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Melese H, Alamer A, Getie K, Nigussie F, Ayhualem S. Extracorporeal shock wave therapy on pain and foot functions in subjects with chronic plantar fasciitis: systematic review of randomized controlled trials. Disabil Rehabil 2022; 44:5007-5014. [PMID: 34038642 DOI: 10.1080/09638288.2021.1928775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this review was to synthesize current evidence on the efficacy of extracorporeal shock wave therapy on pain, and foot function in subjects with plantar fasciitis. MATERIALS AND METHODS A comprehensive search of PubMed/Medline, CINAHL, AMED, PEDro, Cochrane Library, and Scopus were done to identify randomized controlled trials of extracorporeal shock wave therapy in subjects with plantar fasciitis. PEDro scale was used to evaluate the methodological quality of included trials. Visual Analogue Scale and Foot Function Index were the primary outcome measures of this review. Due to varying of entailed trials, meta-analysis was not carried out. RESULTS Eleven randomized controlled trials with 658 patients were included. Extracorporeal shock wave therapy exhibited a moderate confirmation to better pain, and foot function of individuals with chronic plantar fasciitis. CONCLUSION Extracorporeal shock wave therapy could be a promising rehabilitation intervention and might support to improve pain, and foot function of subjects with chronic plantar fasciitis.IMPLICATIONS FOR REHABILITATIONExtracorporeal shock wave therapy (ESWT) exerted beneficial effects on pain and functional outcomes for chronic plantar fasciitis.ESWT could be effectively performed with no side effects.ESWT could be an alternative to the conventional management of chronic plantar fasciitis.
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Affiliation(s)
- Haimanot Melese
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Abayneh Alamer
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Kefale Getie
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Fetene Nigussie
- Department of Nursing Institute of Medicine, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Sileshi Ayhualem
- Department of Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tognolo L, Giordani F, Biz C, Bernini A, Ruggieri P, Stecco C, Frigo AC, Masiero S. Myofascial points treatment with focused extracorporeal shock wave therapy (f-ESWT) for plantar fasciitis: an open label randomized clinical trial. Eur J Phys Rehabil Med 2022; 58:85-93. [PMID: 34786906 PMCID: PMC9980534 DOI: 10.23736/s1973-9087.21.06814-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Plantar fasciitis (PF) is a common cause of heel pain. Among the several conservative treatment options, extracorporeal shock wave therapy (ESWT) is considered the standard treatment. However, recent studies suggest that PF may be sustained by a myofascial impairment proximal to the pain area with a biomechanical disequilibrium of the entire limb and pelvis. AIM By combining the concepts of fascial manipulation and ESWT, the purpose of this study was to evaluate the effectiveness of the ESWT on myofascial points in a sample of subjects with PF. DESIGN Open label randomized controlled clinical trial. SETTING Outpatient clinic. POPULATION Patients with PF were randomly assigned to an experimental treatment group (EG), treated with focused ESWT on myofascial points, and a control group (CG), treated with the focused ESWT traditional approach on the medial calcaneal tubercle. METHODS Every patient underwent a 3-session program and follow-up after 1 and 4 months. Outcome measures included the Foot and Ankle Outcome Score (FAOS) and the Italian Foot Functional Index (17-iFFI). RESULTS Thirty patients were enrolled in the study. Four patients of the CG dropped out the study, therefore twenty-six patients were included in the final analysis. Improvement in 17-iFFI and FAOS scores was observed in both groups starting from the third treatment and confirmed at the 1-month and 4-month follow-ups, with earlier improvement in the score values observed in the EG. CONCLUSIONS Treatment of the myofascial points with ESWT in subjects suffering from plantar fasciitis could be an effective treatment option. It fosters the hypothesis that a global biomechanical re-equilibrium of the body would be necessary to completely solve the pathology. CLINICAL REHABILITATION IMPACT ESWT on myofascial points could provide an interesting alternative with better outcomes in terms of time needed for recovery compared to traditional ESWT for the conservative management of PF.
