Treatment Of Plantar Fasciitis Research Articles

To Compare the Efficacy of Platelet-Rich Plasma with Low-Level Laser Therapy and Low-Level Laser Therapy Alone in the Treatment of Chronic Plantar Fasciitis

Background: Increased body weight, repeated micro trauma and work on hard surfaces are the risk factors for plantar fasciitis. Platelet rich plasma (PRP) can be injected to various tissues where it releases high amounts of platelet derived growth factors that increases growth and healing process. Low level laser therapy (LLLT) is an alternative treatment that uses low power lasers. Potential benefits in reducing the pain and spasm. Methodology: Patients between 18 to 60 years were included in this prospective randomized controlled trial. Diagnosis made mainly on clinical grounds. We divided our patients in two groups randomly using simple number random method. GROUP-A patients treated with PRP along with laser therapy. GROUP-B treated with laser therapy only. We used visual analogue scale (VAS) and foot and ankle disability (FAD) index for assessment of pain relief during follow up. Results: 88 patients were included in this study. The VAS score was significantly (P<0.05) become lower in Group A patients as compared with Group B and significant increase in FAD index (P<0.01) among the Group A patients as compare to Group B from prior to infiltration and at follow up. Conclusion: In these patients local infiltration with platelet rich plasma has yielded good results. Low level light therapy also can be used for treating planter fasciitis, but better result found when it given together.

Effect of Extracorporeal Shock Wave Therapy on Pain in Plantar Fasciitis: A Review Study

Background: The most frequent cause of discomfort in the inferior heel is plantar fasciitis, and Extracorporeal Shock Wave Therapy (ESWT) is one of the most effective therapy for plantar fasciitis. It was aimed to determine how extracorporeal shock wave therapy would affect plantar fasciitis. Method: Studies were searched on Google Scholar and PubMed over the last 10 years. Randomised Control Trials (RCT), meta-analysis, cohort, and observational studies which used extracorporeal shock wave therapy for the treatment of plantar fasciitis were included and the primary outcome of this study is variation in pain relief. Results: Patients with persistent plantar fasciitis who had extracorporeal shock wave therapy showed a moderately positive correlation with reduced pain and improved foot function of individuals. Conclusion: Extracorporeal shock wave therapy is effective in decreasing pain in patients with plantar fasciitis.

Long Term Effectiveness of ESWT in Plantar Fasciitis in Amateur Runners

Shock wave therapy is one of the modern methods of treatment used to treat diseases of muscles, tendons, and entheses in orthopedics, as well as in sports medicine. The therapy is increasingly used in the treatment of plantar fasciitis-a disease that is very difficult and burdensome to treat. Where basic conservative treatment for heel spurs fails, the only alternative consists of excision of the bone outgrowth, and shock wave therapy: a modern, minimally invasive, and relatively safe method. The aim of the study was to determine the long-term effectiveness of extracorporeal shock wave therapy in the treatment of painful ailments occurring in the course of plantar fasciitis in amateur runners. The study includes a group of 39 men and women, aged 34-64 (mean age 54.05 ± 8.16), suffering from chronic pain in one or both feet, occurring in the course of plantar fasciitis. The patients had to meet five criteria to qualify for the study. The group was divided into two subgroups: those who had not undergone other physiotherapeutic procedures prior to the extracorporeal shock wave therapy (ESWT-alone; 23 people), and those who had received other procedures (ESWT-plus; 16 people). The therapy was performed using extracorporeal shock wave (ESWT). No local anesthesia was used. The effectiveness of the extracorporeal shock wave therapy was evaluated using the visual analogue scale of pain (VAS), Modified Laitinen Pain Index Questionnaire, the AOFAS scale (American Orthopedic Foot and Ankle Society), and a survey questionnaire consisting of 10 questions concerning metrics and subjective assessment of the effects of therapy. The interview was conducted before ESWT, and again five years later. The use of extracorporeal shock wave therapy reduced the intensity and frequency of pain, and improved daily and recreational activity. Moreover, a reduction in the level of pain sensation on the VAS scale and pain symptoms during walking was demonstrated. More favorable results were obtained in the ESWT-plus group; however, the first effects were observed later than in the ESWT-alone group. Extracorporeal shock wave therapy is an effective form of therapy for amateur runners. It reduces pain associated with plantar fasciitis that amateur runners may experience at rest, while walking, and during daily and recreational activity.

