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Plantar fasciitis: A degenerative process (Fasciosis) without inflammation

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Abstract

The authors review histologic findings from 50 cases of heel spur surgery for chronic plantar fasciitis. Findings include myxoid degeneration with fragmentation and degeneration of the plantar fascia and bone marrow vascular ectasia. Histologic findings are presented to support the thesis that "plantar fasciitis" is a degenerative fasciosis without inflammation, not a fasciitis. These findings suggest that treatment regimens such as serial corticosteroid injections into the plantar fascia should be reevaluated in the absence of inflammation and in light of their potential to induce plantar fascial rupture.

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... The exact pathology of plantar fasciitis is not certain. The common factors in this regard are excess of proteinous substance, vascularity, damage to collagen fibers, and proliferation of fibroblast in a focal region [12]. Corticosteroids are helpful in the inhibition of the proliferation of fibroblasts and the expression of proteinous substances [13]. ...
... This narrative has been proved by histological examination of the tissue taken from plantar fasciitis. The findings suggested myxoid degeneration and degeneration of the fascia as well as bone marrow with vascular ectasia [12]. PRP is considered as an autologous source of growth factors such as transforming growth factor β (TGF-β), insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and platelet-derived growth factor (PDGF). ...
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Aim: To compare the effectiveness of corticosteroids therapy and platelet-rich plasma (PRP) therapy for the treatment of plantar fasciitis. Methodology: A total of 120 participants were considered in the study. Participants were divided into two groups. Both groups consisted of 60 patients each. One group was treated with corticosteroids injection (n=60) and the other was treated with PRP (n=60). All the participants were assessed clinically at the time of induction of treatment, after six weeks of the treatment, and after six months of the treatment. The clinical assessment included the visual analog pain scale (VAS), Roles and Maudsley scoring, and the American Foot & Ankle Society (FAS). Results: A significant improvement in plantar fascia thickness, VAS, and AFAS was observed after the injection was given to the participants of both groups. The mean AFAS of the PRP group at 6 th week was 84.6±4.8 and in the sixth month, it was 90.4±2.9. The value of AFAS of the corticosteroid group at 6 th week was 75.3±4.7 and it was 80.1±4.2 in the sixth month. The mean value of VAS in the PRP group at the 6 th week was 2.5±1 and at the 6 th month was 1±0.7. Likewise, the value of VAS in the corticosteroid group at 6 th week was 4±1.2 and at 6 th week was 2.7±0.8. There were no complications in both groups. Conclusion: The corticosteroids injection and PRP injection have the same effectivity for the treatment of plantar fasciitis.
... It is known to affect approximately 1 million persons per year, and two-thirds of patients with plantar fasciitis will seek care from their family physician and one third to orthopaedic surgeon (3,4) Plantar fasciitis is caused either due to degenerating process, hard footwear, local and systemic diseases, trauma or is idiopathic. Pathological findings involve myxoid degeneration with fragmentation and degeneration of the plantar fascia and bone marrow vascular ectasia without any signs of inflammation (5). Approximately 15% of all adult foot complaints are due to this disorder (6). ...
... The above tests were normal in all cases and none had received any previous treatment. 5. General exercises -like walking, yoga etc. whichever patient was doing regularly, and no specific plantar fascia stretch exercises taught. ...
Article
A review of 121 patients of idiopathic unilateral plantar fasciitis treated with two different methods of conservative therapy is being reported here. The purpose of the study was to assess the effectiveness of the two different methods of treatment. The first method of treatment involved treatment with 1. Oral tablets of calcium carbonate with cholecalciferol 250 IU once a day for 3 months. 2. Tablet of Vitamin D3 60000 IU given once a week for 3 months. 3. Silicone insoles inside the footwear. 4. Vegetarian diet. 5. Specific plantar fascia stretch exercises, General exercises-like walking, yoga etc. whichever the patient was doing regularly. 6. Hot water fomentation for 5 minutes by dipping the leg, ankle deep, in a bucket of warm water once daily. The second method of treatment involved treatment with 1. Oral tablets of calcium carbonate with cholecalciferol 250 IU once a day for 3 months. 2. Tablet of Vitamin D3 60000 IU given once a week for 3 months. 3. Microcellular rubber insoles inside the footwear 4. No dietary restrictions 5. General exercises-like walking, yoga etc. whichever patient was doing regularly and no specific plantar fascia stretch exercises taught. 6. Ice applications-ice cubes from refrigerator used to foment the painful area for 5 minutes once daily. The heel pain subsided in 84.90% cases slowly and steadily over a period of 6 months with the first method of treatment while it subsided only in 52 % cases with the second method of treatment.
