia oedema, perifascial oedema, and plantar fascia rupture was 15(80.6%), 12(60.7%), 15(77.1%), and 13(68.6%) respectively. The diagnostic accuracy of ultrasonography was lower while evaluating for calcaneal spurs.&#x0D; Conclusion: The present study concluded that ultrasonography could be the basic initial diagnostic imaging modality to confirm clinically suspected cases of plantar fasciitis. However, magnetic resonance imaging could be the preferred diagnostic modality for suspected complex pathology and lack of clinical presentation.

ASSOCIATION AMONG PAIN, SKIN BLOOD FLOW AND TEMPERATURE, PLANTAR FASCIA AND FLEXOR DIGITORUM BREVIS THICKNESS, AND FOOT FUNCTION INDEX IN INDIVIDUALS WITH PLANTAR FASCIITIS: A CROSS-SECTIONAL STUDY

Background: Plantar fasciitis, the impairments include pain, changed skin blood flow (SBF) and temperature, changed plantar fascia (PF) and flexor digitorum brevis (FDB) thickness, and affected foot function index. However, the association is still unknown. Objective: The study aimed to determine the association among pain, SBF and temperature, PF and FDB thickness, and foot function index in individuals with plantar fasciitis. Methods: Thirty-two individuals with unilateral plantar fasciitis were interviewed for demographic data and assessed for pain at the first step in the morning (Pain[Formula: see text]), pain at rest (Pain[Formula: see text]), and pain at 80 N/cm2 pressure (Pain[Formula: see text]) by visual analog scale (VAS), SBF, and skin temperature (ST) by laser dropper flowmetry (LDF), PF and FDB thickness by ultrasound imaging (USI), and foot function by foot functional index (FFI). The association was analyzed by the Spearman correlation coefficient. Results: A significant correlation was found among Pain[Formula: see text] and Pain[Formula: see text], Pain[Formula: see text], SBF, PF, and FFI. Pain[Formula: see text] was correlated with SBF, and FFI. Pain[Formula: see text] was also correlated with FFI. SBF was correlated with ST and FFI. Conclusions: The association among pain, PF thickness, and FFI was reported in individuals with plantar fasciitis, which can be meaningful relationship between clinical outcomes and ultrasonographic evidence.

Hemiplejik hastalarda plantar fasya kalınlığının ultrasonografik değerlendirilmesi

Aims: In hemiplegic patients, changes in load distribution due to spasticity and paralysis cause trauma due to increased pressure and biomechanical problems in the plantar fascia on both sides. The aim of this study was to evaluate the plantar fascia thickness on both plegic and non-plegic sides by ultrasound in hemiplegic patients.&#x0D; Material and Methods: This cross-sectional study included patients with chronic hemiplegia (&gt;6 months) and healthy control individuals. Clinical and demographic features were noted. Plantar fascia was visualized as hyperechoic fibrils by ultrasound. The thickness was measured in both sides and at one cm after the calcaneal connection.&#x0D; Results: We included forty hemiplegic patients (22 males, 18 females) with a mean age of 58.60 ± 11.8 years; and thirty-six age, sex, and body mass index (BMI) matched healthy subjects. Plantar fascia thickness values were significantly higher on the non-plegic side (3.82 ± 0.1 mm) compared to that of plegic side (2.83 ± 0.6 mm) and healthy groups sides ( (right side:2.82 ± 0,50; left side: 2.81 ± 0,6) (p0,05). We also found significantly positive correlation between plantar fascia thickness of the non-plegic side and time since stroke (r=0.538, p

Prolotherapy Versus Phonophoresis and Corticosteroid Injections for the Treatment of Plantar Fasciitis: A Randomized, Double-Blind Clinical Trial

The aim of this study was to compare the effectiveness of prolotherapy with phonophoresis and steroid injection in patients with plantar fasciitis (PF). One hundred forty-six patients with PF were randomly divided into prolotherapy, phonophoresis, and injection groups. The treatment method to be applied to them was determined by drawing lots of equal numbers of papers with "Prolotherapy," "Corticosteroid," and "Phonophoress" written on it among those who accepted to be treated. Patients were evaluated using heel sensitivity index (HSI), visual analog scale (VAS), foot function index (FFI), and Short Form (SF)-36 at baseline, first and third months after the therapy. Plantar fascia thickness (PFT) was measured by ultrasonography (USG) at baseline, first and third months after the therapy. Statistically significant improvements were found in all parameters at 1 and 3 months after treatment in all groups (p < .05). There was no significant difference between VAS and FFI scores between the 3 groups (p > .05). Improvement in the HSI (p=.021) and SF-36 general health (GH) subscales at the third month after treatment in the prolotherapy group was significantly better at the first and third months compared to the other groups (p=.033 and p < .01). No complications were observed in any of the patients. Our study results suggest that prolotherapy, phonophoresis, and steroid injection are beneficial as safe treatment modalities in the early period of PF treatment. The improvement of HSI and SF-36 GH subscale lasts longer with prolotherapy, but ultrasonographic findings do not change in the third month of these treatment applications.