Barefoot Running on Grass as a Potential Treatment for Plantar Fasciitis: A Prospective Case Series

Foot characteristics and running biomechanics in shod populations are associated with the aetiology of plantar fasciitis, the most common musculoskeletal disease of the foot. Previous Case reports have demonstrated improvements in the symptoms of plantar fasciitis after a period of barefoot running on grass. Recreational runners with symptomatic plantar fasciitis were prospectively enrolled into a 6-week grass based barefoot running programme. Duration of symptoms, previous management and current pain scores (NRS, VAS) were recorded at entry. Daily pain scores were recorded during the 6-week period and 12 weeks from entry to the programme. In total, 20 of 28 patients (71.4%) enrolled were included in the analysis. Relative to the entry point, pain at 6-weeks was lower (2.5 ± 1.4 vs. 3.9 ± 1.4, p < 0.001) and pain at the 12-week point was lower (1.5 (1.8), p = 0.002). 19 out of 20 patients had improved at week-6 (mean ± SD % change in pain score, -38.8 ± 21.5%) and at week-12 (median (IQR) % change in pain score, -58.3 (34.8) %). Barefoot running on grass improved pain associated with plantar fasciitis at the 6-week and 12-week follow up points. This type of barefoot running has the ability to improve symptoms whilst allowing patients to continue running, the intervention may also address some impairments of the foot associated with plantar fasciitis.

Outcomes of Endoscopic Treatment for Plantar Fasciitis: A Systematic Review.

Endoscopic plantar fascia release (EPFR) is an established operative treatment for recalcitrant plantar fasciitis. The purpose of this systematic review is to provide a comprehensive review on the outcomes of EPFR in the treatment of plantar fasciitis at mid-term and long-term follow-up. A systematic review was performed using, MEDLINE, EMBASE, and Cochrane library databases in May 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated regarding level of evidence (LOE) and quality of evidence (QOE) using the modified Coleman methodological score. Clinical outcomes and complications were also evaluated. Twenty-six studies including 978 feet were included in this systematic review with a weighted mean follow-up of 25.6 ± 21.0 months. Eighteen papers used the American Orthopaedic Foot and Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.66 ± 10.3, and the postoperative score was 89.6 ± 5.2 out of 100. The total number of patients who had complications was 88 of 994 (8.9%). The most common complication was recurrence of pain experienced by 41 patients (4.2%). Endoscopic plantar fascia release provides good clinical and functional outcomes in patients with refractory plantar fasciitis. However, this procedure is associated with a moderately high complication rate (8.9%) and should only be considered following failure of conservative management. Future prospective studies comparing the various endoscopic and open techniques with nonoperative treatment are required to elucidate the most effective management for recalcitrant plantar fasciitis. Level I: Systematic review of level IV studies.

THERAPEUTIC EFFECT OF COCKTAIL VS PROLOTHERAPY INJECTION IN CHRONIC PLANTAR FASCIITIS, A PROSPECTIVE CONTROLLED RANDOMIZED CLINICAL STUDY

Introduction:- Plantar fasciitis is the most common cause of heel pain. It is a self-limiting condition. If causative factors are not addressed properly, it becomes chronic plantar fasciitis. Objectives:- The study aimed to evaluate the efficacy of 15 % hypertonic dextrose (treatment group) in the treatment of chronic plantar fasciitis through comparison with a cocktail group (control group). Design:- In this prospective controlled, randomized clinical study at N.S.C.B. Medical College Jabalpur, from 1 January 2020 to 31 September 2021. The statistical test used in this study isthe chi-square test and independent students t-test.A totalof 41 patients were taken intothe study. Patients were divided into two groups, In the Prolotherapy group (treating group) (n=18), a single shot of 15% Hypertonic dextrose injection was administered (1.2 ml of 50 % hypertonic dextrose, 1.8 ml distilled water and 1 ml of 2% lignocaine mixture)and the cocktail group (control group) (n=23) single shot of cocktail was given (1ml 40mg local methylprednisolone mixed with 1 ml distilled water and with 1 ml 2% lignocaine). During a 24-week follow-up period, pain intensity was measured using the visual analoguescale and American orthopaedics foot and ankle score, the measurements were undertaken before treatment and post-treatment weeks 4 and 12 and 24. Result:- In this study, both treatments were significantly effective in plantar fasciitis treatment for up to the 12th week. However the cocktail group (control group) was found to have a significantly better result at both the 4th week (AOFAS 93.17±3.33, VAS 1.65±.49 vs AOFAS 71.94±5.46, VAS 4.54±.71) and 12th week (AOFAS 90.43±2.86, VAS 1.91±.29 vs AOFAS 76.78±4.12, VAS 3.94±.64), but significantly better even up to 24th weeks (AOFAS 86.39±4.20, VAS 2.35±.71vs AOFAS 67.22±4.19, VAS 5.00±.34), (p-value &lt;.001) in term of pain intensity and disability as compared to prolotherapy group (treating group). Conclusion:- This study showed a favourable outcome towards the cocktail injectionin terms of VAS and AOFAS score as compared to prolotherapy injection.

