Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis

INTRODUCTION

Plantar fasciitis (PF) is the most common cause of heel pain in adults. There are numerous non-operative treatments available including platelet rich plasma (PRP) injections. PPR has demonstrated effectiveness for a range of musculoskeletal conditions including plantar fasciitis.

PURPOSE/OBJECTIVE

To compare the effectiveness of PRP to other conservative treatment options for the management of PF.

METHODS

A systematic search of PubMed and Google Scholar was performed for randomized control trials (RCT) comparing PRP to other treatment modalities. Studies met inclusion criteria if mean and standard deviations for visual analog scale (VAS) pain scores, plantar fascia thickness (PFT), Foot Function Index (FFI), or American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were reported. Mean differences (MD) were used to compare VAS pain, PFT, FFI, and AOFAS between PRP and other treatments.

RESULTS

Twenty-one RCTs which altogether included 1356 patients were included in the meta-analysis. PRP demonstrated significantly greater improvements in VAS pain scores compared to extracorporeal shock wave therapy (ESWT) (SMD: 0.86; CI: [0.30, 1.41]; p = 0.002), corticosteroid injections (CSI) (SMD: 1.08; CI: [0.05, 2.11]; p = 0.04), and placebo (SMD: 3.42; CI: [2.53, 4.31]; p < 0.00001). In terms of FFI, no significant differences existed among PRP, ESWT, CSI, dextrose prolotherapy (DPT), and meridian trigger points (MTP) in enhancing foot functionality. However, PRP demonstrated a marked advantage over phonophoresis, showing a substantial improvement in FFI scores (SMD: 3.07, 95% CI: 2.34-3.81). PRP did not demonstrate superiority over ESWT, CSI, or MTP for improving PFT, but it was notably more effective than phonophoresis (SMD: 3.18, 95% CI: 2.43-3.94). PRP demonstrated significantly greater improvements in AOFAS scores over CSI (SMD: 3.31, CI: [1.35, 5.27], p = 0.0009) and placebo (SMD: 3.75; CI: [2.81, 4.70]; p < 0.00001).

CONCLUSION

PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement.

LEVEL OF EVIDENCE

Level I Meta-Analysis.

Comparing two protocols of shock wave therapy for patients with plantar fasciitis: A pilot study

OBJECTIVES

This pilot study primarily aimed to detect the adherence as well as the effect size required to estimate the actual sample size needed for a larger scale study to compare and evaluate the effectiveness of two extracorporeal shock wave therapy (ESWT) protocols along, with a physical therapy program in reducing pain and improving function among patients suffering from plantar fasciitis. The study also aimed to report the effects of the ESWT protocols used on pain and function.

METHODS

A total of 26 participants took part in the study, including 17 females and 9 males. The average age of the participants was 34 years with a body mass index (BMI) of 23 kg/m2. Participants were divided into three equal groups; Group A received ESWT at a frequency of 15 Hz and intensity of 3, Group B received ESWT at a frequency of 10 Hz and intensity of 4, while Group C underwent the selected physical therapy program along with sham shock wave therapy as a control. Pain levels were assessed using the Visual Analog Scale (VAS) while functional improvements were evaluated using the Foot Function Index (FFI). Data was collected prior to treatment, after three sessions and at the end of six weeks (after six sessions).

RESULTS

The three groups were well matched, and the results revealed high adherence rates (90%, 90% and 80% respectively). Results also indicated reductions in pain levels and improvements in function for both intervention groups when compared to the control group. Group A demonstrated better outcomes compared to Group B while Group C showed relatively less improvement.

CONCLUSION

The study concluded a high adherence rate for the three groups as well as a small effect size detected of 0.282 that would suggest a total of 123 participants to be required to replicate the study on a larger scale. With regards to the findings of this pilot, the combination of ESWT and a targeted physical therapy program revealed a possible effective therapeutic approach for plantar fasciitis, with a higher frequency potentially yielding more favourable results.

Do the fasciae of the soleus have a role in plantar fasciitis?

Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.

Effectiveness of therapeutic ultrasound on reducing pain intensity and functional disability in patients with plantar fasciitis: a systematic review of randomised controlled trials

Background

Ultrasound therapy is one of the preferred conservative treatments for patients with plantar fasciitis. This study aims to evaluate the effectiveness of therapeutic ultrasound in decreasing pain intensity and improving functional disability in patients with plantar fasciitis.

Methods

Five randomised control trials (RCT) were selected based on an electronic search in PubMed, Trip Database and PEDro. To be included in the systematic review, the study should be an RCT which investigated the effectiveness of therapeutic ultrasound conducted in patients with plantar fasciitis with pain intensity and functional disability as outcome measures. Only studies published in peer-reviewed journals written in the English language were included. The quality of the selected studies was measured by the PEDro scale.

Results

All the included studies showed that ultrasound therapy is beneficial in reducing pain score and improving functional disability, except one study did not recommend using ultrasound therapy for plantar fasciitis. Moreover, regarding another outcome measure, two studies found that ultrasound therapy reduces thickness and tenderness in plantar fasciitis and improves static and dynamic balance.

Conclusion

After reviewing the five studies, this systematic review support using ultrasound therapy to decrease pain and improve functional disability in patients with plantar fasciitis.

Study Registration

https://osf.io/xftzy/.

The association between refractory plantar fasciitis and insertional Achilles tendinopathy and peripheral spondyloarthritis: a report of human leukocyte antigen B-27 investigation and treatment outcome

PURPOSE

This study aimed to determine the presence of peripheral spondyloarthritis and investigate the clinical characteristics of patients with concurrent peripheral spondyloarthritis in those presenting with refractory plantar fasciitis and Achilles tendinopathy by conducting human leukocyte antigen B-27 (HLA-B27) testing.

METHODS

This retrospective study aimed to investigate patients who complained of persistent pain and significant limitations in daily activities due to their respective foot pain, despite receiving conservative treatment for over one year under the diagnosis of plantar fasciitis or insertional Achilles tendinopathy. The study included 63 patients who underwent HLA-B27 testing. The patients were classified into two groups based on the presence or absence of HLA-B27 positivity. The Mann-Whitney U test assessed significant relationships between continuous variables, and the chi-square test was used to compare categorical variables.

RESULTS

Among the 63 included patients, HLA-B27 positivity was confirmed in 11 patients (17.5%), which was significantly associated with a lower average age (22.8 years versus 31.7 years, P = 0.01) and a substantially lower proportion of females compared to HLA-B27-negative patients (9.1% vs. 25.0%, P = 0.001). Ten of the 11 patients initiated treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) combined with oral steroids as the first-line medication after being diagnosed as HLA-B27 positive. Six patients experienced pain relief with the first-line medication (60%). Four patients who did not achieve pain control with the first-line medication received tumour necrosis factor-alpha inhibitors as the second-line medication. Two patients experienced pain relief, while two experienced reduced but persistent pain.

CONCLUSIONS

Among the patients with "refractory" plantar fasciitis and insertional Achilles tendinopathy, 17.5% were diagnosed with peripheral spondyloarthritis. Patients diagnosed with peripheral spondyloarthritis had a higher proportion of men and relatively younger mean age compared to those without the diagnosis. Approximately 70% of these patients achieved symptom improvement in foot and ankle joints by taking conventional synthetic DMARDs, TNF-α inhibitors, or both appropriate for spondyloarthritis.

Predictive Measurement for Windlass Change in Length and Selected Treatment Outcomes in Chronic Plantar Fasciitis

Approximately 10% of patients with plantar fasciitis experience persistent and often severe symptoms, though little is known about its etiology. The goal of this study was to employ an objective, simple, and economical approach to measure the change in length of the windlass and assess the efficiency of a specified therapy protocol applied in this study over a one-month period. Age, weight, normal foot type, and gender were employed as matching factors in a matched design. Fifty individuals diagnosed with unilateral plantar fasciitis and an equal number of healthy volunteers all fulfilled the inclusion criteria and took part in this research. Pain assessment utilized a visual analogue scale and the pain subscale of the foot function index, while a valid goniometric method was employed to evaluate weight-bearing windlass, dorsiflexion and plantar flexion ranges of motion. Additionally, foot plantar pressure (both static and dynamic measures) and tape measurement of windlass change in length were assessed. The assessment was completed by all patients before and after their treatment program. Normal subjects were evaluated for control. Treatment methods encompassed ultrasonic therapy, application of an electrical heating pad, utilization of a night splint, engagement in stretching activities for the plantar aponeurosis and Achilles tendon, as well as both extrinsic and intrinsic strengthening exercises. After one month, the patients were reassessed and compared to control volunteers. In those suffering from plantar fasciitis, a substantial link was found between clinical measurements (tape measurement, windlass range of motion) and foot plantar pressure, indicating improvement. The chosen treatment protocol was effective in 96% of patients. For windlass length change, the measurement technique was found to be valid and objective. The chosen therapy procedure was successful in treating persistent plantar fasciitis in patients.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review

OBJECTIVE

To determine the efficacy of extracorporeal shockwave therapy (ESWT) and investigate outcomes following the use of ESWT for athletes and physically active individuals.