Role of platelet rich plasma in the treatment of plantar fasciitis

Introduction: Plantar fasciitis is a commonly occurring foot complaint that seriously affects the patient’s daily activities and quality of life. Plantar fasciitis is characterised by pain in the heel, which is aggravated on weight bearing after prolonged rest. Conservative noninvasive lines of treatment are numerous, among which platelet-rich plasma (PRP) has recently been demonstrated to be helpful in managing plantar fasciitis. Aim: The aim of this study was to evaluate the effectiveness of platelet-rich plasma as a form of interventional pain management for plantar fasciitis. Materials and Methods: This prospective study was carried out on 40 patients suffering from chronic Plantar Fasciitis who did not respond to conservative therapies including physical therapy, NSAIDs and heel cushions for a longer period. The patients were selected from the outpatient department of the Orthopaedics SKIMS medical College, Bemina Srinagar. All enrolled patients were treated with single dose of local injection of 3 mL autologous PRP. Assessment was done using visual analogue scale (VAS) for pain intensity. Functionally, foot and ankle ability measure (FAAM) was used at baseline and after injection. Results: The mean VAS score before the procedure was 7.21± 2.33 and after procedure were 2.96 ± 0.54. The mean difference of 4.24 was statistically significant. There was a significant raise of mean FAAM score 29.37 after 24 weeks of treatment and the difference was statistically significant. Conclusion: The present study observed by follow-up of PRP treated plantar fasciitis patients at intervals, revealed that this procedure is safe, efficient and effective for long term pain reduction along with reduction in thickness of plantar fascia.

Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial

BackgroundPlantar fasciitis (PF) is a common orthopaedic problem, with heel pain worsening the quality of life. Although steroid injection is often used if the conservative treatment fails, Platelet-Rich Plasma (PRP) injection is gaining popularity due to its safety and long-lasting effect. However, the effect of PRP versus steroid injection in PF has not been studied yet in Nepal. Therefore, this study aimed to assess the effect of PRP compared with steroid injection in the treatment of PF.MethodsThis study was a single-center, hospital-based, open-label, parallel-group randomized clinical trial to compare the effect of PRP injection with steroid injection in plantar fasciitis between August 2020 and March 2022. A total of 90 randomly selected participants aged 18 to 60 years suffering from plantar fasciitis with failed conservative treatment were intervened. The American Orthopaedic Foot and Ankle Society (AOFAS) and the Visual Analog Scale (VAS) scoring system were used to evaluate functional mobility and pain before and after the intervention for three and six months, respectively. Statistical analyses were performed using a Student’s two-sample t-test. P-value < 0.05 was considered statistically significant.ResultsThe PRP injection showed a better outcome than the steroid injection in six months follow-up. The mean (± SD) VAS score was significantly decreased in the PRP group (1.97 + 1.13) than in the steroid group (2.71 ± 0.94) with the group difference of -0.73 (95% CI: -1.18 to -0.28) at six months. Similarly, there was a significant increase in the AOFAS scores in the PRP group (86.04 ± 7.45) compared to the steroid group (81.23 ± 9.60) at six months of follow-up with a group difference of 4.80 (95% CI: 1.15 to 8.45). There was also a significant reduction of plantar fascia thickness in the PRP group compared to that of the steroid group (3.53 ± 0.81 versus 4.58 ± 1.02) at six months of follow-up with the group difference of -1.04 (95% CI: -1.44 to -0.65).ConclusionThe PRP injection showed better outcomes than steroid injection in plantar fasciitis treatment over the course of six months. Further research with a larger population and longer follow-up than six months is needed to generalize the findings and their long-term efficacy.Trial registrationNCT04985396. First registered on 02 August 2021. (https://clinicaltrials.gov/ct2/show/NCT04985396)

Ultrasonographic Assessment of Indian Patients With Plantar Fasciitis and Its Clinical Correlation: A Prospective Observational Study.