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Affiliation(s)
- Lucrezia Tognolo
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences, University of Padua, Padua, Italy -
| | - Federico Giordani
- School of Physical Medicine and Rehabilitation, University of Padua, Padua, Italy
| | - Carlo Biz
- Unit of Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy
| | - Andrea Bernini
- School of Physical Medicine and Rehabilitation, University of Padua, Padua, Italy
| | - Pietro Ruggieri
- Unit of Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Anna C Frigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefano Masiero
- Unit of Physical Medicine and Rehabilitation, Department of Neurosciences, University of Padua, Padua, Italy
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Ferreira GF, Sevilla D, Oliveira CN, Junior LCN, Arliani GG, Oliveira VO, Pereira Filho MV. Comparison of the effect of hyaluronic acid injection versus extracorporeal shockwave therapy on chronic plantar fasciitis: Protocol for a randomized controlled trial. PLoS One 2021; 16:e0250768. [PMID: 34166373 PMCID: PMC8224905 DOI: 10.1371/journal.pone.0250768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Plantar fasciitis is the most common cause of pain in the plantar region of the heel, and extracorporeal shockwave therapy (ESWT) is an option used in cases where conservative treatment fails. Hyaluronic acid (HA), initially used for osteoarthrosis, is a treatment option because it has been applied to extra-articular regions, such as tendons, ligaments, and fascia. The aim of the present study will be to evaluate the outcomes of pain, function, and personal satisfaction after a single injection of HA and to compare the results with those of ESWT in patients with chronic plantar fasciitis. METHODS The study will include 80 patients who will be randomized to receive three sessions of ESWT (n = 40) or a single ultrasound-guided HA injection in the plantar fascia (n = 40). The outcomes will include the visual analog pain scale score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Foot and Ankle Outcome Score (FAOS). All of the assessments will be performed at baseline and 3, 6, and 12 months after treatment. Statistical analysis will be performed using the repeated measures ANOVA (analysis of variance test) for primary and secondary outcomes and also Fisher's Least Significant Difference, a Post-Hoc test. We will use R software for statistical analysis, randomization, and sample size calculation. RESULTS Recruitment and data collection will begin in November 2020, with completion scheduled for November 2022 and final publication available in March 2023. CONCLUSION This trial will evaluate the effects of a single ultrasound-guided HA injection for the treatment of chronic plantar fasciitis. TRIAL REGISTRATION Brazilian Clinical Trials Registry (Register Number: RBR-97vkx4) http://www.ensaiosclinicos.gov.br/rg/RBR-97vkx4/.
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Affiliation(s)
- Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
- * E-mail:
| | - Davy Sevilla
- Department of Orthopaedics and Traumatology, Prevent Senior, São Paulo, Brazil
| | | | | | | | - Victor Otávio Oliveira
- Head of Department, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | - Miguel Viana Pereira Filho
- Head of Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
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Treatment of "plantar fasciitis"/Plantar Heel Pain Syndrome with botulinum toxin - A novel injection paradigm pilot study. Foot (Edinb) 2020; 45:101711. [PMID: 33038660 DOI: 10.1016/j.foot.2020.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 02/04/2023]
Abstract
Randomized controlled trials over the last two decades, although promising with favorable results, have shown varied efficacy in treatment of "plantar fasciitis" with botulinum toxin injection1. One reason may be due to conflating the variabilities of plantar heel conditions solely as plantar fasciitis. Plantar Heel Pain Syndrome can be of one or more etiologies and symptoms which refutes the mistaken tendency to categorize all plantar heel pain singularly as either plantar fasciitis or fasciosis. Recognizing that there is likely an interplay of inflammatory, degenerative, and neuropathic etiologic conditions of this often-difficult malady to treat, a novel injection paradigm of botulinum toxin is explored in the treatment of 4 distinct presentations of Plantar Heel Pain Syndrome with encouraging results. Botulinum toxin injection into two intrinsic foot muscles; Abductor Hallucis and Quadratus Plantae at their origins with electrical stimulation is presented as novel method to treat four distinct etiologies of Plantar Heel Pain Syndrome. This method of botulinum toxin injection resulted in significant prolonged improvement of patient function and pain reduction in four variations of Plantar Heel Pain Syndrome. A precise injection paradigm facilitated with direct intrinsic muscle stimulation of the Abductor Hallucis and Quadratus Plantae at their origins may prove to be effective in reducing the disabilities of Plantar Heel Pain Syndrome and its associated pain.