DESIGN

Systematic review.

DATA SOURCES

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and searched four databases: PubMed (NLM), Embase (Elsevier), CINAHL Complete (EBSCO) and Web of Science (Clarivate).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Included studies were randomised controlled trials, cohort and case-control studies, cases series and reports that evaluated outcomes following ESWT for athletes, physically active individuals and occupational groups requiring regular physical activity such as military cadets.

RESULTS

56 studies with 1874 athletes or physically active individuals were included. Using the Oxford level of evidence rating, included studies were 18 level I (32.1%), 3 level II (5.4%), 10 level III (17.9%), 13 level IV (23.2%) and 12 level V (21.4%). Based on the level I studies, ESWT may be effective alone in plantar fasciitis, lateral epicondylitis and proximal hamstring tendinopathy and as an adjunct to exercise treatment in medial tibial stress syndrome and osteitis pubis in athletes or physically active individuals. In most studies, athletes were allowed to continue activities and training and tolerated ESWT with minimal side effects.

CONCLUSION

ESWT may offer an efficacious treatment alone or as an adjunct to concurrent exercise therapy in selected sports-related injuries and without major adverse events. Further high-level research is needed to better define the role and clinical outcomes of ESWT.

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.

Common Painful Foot and Ankle Conditions: A Review

Importance

Morton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to nonoperative treatment.

Observations

Morton neuroma, consisting of interdigital neuronal thickening and fibrosis, is characterized by burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes (commonly the third and fourth toes). First-line nonoperative therapy consists of reducing activities that cause pain, orthotics, and interdigital corticosteroid injection; however, approximately 30% of patients may not respond to conservative treatment. Plantar fasciitis accounts for more than 1 million patient visits per year in the US and typically presents with plantar heel pain. Fifteen years after diagnosis, approximately 44% of patients continue to have pain. First-line nonoperative therapy includes stretching of the plantar fascia and foot orthotics, followed by extracorporeal shockwave therapy, corticosteroid injection, or platelet-rich plasma injection. Midportion Achilles tendinopathy presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel. The primary nonoperative treatment involves eccentric strengthening exercises, but extracorporeal shockwave therapy may be used.

Conclusions and Relevance

Morton neuroma, plantar fasciitis, and Achilles tendinopathy are painful foot and ankle conditions. First-line therapies are activity restriction, orthotics, and corticosteroid injection for Morton neuroma; stretching and foot orthotics for plantar fasciitis; and eccentric strengthening exercises for Achilles tendinopathy.

Heel Pain - Plantar Fasciitis: Revision 2023

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain. J Orthop Sports Phys Ther 2023;53(12):CPG1-CPG39. doi:10.2519/jospt.2023.0303.

Efficacy of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis: a systematic review and meta-analysis

OBJECTIVE

To investigate the effects of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis.

DESIGN

Systematic review of randomised controlled trials (RCTs).

DATA SOURCES

AMED, MEDLINE, PEDro, Cochrane, SPORTDiscus, CINAHL, EMBASE and PsycINFO without language or date restrictions up to 3 February 2023.

ELIGIBILITY CRITERIA

RCTs that evaluated the efficacy of any pharmacological and non-pharmacological therapies compared with control (placebo, sham, waiting list or no intervention) on pain intensity and disability in people with plantar fasciitis. Two reviewers independently screened eligible trials, extracted data, assessed the methodological quality of included trials and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. Mean differences (MDs) with 95% CIs were reported.

RESULTS

Seventeen different therapies investigated in 28 trials were included in the quantitative analysis. For non-pharmacological therapies, moderate certainty evidence showed short-term effects of customised orthoses on pain intensity when compared with control (MD of -12.0 points (95% CI -17.1 to -7.0) on a 0-100 scale). Low certainty evidence showed short-term effects of taping on pain intensity (-21.3 (95% CI -38.6 to -4.0)). Long-term effects and effects on disability are still uncertain. For pharmacological therapies, low to very low quality evidence from few trials with small samples was inconclusive and supports that high-quality trials are needed.

CONCLUSIONS

Moderate-quality and low-quality evidence demonstrates customised orthoses and taping, respectively, reduce pain intensity in the short term in patients with plantar fasciitis.

PROSPERO REGISTRATION NUMBER

CRD42021224416.

Effect of Dynamic Taping versus Kinesiology Taping on Pain, Foot Function, Balance, and Foot Pressure in 3 Groups of Plantar Fasciitis Patients: A Randomized Clinical Study

BACKGROUND Biomechanical dynamic tape supports muscles, joints, and ligaments and is used in ankle and foot injuries. Kinesiology tape (KT), also known as elastic tape, is widely used in sports medicine. Plantar fasciitis, due to inflammation of the plantar fascia, is a common cause of heel pain. This study aimed to compare the effects of dynamic taping and KT on pain, function, and balance in 3 groups of patients with plantar fasciitis. MATERIAL AND METHODS Sixty-nine patients with plantar fasciitis were randomly assigned to the dynamic taping with physical therapy (PT) group, the KT with PT group, and the control group (23 each). All groups received conservative physical therapy. Dynamic taping and KT were performed twice a week for 4 weeks, and the taping was removed after 12 h of application. Patients' pain, foot function, and balance were assessed using the visual analog scale (VAS), foot function index (FFI), and Y-balance test (YBT), respectively, before and immediately after the intervention. RESULTS In the FFI and YBT, the treatment provided to the dynamic taping with PT group with PT showed a greater effect than in the KT with PT group with PT (P<0.05), and the control group showed the lowest effect. Dynamic taping and KT with PT did not show significant differences in VAS and foot pressure, but both were more effective than the control group (P<0.05). CONCLUSIONS The results of this study suggest that dynamic taping with PT is the most effective method for FFI and YBT in patients with plantar fasciitis, and that dynamic taping and KT with PT are effective methods for treating pain and foot pressure.

Platelet-rich plasma injections as a treatment for Achilles tendinopathy and plantar fasciitis in athletes

Platelet-rich plasma (PRP) injections represent a growing interest in the use of biologic therapies for treatment of musculoskeletal injuries. One possible application of PRP is in the management of overuse injuries commonly experienced by athletes. The aim of this review is to evaluate and summarize existing evidence regarding the efficacy of PRP in the treatment of Achilles tendinopathy and plantar fasciitis in athletes. Although many lower quality single-armed studies have demonstrated clinical improvement in athletes treated for Achilles tendinopathy with PRP, higher quality randomized controlled trials (RCTs) have shown no clear benefit in athletes. Existing data suggest PRP significantly improves clinical outcomes for plantar fasciitis in the general population, but very few studies and no RCTs are available that specifically analyze outcomes in athletic populations. More research is needed to evaluate how platelet concentration, leukocyte and erythrocyte presence, and sport type may interact to affect clinical outcomes in athletes.

Video-Based Information About Plantar Fasciitis Reflects Current Treatment Guidelines

BACKGROUND

Online health-related information has become increasingly popular. Social media platforms have great potential to support and change patients' perspective. Plantar fasciitis (PF) is a common disease that is one of the most frequently researched subjects among foot problems. This study aimed to assess the content, quality, and reliability of YouTube videos related to PF and to evaluate whether they reflect current PF treatment guidelines.