Comparison of effects of low level laser therapy and local corticosteroid injection in the treatment of plantar fasciitis.

The purpose of the study was to compare low-level laser therapy (LLLT) and local corticosteroid injection in the treatment of plantar fasciitis. This retrospective study was performed with 56 patients (6 males, 50 females; mean age: 44.7±10.1 years; range, 18 to 65 years) between January 2015 and March 2016. The patients were equally divided into two groups: Group 1, comprising patients who underwent a one-time local corticosteroid injection into the heel by the same physician, and Group 2, including patients who had gallium arsenide laser therapy at a wavelength of 904 nm lasting 10 sessions. Evaluations were done at pre-treatment, post-treatment, and two weeks, one month, and three months after the post-treatment evaluation. The post-treatment evaluation was accepted as the 10th day after the injection in Group 1 and as the time after the last session of the laser treatment in Group 2. Each visit was compared with the previous visit for within-group analysis. The Visual Analog Scale (VAS), Heel Tenderness Index (HTI), and Foot Function Index (FFI) were assessed. Pain scores in Group 1 and Group 2 were not associated with statistically significant differences (p>0.05). Within-groups analysis demonstrated statistically significant differences concerning VAS subgroups (p <0.05), except for Group 2's resting VAS values (p=0.159). No statistically significant differences were found between groups in the means of FFI scores (p>0.05). Statistically significant differences were observed regarding within-group analyses for all subscores (p <0.001). No statistically significant differences were observed between the two groups for all visits regarding HTI scores (p>0.05). Statistically significant differences were found between baseline and the first after-treatment visit in all groups (p <0.05). Statistically significant differences were found in the first (p=0.020) and third (p=0.010) months compared to the one-week follow-up in Group 2 regarding HTI scores. Both LLLT and local corticosteroid injection for plantar fasciitis have positive effects for three months after treatment. However, LLLT is more effective than local corticosteroid injection at the end of the third month in local tenderness.

Effect of MFR Technique Versus Static Stretching on Pain Among Adults with Plantar Fasciitis

Background: Disorder of plantar fascia caused from overuse, excessive overload or prolonged standing time is called plantar fasciitis. Conservative treatment is a primary choice of treatment for plantar fasciitis and physiotherapist play a vital role. Interventions such as ultrasound, soft tissue massage, orthotics, taping, hot pack, cold pack, stretching and strengthening exercises are used by physiotherapists for treatment of this condition. Objectives: This study is aimed to evaluate and compare the effectiveness of myofascial release technique and static stretching of plantar fascia, on pain among adults with plantar fasciitis. Methods: All the subjects were screened as per the inclusion &amp; exclusion criteria. After getting their written consent, a total of 42 plantar fasciitis patients with mean age of 28 years were included in the study. They were randomly allocated into two groups with n= 21 in each group. Group A was given Myofascial Release Technique whereas Group B was given Static Stretching on the affected plantar fascia. The interventions were carried out for twice a week for two weeks. Visual Analogue Scale was used as the outcome measure and it was measured pre- and post-intervention at baseline during week one and at the end of treatment at week two. Results: The study demonstrated statistically significant difference between pre-treatment and post-treatment visual analogue scale scores, in both groups: MFR (p &lt; .0001) and Static Stretching (p &lt; .0011). Conclusion: Both MFR as well as static stretching are effective in reducing pain in plantar fasciitis patients. KEY WORDS: Plantar Fasciitis, Static Stretching, Myofascial Release, Pain, Visual Analogue Scale.

The Statistical Fragility of Platelet-Rich Plasma as Treatment for Plantar Fasciitis: A Systematic Review and Meta-Analysis