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Li S, Wang K, Sun H, Luo X, Wang P, Fang S, Chen H, Sun X. Clinical effects of extracorporeal shock-wave therapy and ultrasound-guided local corticosteroid injections for plantar fasciitis in adults: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e13687. [PMID: 30558080 PMCID: PMC6320028 DOI: 10.1097/md.0000000000013687] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The argument on whether extracorporeal shock-wave therapy (ESWT) and corticosteroid injections (CSIs) exert an equivalent pain control or which is the better treatment for plantar fasciitis (PF) in adults remains to be resolved. It is important and necessary to conduct a meta-analysis to make a relatively more credible and overall assessment about which treatment method performs better pain control in treatment of PF in adults. METHODS From the inception to July 2018, the Embase, PubMed, Web of Science, and Cochrane Library electronic databases were searched for all relevant studies. Only randomized controlled trials (RCTs) focusing on comparing ESWT and CSI therapies in PF cases in adults were included. The primary outcome measure was visual analog scale (VAS) reduction, whereas the secondary outcomes included treatment success rate, recurrence rate, function scores, and adverse events. RESULTS Nine RCTs involving 658 cases were included in this meta-analysis. In the present study, meta-analysis showed that high-intensity ESWT had superior pain relief and success rates relative to the CSI group within 3 months, but the ESWT with low intensity was slightly inferior to CSI for efficacy within 3 months. In addition, patients with CSI may tend to increase the need for the analgesic and more adverse events may be associated with the ESWT. However, the ESWT and CSI present similar recurrent rate and functional outcomes. CONCLUSION Our analysis showed that the pain relief and success rates were related to energy intensity levels, with the high-intensity ESWT had the highest probability of being the best treatment within 3 months, followed by CSI, and low-intensity ESWT. More high-quality RCTs with long-term follow-up time are needed to further compare the differences of CSI and ESWT for adults with PF.
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Chronic heel pain: when is surgery indicated? CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Valizadeh MA, Afshar A, Hassani E, Tabrizi A, Rezalo S, Dourandish N. Relationship Between Anthropometric Findings and Results of Corticosteroid Injections Treatment in Chronic Plantar Heel Pain. Anesth Pain Med 2018; 8:e64357. [PMID: 29868462 PMCID: PMC5970288 DOI: 10.5812/aapm.64357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/17/2018] [Accepted: 01/30/2018] [Indexed: 11/24/2022] Open
Abstract
Background Chronic plantar heel pain (CPHP) is one of the common, disabling, and painful problems in the foot. Obesity is one of the known causes of CPHP. The aim of this study is to investigate the relationship between the body mass and the treatment of chronic plantar heel pain. Methods In a cohort study, 80 CPHP patients, including 16 men and 64 women, who referred to orthopedic clinic from 2014 to 2016, were investigated. All the patients were initially treated by corticosteroid injections. A total of 80 studied patients were classified according to their body mass index (BMI) in 3 groups: obese, overweight, and ideal weight. Their pain severity, symptoms recurrence, and foot performance were examined. Results The severity of morning pain was 6.6 ± 1.2 in the obese patients while it was 5.6 ± 1.7 and 5.9 ± 1.7 in overweight and ideal weight patients, respectively, which had significant difference (P = 0.005). In 57% of obese patients, symptoms recurrence was observed; this rate was 12% and 5.3% in overweight and ideal-weight patients, which showed significant difference (P = 0.001). Obese people had higher relative risk of CPHP recurrence (OR = 7.52, 95% CI = 4.28 to 16.53, P < 0.001). Conclusions High BMI is a strong risk factor in recurrence of chronic plantar heel pain. There is a strong relationship between the BMI of the patients and the severity of pain in the morning.