METHODS

The descriptive cross-sectional study analyzed the most viewed 79 YouTube videos retrieved by using the keyword "plantar fasciitis." The quality, reliability, and content of the videos were analyzed using Global Quality Scale (GQS), the modified DISCERN instrument, the Journal of the American Medical Association instrument, and a content scoring system by two independent physiotherapists. The analyzed videos were divided into three groups according to their GQS score as high, intermediate, and low quality. Also, video parameters were compared between the useful and misleading groups.

RESULTS

Of the 79 analyzed videos, 26 (32.9%) were of low quality, 29 (36.7%) were of intermediate quality, and 24 were of (30.3%) high quality. Most high-quality videos were uploaded by allied health professionals (39.4%). The view ratio and video power index scores were highest in patients. There were significant differences between useful and misleading videos in terms of DISCERN, GQS, and Journal of the American Medical Association scores (P = .000, P = .000, and P = .020, respectively). Almost all of the evaluated videos contain at least one treatment approach.

CONCLUSIONS

This study demonstrates that the vast of majority of YouTube videos on PF are useful and comprehensive; also, our results may lead us to propose that the vast majority of the videos reflect current treatment guidelines. Video-based information about PF may provide valuable insight to patients, especially in the absence of direct access to health care by stakeholders.

Efficacy of Extracorporeal Shock Wave and Pulse Electromagnetic Field Therapies in Calcaneal Spurs

BACKGROUND

Various treatment methods are available for calcaneal spur, which can cause disability. Objective: To evaluate the efficacy of pulsed electromagnetic field therapy (PEMFT) added to extracorporeal shock wave therapy (ESWT) on pain and functional capacity in treating calcaneal spurs.

METHODS

Patients with calcaneal spurs who were recommended ESWT or ESWT+PEMFT and whose Foot Function Index (FFI) and visual analogue scale (VAS) values were available in their records were retrospectively analyzed. The two groups were ESWT (n=35) and ESWT+PEMFT (n=40). FFI and VAS scores were obtained from their records before treatment, after treatment, and in the third month after treatment.

RESULTS

The two groups were similar regarding their pre-treatment FFI and VAS scores. In intra-group evaluation, statistically significant decreases were found in terms of the FFI pain, disability, and activity limitation and VAS scores in both groups after treatment and in the third month after treatment compared to the pre-treatment period. In the comparison between the groups, the post-treatment and post-treatment third-month FFI pain, disability, and activity limitation and VAS scores were significantly lower in the PEMFT+ESWT group than the ESWT group (P<0.001).

CONCLUSION

A calcaneal spur is a condition that can cause pain and functional limitation in patients. Various studies have demonstrated the efficacy of ESWT in the treatment of calcaneal spurs. In our study, we observed that PEMFT added to ESWT significantly improved the pain and functionality of the patients. Further studies are needed to evaluate the efficacy of PEMFT in calcaneal spurs.

Effects of local vibration combined with extracorporeal shock wave therapy in plantar fasciitis: a randomized controlled trial

OBJECTIVE

To compare the effects of local vibration combined with extracorporeal shock wave therapy and extracorporeal shock wave therapy alone for plantar fasciitis.

METHODS

A randomized controlled trial including 34 participants with a mean age of 37.5 years. Participants were randomly allocated to a group treated with extracorporeal shock wave therapy combined with local vibration (ESWT-LV group) or a group treated with extracorporeal shock wave therapy alone (ESWT-alone group). All participants in each group underwent 2 treatment sessions weekly for 5 weeks. Thickness of the plantar fascia, plantar pain, and foot function were measured using ultrasonography, numerical rating scale for pain, and Foot Function Index, respectively, at baseline and at the end of the 5-week intervention.

RESULTS

Significant improvements were measured in both groups in the thickness of the plantar fascia, numerical rating scale, and Foot Function Index values (p < 0.05). In addition, the thickness of the plantar fascia and pain was significantly more decreased in the ESWT-LV group than in the ESWT-alone group (p < 0.05). However, the differences between groups in Foot Function Index values were not significant (p > 0.05).

CONCLUSION

Local vibration combined with extracorporeal shock wave therapy is an effective treatment for chronic plantar fasciitis.

Comparison of the short-term efficacy of peloid and paraffin treatments on pain and quality of life in the treatment of plantar fasciitis: a randomized controlled study

Although peloid, paraffin, and exercise treatments are effective in patients with plantar fasciitis, there had been no comprehensive and comparative studies of these treatments for plantar fasciitis. The aim of our study was to evaluate the effects of peloid, paraffin, and exercise treatments on pain, functional status, and quality of life in patients with plantar fasciitis. A total of 104 patients, aged 18 years and over, who applied to our clinic with heel pain and were diagnosed with plantar fasciitis according to the American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain guideline, with pain at the level of 3 and more severe according to the visual analog scale were randomly divided into three groups: the peloid group (peloid therapy and home exercise), the paraffin group (paraffin therapy and home exercise), and the control group (home exercise). Peloid and paraffin applications were applied 5 days a week, a total of 15 sessions in 3 weeks. Participants were evaluated with the visual analog scale, heel tenderness index, and the foot and ankle outcome score before treatment, after treatment, and at the first month after treatment. Compared to pre-treatment evaluation, significant improvements were observed in all parameters after treatment and at the first month controls in all 3 groups (p < 0.05). In the peloidotherapy and paraffin therapy added groups, pain reduction and quality of life increase were higher than the exercise group (p < 0.05). Adding peloidotherapy or paraffin therapy to the home exercise program in the treatment of plantar fasciitis can further reduce pain and improve quality of life.

Effectiveness of the Graston Technique on Pain and General Foot Health in Patients with Chronic Plantar Fasciitis: A Randomized Clinical Trial

Background

Chronic plantar fasciitis has been historically treated with conventional physical therapy. The use of the Garston Technique® (GT) is a new intervention for the management of chronic plantar fascitis, but there is lack of evidence in the literature regarding its efficacy.

Study Objective

To evaluate the effectiveness of the GT on pain, foot function and general foot health in patients with plantar fasciitis.

Methods

This was a randomized clinical trial conducted from November 2020 to March 2021. The non-probability purposive sampling technique was used to select 30 patients.

Setting

Madinah Teaching Hospital, Faisalabad, Pakistan.

Participants

A total of 30 patients of both genders with a 6-week history of planter fasciitis and the presence of a calcaneus everted ≥2° were included in this study and randomly assigned to one of two groups.

Intervention

Both groups received conventional physical therapy (CPT) for 4 weeks and the experimental group in addition received GT.

Primary outcome measures

The primary outcome measures were pain, measured at baseline, after the second week and after the end of treatment (ie, the fourth week) on the visual analog scale (VAS); and general foot health and foot function, measured at baseline and after the end of treatment with the Modified Foot Health Status Questionnaire (FHSQ).

Results

The mean age of the study patients was 34.1 ± 6.67 years. There was significant improvement in pain in the GT group compared with the CPT group after the second (P = .005; partial η2 = 0.263) and the 4th (P = .000; partial η2 = 0.535) week of intervention. Foot function was also significantly improved (P < .05) in the GT group compared with the CPT group with a large effect size (Cohen's d = 0.080). But in the case of general foot health, no significant difference was observed between the groups at the end of the fourth week.

Conclusion

The use of the GT combined with CPT shows significant results compared with CPT alone; ie, GT speeds up the recovery from heel pain and foot function in patients with chronic plantar fasciitis.

Does a corticosteroid injection plus exercise or exercise alone add to the effect of patient advice and a heel cup for patients with plantar fasciopathy? A randomised clinical trial

OBJECTIVE

To compare the effectiveness of patient advice plus heel cup alone (PA) versus PA and lower limb exercise (PAX) versus PAX plus corticosteroid injection (PAXI) to improve self-reported pain in patients with plantar fasciopathy.

METHODS

We recruited 180 adults with plantar fasciopathy confirmed by ultrasonography for this prospectively registered three-armed, randomised, single-blinded superiority trial. Patients were randomly allocated to PA (n=62), PA plus self-dosed lower limb heavy-slow resistance training consisting of heel raises (PAX) (n=59), or PAX plus an ultrasound-guided injection of 1 mL triamcinolone 20 mg/mL (PAXI) (n=59). The primary outcome was changed in the pain domain of the Foot Health Status Questionnaire (ranging from 0 'worst' to 100 'best') from baseline to the 12-week follow-up. The minimal important difference in the pain domain is 14.1 points. The outcome was collected at baseline and at 4, 12, 26, and 52 weeks.