Category: Basic Sciences/Biologics; Hindfoot; Sports Introduction/Purpose: Plantar fasciitis (PF) is estimated to account for 8% of all running-related injuries, affecting nearly 1 out of every 10 adults aged 50 and older. Recent randomized controlled trials (RCTs) suggest platelet-rich plasma (PRP) injection may be an effective non-operative treatment option for chronic, refractory PF. However, RCTs in general have come under scrutiny due to a frequent lack of reproducibility, which is largely attributable to shortcomings of the commonly used p&lt;0.05 threshold for significance. Fragility indices may be an appropriate tool to gauge the clinical importance of RCT findings in these situations. In this study, we utilize the continuous fragility index (CFI) and continuous fragility quotient (CFQ) to determine the statistical robustness of data from RCTs evaluating PRP for PF. Methods: RCTs comparing outcomes after PRP injection versus other conservative treatment in chronic PF patients were evaluated. Representative datasets were generated for each reported outcome event using summary statistics. The CFI was determined by manipulating each dataset until reversal of significance (a=0.05) was achieved. The corresponding CFQ was calculated by dividing the CFI by the sample size. Results: Of 259 studies screened, 27 studies (59 outcome events) were included in this analysis. The median CFI for all events was 9 (CFQ=0.177), suggesting that altering the treatment of only 9 patients (or 17.7 out of 100) would be sufficient to reverse trial significance (Table 1). Of the 36 outcome events reporting lost to follow-up data, 10 events (27.8%) lost &gt;=9 patients. Outcome events that were originally reported as significant (p&lt;0.05) were considerably more fragile (CFI=5; CFQ=0.122) than events that were reported as nonsignificant (CFI=10; CFQ=0.179). Conclusion: Fragility indices are a useful adjunct to p-values and provide an assessment of how easily statistical significance can be overturned. While there is some preliminary evidence supporting the clinical efficacy of PRP, our fragility analysis suggests that RCT findings may be underpowered in some cases. Over 27% of outcome events may have experienced a reversal of significance if the studies had simply maintained follow-up. Given the importance of RCTs in clinical decision-making, fragility indices should be reported alongside p-values to indicate the strength of statistical findings.

The Statistical Fragility of Platelet-Rich Plasma as Treatment for Plantar Fasciitis: A Systematic Review and Simulated Fragility Analysis

Plantar fasciitis (PF) is the most common cause of heel pain and can be a source of extensive physical disability and financial burden. Platelet-rich plasma (PRP) offers a potentially definitive, regenerative treatment modality that, if effective, could change the current paradigm of PF care. However, randomized controlled trials (RCTs) on the clinical benefits of PRP for refractory PF offer inconsistent conclusions, potentially because of the broader limitations of using P value thresholds to declare statistical and clinical significance. In this study, we use the Continuous Fragility Index (CFI) and Quotient (CFQ) to appraise the statistical robustness of data from RCTs evaluating PRP for treatment of PF. RCTs comparing outcomes after PRP injection vs alternative treatment in patients with chronic PF were evaluated. Representative simulated data sets were generated for each reported outcome event using summary statistics. The CFI was determined by manipulating each data set until reversal of significance (α=0.05) was achieved. The corresponding CFQ was calculated by dividing the CFI by the sample size. Of 259 studies screened, 20 studies (59 outcome events) were included in this analysis. From these simulations, the median CFI for all events was 9, suggesting that varying the treatment of 9 patients would be required to reverse trial significance. The corresponding CFQ was 0.177. Studies with reported P value <.05 were more statistically fragile (CFI=10, CFQ=0.122) than studies with reported P value >.05 (CFI=5, CFQ=0.179). Of 36 outcome events reporting lost to follow-up data, 10 events (27.8%) lost ≥9 patients. Our findings suggest that, on average, the statistical fragility of RCTs evaluating PRP for nonoperative PF therapy is at least comparable to that of the sports medicine literature. However, several included studies had concerningly low simulated fragility scores. Orthopaedic surgeons may benefit from preferentially relying on studies with higher CFI and CFQ values when evaluating the utility of PRP for chronic PF in their own clinical practice. Given the importance of RCT data in clinical decision making, fragility indices could help give context to the stability of statistical findings. Level I, systematic review.

What Makes Plantar Heel Spur Painful? A Matched Case-Control Study

Category: Hindfoot; Other Introduction/Purpose: Plantar heel spur has been considered one of the reasons for heel pain in plantar fasciitis although its pathophysiology is not clear. The purpose of this study is to investigate the demographic and radiographic differences between the plantar fasciitis cohort and age/sex-matched control cohort, and identify risk factors that make plantar heel spurs painful. Methods: Patients who visited the office under the diagnosis of plantar fasciitis from September 2020 to December 2021 and age/sex-matched control cohort were included. Demographics and radiographic findings between the two groups were compared. A subgroup analysis was performed on only patients who had plantar heel spur. Patients who had plantar feel spur from the study group and the control group were extracted. All demographics and radiographic data were compared between the two subgroups and a multivariable logistic regression analysis was performed to identify independent risk factors that make plantar heel spur painful. Results: 76 patients were enrolled in the study group (Painful heel) and age/sex-matched control group (Non-painful heel). BMI was significantly higher in the study group compared to the control group: 33.2 vs 28.7 (P &lt; .001). In the study group, plantar heel spur was present in 67.1% (51 out of 76), while in 38.2% (29 out of 76) in the control group (P &lt; .001). In the subgroup analysis, BMI in the study group was significantly higher compared to the control group: 34.6 vs 30.3 (P &lt; .001). All variables which can have an effect on painful plantar heel spur in patients with plantar fasciitis were included in a multivariable logistic regression analysis. The analysis through this subgroup comparison identified high BMI as an independent risk factor of painful plantar heel spur. Conclusion: High BMI was the one single independent predictor of painful heel spur resulting in plantar fasciitis heel pain. Concerning the treatment for plantar fasciitis, we need to counsel patients on emphasizing protection and cushioning for plantar heel to relieve axial loading and weight loss to decrease BMI.

