Treatment Of Plantar Fasciitis Research Articles

Views about the clinical, diagnostic and comprehensive treatment of plantar fasciitis: a review

INTRODUCTION. One of the problems in modern podiatry is plantar fasciitis. According to population studies, more than two million patients are treated for plantar fasciitis each year in the United States, 1 in 10 people will develop heel pain during their lifetime, and 1 % of visits to podiatrists are related to heel pain. Plantar fasciitis occurs in approximately 10 % of the general population, with 83 % of these patients being active working adults between the ages of 25 and 65. The high prevalence of plantar fasciitis in the population necessitates the search and development of new and effective methods for its recognition and treatment. AIM. Generalization of literature data on the mechanisms of development of plantar fasciitis, methods of diagnosis and treatment. MATERIALS AND METHODS. The databases PubMed, Scopus and the electronic scientific library eLIBRARY were searched for articles using the keywords: “plantar fasciitis”, “plantar fasciosis”, “heel pain”, “heel spur”. Search depth — 10 years. Publications related to the diagnosis and treatment of PF were selected. During the study, 40 publications were selected, the content of which, to one degree or another, corresponded to the purpose of this study. RESULTS AND DISCUSSION. Pain syndrome in the area of the heel bone is the main reason for seeking medical care in patients with plantar fasciitis. Currently, there are several approaches to the treatment of plantar fasciitis: conservative and surgical treatment. Conservative treatment is represented by methods of manual therapy, physical therapy, and physical therapy. Surgical methods include various variants of resection of the bony outgrowth of the calcaneal region and other interventions. CONCLUSION. Treatment of plantar fasciitis requires a multidisciplinary approach to treatment, as no single treatment method is universal. Conservative treatment of patients with plantar fasciitis should be comprehensive. Due to the high prevalence of plantar fasciitis in the population, the introduction of new treatment techniques and the development and use of a unified patient management tactic can improve patient outcomes and quality of life. Among other surgical methods, the use of RFD has a positive effect in patients with PF refractory to conservative therapy and is the least invasive method among surgical methods.

PROSPECTIVE STUDY ON THE EFFECTIVENESS OF PLATELET-RICH PLASMA IN MANAGING CHRONIC PLANTAR FASCIITIS

Objectives: The objectives of this study were as follows: (1) Assess the impact of a single dose of platelet-rich plasma (PRP) injection on visual analog scale (VAS) scores for heel pain. (2) Evaluate the functional outcome scores following PRP treatment for chronic plantar fasciitis. (3) Measure and confirm the restoration of plantar fascia thickness through ultrasound (USG) assessments. (4) Determine the safety and viability of local PRP injection as a treatment option for individuals with chronic plantar fasciitis. Methods: This hospital-based prospective case series, spanning January 2019 to January 2020, enrolled 40 participants aged 25–65 with unilateral, persistent plantar fasciitis resistant to conservative treatment. Exclusion criteria included BMI ≥30, various pathologies, and recent injections. Ethical clearance was obtained, and participants received autologous PRP injections, with ultrasound measuring plantar fascia thickness. Post-injection, patients were monitored for adverse reactions, initiated stretching exercises, and progressed to weight-bearing activities after 6 weeks. Results: The study cohort, averaging 45 years (standard deviation [SD] 7.7), primarily comprised females with the right-foot prevalence. Symptom duration averaged 20 weeks (SD 4.5). Pre-injection VAS scores (6.7±1.2) significantly improved at 6 weeks (2.9±0.6) and 12 weeks (2.0±0.9) post-PRP injection (p<0.001). Plantar fascia thickness reduced from 5.1 mm (SD 0.6) to 4.1 mm (SD 0.5) at 12 weeks (p<0.001) and regular foot thickness: 3.7 mm (SD 0.5). Conclusion: The study reveals that a singular PRP injection brings about substantial and clinically meaningful enhancements in heel pain, functional outcomes, and the restoration of plantar fascia thickness, supported by ultrasound measurements. This underscores local PRP injection as a viable and safe therapeutic choice for those grappling with chronic plantar fasciitis.

Dose Escalation Can Enhance the Therapeutic Potential of Radial Extracorporeal Shock-Wave Therapy in the Treatment of Plantar Fasciitis in Runners.

