Plantar Fasciitis/Fasciosis

Frequency of central sensitization and nociplastic pain in patients with plantar fasciitis : Central sensitization and nociplastic pain in plantar fasciitis

PURPOSE

If the pain persists for a long time in the treatment of plantar fasciitis (PF) or if there is no response to treatment, central sensitization (CS) may develop and the pain may transform into nociplastic pain (NP). This study aimed to evaluate the frequency of CS and NP in patients with PF.

METHODS

This cross-sectional study was undertaken between November 2023 and March 2024. The Foot Function Index (FFI) scale, which evaluates the foot's functionality, was applied to the patient group. The Visual Analog Scale (VAS), which evaluates pain intensity; the Pain-DETECT scale, which evaluates NP; and the Central Sensitization Scale (CSI), which evaluates CS, were applied to patient and control groups.

RESULTS

A total of 206 people were included in the study; 106 were in the patient group with PF, and 100 constituted the control group. While we detected NP in 67 (63.2%) patients according to Pain-DETECT and CS was detected in 91 (85.8%) patients according to CSI among 106 patients with chronic PF; we detected NP in seven (7%) patients according to Pain-DETECT and CS in 44 (44.0%) patients according to CSI among 100 control patients. VAS-score and FFI-pain are moderately and positively correlated with pain-DETECT scores and fairly and positively correlated with CSI scores in the PF group. The pain-DETECT score is moderately and positively correlated with the CSI score in the two groups.

CONCLUSIONS

This is the first study to evaluate the presence of CS and NP in PF patients. We found NP and CS to be common in patients with chronic PF. Effective pain management in patients with PF before it becomes chronic can prevent the development of CS and NP.

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

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

The four-step surgical regimen is an appropriate and effective surgical procedure to treat plantar fasciitis with bone spurs.

Botulinum toxin A versus platelet rich plasma ultrasound-guided injection in the treatment of plantar fasciitis: A randomised controlled trial

BACKGROUND

Platelet-rich plasma (PRP) and botulinum toxin type A (BTX-A) injections have proven effective in clinical trials for plantar fasciitis treatment but have not been directly compared. We aimed to compare clinical outcomes in patients undergoing PRP or BTX-A injections.

METHODS

We performed a randomised controlled trial (59 patients; 1-year follow-up) to assess efficacy, using pain and functional scales (VAS, AOFAS Hindfoot-scale and FAAM questionnaire) and fascia thickness reduction, in control and single ultrasound-guided BTX-A or PRP injection groups.

RESULTS

The BTX-A group showed better results at 1-month after treatment. Conversely, the PRP injection was more effective in the long-term, with significant pain reduction and functional improvement. Plantar fascia thickness significantly reduced from months 1 and 3 in the PRP and BTX-A groups, respectively.

CONCLUSION

PRP and BTX-A injections are effective in patients with plantar fasciitis with BTX-A achieving better short-term pain reduction and PRP better long-term results.

LEVEL OF EVIDENCE

Level I; Randomised Controlled Trial.

Comprehensive Physiotherapy Rehabilitation Protocol of Plantar Fasciitis for a 45-Year-Old Female: A Case Report

Plantar fasciitis is stated to arise because of inadequate accumulated tension at the plantar fascia's enthesis. Tensile load and prolonged strain cause tiny rips in the fascia, which trigger a chronic inflammation process of healing. This case report shows the diagnostic evaluations, assessment of the condition, and physical rehabilitation management for a 45-year-old female nurse working in the neurosurgical critical care unit who had been experiencing plantar medial and posterior heel pain, as well as discomfort at the calcaneal tuberosity, for the previous six months. To increase functional mobility and alleviate symptoms, the patient sought out physiotherapy intervention. In this case, a physiotherapeutic program was implemented to treat plantar fasciitis, enhance mobility, and encourage long-term recovery. The evaluation included a detailed review of the patient's gait, biomechanics, and circumstances that may have contributed to the ongoing problems. The multimodal strategy used in the intervention plan included manual therapy, strengthening and stretching exercises, as well as patient education and counselling on self-management techniques. The patient's functional mobility increased along with a steady reduction in discomfort during the duration of the physiotherapy sessions. The instance emphasises how important it is to manage persistent plantar fasciitis with a customised physical therapy strategy that takes the patient's specific requirements into account and addresses contributory variables. The present study adds to the extant literature on efficacious physiotherapeutic approaches for plantar fasciitis, highlighting the need for a holistic approach in attaining favourable results for individuals enduring heel discomfort.

Presurgical Perspective and Posttreatment Evaluation of Soft Tissue Tumors of the Ankle and Foot in Adults

This article discusses soft tissue tumors of the ankle and foot region in adults, including tumors of the joints, and also briefly addresses tumor-simulating lesions. We offer general recommendations and describe specific aspects of common entities in that region, such as typical imaging appearance, therapeutic strategies, and posttherapeutic considerations. Focal masses and diffuse swelling are common in the foot and ankle region; most of them are non-neoplastic. Some of the tumors, such as plantar fibromatosis, tenosynovial giant cell tumor, synovial chondromatosis, or schwannoma, have a very typical appearance on magnetic resonance imaging. Sarcomas are rare among true soft tissue tumors; however, they can be small and well demarcated, may grow slowly, and are often misinterpreted as benign. This is especially true for synovial sarcoma, one of the most common sarcomas in this region. Densely packed tissues in the foot and ankle may hamper determining the tissue of origin. Adherence to diagnostic guidelines and cooperation with tumor centers is crucial including for posttherapeutic surveillance. We also describe typical posttherapeutic changes and complications after surgery, radiation therapy, and chemotherapy, as well as parameters for the detection and exclusion of recurrence of soft tissue tumors of the ankle and foot.