Chronic Plantar Fasciitis: Comparison of Ultrasonic Guided Percutaneous Fasciotomy vs New Technique Combining Fasciotomy with Amniotic Membrane Allograft

Category: Basic Sciences/Biologics Introduction/Purpose: Plantar fasciitis is a common condition affecting approximately one in ten people in their lifetime. Treatment is typically conservative and symptoms are self-limiting. Operative treatment is indicated in recalcitrant cases. Minimally-invasive partial plantar fasciotomy can be performed using ultrasound-guided percutaneous techniques and is an attractive alternative to traditional surgery. Methods: A retrospective review was performed on consecutive patients who underwent either an ultrasound-guided fasciotomy or a combined percutaneous fasciotomy with a flowable amniotic matrix allograft. All ultrasound-guided percutaneous fasciotomy procedures were performed using the Tenex TX2 cutting device. Human amniotic allograft consisted of an injection of 0.5 mL of a flowable placental tissue matrix. Outcomes were assessed at short-term (2, 8, and 16 weeks) and long-term follow-up (26 and 52 weeks). Results: Both groups demonstrated a significant reduction in pain from baseline after the respective interventions and demonstrated a high level of patient satisfaction. The only significant difference in the 2 groups was at short-term follow-up in which the percutaneous fasciotomy with the amniotic membrane allograft (n=12) showed a statistically-significant reduction (p&lt;0.05) in pain when compared to the fasciotomy alone group (n=11). There was no difference between the 2 groups at long- term follow-up. Conclusion: Treatment of chronic plantar fasciitis using ultrasound-guided fasciotomy is an attractive alternative to traditional surgery. Ultrasound-guided fasciotomy did improve pain from baseline with high level of patient satisfaction. Furthermore, the combination of percutaneous fasciotomy with a flowable amniotic matrix allograft may provide a greater reduction in pain earlier in the post-operative period, but does not seem to alter the long-term outcome of the procedure. More subjects are needed to possibly detect long-term effects.

The Prevalence and Risk Factors of Plantar Fasciitis Amongst the Population of Jazan.

BackgroundPlantar fasciitis develops as a consequence of irritation of the plantar fascia, which is responsible for supporting the arches and absorbing shock. Multiple factors can contribute to plantar fasciitis, but the most common factor is overuse stress. The classical presentation is a sharp pain that is felt at the plantar aponeurosis (near the area of its insertion on the medial process of the calcaneal tuberosity), and it is possible to find a heel spur (osteophyte) in some cases. Most treatments for plantar fasciitis are ineffective and unsatisfactory for patients.ObjectiveTo estimate the prevalence and assess risk factors for plantar fasciitis among the population of the Jazan region.MethodsA cross-sectional online survey was conducted on the population of the Jazan region. An online Google form questionnaire was prepared and distributed to the study population. Data was then entered and analyzed using IBM SPSS (Statistical Package for the Social Sciences) Statistics, version 21.0.ResultsA total of 695 participants were enrolled in the study. Out of that, 350 (50.4%) of the participants were males, while 345 (49.6%) were females. About the age of the participants, 507 (72.9%) were younger than 40 years of age. Participants with hypertension were 43 (6.2%), and 37 (5.3%) participants had diabetes. In terms of occupation, 120 (17.3%) worked in healthcare, 187 (26.9%) taught, and 43 (6.2%) served in the military. A great quantity of standing or walking was necessary for the jobs for 127 people (18.3%), while moderate amounts were recorded for 273 people (39.3%). The most commonly reported lower limb conditions were: pes planus (low arches) in 26 (3.7%) participants; and weakness of the gastrocnemius, soleus, and intrinsic foot muscles. The most commonly reported exercises were walking for 499 (71.8%) participants and jogging for 97 (14%) participants. The prevalence of plantar fasciitis was found to be 37% of the participants. Regarding the Foot and Ankle Outcome Score (FAOS) survey, the mean symptoms subscale score was 57.81 + 11.28, the mean pain subscale score was 72.87±20.84, the mean daily living subscale score was 72.73 ± 22.25, the mean sports and recreation subscale score was 76.83 ± 23.06, and the mean quality of life subscale score was 70.23 ± 25.17. Multivariate logistic regression was done and the following factors predicted a higher rate of plantar fasciitis: being 40 to 55 years old (p < 0.001, odds ratio = 2.15), being 56 to 65 years old (p = 0.037, odds ratio = 3.58), being obese (p = 0.031, odds ratio = 2.16), having weakness of the gastrocnemius, soleus, and the intrinsic foot muscles (p = 0.003, odds ratio = 7.39), jobs requiring a great amount of time standing or walking (p < 0.001, odds ratio = 3.17), and jobs requiring a moderate amount of time standing or walking (p = 0.012, odds ratio = 1.83). Being male predicted a lower rate of plantar fasciitis (p < 0.001, odds ratio = 0.52).ConclusionPlantar fasciitis is a prevalent and disabling condition with considerable effects on quality of life. Jobs that require long hours of walking or standing were associated with an increased risk of developing plantar fasciitis. Middle age, prolonged exercise, and gastrocnemius muscle tightness were also associated with plantar fasciitis. Efforts should be directed towards health education of the population regarding the risk factors and management of plantar fasciitis.