... [3] Although the etiopathogenesis of plantar fasciitis is still unclear, the degeneration of plantar fascia (PF) is considered an important mechanism. [4] One recent meta-analysis [5] found increased ankle dorsiflexion, high body mass index, and high body mass as the most significant risk factors. ...
... [5,46] Although traditionally thought to be an inflammatory process involving the PF, [1] Lemont et al discovered that the histopathology of plantar fasciitis is more related to a degenerative process, that is, a form of "fasciosis." [4] Consequently, regenerative therapies like PRP injection, ESWT, and DPT have been used in the treatment of plantar fasciitis. [24,47,48] In our meta-analysis, DPT demonstrated comparable efficacy to ESWT and PRP injection. ...
Article
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Background: Dextrose prolotherapy (DPT) is considered to be a type of regenerative therapy and is widely used in various musculoskeletal disorders. Plantar fasciitis is a common cause of heel pain that affects the quality of life of many people. We aimed to evaluate the effectiveness and safety of DPT for plantar fasciitis. Methods: PubMed, Embase, and the Cochrane Library were searched from their respective inception dates to June 2021. Only randomized controlled trials comparing DPT and other interventions for plantar fasciitis were included in this review. Standardized mean differences (SMDs) with 95% confidence intervals were calculated for comparison. The outcome measurements included visual analog score, numeric rating scale, Foot Function index, Revised Foot Function index, American Orthopedic Foot and Ankle Score, and plantar fascia thickness. Post-treatment duration was classified as short-term (1-2 months), medium-term (3 months), or long-term (6 months). Results: Six studies with 388 adult patients diagnosed with plantar fasciitis were included for the meta-analysis. In terms of pain scores improvement, DPT was superior to placebo or exercise in the short-term (SMD: -1.163, 95%CI: -2.17 to -0.156) and the medium-term (SMD: -1.394, 95%CI: -2.702 to -0.085). DPT was inferior to corticosteroid injection in the short-term (SMD: 0.781, 95%CI: 0.41 to 1.152). For functional improvement, DPT was superior to placebo or exercise in the short-term (SMD: -1.51, 95%CI: -2.96 to -0.059), but inferior to corticosteroid injection (SMD: 0.526, 95%CI: 0.161 to 0.89) and extracorporeal shock wave therapy in the short-term (SMD: 0.484, 95%CI: 0.145 to 0.822). Randomized controlled trials showed a better pain improvement in the long-term for patients treated with DPT compared to corticosteroid (P = .002) and exercise control (P < .05). No significant differences were found between patients treated with DPT and patients treated with platelet-rich plasma. Conclusion: Dextrose prolotherapy was a safe and effective treatment option for plantar fasciitis that may have long-term benefits for patients. The effects were comparable to extracorporeal shock wave therapy or platelet-rich plasma injection. Further studies with standardized protocols and long-term follow-up are needed to address potential biases.