Background and Objectives: Treatment of chronic plantar fasciitis is challenging given that there are various of available treatment options with no clear gold standard. The aim of the study was to examine the dose-escalation effect of rESWT on the biomechanical parameters of the plantar fascia and pain ailments. Materials and Methods: In the experimental group (n = 30), the intensity of the shock wave was increased every two subsequent treatment sessions. In the control group (n = 32), the treatment parameters were not changed. In both groups, six treatments were performed, with two treatment sessions a week. In order to assess the biomechanical parameters of the plantar fascia, myotonometric measurements were performed. The pain intensity was assessed using the Visual Analog Scale (VAS). Results: The tension of the plantar fascia attachment in the experimental group decreased from 27.69 ± 2.06 [Hz] before treatment to 26.29 ± 1.69 [Hz] after treatment (p = 0.009) and to 26.03 ± 2.15 [Hz] 1 month after the beginning of treatment (p = 0.003). In the control group, the frequency results did not change significantly (p > 0.05). Flexibility increased in both groups. The test results before treatment and 1 month after the beginning of the treatment showed statistical significance in the experimental group (p = 0.001) vs. (p = 0.002) in the control group. The differences were not statistically significant between groups (p > 0.05). The assessment of pain intensity carried out 1 month after the end of treatment in the experimental group amounted to 3.14 ± 2.28 points, which was statistically significantly lower compared to that in the control group, where it amounted to 5.14 ± 1.92 points. (p < 0.001). Conclusions: The use of rESWT performed with an increasing intensity of impact during subsequent treatment procedures demonstrated greater effectiveness in improving the biomechanical parameters of the plantar fascia and was also more effective in reducing the pain ailments. Our results are encouraging. The dose escalation in the treatment cycle is worth considering. To prove that this method of treatment is more effective, a randomized controlled trial should be carried out on a representative sample.

Clinical Efficacy of Application-Linked Stretching Ball as Digital Therapeutics in Plantar Fasciitis.

Background/Objectives: This study aimed to evaluate the efficacy of application-linked stretching ball instruments that record the rolling time and force of patients compared with a traditional simple stretching ball. Methods: Fourteen participants with plantar fasciitis were divided into a simple massage ball group (group A, n = 8) and an application-linked massage ball group (group B, n = 6). The application-linked massage ball sends information regarding the massages, such as the frequency and force of the massage on the foot, to the application on the patient's smartphone. All clinical outcomes were evaluated at the beginning of the study and 1-, 2-, and 3-month follow-up. The primary outcome measure was the Manchester-Oxford Foot Questionnaire (MOXFQ) score. Results: At the beginning of the study, the initial MOXFQ score was not significantly different between the two groups (p = 0.948). At each time point, the MOXFQ score of the whole population did not improve significantly compared to that of the initial state (p = 0.131). Generalized estimating equation modeling demonstrated that there was no significant difference in the improvement of the MOXFQ score between groups A and B during follow-up (p = 0.826). In addition, no group-by-time interactions were observed (p = 0.457). Conclusions: The efficacy of an application-linked massage ball for the treatment of plantar fasciitis was not as definite as that of a traditional simple stretching ball in patients whose symptoms persisted for at least six months. Future studies that include patients with acute plantar fasciitis are required.

Clinical Study of a Four-Step Program for the Treatment of Plantar Fasciitis with Bone Spurs.

The most common causes of plantar and heel pain are plantar fasciitis and calcaneal spurs, and they often co-exist. Surgery is a recognized treatment for refractory plantar fasciitis. However, few studies have proposed treatment options for patients with metatarsophalangeal fasciitis with bone spurs. Accordingly, this study's purpose was to propose a four-step surgical regimen, and to improve the surgical outcome of plantar fasciitis with osteophytes and to establish a procedure for surgical treatment. Retrospective analysis of 45 patients suffering from plantar fasciitis with bone spurs from 2020 to 2023. All patients underwent a four-step procedure, including plantar fascia release, calcaneal spur grinding, inflammatory tissue removal, and calcaneal burr decompression. The imaging parameters and functional scores were recorded before and after the operation. The objective evaluation included the measurement of calcaneal spur length on radiographs. Clinical evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS), the Visual Analog Scale (VAS), and the Foot and Ankle Outcome Scale (FAOS). Measurement data that conformed to normal distribution were expressed as (x2 ± s), and pre-and postoperative AOFAS, FAOS, and VAS scores were compared using repeated-measures ANOVA, and preoperative and postoperative spur lengths were compared using paired t-tests. The 45 patients were followed up for 3 to 30 months, (17.72 ± 8.53) months, at final follow-up, the patient's AOFAS score improved from preoperative (74.93 ± 5.56) to (94.78 ± 3.98), FAOS score increased from preoperative (76.42 ± 3.37) to (96.16 ± 2.74), the VAS score decreased from (3.18 ± 0.54) to (1.07 ± 1.20) (p < 0.05), the length of spur decreased from (0.72 ± 1.81) cm to (0.23 ± 1.19) cm, and there were significant differences before and after operation (p < 0.05). The four-step surgical regimen is an appropriate and effective surgical procedure to treat plantar fasciitis with bone spurs.