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Affiliation(s)
| | - Ahmadreza Afshar
- Department of Orthopedics, Emam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Ebrahim Hassani
- Anesthesiology Department, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Tabrizi
- Department of Orthopedics, Emam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
- Corresponding author: Ali Tabrizi, Moderres Ave., Emam Khomeini Educational Hospital, Urmia University of Medical Sciences, Urmia, Iran. Tel: +98-9143130829, E-mail:
| | - Shaghayeg Rezalo
- School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Nilsa Dourandish
- Department of Internal Medicine, Emam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
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Ersen Ö, Koca K, Akpancar S, Seven MM, Akyıldız F, Yıldız Y, Özkan H. A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis. Turk J Phys Med Rehabil 2018; 64:59-65. [PMID: 31453490 PMCID: PMC6709612 DOI: 10.5606/tftrd.2018.944] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/06/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the efficacy of prolotherapy injections for the treatment of plantar fasciitis. MATERIAL AND METHODS Between October 2014 and October 2015, 60 patients with symptomatic chronic plantar fasciitis were randomly divided into two groups, as control (n=31) and prolotherapy (n=29) groups. In the prolotherapy group, ultrasound-guided prolotherapy injections into the plantar fascia up to five different points were performed three times every 21 days. In the control group, the patients received instructions for plantar fascia and Achilles tendon stretching exercises three times a week for three months. Additionally, all patients were given heel lifts and instructed to refrain from heavy loading activity. The patients were evaluated via the Visual Analog Scale (VAS), Food and Ankle Outcome Score (FAOS), and Foot Function Index (FFI) at baseline and at 21, 42, 90, and 360 days during follow-up. RESULTS A total of 50 patients completed follow-up (26 patients in the prolotherapy group and 24 patients in the control group). The VAS, FAOS, and FFI scores were significantly improved in both groups (p<0.001). There were no statistically significant differences in the pain and functional scores at 21 days of treatment between the groups. The VAS and FAOS scores were higher in the prolotherapy group than the control group at 42, 90, and 360 days of treatment. The FFI scores were also higher in the prolotherapy group than the controls at 42 and 90 days of treatment; however, both groups had similar scores at 360 days. CONCLUSION Our study results suggest that prolotherapy is an effective auxiliary method for treating chronic plantar fasciitis.
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Affiliation(s)
- Ömer Ersen
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Kenan Koca
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Serkan Akpancar
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mehmet Murat Seven
- Department of Sports Medicine, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Faruk Akyıldız
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yavuz Yıldız
- Department of Sports Medicine, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Hüseyin Özkan
- Department of Orthopedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
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Abstract
BACKGROUND This study examined the effect of botulinum toxin upon plantar fasciitis through a randomized, controlled, and blinded trial. MATERIALS Between 2012 and 2015, 50 patients presented with plantar fasciitis. Twenty-five patients each randomly received an IncobotulinumtoxinA (IBTA) or saline injection of their affected foot. Pre- and postinjection function and pain were graded with the Foot and Ankle Ability Measures (FAAM) and visual analog scale (VAS), respectively. All 50 study patients who randomly received either placebo or IBTA presented at 6 and 12 months after injection. RESULTS At 6 months, the mean FAAM increased from 35.9 to 40.9 of 100, and the mean pain score decreased from 8.4 to 7.9 of 10 within the placebo group. At 6 months, the mean FAAM increased from 36.3 to 73.8 of 100, and mean pain score decreased from 7.2 to 3.6 of 10 within the IBTA group. These postinjection scores were significantly better than the placebo group ( P = .01). At 12 months after injection, the IBTA group maintained significantly better function and pain than the placebo group ( P < .05). By that time, 0 (0%) and 3 (12%) patients who received IBTA and saline, respectively, underwent surgery for recalcitrant plantar fasciitis ( P < .005). CONCLUSION Compared with placebo saline injection, using IBTA to treat plantar fasciitis resulted in significantly better improvement in foot function and pain. IBTA also lessened the need for operative treatment of plantar fasciitis. LEVEL OF EVIDENCE I, Randomized, double-blinded, placebo-controlled study.