RESULTS

The primary analysis found a statistically significant difference between PA and PAXI after 12 weeks favouring PAXI (adjusted mean difference: -9.1 (95% CI -16.8 to -1.3; p=0.023)) and over 52 weeks (adjusted mean difference: -5.2 (95% CI -10.4 to -0.1; p=0.045)). At no follow-up did the mean difference between groups exceed the pre-specified minimal important difference. No statistically significant difference was found between PAX and PAXI or between PA and PAX at any time.

CONCLUSION

No clinically relevant between-group differences were found after 12 weeks. The results indicate that combining a corticosteroid injection with exercise is not superior to exercise or no exercise.

TRIAL REGISTRATION NUMBER

NCT03804008.

Which Treatment Method Is Better in the Treatment of Chronic Plantar Fasciitis: Corticosteroid Injection, Extracorporeal Shock Wave Therapy, or Radiofrequency Thermal Lesioning?

BACKGROUND

Chronic plantar fasciitis (CPF) is a common disease that has various treatment options. This study aimed to compare the effectiveness of three of these options: corticosteroid injection (CSI), extracorporeal shock wave therapy (ESWT), and radiofrequency thermal lesioning (RTL).

METHODS

The records of 229 patients treated with CSI (n = 81), ESWT (n = 76), or RTL (n = 72) were retrospectively analyzed. Visual analog scale scores, patient satisfaction-related success rates, repeated treatment rates, and initial treatment change rates were compared.

RESULTS

Mean ± SD follow-up was 19.0 ± 4.5 months. Baseline clinical characteristics, mean visual analog scale scores (before treatment and at months 3, 6, and 12), patient satisfaction and success rates (at months 6 and 12), and repeated treatment and initial treatment change rates were similar between treatment groups. No complications were observed after the treatments.

CONCLUSIONS

All three options-CSI, ESWT, and RTL-were found to be safe and effective in treating CPF, with similar outcomes up to 1 year. Use of CSIs is advantageous because it is more accessible than the other treatments. Similarly, the noninvasive nature of ESWT is glaring among other minimally invasive options. Therefore, the first-line treatment modality of CPF can be CSI or ESWT, depending on the patient's and physician's joint preference; RTL treatment should be tried in patients who do not respond to these treatments.

An overlooked cause of plantar fasciitis: Myofascial trigger point of the abductor hallucis muscle

The etiology of plantar heel pain is multifactorial. Myofascial trigger points of abductor hallucis muscle one of the muscles that should be carefully evaluated and treated in patients diagnosed with plantar fasciitis.

The effectiveness of shockwave therapy on patellar tendinopathy, Achilles tendinopathy, and plantar fasciitis: a systematic review and meta-analysis

Background

Tendinopathy is a growing global concern affecting many people, like athletes, workers, and the elderly. Despite its commonality among the sporting population, there is no practical clinical guideline for patellar tendinopathy (PT). Furthermore, there is conflicting evidence between clinical guidelines on shockwave therapy's application and clinical utility for Achilles tendinopathy (AT) and plantar fasciitis (PF). Thus, our aim of this study is to evaluate the evidence for shockwave therapy; to provide a Grading of Recommendation, Assessment, Development and Evaluation (GRADE) level of the evidence and effectiveness of shockwave therapy for patellar tendinopathy, Achilles tendinopathy, and Plantar fasciitis.

Method

Medical Literature Analysis and Retrieval System Online (Medline), Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro) and China National Knowledge Infrastructure database (CNKI) were searched to find relevant studies published before December 14th, 2022.

Results

Our study showed that for PT in the short term, extracorporeal shockwave therapy (ESWT) or ESWT + eccentric exercise (EE) has a negligible effect on pain and function compared to a placebo or placebo + EE. On the contrary, ESWT significantly affects pain compared to conservative treatment (CT). For AT, ESWT has a small inconclusive effect on pain and function in the short term compared to EE. On the other hand, a placebo outperformed ESWT in improving function for AT but not pain outcomes. PF showed that ESWT significantly affects short- and long-term pain and function. When ESWT was compared to other interventions such as low laser therapy (LLLT), corticosteroid injection (CSI), or CT, there was a small inconclusive effect on pain and function in the short term.

Conclusion

There is low-moderate evidence that ESWT has a negligible effect on pain and function for PT and AT. However, high-quality evidence suggests ESWT has a large effect on pain and function for PF.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023396835, identifier CRD42023396835.

Effects of customized insoles with medial wedges on lower extremity kinematics and ultrasonographic findings in plantar fasciitis persons

The customized insole is widely recommended as an effective intervention for pain reduction and foot function improvement in plantar fasciitis persons. However, it is unclear whether the additional correction of medial wedges could change the kinematics from the only insole. The objectives of this study were thus to compare customized insoles with and without medial wedges on lower extremity kinematics during gait and to determine the short-term effects of the customized insole with medial wedges on pain intensity, foot function, and ultrasonographic findings in plantar fasciitis persons. A within-subject, randomized, crossover design within motion analysis research laboratory was conducted among 35 persons with plantar fasciitis. Main outcome measures included joint motions of the lower extremity and multi-segment foot, pain intensity, foot function, and ultrasonographic findings. The customized insole with medial wedges produced less knee motion in the transverse plane and hallux motion in all planes during the propulsive phase than that without medial wedges (all p < 0.05). After the 3-month follow-up, the insoles with medial wedges decreased pain intensity and increased foot function. Abnormal ultrasonographic findings also decreased significantly after the 3-month treatment of insoles with medial wedges. Customized insoles with medial wedges seem superior to those without medial wedges on both multi-segment foot motion and knee motion during propulsion. Positive outcomes from this study supported the use of customized insoles with medial wedges as an effective conservative treatment in patients with plantar fasciitis.Trial registration: TCTR20210928006 (28/09/2021).

Effect of radial shock wave and ultrasound therapy combined with traditional physical therapy exercises on foot function and dorsiflexion range in plantar fasciitis: a prospective randomized clinical trial

OBJECTIVE

This study aimed to assess the effect of radial shock wave and ultrasound therapy combined with traditional physical therapy on foot function and range of motion in chronic plantar fasciitis.

PATIENTS AND METHODS

Sixty-nine participants with chronic plantar fasciitis (25-56 years) were allocated randomly into three groups. Group (A) received ultrasound (US) therapy plus conventional physical therapy exercises (in the form of stretching, strengthening exercise, and deep friction massage), Group (B) received a radial shock wave (RSW) therapy plus conventional physical therapy exercises, and Group (C) received a combination of both RSW and US therapy in addition to conventional physical therapy exercises, with 3 sessions per week for US therapy and one session for RSW therapy, in addition to 45 minutes of exercises for all groups for 4 consecutive weeks. Foot function was assessed using the foot function index (FFI), and ankle dorsiflexion range of motion was measured using the Baseline® bubble inclinometer at baseline and 4 weeks following treatment.

RESULTS

ANOVA revealed significant differences (p<0.05) in the measured outcomes among the groups after treatment. Tukey's honest significant difference post-hoc test demonstrated a highly statistically significant (p<0.001) improvement in the assessed outcomes of group C in the post-intervention settings when compared to the other groups. After 4 weeks of intervention, the mean (SD) of FFI in groups A, B, and C were (64.54±4.91, 61.93±4.17, and 45.16±4.57) respectively, and the active range of motion (ROM) of the ankle dorsiflexion were (35.27±3.22, 36.59±2.91, and 41.85±3.04) respectively.

CONCLUSIONS

The addition of RSW to US with the conventional physical therapy program improved foot function and ankle dorsiflexion range of motion significantly for patients with chronic plantar fasciitis.

Plantar Fasciitis or Flexor Digitorum Brevis Myositis

BACKGROUND

As common as plantar fasciitis is, there's a lack of evidence regarding the true pathophysiologic process causing plantar fasciitis and plantar heel pain in general. This may partially explain the high variability and outcomes with current treatment of recalcitrant plantar fasciitis. Although Lemont reported myxoid degeneration of plantar fascia with histologic analysis of patients with fasciitis, muscle biopsy results were not reported. So far it appears we have not focused on the muscular component that may be present with plantar heel pain in general and in patients we diagnose with plantar fasciitis in particular.