Comparison of Radiofrequency Ablation and Steroid Injection in the Treatment of Plantar Fasciitis; Short and Medium Term Results

Objective: Plantar fasciitis, commonly found in orthopaedic practice, may restrict daily life activities and lead to loss of workforce. We aimed to evaluate the short- and medium-term outcomes of radiofrequency ablation (RFA) and steroid injection treatments in patients with plantar fasciitis who did not benefit from conservative therapies through pain and function scores. Material and Method: Patients studied at the Hakkari State Hospital for at least six months of conservative treatment due to plantar fasciitis between 01.07.2021-01.01.2023. The patients were divided into two groups: those who received RFA and those who were given steroid injections. Demographic information of the patients, the Visual Analog Scale (VAS) and the American Orthopedic Foot Ankle Society (AOFAS) score were studied, and both gups were compared. Results: No significant difference was observed when comparing preop VAS and AOFAS values for both groups (p=0.469 p=0.244). No significant difference was observed when comparing the VAS and AOFAS values of the two groups for the first month (p=0.764 p=0.466 respectively). A significant difference was observed when comparing the VAS and AOFAS values in the post-6 month (p=0,001 p=0.001). Significant differences were observed between VAS and AOFAS values in patients receiving RFA in preop and 6 months (p=0.001 p=0.001). No significant difference was observed in preop and 6 month VAS and AOFAS values in steroid injections (p=0.512 p=0.844 respectively).No complications were observed in both groups during the follow-up period. Conclusion: In patients who have received conservative treatment but have not benefited, radiofrequency ablation has been found to be an effective, safe and minimally invasive method of reducing the severity of pain in the short to medium term and improving daily activities.

Comparison of tibial nerve pulsed radiofrequency and intralesional radiofrequency thermocoagulation in the treatment of painful calcaneal spur and plantar fasciitis: A randomized clinical trial.

Ultrasound-guided tibial nerve pulsed radiofrequency (US-TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur (PCS) and plantar fasciitis (PF). This study aimed to compare the effectiveness of the two procedures. A prospective, randomized, single-blind study. Single-center pain clinic. Forty-nine patients who met the inclusion criteria were randomized into two groups. 25 patients (group U) received US-TN PRF at 42 °C for 240 s, while 24 patients (group F) received intralesional FL-RFT at 80 °C for 90 s. The most severe Numeric Rating Scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness using the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. NRS and AOFAS scores significantly improved in groups U and F at 1 and 3 months compared to baseline (p < 0.05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in group U and 75% in group F. No significant difference was observed in the incidence of mild adverse events between the groups. US-TN PRF and intralesional FL-RFT have shown significant effectiveness in the treatment of PCS and PF. Larger randomized controlled trials are needed.

A Multi-centered Retrospective Study on the Efficacy of Pulsed Radiofrequency Nerve Ablation in the Treatment of Recalcitrant Plantar Fasciitis: A Mid-term Outcome.