Plantar fasciitis is a debilitating clinical condition and is one of the most common causes of heel pain. The risk factors include frequent and prolonged running, obesity, a sedentary lifestyle, work-related weight bearing, and inappropriate footwear. Ultrasonography being a non-invasive, cost-effective, and easily available modality is a useful adjunct in the diagnosis. A prospective observational study was conducted among 30 patients with unilateral plantar fasciitis. The diagnosis was based on history and examination. Heel pad thickness and plantar fascia thickness were recorded using ultrasonography. The ultrasonography results showed increased plantar fascia and heel pad thickness in the affected limb with plantar fasciitis than the normal one (p<0.001). The BMI was positively correlated with the heel pad thickness (p<0.05). The receiver operating characteristic (ROC) curve showed 90% sensitivity and 60% specificity for heel pad thickness (p<0.001). Ultrasonography is a sensitive and specific tool to identify patients with plantar fasciitis.

A Case Report of Ultrasound-guided Bee Venom Pharmacopuncture on Plantar Fasciitis

Objectives: This study is to report the usefulness of ultrasound in diagnosing plantar fasciitis and the effectiveness of ultrasound-guided bee venom pharmacopuncture as a treatment of it.Methods: A 61-year-old woman suffered from plantar fasciitis on her right foot for 1 month. The sonographic findings were fascial thickening, blurring of perifascial border and perifascial effusion. The ultrasound-guided bee venom pharmacopuncture for 6 times and conventional Korean medicine therapies like acupuncture and moxibustion for 12 times in 5 weeks. Numeric rating scale (NRS) and foot function index(FFI) was used to evaluate the pain and its progress. and thickness of plantar fascia was measured by sonography every week.Results: After treatments, NRS and FFI were reduced from 10 to 1 and from 190 to 72. The thickness of fascia was reduced from 0.43cm to 0.40. Blurring and effusion of perifascial border were also improved.Conclusion: This report suggests that the Ultrasound-guided Bee Venom Pharmacopuncture is effective for Plantar Fasciitis. Ultrasonography could be one of the most valuable items in the clinical practice of Korean medicine doctors who seek minimally invasive treatment.

Extracorporeal Shockwave Therapy Versus Platelet Rich Plasma Injection in Patients of Chronic Plantar Fasciitis: A Randomized Controlled Trial From a Tertiary Center of Eastern India.

Introduction Plantar fasciitis is a degenerative condition of the plantar fascia that leads to heel and sole pain. Physical modalities, physiotherapy, medication, and orthoses have been tried before as treatments. Extracorporeal shockwave therapy (ESWT) and the injection of autologous platelet-rich plasma (PRP) are generally effective in the treatment of plantar fasciitis, which might be resistant to other conservative measures. The present study compares the efficacy of ESWT and PRP injection in respect of symptomatic relief, functional improvement, and change in plantar fascia thickness (PFT). Methods Seventy-two patients were enrolled and randomized into two groups. Patients in the first group received ESWT, whereas patients in the second group received PRP injections. Patients were evaluated using the Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) score, along with PFTmeasurement (using ultrasonography) before the treatment and at days 15, 30, and 90 after the treatment. The X2 test was used to compare qualitative variables, and the paired T-test was used to evaluate quantitative data. Quantitative variables had a normal distribution with a standard deviation, and the significance level was set at P-value=0.05. Results On day 0, the mean VAS of the ESWT and PRP groups were 6.44±1.11 and 6.78±1.17, respectively (p=0.237). On day 15, the mean VAS of the ESWT and PRP groups were 4.67±1.45 and 6.67±1.35, respectively (p<0.001). At day 30, the mean VAS of the ESWT and PRP groups were 4.97±1.46 and 4.69±1.39, respectively (p=0.391). On day 90, the mean VAS of the ESWT and PRP groups were 5.47±1.63 and 3.36±0.96 (p<0.001). On day 0, the mean PFTs of the ESWT and PRP groups were 4.73±0.40 and 5.19±0.51, respectively (p<0.001). At day 15, the mean PFT of the ESWT and PRP groups were 4.64±0.46 and 5.11±0.62, respectively (p<0.001) which changed to 4.52±0.53 and 4.40±0.58 at day 30 (p<0.001), and to 4.40±0.50 and 3.82±0.45 at day 90 (p<0.001). The mean AOFAS of the ESWT and PRP groups were 68.39±5.88 and 64.86±8.95 on day 0 (p=0.115), 72.58±6.26 and 67.22±10.47 on day 15 (p=0.115), 73.22±6.92 and 74.72±7.52 on day 30 (p=0.276), and 72.75±7.90 and 81.08±6.01 on day 90, respectively (p<0.001). Conclusion Both PRP injection and ESWT are very effective methods to improve pain and cause reduced plantar fascia thickness in patients with chronic plantar fasciitis non-responsive to other conservative measures. PRP injection is more effective at a longer duration as compared to ESWT.