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Affiliation(s)
- Jamal Ahmad
- 1 Orthopaedic Foot and Ankle Surgery, Rothman Institute Orthopaedics, Philadelphia, PA, USA
| | - Stacy H Ahmad
- 2 Department of Anatomy, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kennis Jones
- 3 Rothman Institute Orthopaedics, Philadelphia, PA
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Eslamian F, Shakouri SK, Jahanjoo F, Hajialiloo M, Notghi F. Extra Corporeal Shock Wave Therapy Versus Local Corticosteroid Injection in the Treatment of Chronic Plantar Fasciitis, a Single Blinded Randomized Clinical Trial. PAIN MEDICINE 2016; 17:1722-31. [PMID: 27282594 DOI: 10.1093/pm/pnw113] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Plantar fasciitis is a self-limiting condition, but can be painful and disabling. Among the different treatments which exist, corticosteroid injections are effective and popular. Extracorporeal shock wave therapy (ESWT) is another treatment modality used for resistant conditions. In this study, the authors evaluated the efficacy of radial ESWT versus corticosteroid injections in the treatment of chronic plantar fasciitis. DESIGN Randomized clinical trial. SETTING Physical medicine and rehabilitation research center in a university hospital. SUBJECTS Forty patients with plantar fasciitis who did not respond to conservative treatment. METHODS Patients were allocated to radial ESWT with 2000 shock waves/session of 0.2 mJ/mm(2) (n = 20) or local methylprednisolone injections (n = 20). Pain in the morning and during the day based on a visual analog scale (VAS), functional abilities using the foot function index (FFI), and satisfaction were evaluated before treatment and at 4 and 8 weeks after treatment. RESULTS Patients (average age: 42.1± 8.20) received five sessions of ESWT or single steroid injection. Changes in the VAS in morning and during the day and the FFI throughout the study period were significant in both groups (P < 0.001). ESWT group had a higher reduction in VAS in morning and better function in FFI, but these changes were insignificant statistically [FFI decreased to 19.65 ± 21.26 points (67.4% improvement) in ESWT vs 31.50 ± 20.53 points (47.7%) in injection group at week 8, P = 0.072)]. Good or excellent results in the opinions of patients were achieved in 55% of ESWT and 30% of corticosteroid injection groups (P = 0.11). CONCLUSION Both interventions caused improvement in pain and functional ability 2 months after treatment. Although inter-group differences were not significant, the FFI was improved more with ESWT and patients were more satisfied with ESWT, thus shockwave therapy seems a safe alternative for management of chronic plantar fasciitis.
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Affiliation(s)
- Fariba Eslamian
- *Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Kazem Shakouri
- *Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Jahanjoo
- †Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrzad Hajialiloo
- ‡Department of Internal Medicine, Division of Rheumatology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faraz Notghi
- *Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Kim JK, Chung JY. Effectiveness of polydeoxyribonucleotide injection versus normal saline injection for treatment of chronic plantar fasciitis: a prospective randomised clinical trial. INTERNATIONAL ORTHOPAEDICS 2015; 39:1329-34. [PMID: 25920599 DOI: 10.1007/s00264-015-2772-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/22/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE Polydeoxyribonucleotide (PDRN) has been used for the treatment of chronic tendinosis. This prospective randomised study was conducted to evaluate the efficacy and complications of PDRN injection for treatment of plantar fasciitis. METHODS Forty patients with a clinical diagnosis of plantar fasciitis were randomly allocated to PDRN injection (PDRN group, n = 20) or normal saline injection (placebo group, n = 20). Injections were performed weekly for three weeks. Clinical evaluations were done at baseline and four and 12 weeks after treatment began using the visual analogue scale (VAS) for foot pain and Manchester-Oxford Foot Questionnaire (MOXFQ). We also monitored the complications in both groups at one, two, four and 12 weeks after initial treatment. RESULTS The PDRN group achieved a significant improvement in VAS and MOXFQ scores at four weeks after treatment, and this improvement continued until 12 weeks after treatment. On the other hand, the placebo group did not achieve a significant improvement in the VAS or MOXFQ scores at four or 12 weeks. The initial VAS and MOXFQ scores of the PDRN group were not significantly different from those of the placebo group. At four weeks after treatment, the VAS and MOXFQ scores of the PDRN group were better than those of the placebo group, but the difference was not statistically significant. At 12 weeks after treatment, the VAS and MOXFQ scores of the PDRN group were significantly better than those of the placebo group. We noticed no injection-related complications, such as itching, urticaria, redness or infection signs around the injection site in either group. CONCLUSIONS PDRN injection is an effective and safe treatment option and may be considered for plantar fasciitis.