Background Plantar fasciitis, a condition marked by persistent and often excruciating heel pain, frequently poses a formidable hurdle when conservative treatment approaches fall short. This multi-centered retrospective study embarks on a journey to explore the potential effectiveness of pulsed radiofrequency nerve ablation (RFNA), an innovative and less invasive procedure, as a novel avenue for treating recalcitrant plantar fasciitis. This investigation centers around a group of 24 patients who have faced the persistence of this challenging ailment. By meticulously scrutinizing patient outcomes and conducting a comprehensive analysis of safety aspects, this study aspires to offer enlightening revelations regarding the promise and practicality of pulsed RFNA as a therapeutic solution for tackling this intricate and tenacious condition. Methods This retrospective study included 24 patients who had undergone pulsed RFNA for recalcitrant plantar fasciitis between June 1, 2020, and June 1, 2022, at Hospital Pengajar Universiti Putra Malaysia (HPUPM), Hospital Universiti Teknologi Mara (UiTM), and Hospital Serdang. Patients were selected from the Orthopedic Clinics at HPUPM, Hospital UiTM, and Hospital Serdang and were screened according to the inclusion and exclusion criteria. Patient data was extracted from the hospital information systemand electronic medical records. Pre-procedure and post-procedure assessments were conducted at one, three, and six months on the selected patients using the visual analog scaleand American Orthopaedic Foot and Ankle SocietyAnkle-Hindfoot Scoring systems. All selected patient data was traced and tabulated accordingly. Results This study evaluates the effectiveness of pulsed RFNA in treating recalcitrant plantar fasciitis in 24 participants (39 feet). Results show a significant reduction in pain and improvement in functionality at one, three, and six months post-RFNA. Demographic factors (age, gender, and specific diagnosis) did not significantly impact outcomes. The study supports pulsed RFNA as an effective treatment for recalcitrant plantar fasciitis, emphasizing consistent benefits across various patient characteristics. Conclusion In conclusion, the study demonstrates the notable effectiveness of pulsedRFNAin improving pain reduction and functional outcomes for individuals with recalcitrant plantar fasciitis. The findings, consistent across various demographic factors, support pulsed RFNA as a promising and uniform treatment option for those who do not respond to conservative measures.

Role of Insole Material in Treatment of Plantar Fasciitis: A Randomized Clinical Trial

BackgroundIn this randomized clinical trial, we compared the early effects of polyethylene (PE), polyurethane (PU), and Carbon Fiber insoles in the treatment of PF using a set of patient-reported outcomes. MethodsPatients were randomly allocated one of the three prefabricated insoles – Carbon Fiber (n=14), PU (n=14), or PE (n=17) for regular use. Their response was recorded using PROMIS 3a (for pain intensity), PROMIS 4a (for pain interference), FAOS (Foot and Ankle Outcome Score), and VAS for pain at baseline, two, six, and twelve weeks. ResultsThe PROMIS pain intensity scores improved in both the Carbon Fiber and the PE groups starting at the 6th week (p=0.04) and 2nd week (p=0.002), respectively. PROMIS pain interference scores also showed positive trends in these two groups (p=0.02, p=0.004, respectively). ConclusionPrefabricated Carbon Fiber and PE insoles showed significant pain-reducing effects in patients with PF. Levels of evidenceLevel I, Randomized controlled trial.

A Review of Common Interventions and Preventive Options Used in the Treatment of Plantar Fasciitis

Plantar fasciitis is a frequent, chronic ailment that significantly affects day-to-day functioning. This review takes a deep look at the different therapies and preventions used in the treatment of this condition to improve foot function, reduce pain, and improve patient outcomes. The efficacy of common treatment options such as physical therapy, medication, stretching, night splints, therapeutic ultrasound, and extracorporeal shock wave therapy has been mentioned again in this study. Moreover, the importance of injection treatment and surgery also play a significant role in the management of plantar fasciitis. In addition to conventional treatment, the health care professional also needs to pay attention to the prevention of this overuse foot injury. The available approaches involve stretching the particular posterior muscles of the low limbs. Eventually, the impact of interdisciplinary considerations, including physiological factors and strength training methods, on plantar fasciitis was explored in order to provide a certain theoretical basis for clinical practice.

Ultrasound-guided platelet-rich plasma vs. radiofrequency nerve ablation for refractory plantar fasciitis

Objectives: Plantar fasciitis (PF), which accounts for approximately 80% of heel pain, is a common condition affecting adults' quality of life. There are many different treatment modalities used in the treatment of PF. In this study, we compared the clinical and functional outcomes of patients diagnosed with chronic PF in our clinic who underwent USG-guided PRP (platelet-rich plasma) injection and patients who underwent RFNA (radiofrequency nerve ablation) treatment. Methods: Ultrasound-guided PRP injection or RFNA was performed on 95 patients who were diagnosed with chronic PF and met the inclusion criteria. This group of patients was followed for at least one year (October 2021-October 2023), and the clinical and functional results of the patients were compared. Results: The mean pre-treatment Visual Analog Scale (VAS), Foot Function Index (FFI), and American Orthopaedic Foot and Ankle Society (AOFAS) posterior-ankle scores were similar, and no significant difference was found (P&amp;gt;0.05). A significant improvement was observed in the groups' FFI, VAS, and AFOAS scores after treatment (P&amp;lt;0.05). However, no significant difference was found in treatment modalities (P&amp;gt;0.05). Conclusions: As a result of the study, it was concluded that PRP injection and RFNA are effective treatment methods in patients diagnosed with chronic plantar fasciitis without response to other conservative treatment methods, but these two methods are not superior to each other.