Effectiveness of stretching exercises in conservative therapy of plantar fasciitis (PF)

Introduction and objective: Plantar fasciitis affects both young active patients and older people leading a sedentary lifestyle. It is result from chronic overload of the plantar fascia. About 80% of patients with plantar fasciitis improve within 12 months with non-surgical treatment. Nonsurgical management includes e.g. activity modification, cooling, non-steroidal anti-inflammatory drugs, stretching and strengthening exercises and manual therapy. Materials and methods: PubMed database was searched. The criteria for qualifying the articles for the review were the following keywords: plantar fasciitis, muscle stretching, exercise, manual therapy, heel spur. 11 articles from 2017 to 2022 were analyzed. Description of the state of knowledge: Calf stretching is one of the treatments for plantar fasciitis with the best results in the long run. In turn, strengthening exercises turn out to be more effective in a short time. One should also not forget about influence other methods of conservative treatment, such as cooling, orthoses or physical therapy, that support and accelerate the treatment process. Summary: Strengthening exercises of the plantar fascia are more effective than stretching in terms of reducing pain and improving function in the short term, while stretching exercises show better results in the long term. The best results are obtained by combining stretching of the triceps calf muscle with other methods of conservative treatment. There are no studies supporting the hypothesis that stretching alone is more effective in the treatment process than other methods and placebo.

Plantar Fasciitis Turned Complex Regional Pain Syndrome

HISTORY: A 54 year-old female presented to our Sports Medicine clinic with 6 months of left heel pain. She was evaluated by podiatry and diagnosed with plantar fasciitis. Her pain persisted despite conservative measures. MRI showed plantar fascia tear with 2 mm retraction so they gave her steroid injections, placed her in a boot and referred to physical therapy. After 8 weeks, her pain worsened. Repeat MRI showed progression of the initial plantar fascia tear now with 4 mm retraction. An oral steroid significantly helped her pain temporarily. She was referred to us for PRP consultation. She reported her foot would intermittently get cold and was extremely sensitive to touch. She showed pictures of occasional swelling and discoloration of the left foot with mottled skin. PHYSICAL EXAM: She was ambulating with a walker. Left foot examination revealed mild swelling, severe hypersensitivity to light touch of the entire medial and plantar aspect, felt cool to touch, and active ROM of digits was limited. Pulses and reflexes were intact and symmetrical bilaterally. DIFFERENTIAL DIAGNOSIS: 1. Plantar fasciitis 2. Peripheral Neuropathy 3. Tarsal Tunnel Syndrome 4. Complex Regional Pain Syndrome (CRPS) TESTS/RESULTS: - CBC, CMP, TSH, HbA1c, B12, Folate all within normal limits - XR Foot: Diffuse osteopenia FINAL WORKING DIAGNOSIS:CRPS; Plantar fascia tear TREATMENT AND OUTCOMES: - Started topical analgesics, oral steroids, gabapentin; restarted physical therapy and placed back into a boot. - She had minimal improvement at follow up visits; Additional XR’s showed diffuse osteopenia; it was recommended that she start bisphosphonate therapy. Patient elected to get a bone scan/DXA prior to starting. - Patient has had minimal improvement in her pain and function despite recommended treatments for both plantar fasciitis and CRPS. Alternative treatments are being explored including perineural injection therapy, mirror therapy, and pain management consultation for lumbar sympathetic blocks

Platelet-Rich Plasma vs Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial.