... Impossible to isolate effect, combined treatments compared with other treatment Aigner et al. 1996 2 No control group Ashok et al. 2018 3 Lacks randomisation Atik et al. 2018 4 Commentary only Bjordal et al. 2006 5 Outcomes of interest not reported Chang et al. 2015 6 Outcomes of interest not reported Cinar et al. 2013 7 Conference paper only (author contacted) Cinar et al. 2012 8 Solely abstract available Costantino et al. 2005 9 Not LLLT, high intensity laser therapy Coughlin et al. 2014 10 Solely abstract available Fernandes et al. 1991 11 Mixed population with unclear inclusion of diagnosis Foley et al. 2016 12 Not LLLT, light emitting diode therapy Jastifer et al. 2014 13 No control group Lögdberg-Andersson et al. 1994 14 Only pooled data on lower and upper extremity available Mardh et al. 2016 15 Not LLLT, high intensity laser therapy Meier et al. 1988 16 Outcomes of interest not reported Morimoto et al. 2013 17 No control group Mulcahy et al. 1995 18 Lacks credible control group, includes only 3 patients with tendinopathy Notarnicola et al. 2014 19 Not LLLT, high intensity laser therapy Olivera et al. 2009 20 Animal study Orellana-Molina et al. 2010 21 Outcomes of interest not reported Saxena et al. 2015 22 Not LLLT Scott et al. 2011 23 Review Siebert et al. 1987 24 Mixed population/diagnoses Simunovic 1996 25 Narrative review Suleymanoglu et al. 2014 26 Conference abstract Takla et al. 2019 27 Used a combination of LLLT and light emitting diode therapy Tumilty et al. 2015 28 Conference abstract Tumilty et al. 2016 29 Not LLLT, high intensity laser therapy ...
Article
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OBJECTIVES: We investigated the effectiveness of low-level laser therapy (LLLT) in lower extremity tendinopathy and plantar fasciitis on patient-reported pain and disability. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Eligible articles in any language were identified through PubMed, Embase and Physiotherapy Evidence Database (PEDro) on the 20 August 2020, references, citations and experts. ELIGIBILITY CRITERIA FOR SELECTION OF STUDIES: Only randomised controlled trials involving participants with lower extremity tendinopathy or plantar fasciitis treated with LLLT were included. DATA EXTRACTION AND SYNTHESIS: Random effects meta-analyses with dose subgroups based on the World Association for Laser Therapy treatment recommendations were conducted. Risk of bias was assessed with the PEDro scale. RESULTS: LLLT was compared with placebo (10 trials), other interventions (5 trials) and as an add-on intervention (3 trials). The study quality was moderate to high. Overall, pain was significantly reduced by LLLT at completed therapy (13.15 mm Visual Analogue Scale (VAS; 95% CI 7.82 to 18.48)) and 4–12 weeks later (12.56 mm VAS (95% CI 5.69 to 19.42)). Overall, disability was significantly reduced by LLLT at completed therapy (Standardised Mean Difference (SMD)=0.39 (95% CI 0.09 to 0.7) and 4–9 weeks later (SMD=0.32 (95% CI 0.05 to 0.59)). Compared with placebo control, the recommended doses significantly reduced pain at completed therapy (14.98 mm VAS (95% CI 3.74 to 26.22)) and 4–8 weeks later (14.00 mm VAS (95% CI 2.81 to 25.19)). The recommended doses significantly reduced pain as an add-on to exercise therapy versus exercise therapy alone at completed therapy (18.15 mm VAS (95% CI 10.55 to 25.76)) and 4–9 weeks later (15.90 mm VAS (95% CI 2.3 to 29.51)). No adverse events were reported. CONCLUSION LLLT significantly reduces pain and disability in lower extremity tendinopathy and plantar fasciitis in the short and medium term. Long-term data were not available. Some uncertainty about the effect size remains due to wide CIs and lack of large trials. PROSPERO REGISTRATION NUMBER: CRD42017077511.
... Plantar fasciitis is the most common cause for heel pain and it is difficult to treat. In recent times, PRP has gained popularity in the treatment of various musculoskeletal disorders and in the field of sports medicine [2,3,4] . PRP has numerous growth factors and cytokines that is released from the alpha granules of the platelets which is responsible for the healing response in the plantar fascia injury zone [5,6,7] . ...
... The use of a more precise term is recommended when describing imaging findings if possible. Fasciosis 52,53 A chronic condition characterized histologically as degeneration, collagen necrosis, angiofibrotic hyperplasia, chondroid metaplasia, and fibrosis. Although primarily a degenerative process from mechanical overload with absence of an acute inflammatory infiltrate, inflammatory mediators may be present. ...