Ultrasound-guided injection of corticosteroid versus placebo in management of plantar fasciitis

: Plantar Fasciitis (PF) is a prevalent musculoskeletal condition causing heel pain, with approximately 1 million annual U.S. physician visits. It is more common in women, aged 45-64, and obese individuals. Diagnosis relies on clinical history and examination, and various treatments target pain relief, though consensus on the most effective modality is lacking. Corticosteroid injections are commonly used but pose risks. This six-month prospective randomized controlled trial with 50 individuals assessed the efficacy of corticosteroid versus placebo injections for resistant PF. Ultrasound-guided injections were administered, and outcomes were measured at 3 weeks and 3 months.: Results indicated significant improvement in pain scores, Ankle and Hindfoot scores, and plantar fascia thickness with corticosteroid injections compared to placebo. No serious adverse events were observed. Corticosteroids aim to reduce inflammation, and studies link decreased plantar fascia thickness to pain relief. Ultrasound guidance enhances precision in delivery. While some protocol limitations exist, this trial contributes valuable insights into the pharmacological effects of corticosteroids in PF treatment, aiding in evidence-based recommendations.

Evaluation of the efficacy of trigger points combined with extracorporeal shock waves in the treatment of plantar fasciitis: heel temperature and plantar pressure

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain. Among conservative treatments, extracorporeal shock wave therapy (ESWT) is considered effective for refractory PF. Studies have shown that applying ESWT to the trigger points (TrPs) in the triceps surae may play an important role in pain treatment in patients with PF. Therefore, the purpose of this study was to combine the concept of trigger points and ESWT to explore the effect of this combination on plantar temperature and pressure in patients with PF.MethodsAfter applying inclusion and exclusion criteria, 86 patients with PF were recruited from the pain clinic of Huadong Hospital, Fudan University and randomly divided into experimental (n = 43) and control groups (n = 43). The experimental group was treated with extracorporeal shock waves to treat the medial heel pain point and the gastrocnemius and soleus TrPs. The control group was only treated with extracorporeal shock waves at the medial heel pain point. The two groups were treated twice with an interval of 1 week. Primary measurements included a numerical rating scale (NRS) score (overall, first step, heel pain during daily activities), and secondary measurements included heel temperature, Roles–Maudsley score (RMS), and plantar pressure. All assessments were performed before treatment (i.e., baseline) and 6 and 12 weeks after treatment.ResultsDuring the trial, 3 patients in the experimental group withdrew from the study, 2 due to interruption of the course of treatment by the COVID-19 epidemic and 1 due to personal reasons. In the control group, 3 patients fell and were removed due to swelling of the heel. Therefore, only 80 patients with PF were finally included. After treatment, the two groups showed good results in NRS score (overall, first step, heel pain during daily activities), RMS, and plantar temperature, especially in the experimental group, who showed a significantly better effect than the control group.ConclusionESWT of the heel combined with the triceps trigger point of the calf can more effectively improve the pain, function and quality of life of refractory PF than ESWT of the heel alone. In addition, ESWT of the heel combined with the triceps trigger point of the calf can effectively reduce the skin temperature of the heel on the symptomatic side, indicating that the heel temperature as measured by infrared thermal imaging may be used as an independent tool to evaluate the therapeutic effect for patients with chronic PF. Although extracorporeal shock waves combined with TrPs treatment can cause changes in the patients’ gait structure, plantar pressure is still difficult to use as an independent tool to evaluate the therapeutic effect for PF.Trial registrationRegistered in the Chinese Clinical Trial Registry (www.chictr.org.cn) on 12/17/2021 with the following code: ChiCTR-INR-2,100,054,439.

Comparison of Plantar Pressure Distribution and Ultrasonographic and Clinical Features After Application of Different Energy Levels of Extracorporeal Shockwave Therapy in Patients with Plantar Fasciitis: A Randomized, Prospective, Double-Blind Clinical Trial.