METHODS

In this article we performed a retrospective analysis of biopsy results from five patients with the diagnosis of recalcitrant plantar fasciitis to determine whether this diagnosis was correct or whether other component pathologies contribute to the chronicity of symptoms or to the failure of treatment.

RESULTS

Three of the five pathology reports included specific mention of inflammation, degeneration and atrophy of the intrinsic musculature consistent with myositis. Two of these showed lymphocytic infiltration in the muscle consistent with inflammation, with no signs of inflammation in the fascia. One showed inflammation of the fascia without signs of inflammation of the muscle.

CONCLUSIONS

This small study introduces the idea that intrinsic myositis may contribute to, or be responsible for some cases of plantar heel pain and plantar fasciitis. This may be important in changing the way we deal with plantar heel pain in the future.

An assessment of plantar fascia with ultrasound findings in patients with plantar fasciitis: a systematic review

INTRODUCTION

Plantar fasciitis (PFS) is described by an intense pain over medial tubercle of calcaneus, increased with the first step after waking up, after rest and during weightbearing activity. It is the most common cause of plantar heel pain in adults with the prevalence estimated 10% of the general population. Ultrasound imaging is commonly being used to measure the PF thickness, evaluate the efficacy of different treatments and a guide therapeutic technique in patients with PFS. The objective of this study was to systematically review the studies that were previously published to evaluate the role of ultrasound in the assessment of PF in patients with PFS.

METHODS

A systematic search was carried out over the last 5 years from 2017 to 2022 on basis the following electronic databases: Science Direct, Scopus, Web of Science, Springer and PubMed. The keywords that used in the searching were: ultrasound, sonography, ultrasonography, plantar fasciitis, imaging of plantar fascia, physiotherapy of plantar fasciitis, interventional treatment of plantar fasciitis, randomized controlled trial of plantar fasciitis and interventional ultrasound. The review focused on the assessment of PF in patients with PFS underwent different interventions using B-mode, shear wave elastography (SWE) and color Doppler ultrasound.

RESULTS

During the search process, 1661 were recorded using the proper keywords from 2017 to 2022 in which 666 original articles were found after removing the review and duplicated articles. Of these, thirty articles met the inclusion criteria and included in this review. The articles have assessed the PF in patients with PFS under different conditions using different ultrasound modes. Twenty-six articles evaluated the effectiveness of different treatment on PF in patients with PFS using different ultrasound modes. In 8 of 26 articles, the ultrasound was used as both an assessment tool of PF and guide therapeutic technique in patients with PFS. In 18 articles, the ultrasound was used as only assessment tool to identify the PF thickness and its observation changes in patients with PFS. Four articles compared the PF thickness and its intrafascial changes between patients with PFS and healthy subjects.

CONCLUSION

The ultrasound can be a reliable tool in assessment the effect of different interventions on PF by evaluating its thickness, echogenicity and stiffness changes in patients with PFS. There were different methods and treatments were used among the studies.

The therapeutic effect of extracorporeal shock wave therapy combined with Kinesio Tape on plantar fasciitis

BACKGROUND

Extracorporeal shock wave therapy (ESWT) combined with Kinesio Tape (KT) for plantar fasciitis (PF) is lacking in the literature.

OBJECTIVE

This study aimed to investigate the effect of ESWT combined with KT on foot pain and function in patients with PF based on ultrashort wave therapy and stretching.

METHODS

A total of 91 patients with PF were randomly divided into the ESWT group (ETG, n= 23), KT group (KTG, n= 23), combined treatment group (CTG, n= 22) and control group (CG, n= 23). Herein, changes in visual analysis scale (VAS) score, plantar fascia thickness (PFT) and American Orthopaedic Foot and Ankle Society (AOFAS) score were examined.

RESULTS

The groups were compared after 4 weeks and the results showed that the VAS scores of ETG, KTG and CTG were significantly smaller than that of CG (P< 0.05). In addition, the VAS score of CTG was significantly smaller than that of KTG (P< 0.001). Meanwhile, the AOFAS scores of ETG and CTG were significantly greater than that of CG (P< 0.001). Moreover, the AOFAS score of CTG was significantly greater than those of ETG and KTG (P< 0.01). Comparisons within groups were also conducted at weeks 0 and 4 and the results showed that the VAS scores of ETG, KTG and CTG significantly decreased (P< 0.001); the PFT of ETG and CTG significantly decreased (P< 0.05); and the AOFAS score of ETG, KTG and CTG significantly increased (P< 0.001).

CONCLUSION

Based on ultrashort wave therapy and stretching, ESWT and KT therapy could improve the foot pain and function of patients with PF, and the combined modality therapy is more effective. ESWT and combined treatment has a positive effect on patients' PFT. However, single KT treatment has a limited effect on PFT.

Lower Extremity Muscle Performance and Foot Pressure in Patients Who Have Plantar Fasciitis with and without Flat Foot Posture

Abnormal foot posture and poor muscle performance are potential causes of plantar fasciitis (PF). However, no study has compared the differences between lower extremity muscle performance and foot pressure in patients who have PF with and without abnormal foot postures. This study aimed to compare the differences in lower extremity muscle performance, such as in the hip, quadriceps, hamstring, and plantar flexor, and foot pressure in patients who have PF with and without flat foot postures. Seventy patients with plantar heel pain were enrolled (37 flat feet and 33 without flat feet). The hip muscle strength was measured using a handheld digital dynamometer. The strength and reaction time of the quadriceps, hamstring, and plantar flexor muscles were evaluated using an isokinetic device. Foot pressure parameters were assessed using pedobarography. The strength of the plantar flexor muscles was significantly lower (p = 0.008), while the reaction time of the plantar flexor muscles was significantly faster (p = 0.007) for the involved feet of PF patients with flat feet than in those without flat feet. This study confirmed the differences in muscle performance between patients who have PF with different foot postures. Therefore, clinicians and therapists should plan treatment considering the differences in these characteristics for the management of these patients.

The Short-Term Effect of Dynamic Tape versus the Low-Dye Taping Technique in Plantar Fasciitis: A Randomized Clinical Trial

BACKGROUND

Plantar fasciitis is a painful disorder that affects the plantar fascia of the foot, with a multifactorial aetiology. Dorsal flexion deficiency in the ankle is a risk factor for it. The provisional use of taping is described as part of conservative treatment. Dynamic Tape^® is a type of tape that, adhered to muscles, allows for potential elastic energy to accumulate and dissipate later, optimizing its function. Therefore, it can offer immediate benefits while the patient awaits definitive treatment depending on the cause.

OBJECTIVE

To verify the effectiveness of Dynamic Tape^® and the low-dye taping technique on pain intensity, ankle range of motion, and foot posture index.

METHOD

A randomised, double-blind clinical trial was conducted. A total of 57 subjects from the Clinical Podiatry Area of the University of Seville (Spain), clinically diagnosed with plantar fasciitis, were randomized into two groups. For one week, in the gastrocnemius-Achilles-plantar system, one group was treated with Dynamic Tape^® and another group with low-dye taping. Pain, degrees of movement of dorsal flexion, and the foot posture index were measured in both groups before the intervention and one week after the intervention. A repeated-measures analysis of variance (ANOVA) was used to explore the differences between groups.

RESULTS

Significant differences in the decrease in pain intensity using Dynamic Tape^® were found when comparing the treatments (p = 0.015) and the foot posture index was more normal in low-dye taping (p < 0.001). In both cases, the treatment showed similar behaviour with respect to the dorsal flexion ankle movement.

CONCLUSION

The effectiveness of Dynamic Tape^®, compared to that of the low-dye taping, has a major benefit with regard to pain intensity from fasciitis, although it does not produce changes in the ankle range of motion and foot posture index. Consequently, Dynamic Tape^® can be considered a taping technique with beneficial effects on pain intensity in the provisional approach to plantar fasciitis.