Article
Objectives: The current lack of agreement regarding standardized terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice, and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. Methods: A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus which was defined as group level agreement >80%. Results: Content was organized into seven general topics including: 1) General Definitions, 2) Equipment and Transducer Manipulation, 3) Anatomic and Descriptive Terminology, 4) Pathology, 5) Procedural Terminology, 6) Image Labeling, and 7) Documentation. Terms and definitions which reached consensus agreement are presented herein. Conclusions: The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients, and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
... Physical factors include running activities, standing for prolonged periods, and increased activity level [1,2,[6][7][8]. These factors lead to pathologic overload at the calcaneal insertion of the plantar fascia, causing degenerative changes that include microtrauma in the fascia, necrosis of collagen, myxoid degeneration, and angiofibroblastic hyperplasia [1,9]. ...
Article
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We aimed to determine the seasonal trends in internet searches for plantar fasciitis and related symptoms in various countries using search engine query data on Google. We used Google Trends to obtain internet search query data from January 2009 to December 2019. We collected monthly search volumes for the query terms “plantar fasciitis” and “heel pain” in the USA, Canada, the U.K., Ireland, Australia, and New Zealand. Statistical analysis of the seasonal effects on plantar fasciitis was performed using a cosinor model. The cosinor analyses confirmed statistically significant seasonal patterns in the relative search volumes for the terms “plantar fasciitis” and “heel pain” in the USA, Canada, the U.K., Ireland, and Australia, with peaks during the summer and troughs during the winter. For New Zealand, the seasonal trend was statistically significant only for the term “plantar fasciitis”, while a similar trend for the term “heel pain” was present without achieving statistical significance for seasonality. This seasonality is thought to be related to more frequent occurrence of plantar fasciitis due to increased physical activity of people during the warmer months. In this study, the search query data using the terms “plantar fasciitis” and “heel pain” on Google Trends show significant seasonal variation across several countries, with a peak in the summer and a trough in the winter.
... 5 Histologic analysis demonstrates marked thickening and fibrosis of the plantar fascia along with collagen necrosis, chondroid metaplasia, and calcification. 15,16 Although plantar fasciitis has historically been assumed to be primarily an inflammatory process, these findings suggest a principally degenerative mechanism, leading some authors to suggest that "plantar fasciosis" may be a more histologically accurate term. 15,17 Plantar fasciitis usually develops due to the coexistence of many etiologic factors. ...
Article
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Plantar Fasciitis (PF) is a common cause of heel pain which occurs mostly due to weight-bearing, standing occupation, injury to the heel of foot. It is often characterized by progressive pain with weight-bearing, especially the first few steps in the morning often persisting for months. Present literatures provides management strategies for this musculoskeletal issue, where different protocols were studied for their effectiveness. Myofascial release technique, plantar fascia stretching, ultrasound therapy, etc were all proven to be effective in the management of PF, but there exists very little evidence that studied the combined effects of the different physical interventions. Therefore the main objective of the study was to determine the effects of the MFR technique in combination with stretching for patients with plantar fasciitis and to find out whether this combination of interventions proved better than MFR alone. 30 subjects participated and were randomly divided into 2 groups (n=15). Group-A (control) received Myofascial Release Technique and Group B (experimental) received Myofascial Release Technique with stretching technique. Both the groups received Ultrasound therapy as a common modality. All the subjects of both groups were assessed by the Visual Analog Scale and Foot Function Index of ankle joints before and after receiving treatment. The data was analyzed statistically by using paired t-test and independent t-test. In the comparison of both groups, it was found out that the mean values of VAS (t= 4.25) and FFI (t= 4.53) of the experimental group (Group B) was highly significant (p=0.00) which concluded that Myofascial Release Technique with stretching technique is more effective in Plantar fasciitis management than only Myofascial Release Technique. From this study, conclusions could be made that in the management of Plantar fasciitis the Myofascial Release Technique with stretching technique was more precise and beneficial than only MFR technique in relieving pain and increasing functional ability.
... The normal fascia tissue is replaced by an angiofibroblastic hyperplastic tissue which spreads itself throughout the surrounding tissues creating a cycle of degeneration. [9] It is one of the conditions, which has numerous factors causing it mentioned in the literature that includes incorrect footwear, tight gastrocnemius, obesity, flat foot, sedentary lifestyle, increased BMI, pronated foot, and nerve entrapment. [3,10] In a study done by Tisdale CL in 2003, it was found that the prevalence for PF as a cause of planter heel pain was 80% among patients with symptoms. ...