The effectiveness of different energy levels used in extracorporeal shockwave therapy (ESWT) has been investigated in previous studies, but controversy remains regarding which energy levels should be used in the treatment of plantar fasciitis. We compared the efficacy of different energy levels used in ESWT in the treatment of plantar fasciitis using plantar fascia thickness and pressure distribution. Between July 2021 and September 2021, a total of 51 patients (71 feet) with plantar fasciitis were randomized into three treatment groups using the sealed envelope method. Group 1 (n = 25) received low energy density (0.09 mJ/mm2), group 2 (n = 25) received medium energy density (0.18 mJ/mm2), and group 3 (n = 21) received high energy density (0.38 mJ/mm2). Each group received three sessions of ESWT at a frequency of 2,000 shocks per minute at 1-week intervals. Patients were evaluated before and after treatment using a visual analog scale (VAS) for pain, the Foot Function Index (FFI), plantar fascia thickness measured by ultrasonography, and plantar pressure distribution. Posttreatment VAS and FFI scores were determined to be significantly lower than the values before treatment in the three groups (P < .001). There were no significant differences among groups in pretreatment and posttreatment values of VAS, FFI, plantar fascia thickness, and pressure distribution (P > .05). No significant differences were found among groups in percentage changes in all of the outcome parameters (P > .05). There was no superiority among low, medium, or high levels of ESWT in terms of pain, foot functions, fascia thickness, and pressure distribution in the treatment of plantar fasciitis.

Comparing Myofascial Pain Syndrome Treatment with Dry Needling Versus Extracorporeal Shock Wave Therapy for Plantar Fasciitis on Pain and Function of the Heel

The aim of this study was to compare the effects of dry needling (DN) and extracorporeal shock wave therapy (ESWT) in the treatment of plantar fasciitis (PF). The study included 55 patients with PF. The patients were randomly divided into 2 groups. The DN group applied 3 sessions of DN to the myofascial trigger points in the lower limb muscles. The ESWT group applied 3 sessions of ESWT to the plantar fascia. For clinical evaluation, we used a visual analog scale (VAS) (first step, rest, activity) and Foot Function Index (FFI) (pain, disability, activity). Assessments were done baseline, post-treatment first week, and fourth week. Maximum pain-free standing time (Max PfST) and maximum pain-free walking distance (Max PfWD) were recorded at baseline and post-treatment fourth week. In this study, we found significant improvement in VAS, FFI, Max PfST, and Max PfWD in both groups (p<0.01). VAS-activity baseline-forth week change was significantly superior in the DN group compared to the ESWT group (p=0.023). FFI-disability baseline-fourth week change was significantly superior in the DN group compared to the ESWT group (p=0.048). There was no significant difference in other treatment-related changes between the groups (p>0.05). However, VAS-rest baseline-fourth week change and FFI-pain baseline-fourth week change trended towards statistical significance between groups ((p=0.056), (p=0.052) respectively). This study showed that DN may be a good alternative treatment for patients with PF, with effects similar to or even superior to ESWT.

Platelet-Rich Plasma vs Extracorporeal Shock Wave Therapy in the Treatment of Plantar Fasciitis at 3-6 Months: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Plantar fasciitis (PF) is a common foot disorder with variability in treatment strategy. Two effective management techniques include platelet-rich plasma (PRP) injections and extracorporeal shock wave therapy (ESWT). The purpose of this meta-analysis is to compare the effectiveness of PRP vs ESWT in the management of PF. A systematic search was performed of PubMed, Cochrane, and Google Scholar for randomized controlled trials comparing PRP to ESWT. Studies met inclusion criteria if mean and SDs for visual analog scale (VAS) pain scores and plantar fascia thickness (PFT) were reported. Mean differences were used to compare VAS pain score and PFT between PRP and ESWT. Six randomized controlled trials, comparing a total of 214 subjects in the PRP group and 218 subjects in the ESWT group, were analyzed. A significantly greater statistical improvement was seen in the PRP group in VAS pain (mean difference = -0.67 [95% CI -1.16, -0.18], P = .007) and plantar fascia thickness (PFT) (mean difference = -0.56 [95% CI -0.77, -0.35], P < .001). PRP had a statistically higher pain reduction than ESWT, but the difference does not reach clinical significance in this meta-analysis.