Plantar Fasciitis in Soccer Players-A Systemic Review

Soccer is one of the most popular sports in the world. Players often suffer a variety of injuries, the most common being injuries to muscles and tendons. It is striking that with soccer, being the most practiced sport, and considering that most injuries occur in the lower extremities, plantar fasciitis (PF) is not one of the most frequent injuries (at least in terms of clinical data collected). The purpose of this review was to provide a comprehensive update of the topic "plantar fasciitis" focusing on soccer players. The review was conducted in accordance with the PRISMA (Preferred Reportiog ltems for Systmiatic reviews and Meta-Analyses) statement. PubMed, Cochrane Library and Scopus were researched. PICO (Patient, Population or Problem; Intervention; Comparison; and Outcome) components were identified. The keywords used were "plantar fasciitis", "plantar fasciitis and sport", "plantar fasciitis risk factors", "plantar fasciitis soccer" and "plantar fasciitis football players". With respect to the objective proposed for the research, we found eight specific articles focused on soccer. Of these, five were general reviews discussing the different methods of treatment of this pathology, and we have only found three studies that focused on PF in soccer, with two of them referring to a clinical case whereby the report and discussion only dealt with the specific treatment followed by the soccer player. After reviewing the manuscripts included in this work, we were surprised that there is no data in which the Silfverskiöld test was performed, as this test explores the passive mobility of the ankle and the degree of dorsiflexion in the supine position. We concluded that soccer players suffer pain in the sole of the foot compatible with plantar fasciitis; however, as indicated by Suzue et al., it is often not diagnosed because the athlete does not consider performing the clinical examinations necessary for its diagnosis. The shortage of reported publications in soccer may mask other PF-associated injuries.

Extracorporeal shock wave therapy on pain and foot functions in subjects with chronic plantar fasciitis: systematic review of randomized controlled trials

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.

Artificial Intelligence Technology Combined with Ultrasound-Guided Needle Knife Interventional Treatment of PF: Improvement of Pain, Fascia Thickness, and Ankle-Foot Function in Patients

Objective

To explore the effect of artificial intelligence (AI) technology combined with ultrasound-guided needle knife intervention in the treatment of plantar fasciitis (PF) on pain, fascia thickness, and ankle and foot function.

Methods

A total of 130 patients with PF treated in our hospital from January 2019 to April 2021 were enrolled. The patients were randomly assigned into the control group and the study group. The control group received ultrasound-guided needle knife interventional therapy, and the study group received AI technology combined with ultrasound-guided needle knife interventional therapy. The curative effect, VAS score, plantar fascia thickness, plantar fascia elasticity score, plantar fascia blood flow index, and AOFAS score were investigated.

Results

The total effective rate of the study group was higher compared to that of the control (P < 0.05). There exhibited no significant difference in VAS score before treatment, but the VAS score of the study group was lower compared to that of the control group at 2, 4, and 8 weeks after treatment. There exhibited no significant difference in plantar fascia thickness before treatment (P > 0.05), but after treatment, the plantar fascia thickness in the study group was lower compared to that in the control (P < 0.05). The plantar fascia thickness in the study group was lower compared to that in the control at 2, 4, and 8 weeks after treatment (P < 0.05). In terms of the plantar fascia elasticity score, there exhibited no significant difference before treatment (P > 0.05), but the plantar fascia elasticity score of the study group was lower compared to that of the control at 2, 4, and 8 weeks after treatment (P < 0.05). There exhibited no significant difference in plantar fascia blood flow index before treatment (P > 0.05), but after treatment, the plantar fascia blood flow index in the study group was higher compared to that in the control (P < 0.05). The plantar fascia blood flow index in the study group was higher compared to that in the control at 2, 4, and 8 weeks after treatment (P < 0.05). There exhibited no significant difference in the AOFAS score before treatment, but after treatment, the AOFAS score of the study group was higher compared to that of the control at 2, 4, and 8 weeks after treatment.

Conclusion

Patients with PF receive AI technology combined with ultrasound-guided needle knife interventional therapy, which can effectively relieve pain and improve fascia thickness and ankle-foot function. Thus, AI technology combined with ultrasound-guided needle knife interventional therapy has the advantages of convenient operation, safety, and effectiveness, which is worthy of clinical application.

Gastrocnemius Recession in Recalcitrant Plantar Fasciitis: A Systematic Review

Plantar fasciitis is a common cause of heel pain. Recalcitrant plantar fasciitis can be difficult to manage. Medial gastrocnemius recession is increasingly being used to treat recalcitrant plantar fasciitis, with advocates describing fewer complications and quicker recovery time than other surgical options. This systematic review aimed to determine the effectiveness of gastrocnemius recession for the treatment of patients with recalcitrant plantar fasciitis. Multiple databases were searched using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The level of evidence of each study was assessed according to the American Academy of Orthopaedic Surgeons Levels of Evidence. The level of bias for each study was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Seven studies were retrieved: 3 retrospective case series, 1 retrospective study that compared gastrocnemius recession to open plantar fasciotomy, 1 prospective cohort study (pre-post study with no control group), and 2 randomized controlled trials. All 6 studies that assessed pre- and postoperative pain using the Visual Analogue Scale showed a large reduction in pain postoperatively. Four studies that assessed pain at 12 months postoperatively showed a weighted mean of 76.06 ± 10.65% reduction in pain. No major complications were reported. Minor complications included sural neuritis. This review found a consistent reduction in pain following gastrocnemius release in patients with recalcitrant plantar fasciitis, suggesting it is a very promising treatment. However, the included studies are limited by low quality study designs and inherent biases, limiting the strength of recommendation. Further definitive, well-designed trials are required.

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

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

SIGNIFICANCE

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.

[CME: Plantar fasciitis]

CME: Plantar fasciitis Abstract. Plantar fasciitis is a common pathology in general practice. There are diverse treatment options described in the literature, but no simple treatment algorithm for general practice has been published yet. In this article, we present an evidence-based and simple treatment algorithm for use in busy general practices. Important to note, adequate patient education is crucial since the patient himself has a great influence on the healing process. In most cases, conservative treatment is promising and remission can be achieved within weeks or a few months.

Platelet rich plasma versus glucocorticoid for plantar fasciitis: A protocol for systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Plantar fasciitis (PF) is the most common cause of heel pain in adult. There are a variety of ways to treat PF, but these treatments have varied result in their effectiveness, and exist different degrees of limitations. At present, clinical studies focus on the effect of glucocorticoid (GC) and platelet rich plasma (PRP) in the treatment of PF, but there is a lack of systematic evaluation PRP and GC's clinical effect towards PF. This study aims to evaluate the long-term efficacy of GCs and PRP in the treatment of PF by means of meta-analysis.

METHODS

The literature of a randomized controlled clinical trial of PRP in the treatment of plantantifasciitis was searched on the Internet. Retrieve 7 databases. EndNote X9 software was used for document management. The Jadad scale was used to score the literature. Risk assessment of the literature was conducted according to Cochrane's systematic evaluation manual 5.0. RevMan5.3 software was used for literature risk bias analysis. Stata12.0 software is used for sensitivity analysis.

RESULTS

This study will provide effective evidence-based evidence for the long-term efficacy of PRP and GC in treating PF.

CONCLUSION

A systematic review and meta-analysis were conducted for the comparison of the long-term effect of PRP and GC on plantar fascia in the treatment of PF.

Comparative Effectiveness of Minimally Invasive Nonsurgical Treatments for Plantar Fasciitis: A Network Meta-analysis of 30 Randomized Controlled Trials

BACKGROUND

Several minimally invasive nonsurgical treatments have been widely applied for plantar fasciitis (PF). To date, controversy still exists regarding the effectiveness of these approaches for treating PF.

OBJECTIVE

The purpose of this study was to perform a comprehensive comparison of the currently available invasive nonsurgical treatments for PF regarding short- and mid-term reductions in pain using a network meta-analysis (NMA).

STUDY DESIGN

NMA of randomized controlled trials (RCTs) for minimally invasive nonsurgical treatments of PF.

METHODS

The EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for eligible studies. Patients were adults age >= 18 years with PF. The outcome measures were the visual analog scale (VAS) scores at 3-6 weeks and 4-6 months. Pairwise meta-analysis and NMA based on a Bayesian analysis were performed, and all potential comparisons and rank of probabilities were calculated.

RESULTS

Thirty RCTs were included in the NMA. The trials investigated 20 treatments or combined treatments, including autologous whole blood, botulinum toxin A (BTA), ultrasound-guided gastrocnemius injection of botulinum toxin (BTA in the gastrocnemius), corticosteroid (CS), miniscalpel-needle (MSN), placebo, platelet-rich plasma (PRP), and the ultrasound-guided technique and peppering technique (PEP). The MSN treatment may be the best choice.