Article
Introduction: Plantar fasciitis (PF) is one of the most common causes of heel pain in adults. Common causes of PF include prolonged standing, obesity, flat foot, and nerve entrapment. PF caused due to nerve entrapment is often left unnoticed when making a diagnosis or management for PF. Lateral and medial plantar nerves are the common nerves to get entrapped causing pain and tingling in the foot ultimately leading to PF. Aims: This study aimed to come up with the prevalence of PF of neural origin in community-dwelling adults. Settings and Design: A cross-sectional study was conducted on fifty patients with PF attending Department of Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune, over a 6 months period. Subjects and Methods: Patients were assessed based on their symptoms and whether they meet the criteria for diagnosing the condition as PF. Assessment for classifying PF of neural origin was done using Standard Neurodynamic Testing for Plantar nerves branch of tibial nerve. Statistical Analysis Used: Descriptive statistics was presented as frequency percentage. Results: The prevalence of neural origin PF among fifty patients was 54%. Forty-eight percent of them were females and 6% were males. Conclusion: This study concludes that the burden of PF of Neural Origin is more in Community Dwelling Adults yet goes undiagnosed due to the tendency of following a set battery of physical examination by physiotherapists which does not include neurodynamic tests.
... 2 It is a degenerative process with micro-tears and fascial thickening predominating over inflammatory changes. 3 The main concern in PF is heel pain during weight-bearing activities, especially walking, which is the most essential function for daily living. 4 A widely accepted theory is that an increased weightbearing in the foot leads to repetitive trauma or stress that can irritate the plantar fascia at its origin on the calcaneus. ...
... Lemont et al. in their study claimed plantar fasciitis is degenerative fasciosis without inflammation, not fasciitis and they questioned the role of NSAIDs and corticosteroid injections for its treatment. 8 Though conservative treatment in the form of stretching exercises of the calf, plantar fascia specific stretching, ice massaging, night splints, and orthotics are helpful in most of the cases of isolated gastrocnemius tightness but not in all, and patients do feel relief in symptoms but not completely cured. 9 American Orthopaedic Foot and Ankle Score has recommended the use of conservative treatment at least for 6 months before surgical intervention. ...
... Inflammation is classically considered the main pathogenic mechanism, but no evidence about inflammation has been found in most studies. Otherwise, evidence of degenerative changes in the plantar fascia led many authors to identify it as "fasciosis" [3]. PF usually generates pain that involves the medial calcaneal tuberosity and is often worse in the morning [1]. ...
Article
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(1) Background: Plantar fasciitis (PF) is the most common cause of heel pain in adults. Extracorporeal shockwave therapy (ESWT) is a minimally invasive treatments commonly used for treating PF. Our aim is to provide a complete overview of which treatments have been compared to ESWT, with a focus on the modalities that have been used. (2) Methods: A thorough search of the literature was performed on Medline via Pubmed, Cochrane Database of Systematic Reviews (CDSR) of the Cochrane Library and Physiotherapy Evidence Databases (PEDro) up to 18 November 2021. In the study were included only systematic reviews and meta-analysis in English language, published from 2010 to date. (3) Results: A total of 14 systematic reviews and meta-analysis were included in the umbrella review. A total of eight studies compared the efficacy of ESWT treatment with placebo, three studies compared ESWT with another therapy (two studies compared ESWT and corticosteroids, one study ESWT and ultrasound therapy), and three studies had more than one comparison. (4) Conclusions: When compared to placebo, ESWT demonstrated to be effective. More randomized trials with specific comparisons between different types and intensity of SW are needed to obtain more precise information on SW effectiveness.
... Similarly, degeneration of plantar fascia within 2-4 cm of its origin has been implicated in the lower, medial aspect of heel pain. Primarily the heel pain has been ascribed to degenerative changes at the site rather than inflammatory changes [10,13]. The primary causes of mineral imbalances are usually nutritional in origin. ...