Plantar fasciitis (PF) is the most common cause of heel pain. Previous work has shown promising results regarding platelet-rich plasma (PRP) injections for the treatment of PF. The aim of this study is to prospectively compare the efficacy of PRP and autologous blood injections in a randomized anonymized patient group to treat PF. PF patients who failed at least 6 weeks of noninvasive conservative treatment aged between 40 and 65 years were recruited to be in the study. Patients were randomly assigned into group A (PRP) or group B (autologous blood). Injections were performed under ultrasonographic guidance in a double-anonymized manner. The groups were compared according to preinjection and postinjection health-related quality of life (HRQoL) scores measured with Foot and Ankle Disability Index (FADI) and visual analog scale (VAS). Intragroup comparative analysis was also performed at different time points. Independent t tests and repeated measures analyses of variance were used for statistical analysis, with P <.05 set for statistical significance. Group A (PRP) included 30 (19 female, 11 male) patients with mean age 52.2 ±6.3; group B (ABI) included 30 (20 female, 10 male) patients with mean age 52.7 ± 6.5. Both groups had similar body mass index (P = .719). No injection-related complications were recorded. After treatment, both groups had improved FADI and VAS scores compared to the baseline. Although the mean HRQoL scores were higher in the PRP group, there was no significant difference between the 2 groups (PVAS = .589; PFADI = .742). Participants with plantar fasciitis improved statistically significantly after either PRP or ABI injections compared with baseline HRQoL scores, with no significant differences seen between the groups. Level I, prospective randomized double-anonymized clinical comparative study.

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

Development and Clinical Evaluation of a Novel Foot Stretching Robot That Simultaneously Stretches Plantar Fascia and Achilles Tendon for Treatment of Plantar Fasciitis.

This paper presents the development and clinical evaluation of a foot stretching robot that simultaneously stretches the plantar fascia and Achilles tendon for the treatment of plantar fasciitis. The therapeutic effectiveness of the robot and feasibility of using metatarsophalangeal joint stiffness as an indicator of recovery were identified through the clinical evaluations. The robot implements an effective foot stretching protocol through a novel mechanism design that simultaneously stretches the plantar fascia and Achilles tendon using a single motor. Thirty patients with plantar fasciitis and fifteen healthy participants volunteered in the cross-sectional clinical evaluation, and nine patients from the patients group participated in the one-month clinical trial. Four main outcomes (Foot Function Index, Visual Analogue Scale-Foot and Ankle, plantar fascia thickness, and metatarsophalangeal joint stiffness) were used for the clinical evaluations. In the cross-sectional clinical evaluation, the symptomatic feet of patients showed moderate negative correlation between normalized metatarsophalangeal joint stiffness and plantar fascia thickness with statistical significance. In the one-month clinical trial, all the main outcomes showed significant improvement after using the developed robot. Comparing our results with previous studies also indicated a therapeutic superiority of our robot for treating plantar fasciitis. Our foot stretching robot had significant therapeutic effect on plantar fasciitis, and normalized metatarsophalangeal joint stiffness measured by our robot could be used as a monitoring indicator for recovery from plantar fasciitis. This study contributed to practical issues related to treatment of plantar fasciitis, and our results could be applied to effective treatment of plantar fasciitis and progressive monitoring of recovery.

Treatment of chronic plantar fasciitis: a comparative study between shockwave therapies and local corticosteroid injection