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Affiliation(s)
- Jae Kwang Kim
- Department of Orthopedic Surgery, Ewha Womans University School of Medicine, 911-1, Mok-5-dong, Yangcheon-gu, Seoul, 158-710, South Korea,
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Moghtaderi A, Khosrawi S, Dehghan F. Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial. Adv Biomed Res 2014; 3:99. [PMID: 24800188 PMCID: PMC4007320 DOI: 10.4103/2277-9175.129369] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/20/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Plantar fasciitis is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is an alternative treatment for refractory cases of plantar fasciitis. Studies also demonstrated that ESWT may be an appropriate treatment for myofascial trigger points. This study was designed to evaluate its effectiveness by comparing the ESWT of Gastrocnemius/Soleus (gastroc-soleus) trigger points and heel region with the ESWT of the heel region alone. MATERIALS AND METHODS The study was carried out among 40 patients with a clinical diagnosis of plantar fasciitis, divided randomly to case (n = 20) and control (n = 20) groups. The case group received ESWT for the heel region and for the gastroc-soleus trigger points. The control group received ESWT just for the heel region. The protocol was the same in both groups and they were treated for three sessions every week. The pain score (100 mm visual analog score [VAS]) and the modified Roles and Maudsley score was evaluated before the first session and eight weeks after the last session. RESULTS Eight weeks after the last session, although the mean VAS had decreased significantly in both groups, this decrement was more significant in the case group. (P = 0.04). According to the modified Roles and Maudsley score, there was a significant improvement in both the case (P < 0.001) and control (P = 0.01) groups, eight weeks after treatment, but there were significantly better results in the case group. CONCLUSION The combination of ESWT for both plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis.
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Affiliation(s)
- Alireza Moghtaderi
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Khosrawi
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farnaz Dehghan
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
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Elizondo-Rodriguez J, Araujo-Lopez Y, Moreno-Gonzalez JA, Cardenas-Estrada E, Mendoza-Lemus O, Acosta-Olivo C. A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study. Foot Ankle Int 2013; 34:8-14. [PMID: 23386757 DOI: 10.1177/1071100712460215] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this study was to compare intramuscularly applied botulinum toxin A (BTX-A) in the gastroc-soleus complex with intralesional steroids for the treatment of plantar fasciitis. METHODS The patients were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 6 months. The evaluation scores included the Visual Analog Scale (VAS), Maryland Foot and Ankle, Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, patients were instructed to perform plantar fascia stretching exercises over the course of the study. The final number of patients was 36, of whom 19 received BTX-A (10 men and 9 women) and 17 (6 men and 11 women) received steroids. RESULTS When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study. CONCLUSION A combination of BTX-A and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids. LEVEL OF EVIDENCE Level I, therapeutic studies.
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Rawicki B, Sheean G, Fung VSC, Goldsmith S, Morgan C, Novak I. Botulinum toxin assessment, intervention and aftercare for paediatric and adult niche indications including pain: international consensus statement. Eur J Neurol 2011; 17 Suppl 2:122-34. [PMID: 20633183 DOI: 10.1111/j.1468-1331.2010.03132.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evidence is emerging for the use of botulinum neurotoxin type-A (BoNT-A) for niche indications including pain independent of spasticity. Pain indications such as chronic nociceptive back pain, piriformis syndrome, chronic myofascial pain, pelvic pain, complex regional pain syndrome, facial pain and neuropathic pain are outlined in this paper. Of these, class I evidence is available for the treatment of chronic nociceptive low back pain, piriformis syndrome, myofascial pain, facial pain, neuropathic pain and plantar fasciitis. Peri-operative use of BoNT-A is emerging, with indications including planning for surgery and facilitating surgery, as well as healing and improving analgesia post-operatively. Evidence is limited, although there are some reports that clinicians are successfully using BoNT-A peri-operatively. There is class I evidence showing pre-operative use of BoNT-A has a beneficial effect on outcomes following adductor-release surgery. The use of BoNT for treatment of tremor, other than neck tremor in the setting of cervical dystonia, including evidence for upper limb tremor, cranial tremor and non-dystonic neck tremor is reviewed. The evidence is variable at this stage, and further study is required to develop definitive recommendations for the clinical utility of BoNT-A for these indications.