Article
Full-text available
Introduction: The pain of the Achilles tendon and heel (ATHP) is a major concern, particularly for athletes, military people, and ordinary workers badly using inferior arts. Mineral displacement therapy to rescue the correct mineral balance in the osteoarticular districts can ameliorate heel pain. Methods: The present study investigated if treatment with mineral salts in subjects suffering from ATHP can rescue their normal health and decrease pain. A cohort of 15 persons, aged 50-65 years equally sex distributed, suffering from chronic heel pain, underwent the administration of 5.0 mg copper sulfate and 200 mg disodium-hydrogen-orthophosphate (with 500 mg of ascorbate) dissolved separately in 100 ml of drinking water as a daily beverage, morning/evening one hour after meals for three weeks. In the study, pain perception was the main outcome measure. Results: Mineral treatment improved ATHP with a different trend according to age and sex distribution. The scores of pain perception showed differential sensitivity among different genders. No one of the patients in the study experienced a relapse during the two years of follow-up. Conclusions: The present study showed that the therapeutic supplementation with displaced minerals might address the concern of heel pain in males and females with encouraging results in the early elderly population. Placebo-controlled such trials involving large populations with monitoring of blood/hair mineral profiles are suggested and further recommended. Monitoring of quantitative mineral profiles in blood and hair should be considered during medications for any ill effects.
... It can be also named as heel spur syndrome or painful heel syndrome. [1,2] Although its etiology is not fully known, limited ankle dorsiflexion, increased body mass index, long durations standing, overwork, sedentary life styles, pes cavus, pes planus, strained Achilles tendon and intrinsic foot muscles have been implicated. [3,4] For diagnosis, examination findings are critical with patient history and presence of risk factors. ...
Article
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Objectives: The aim of this study was to investigate the efficacy of peloidotherapy on pain, functional status, and quality of life (QoL) in patients with unilateral plantar fasciitis (PF). Patients and methods: This prospective, observational pilot study included a total of 80 patients (13 males, 67 females; mean age: 47.7±9.9 years; range, 28 to 68 years) with a diagnosis of unilateral PF between April 2018 and October 2018. The patients were divided into two equal groups. The study group (n=40) received peloidotherapy (five days per week for two weeks, total of 10 sessions) + Achilles tendon and plantar fascia stretching exercises (self-stretching for two weeks twice per day for 30 sec, 10 repeats) + heel cup treatment. The control group (n=40) received Achilles tendon and plantar fascia stretching exercises + heel cup treatment. The patients were evaluated before and after treatment using the Visual Analog Scale-pain (VAS-pain), Foot and Ankle Outcome Scores (FAOS), and Heel Tenderness Index (HTI). Results: The study group showed statistically significant improvements for all parameters after treatment compared to baseline (p<0.05). Control group showed statistically significant improvements in the VAS-pain, HTI, and FAOS-QoL subscales after treatment compared to baseline (p<0.05). The study group had a better improvement in the VAS-pain, FAOS-pain, and FAOS-work daily life subscales than the control group (p<0.05). Conclusion: These results indicate that peloidotherapy may be effective in reducing pain and improving functional status and QoL for patients with unilateral PF. Keywords: Heel pain, peloidotherapy, plantar fasciitis, stretching exercise
... Thus, it is frequent to find literature with the terms: neuritis, subcalcaneal bursitis, calcaneal periostitis or heel spur syndrome [3]. Lemont et al. reported that PF episodes could be associated with or without inflammation [4]. Several authors have argued that PF develops due to repeated trauma, therefore considering it an overuse injury [5]. ...
Article
Introduction: Plantar fasciitis (PF) is the most common cause of heel pain.(1) This condition was described as a degenerative syndrome associated with pain, lack of functionality and stiffness on the plantar fascia. The aim of the present study was to compare with ultrasound imaging (USI) the thickness and cross-sectional area of the intrinsic foot muscles between individuals with and without plantar fasciitis (PF). Material and methods: A total of 64 volunteers from 18 to 55 years were recruited for the present study. The sample was divided in two groups: A group, composed of participants diagnosed by PF (n = 32) and B group, composed by healthy participants (n = 32). Results: USI measurements for FBH CSA (p = 0.035) was decreasing showing statistically significant differences for the PF group, while the QP CSA (p = 0.40) was increasing reporting statistically significant differences for the PF group with respect the healthy group. The rest of the IFM did not show statistically significant differences, however in FHB, FDB, QP and AHB thicknesses and FDB CSA a slightly decrease for the PF group have been observed. Conclusions: USI measurements showed that the CSA of the FHB muscle is reduced in patients with PF while the CSA of the QP muscle is increased in patients with PF.