Intralesional Steroid Injection Versus Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Comparative, Prospective, Case Series Study.

Background This study aimed to compare and evaluate the outcomes of intralesional steroid injections (ultrasound-guided) versus extracorporeal shockwave therapy in the treatment of plantar fasciitis. Methodology Between January 2021 and March 2022, 120 (84 male, 36 female) patients with a confirmed diagnosis of plantar fasciitis were identified. Subjective assessment was done using Mayo Clinical Score, and objective evaluation was done by measuring plantar fascia thickness using ultrasonography. For this study, two groups were made, wherein group A was administered a high dose of extracorporeal shockwave therapy, and group B was administered ultrasound-guided intralesional or local steroid injections. Results Plantar fascia thickness was considerably reduced after therapy in both groups; however, the difference in thickness reduction was not statistically significant between both groups. Mayo Clinic Scores showed statistically significant improvement in pain; however, the difference in pain reduction was not statistically significant between both groups. Conclusions A considerable clinical and radiological improvement was noted in both groups; however, we did not record statistically significant and superior results in either group. Intralesional steroid injections provided faster clinical improvement and better patient compliance.

Comparison between Ultrasound-guided Pulsed Radiofrequency Ablation of the Medial Calcaneal Nerve and Extracorporeal Shockwave Therapy in Managing Recalcitrant Plantar Fasciitis: A Randomised Controlled Trial

Introduction: Plantar Fasciitis (PF) is one of the most common causes of heel pain, with a prevalence ranging from 3.6-7% in the general population. Approximately 90% of patients with PF respond well to conservative therapy, including rest, stretching, analgesics, physical therapy, shoe modifications, or steroid injections. However, around 10% of patients have recalcitrant cases that require invasive or surgical interventions. Pulsed Radiofrequency Ablation (PRFA) is a non neurodestructive method that provides non surgical pain relief in such cases. Aim: To compare the effectiveness of ultrasound-guided PRFA of the Medial Calcaneal Nerve (MCN) and Extracorporeal Shockwave Therapy (ESWT) in managing recalcitrant PF. Materials and Methods: This randomised controlled trial was conducted at the Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur, India over a two-year period from September 2018 to August 2020. A total of 78 patients with PF were included in the study, divided equally into two groups: a study group and a control group, each consisting of 39 participants. The study group received PRFA of the MCN, while the control group received ESWT of the plantar fascia. The Visual Analog Scale (VAS), Plantar Fascia Thickness (PFT), and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were measured at 1, 4, 12, and 24 weeks as outcome variables. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0, and statistical tests like Chi-square test, t-test, and repeated measures Analysis of Variance (ANOVA) were used. A p-value of &lt;0.05 was considered significant. Results: Of the 78 patients included in the study, 42 (53.8%) were females and 36 (46.2%) were males, with a mean age of 41.08±10.09 years. The VAS score in the study group improved from 5.51±0.82 at baseline to 1.92±0.80 at 24 weeks, while in the control group, the VAS score improved from 5.36±0.97 at baseline to 2.33±0.66 at 24 weeks. PFT in the study group improved from 4.45±0.374 at baseline to 2.26±0.231 at 24 weeks, while in the control group, PFT improved from 4.42±0.366 at baseline to 2.49±0.357 at 24 weeks. The AOFAS score also improved from 50.49±13.13 at baseline to 74.03±11.53 in the study group, and in the control group, the AOFAS score improved from 49.74±12.26 at baseline to 71.36±10.72 at 24 weeks (p-value &lt;0.05). Conclusion: Significant improvements were observed in all outcome measures in both the study and control groups, with a p-value &lt;0.05. However, the improvements were more pronounced in the study group, with minimal to no sideeffects. Hence, ultrasound-guided PRFA of the MCN can be considered an effective minimally invasive treatment modality for recalcitrant PF.