Introduction One of the most prevalent ailments for which people seek treatment at a foot and ankle surgery facility is heel discomfort. Plantar fasciitis (PF) is one of the most common causes of adult heel pain and accounts for 11 to 15 % of all foot illnesses requiring medical care. The major symptom is pain and soreness at the heel where the plantar fascia is attached while starting weight- bearing after lengthy periods of rest. Rest, non-steroidal anti-inflammatory drugs (NSAIDs), stretching of the plantar fascia, physical therapy, foot cushioning, and orthotic devices, which may be utilized to meet the patient's demands, are some of the current conservative therapies for PF(planter fasciitis). In intractable instances of plantar fasciitis, where conservative therapy have failed to provide relief, steroid injections into the plantar fascia are often employed. Other treatment options for PF, including extracorporeal shockwave therapy (ESWT) are advised if patients do not react to conservative therapies. Patients and methods This study included 50 patients with chronic PF who had failed to react to conservative treatments such as physical therapy, NSAIDs, stretching exercises, and heel cushions for at least 6 months, and who did not have flatfeet or gastrocnemius contracture met the inclusion criteria. Patients were randomly divided into 2 groups: 25 patients received radial extracorporeal shockwave therapy (ESWT) once a week for six weeks (Group I); 25 patients got a single local corticosteroid injection at the plantar fascia's origin (40 mg / 2 ml of methylprednisolone together with 1 ml of local anesthesia, once) (Group II). Assessment of heel pain was done at the start of the trial and before each session using VAS score which was the primary outcome measure at 1, 3 and 6 months. Results A total of 50 individuals with persistent planter fasciitis (PF) were included in this investigation. Their age varied from 25 to 45 years old. Females made up 70 % of the sample, while males made up 30 %. Group I: 25 patients with PF who got extracorporeal shockwave treatment for 6 weeks at a time (once a week). There were 17 females (68 %) and 8 males (32 %), in the age ranging from 28 to 44 (mean SD 18.2).Group II: consisted of 25 individuals with PF who were given a local corticosteroid injection. There were 18 females (86.7 percent) and 7 males (13.3 percent) with ages ranging from 25 to 45 years (mean SD 21.9). Group I included 20 patients (80 %) and group II had 22 patients (88 %) who had pain in one foot, whereas 5 (20 %) patients and 3 (12 %) patients had pain in both feet, with no statistically significant difference. There was no significant difference between the groups in terms of the VAS score at the start of the trial (p = 0.26), the mean VAS scores were 6.4 and 6.2 in groups I and II, respectively. At one month, the mean VAS scores were 1.6 and 1.2 in group I and II, respectively. At 3 months, the mean VAS score were 2.2 and 1.7, at 6 months 5.1 and 2.3 for groups I and II, respectively. Conclusion ESWT and local corticosteroid injection therapies are safe and effective but local corticosteroid injection is more effective than ESWT in the treatment of chronic plantar fasciitis.

Effectiveness of platelet rich plasma versus corticosteroid in the treatment of plantar fasciitis: a double-blind randomized controlled trial

Background: Plantar fasciitis is a common cause of heel pain. This condition is caused bydegenerative changes resulting in repetitive microtears of the plantar fascia, which are in turn causedby biomechanical overuse from prolonged standing or running. Several nonoperative treatments havebeen employed, such as stretching, physical therapy, nonsteroidal anti-inflammatory drugs,extracorporeal shock wave therapy, needling and night splints, relative rest, etc. But clinical outcomesof these methods are controversial. Corticosteroid is also effective but provides only short-term painrelief with disappointing long-term results. This procedure is also associated with complications,including localized infection, fat pad atrophy, and plantar fascia rupture. In recent years, platelet-richplasma (PRP) has been investigated as a treatment option for plantar fasciitis. PRP is a bioactiveconcentrate of various growth factors and cytokines that modulate cell proliferation and differentiation,angiogenesis, and chemotaxis. Objectives: To evaluate the effectiveness of platelet rich plasma versus corticosteroid in the treatmentof plantar fasciitis. Materials &amp; method: This Quasi-experimental study was carried out on adult patients with chronicPlantar Fasciitis attended in Dhaka Medical College Hospital, during the period of October 2021 toMay 2022. The patients were randomly assigned to one of the two groups; group A (patients treated withPRP); group B (patients treated by with corticosteroid). After providing the allocated treatment, allpatients were undergone follow-up examination at 1st week, 1st month, 3rd month and at 6th month forclinical improvement. Visual Analog Scale (VAS), Roles and Maudsley (RM), and Foot Function Index(FFI) scoring systems were used as outcome measures. Result: Mean ± SD of age was calculated to be, 42.31 ± 7.6 for Group A and 42.29 ± 8.0 for Group B.Most of the participants in Group A [13 (72.1)] &amp; in Group B [15 (65.2)] were females. Mean VAS scoreat different follow up time reveals, after 1 week of intervention, score was turn down or pain reduced inboth groups, but comparatively better in group B. At 3rd month (Mean VAS 3.05 &amp; 4.82 in group A &amp;B respectively) and 6th month later (Mean VAS 1.67 &amp; 4.12 in group A &amp; B respectively) follow upperiod, significant improvement was found in group A. Use of corticosteroid (Group B) showedimprovement in symptoms immediately at 1st week to one month (short duration), which did not lastlong. But PRP effective in prolong time. RM score shows that a significant difference among two groupsat 1 and 3 months with P = 0.051 and P = 0.001, respectively. Mean FFI scores in Group A weresignificantly lower than Group B. No adverse events were noticed in any of the groups. Conclusion: Platelet-rich plasma (PRP) injection is better than steroid injection in relieving the painof planar fasciitis and improvement function of the patient foot. JBSA 2022; 35 (2) : 22-29