LIMITATIONS

Some treatments were investigated in only one study or at one follow-up period and were separated from the network at 4-6 months. Other limitations include the inconformity of the treatment schedule and dose.

CONCLUSIONS

The MSN treatment should be recommended as the best therapy, followed by BTA in the gastrocnemius and BTA. CS and PRP are common medications that remain valuable in clinical practice. PEP can be performed after the injection of medication.

[Plantar fasciitis: update 2021]

Plantar heel pain affects 4 to 9% of the population and is a common reason for consultation. Plantar fasciitis is the most frequent cause. Its diagnosis is essentially clinical, possibly supported initially by combination of X-ray/ultrasound. Ultrasound is the modality of choice to confirm the diagnosis. The prognosis is favorable, but the evolution can be long. Its management should be structured in a progressive manner, based on therapeutic education and physical measures. These simple measures have the highest level of evidence of effectiveness and should be implemented before proposing, sometimes too early, second-line therapies.

Comparison of the effect of hyaluronic acid injection versus extracorporeal shockwave therapy on chronic plantar fasciitis: Protocol for a randomized controlled trial

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/.

Effects of adjuvant low-dye Kinesio taping, adjuvant sham taping, or extracorporeal shockwave therapy alone in plantar fasciitis: A randomised double-blind controlled trial

AIM

Extracorporeal shockwave therapy (ESWT) is known as one of the most effective treatment methods in plantar fasciitis (PF). Low-dye taping, which is the most preferred method of banding treatments, provides an analgesic effect by correcting biomechanics. It was aimed to compare the efficacy of adjuvant low-dye kinesio-taping (KT), sham-taping, or ESWT alone in PF.

METHODS

In this double-blind, sham-controlled study, 45 patients with PF were randomised into Group 3 (Group 1: ESWT plus low-dye KT, n = 15; Group 2: ESWT plus Sham-taping, n = 15; and Group 3: ESWT only, n = 15) five-session ESWT were administrated. KT was performed and changed every 1-week for the ESWT sessions in Groups 1 and 2. The main outcome measures were the visual analogue scale (VAS) change, the heel tenderness index (HTI), foot function index (FFI). The patients were evaluated at the beginning and end of the treatment and at the 4-week follow-up.

RESULTS

The demographic characteristics and baseline outcomes between groups were similar (P > .05). No significant difference was found between Groups 1 and 2, Groups 1 and 3 and Groups 2 and 3 with respect to VAS, HTI changes during the 4-week follow-up. VAS and HTI changes were observed in all three groups, there were no differences between groups. Repeated-measures ANOVA showed a significant interaction between the time and the groups in FFI-total (F_3.919  = 2.607; P = .043). For the FFI total, there was only a significant difference in favour of Group 1 when compared with Group 2 (P = .027).

CONCLUSIONS

Although low-dye KT in addition to ESWT was more effective on foot function improvement than additive sham-taping and ESWT alone, it did not provide a significant benefit on pain and heel tenderness because of PF.

CLINICAL TRIAL REGISTRATION NUMBER

The study was registered at the U.S. National Institutes of Health (ClinicalTrials.gov) (NCT03904966).

Common Complaints of the Hands and Feet

Primary care providers frequently care for complaints of the hands and feet. Here, the author describes the typical presentations of hand osteoarthritis, carpal tunnel syndrome, ganglion cysts, plantar fasciitis, onychomycosis, and Morton neuroma. Useful physical examination techniques are described. The history and physical examination are usually sufficient to diagnose these conditions without the need for more advanced testing. All of these conditions have evidence-based therapy that can be initiated by the primary care provider. These treatments as well as reasons to refer to a specialist are reviewed.

Development and Validation of a Novel Scoring System for Severity of Plantar Fasciitis

OBJECTIVES

Plantar fasciitis (PF) is the most common cause of heel pain. Though PF is self-limited, it can develop into chronic pain and thus treatment is needed. Early and accurate prognostic assessment of patients with PF is critically important for selecting the optimal treatment pathway. Nevertheless, there is no scoring system to determine the severity of PF and no prognostic model in choosing between conservative or surgical treatment. The study aimed to develop a novel scoring system to evaluate the severity of plantar fasciitis and predict the prognosis of conservative treatment.

METHODS

Data of consecutive patients treated from 2014 to 2018 were retrospectively collected. One hundred and eighty patients were eligible for the study. The demographics and clinical characteristics served as independent variables. The least follow-up time was 6 months. A minimal reduction of 60% in the visual analog scale (VAS) score from baseline was considered as minimal clinically important difference (MCID). Those factors significantly associated with achieving MCID in univariate analyses were further analyzed by multivariate logistic regression. A novel scoring system was developed using the best available literature and expert-opinion consensus. Inter-observer reliability and intra-observer reproducibility were evaluated. The appropriate cut-off points for the novel score system were obtained using receiver operating characteristic (ROC) curves.

RESULTS

The system score = VAS (0-3 point = 1; 3.1-7 point = 3; 7.1-10 point = 5) + duration of symptoms (<6 months = 1; ≥1 6 months = 2) + ability to walk without pain (>1 h = 1; ≤1 h = 4) + heel spur in X-ray (No = 0; Yes = 2) + high intensity zone (HIZ) in MRI (No = 0; Yes = 2). The total score was divided in four categories of severity: mild (2-4 points), moderate (5-8 points), severe (9-12 points), and critical (13-15 points). Inter-observer agreement with a value of 0.84 was considered as perfect reliability. Intra-observer reproducibility with a value of 0.92 was considered as perfect reproducibility. The optimum cut-off value was 10 points. The sensitivity of predictive factors was 86.37%, 84.21%, 91.22%, 84.12%, and 89.32%, respectively; the specificity was 64.21%, 53.27%, 67.76%, 62.37%, and 79.58%, respectively; the area under curve was 0.75, 0.71, 0.72, 0.87, and 0.77, respectively. The Hosmer-Lemeshow test showed a good fitting of the score system with an overall accuracy of 90.6%.

CONCLUSIONS

Based on prognostic factors, the present study establishes a novel scoring system which is highly comprehensible, reliable, and reproducible. This score system can be used to identify the severity of plantar fasciitis and predict the prognosis of conservative treatment accurately. The application of this scoring system in clinical settings can significantly improve the decision-making process.

Efficacy of acupuncture versus sham acupuncture or waitlist control for patients with chronic plantar fasciitis: study protocol for a two-centre randomised controlled trial

INTRODUCTION

Plantar fasciitis (PF) is reported to be the most common cause of plantar heel pain. Acupuncture has been used for patients experiencing PF, but evidence of the efficacy of acupuncture on PF is limited. The primary objective of this trial is to compare combined acupuncture and sham acupuncture (SA) versus waitlist control for improving the level of pain experienced by patients suffering from chronic PF.

METHODS AND ANALYSIS

This will be a two-centre, parallel-group, sham and no-treatment controlled, assessor-blinded randomised trial. We will randomly allocate 120 participants with chronic PF to acupuncture, SA and waitlist control groups at a ratio of 2:1:1. Participants in the acupuncture and SA groups will receive a 30 min acupuncture or SA treatment for a total of 12 sessions over 4 weeks, with a 12-week follow-up. Participants in the waitlist control group will not undergo treatment for a period of 16 weeks but instead will have the option of 4 weeks (12 sessions) of acupuncture free of charge at the end of the follow-up period. The primary outcome will be the treatment response rate 4 weeks after randomisation, assessed as a minimum of 50% improvement in the worst pain intensity during the first steps in the morning compared with the baseline. All analyses will be performed with a two-sided p value of <0.05 considered significant following the intention-to-treat principle.

ETHICS AND DISSEMINATION

The study has been approved by the Ethical Committee of the Guang'anmen Hospital, China Academy of Chinese Medical Sciences (approval no. 2019-210-KY). The results will be disseminated through presentation at a peer-reviewed medical journal, the relevant conferences and scientific meetings.

TRIAL REGISTRATION

NCT04185259.

The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: randomized participant blind controlled trial

Objectives:

To evaluate and compare the efficacy of high-intensity laser therapy (HILT) and low-level laser therapy (LLLT) for plantar fasciitis.