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Affiliation(s)
- B Rawicki
- Victorian Paediatric Rehabilitation Service, Monash Medical Centre, Clayton, Victoria, Australia.
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Chou LW, Hong CZ, Wu ES, Hsueh WH, Kao MJ. Serial Ultrasonographic Findings of Plantar Fasciitis After Treatment With Botulinum Toxin A: A Case Study. Arch Phys Med Rehabil 2011; 92:316-9. [DOI: 10.1016/j.apmr.2010.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 08/04/2010] [Accepted: 10/14/2010] [Indexed: 11/29/2022]
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Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, Weil LS, Zlotoff HJ, Bouché R, Baker J. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg 2010; 49:S1-19. [PMID: 20439021 DOI: 10.1053/j.jfas.2010.01.001] [Citation(s) in RCA: 242] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Indexed: 02/03/2023]
Abstract
Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.
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Affiliation(s)
- James L Thomas
- Chair, Clinical Practice Guideline Heel Pain Panel (2001), Morgantown, WV, USA
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Abstract
Plantar fasciitis is a common problem without known etiology. It responds well to multiple conservative modalities and no particular modality has been demonstrated to be clearly superior in the treatment of this condition. Over 90% of patients will be cured by non-operative treatment but this may require 6 to 12 months of treatment and encouragement by the physician. Extracorporeal shock wave therapy is a noninvasive treatment with a success rate comparable to surgery and a low complication rate. Surgery can be done endoscopically or open with similar long-term outcomes. Patients appear to recover from endoscopic treatment 4 to 5 weeks earlier than the open group. If there is a suggestion of FBLPN entrapment, then patients should have an open release.
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Abstract
Plantar fasciitis is the most common cause of plantar heel pain. Its characteristic features are pain and tenderness, predominately on the medial aspect of the calcaneus near the sole of the heel. Considering a complete differential diagnosis of plantar heel pain is important; a comprehensive history and physical examination guide accurate diagnosis. Many nonsurgical treatment modalities have been used in managing the disorder, including rest, massage, nonsteroidal anti-inflammatory drugs, night splints, heel cups/pads, custom and off-the-shelf orthoses, injections, casts, and physical therapy measures such as shock wave therapy. Most reported treatment outcomes rely on anecdotal experience or combinations of multiple modalities. Nevertheless, nonsurgical management of plantar fasciitis is successful in approximately 90% of patients. Surgical treatment is considered in only a small subset of patients with persistent, severe symptoms refractory to nonsurgical intervention for at least 6 to 12 months.
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Jeynes LC, Gauci CA. Evidence for the use of botulinum toxin in the chronic pain setting--a review of the literature. Pain Pract 2008; 8:269-76. [PMID: 18503628 DOI: 10.1111/j.1533-2500.2008.00202.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A significant proportion of chronic pain is of musculoskeletal origin. Botulinum toxin (BTX) has been successfully used in the treatment of spasmodic torticollis, limb dystonia, and spasticity. Investigators have, thus, become interested in its potential use in treating many chronic pain conditions. Practitioners have used BTX, outside the product license, in the treatment of refractory myofascial pain syndrome and neck and low back pain (LBP). This article reviews the current evidence relating to chronic pain practice. There is evidence supporting the use of both BTX type A and type B in the treatment of cervical dystonias. The weight of evidence is in favor of BTX type A as a treatment in: pelvic pain, plantar fasciitis, temporomandibular joint dysfunction associated facial pain, chronic LBP, carpal tunnel syndrome, joint pain, and in complex regional pain syndrome and selected neuropathic pain syndromes. The weight of evidence is also in favor of BTX type A and type B in piriformis syndrome. There is conflicting evidence relating to the use of BTX in the treatment whiplash, myofascial pain, and myogenous jaw pain. It does appear that BTX is useful in selected patients, and its duration of action may exceed that of conventional treatments. This seems a promising treatment that must be further evaluated.
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Affiliation(s)
- Louise C Jeynes
- The Boyle Department of Anesthesia, St. Bartholomew's Hospital, London, UK
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