Comparison of Platelet Rich Plasma and Steroid Injection in the Treatment of Plantar Fasciitis

Comparison of Platelet Rich Plasma and Steroid Injection in the Treatment of Plantar Fasciitis

Discrepancies in plantar pressure distribution between affected and unaffected sides in patients with plantar fasciitis.

A fundamental understanding of plantar pressure distribution is important for prescribing an appropriate orthosis and applying nonoperative methods, such as stretching exercises, for the treatment of plantar fasciitis. Despite existing research on plantar pressure distribution, discrepancies between affected and unaffected sides in unilateral plantar fasciitis patients warrant further investigation. This study aimed to evaluate the plantar pressure distribution in patients with unilateral plantar fasciitis by comparing it with that on the contralateral unaffected side. We retrospectively reviewed records from 20 consecutive patients diagnosed with unilateral plantar fasciitis, using the unaffected side as the control. The emed® pedobarographic system was used to measure the plantar pressure distribution during gait. The analysis was performed using a 4-mask configuration (toes, forefoot, midfoot, and hindfoot). Both sides showed no significant differences in radiographic parameters. The affected side showed a significantly higher contact area, maximum force, and force-time integrals in the midfoot. However, the unaffected side demonstrated significantly higher maximum force and force-time integrals in the hindfoot. There was no difference in the distribution of the peak pressure and pressure-time integrals between the two sides in all mask regions. The increased contact area and maximum force in the midfoot on the side with plantar fasciitis may result from heel pain-induced weight transfer from the hindfoot. The findings of this study provide a basic understanding of plantar pressure distribution in the treatment of plantar fasciitis and highlight the importance of considering inter-side differences when designing treatment interventions or orthotic devices.

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

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

Efficacy and Safety of Platelet-Rich Plasma Injection for Chronic Plantar Fasciitis: A Prospective Study on Functional Restoration and Pain Relief.

Background Heel discomfort and functional impairment are frequently caused by plantar fasciitis, and treating it can be extremely difficult for clinicians and occasionally have unfavorable clinical consequences. Recently, platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. We evaluated the current evidence concerning the efficacy and safety of PRP as a treatment for PF. Methodology This was a hospital-based prospective study on patients with plantar fasciitis with a symptom duration of six months or more with failed conservative therapy. All patients included in the study were assessed clinically and by a visual analog score (VAS) for heel pain, the Ankle-Hindfoot Scale (AHS) component of the American Orthopedic Foot and Ankle Society (AOFAS) and Foot and Ankle Ability Measure (FAAM) scores before injection, and at three weeks, three and six-months post-PRP treatment follow-up. Ultrasonography (USG) measurement of plantar fascia thickness was done pre-injection and at the six-month follow-up for clinical outcomes and any complications. Results The study included 25 patients with plantar fasciitis, with the majority (48%) in the age group of 21-30 years. Females accounted for 64% of the patientswhile males accounted for 36%. Most patients (56%) had a moderately active daily activity level. The study found that 16 patients had bilateral plantar fasciitiswhile nine had unilateral plantar fasciitis. Among the patients with bilateral plantar fasciitis, a total of 32 heels were affectedwhile the 9 patients with unilateral plantar fasciitis had 9 affected heels. Most female patients (75%) had bilateral plantar fasciitiswhile most male patients (56%) had unilateral plantar fasciitis. Before PRP therapy, both male and female patients reported high pain scores on theVASfor both heels. However, after PRP infiltration, the VAS scores significantly decreased at three weeks, three months, and six months post-injection, indicating pain relief. The AOFAS hindfoot and ankle scores and FAAM scores showed improvement over the follow-up period. Both male and female patients experienced significant improvements in functional outcomes, with increases in AOFAS (p-value 0.45) and FAAM scores (p-value 0.31) at three weeks, three months, and six months post-injection compared to baseline. Statistical analysis revealed a significant decrease in pain scores (73% pain relief), as well as significant improvements in AOFAS scores with an average of 22.33 from baseline (mean = 67.75±9.7) to final follow-up (mean = 90.08±7.9) and FAAM scores with an average of 23.72 from baseline (mean = 49.38±5.2) to final follow-up (mean = 73.10±5.2) after PRP infiltration. Conclusion The outcomes of a single dosage of PRP injections demonstrate clinically and statistically substantial improvements in functional outcome scores, plantar fascia thickness evaluated by USG, and VAS scores for heel pain. According to the results of this study, local PRP injection is an effective treatment for chronic plantar fasciitis.