Design:

A participant blind randomized controlled trial with parallel group design and an active comparator with follow-up at four weeks.

Settings:

Outpatient, University hospital.

Subjects:

Unilateral plantar fasciitis participants (n = 102) were randomly assigned into two groups. Recruitment period was from January 2017 to April 2019.

Interventions:

Interventions included eight sessions of laser therapy over three weeks and single session of patient education. The HILT group (n = 51) received HILT and the LLLT group (n = 51) received LLLT.

Main measures:

Primary outcomes: visual analogue scale; secondary outcomes: pressure algometry, sonography of plantar fascia thickness (time frame: baseline to three-week and four-week follow-up) and numeric rating scale (0%–100%) for opinion of participants on effect of treatment (time frame: three weeks). Data presented: mean (SD) or n (%).

Results:

There was no statistically significant difference between the groups according to visual analogue scale (pain in general reduction in three weeks: 2.57(3.45) vs. 2.88(3.28) cm), pressure algometry (pain threshold difference between healthy and affected heel reduction in three weeks: 1.80(6.39) vs. 1.77(2.85) kg) and sonography measurements (plantar fascia thickness difference between healthy and affected heel reduction in three weeks: 0.19(0.56) vs. 0.30(0.57) mm). There was a statistically significant difference between the groups in participants’ opinion in favor to HILT group (efficacy of treatment better than 50%: 26(51%) vs. 37(73%)).

Conclusion:

No statistically significant difference between groups was observed.

Extracorporeal shock wave therapy versus corticosteroid injection for chronic plantar fasciitis: A protocol of randomized controlled trial

BACKGROUND

The outcomes of corticosteroid injection (CSI) and extracorporeal shock wave therapy (ESWT) as primary treatment of plantar fasciitis have been debated. This study was conducted to compare and evaluate the therapeutic effects of ultrasound-guided CSI versus medium frequency ESWT in the treatment of plantar fasciitis among Chinese population.

METHODS

This study was a single-center, randomized, and double-blinded trial. The study protocol was approved by local ethics committee board and subsequently registered in Research Registry. Eighty patients with unilateral plantar fasciitis were randomized to receive either ESWT (3 times once per week) (n = 40) or CSI treatment (a single 1-mL dose of betamethasone sodium plus 0.5 mL of prilocaine under ultrasound guidance by injection into the plantar fascia) (n = 40). The primary outcome measures were visual analog scale and Foot Function Index scores. Secondary outcome measures included the heel tenderness index score and plantar fascia thickness as obtained by ultrasound examination. All of the assessments were performed at baseline and 1, 3, and 6 months after treatment.

RESULTS

This is a randomized controlled trial evaluating the efficacy of CSI versus ESWT in the treatment of plantar fasciitis. This study has limited inclusion and exclusion criteria and a well-controlled intervention.

CONCLUSIONS

The results of this trial will provide more evidence on which method can better treat plantar fasciitis.

TRIAL REGISTRATION

This study protocol was registered in Research Registry (researchregistry5428).

The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression

BACKGROUND

Shockwave therapy (SWT) is a commonly used intervention for a number of musculoskeletal conditions with varying clinical outcomes. However, the capacity of SWT to influence pathophysiological processes and the morphology of affected tissues remains unclear. The objective of the current review is to evaluate changes in imaging outcomes of musculoskeletal conditions following SWT.

METHODS

A comprehensive search of Medline, Embase, Cochrane Controlled Trials Register, CINAHL and SportDiscus was conducted from inception to October 2018. Prospective clinical trials evaluating the effectiveness of SWT based on changes in imaging outcomes were eligible for inclusion. Articles were evaluated independently for risk of bias using the Cochrane Risk of Bias list and the Methodological Index for Non-Randomized Studies. Random-effects meta-analysis and meta-regression with a priori determined covariates was conducted for each condition to determine potential predictors of SWT effects.

RESULTS

Sixty-three studies were included, with data from 27 studies available for effect size pooling. Meta-analyses and meta-regression on imaging outcomes were performed for rotator cuff calcific tendinitis (n = 11), plantar fasciitis (n = 7) and osteonecrosis of the femoral head (n = 9). There was an overall reduction in the size of measured lesion following SWT (MD 8.44 mm (95%CI -4.30, 12.57), p < 0.001) for calcium deposit diameter, (MD 0.92 mm (95%CI -0.03, 1.81), p = 0.04) for plantar fascia thickness and (MD 4.84% (95%CI -0.06, 9.75), p = 0.05) for lesion size in femoral head osteonecrosis. Meta-regression showed no influence of SWT dosage parameters, however, baseline lesion size was an independent predictor for changes in imaging outcomes.

CONCLUSIONS

SWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. The parameters of SWT dosage are not significant predictors of changes in imaging outcomes. Lack of adequate reporting of imaging outcomes limited the conclusions that could be drawn from the current review. Registration number: PROSPERO CRD42018091140.

Shock-wave therapy improved outcome with plantar fasciitis: a meta-analysis of randomized controlled trials

BACKGROUND

Shock-wave therapy (SWT) has been widely applied and proven to be an effective treatment in ameliorating symptoms of plantar fasciitis (PF). Ultrasound therapy (UT) is another common treatment of PF, and several researches have documented its advantages when compared to corticosteroid injection. Despite this, few studies have focused on comparing the use of SWT and UT in the treatment of PF. The purpose of our meta-analysis is to evaluate whether SWT is better than UT in managing PF, both in terms of ameliorating pain and improving functionality.

METHODS

A systematic search of the literature was conducted to identify relevant articles that were published in Pubmed, Medline, Embase, the Cochrane Library, SpringerLink, Clinical Trials.gov and OVID from the databases' inception to October 2018. All studies comparing the efficacy of SWT and UT in terms of pain levels and functionality improvement were included. Data on the two primary outcomes were collected and analyzed using the Review Manager 5.3.

RESULTS

Five studies were included in the current meta-analysis. A significant difference in VAS score (MD = - 13.14, Cl - 14.07 to - 12.75 P < 0.00001, I² = 100%) was noted between the SWT group and the UT group. No significant difference was seen in the AOFAS (MD = 3.19, Cl - 1.72 to 8.10 P = 0.20, I² = 100%); FFI or PFPS score was not found significant difference either (SMD = - 1.17, Cl - 4.45 to 2.10 P = 0.48, I² = 96%).

CONCLUSIONS

The results from this meta-analysis highlight the effectiveness of both SWT and UT in the treatment of PF. Although inter-group differences were not significant, the VAS score was better improved in the SWT group, suggesting that SWT may be a superior alternative for the treatment of PF.

Elastosonographic evaluation after extracorporeal shockwave treatment in plantar fasciopathy

AIM

To assess the ultrasound features in patients with plantar fasciopathy before and after extracorporeal shock waves therapy (ESWT), using conventional grey-scale imaging and both strain (SE) and shear wave (SWE) elastosonographic evaluation.

MATERIAL AND METHOD

Consecutive patients of both sexes attending our outpatient's clinic, with diagnosis of unilateral plantar fasciopathy, were enrolled. Patients were treated with 3 sessions of ESWT once a week, and underwent clinical and ultrasound evaluation at baseline and at one and three months after treatment. Roles and Maudsley score (RM), visual analog scale (VAS) and 17-Italian Foot Function Index (FFI), were used to assess pain and functional improvement.

RESULTS

Twenty patients (11 female and 9 male) were enrolled in the study. Contralateral asymptomatic healthy plantar fascia was used as a control. At baseline, SWE velocity (SWEv) showed statistically significant difference between affected 3.8 (1.5; 5.1) m/s and healthy side 4.7 (4.07; 7.04) m/s, (p=0.006); no significant difference was found for strain ratio values (p=0.656). SWEv post hoc test results showed a significant difference from baseline 3.8 (1.5-5.1) m/s and three month 5.23 (4.55-6.74) m/s follow up visit (p=0.003). Significant statistical negative correlation was found between the SWEv and VAS (p=0.001) and positive correlation between the SWEv and FFI (p=0.012).

CONCLUSION

SWE was effective in assessing plantar fascia elasticity and its alteration in fasciopathy. Furthermore, on the basis of the correlation with pain and functional scales, this technique appears to be a useful additional technique to conventional ultrasound for monitoring the efficacy of treatment.