... It is usually a self-limiting condition and 90% of the patients can be treated conservatively using orthotics, nonsteroidal anti-inflammatory medications (NSAIDs), and exercises [4]. ...
Article
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Background Plantar fasciitis due to calcaneal spur is a common cause of heel pain and functional disability, and its management presents a huge challenge for clinicians which results sometimes in unpleasant clinical outcomes. The efficacy of extracorporeal shock wave therapy (ESWT) as an alternative therapeutic option to surgical management after failure of conservative treatment has been addressed. Our aim was to evaluate the efficacy of ESWT in the treatment of plantar fasciitis in calcaneal spur patients using ultrasonography. Results The mean plantar fascia (PF) thickness was statistically significantly higher in the calcaneal spur patient group (5.66 ± 1.14 mm) than in the healthy control group (2.40 ± 0.35 mm), ( P = 0.001). Significant PF thickness reduction, visual analog scale (VAS), and Roles and Maudsley score (RMS) improvement were observed ( P < 0.001) after 4 sessions of ESWT. Conclusion PF thickness increases significantly in calcaneal spur patients and responds to treatment. ESWT decreases the thickness of the PF and improves pain and function significantly.
... This musculoskeletal disorder accounts for 3% of all injuries associated with sports activities and 14% of all injuries in runners [9,10]. Although the word "fasciitis" assumes an inflammatory state, the evidence shows that PF is a degenerative disorder and should be appropriately classified as a "fasciosis" or "fasciopathy" [11][12][13]. PF is a degenerative syndrome of the plantar fascia resulting from frequent trauma on the calcaneus [14,15]. Over time, the repetitive trauma makes structural fatigue and weakening of the connective tissue, leading to pain and discomfort on the medial plantar side of the foot in heel area [15]. ...
Article
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Introduction: Plantar Fasciitis (PF) is an overuse syndrome as it develops over time. It is most frequently seen in both the non-athletic and athletic populations. PF is a multifactorial and self-limiting disorder that several factors are involved in its onset. Many well-established treatments are available for plantar heel pain. The purpose of this review is to determine the effectiveness of dry needling for the management of PF. Materials and Methods: This article is a review study, in which we present the studies that compare dry needling with other treatments for the management of plantar heel pain. We included all of the studies on patients with plantar heel pain and plantar fasciitis that investigated the effects of dry needling. Finally, seven articles were included in this review. The study designs were randomized controlled, quasi-experimental, and case-control. The Physiotherapy Evidence-based Database (PED) scale was used to measure the methodological quality of the studies. Results: The PEDro scoring of the articles ranged between 2.10-7.10. The results of this review show that dry needling may be useful in improving the pain of individuals with plantar heel pain and plantar fasciitis. Conclusion: Further high-quality research studies are needed to determine the effectiveness of dry needling in the management of plantar heel pain. Because a variety of protocol treatments of dry needling were used in the studies, we cannot recommend dry needling schedule prescriptions for the management of individuals with plantar heel pain and plantar fasciitis.
... The use of a more precise term is recommended when describing imaging findings if possible. Fasciosis 52,53 A chronic condition characterized histologically as degeneration, collagen necrosis, angiofibrotic hyperplasia, chondroid metaplasia, and fibrosis. Although primarily a degenerative process from mechanical overload with absence of an acute inflammatory infiltrate, inflammatory mediators may be present. ...
Article
The current lack of agreement regarding standardised terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus, which was defined as group level agreement of >80%. Content was organised into seven general topics including: (1) general definitions, (2) equipment and transducer manipulation, (3) anatomical and descriptive terminology, (4) pathology, (5) procedural terminology, (6) image labelling and (7) documentation. Terms and definitions which reached consensus agreement are presented herein. The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
... These patients present with night pain, pain with the initial steps after waking up in the morning which gets relieved with further walking and rest. [12][13][14] Treatment aspect ranges from initial conservative methods such as ice pack, underwater exercises, log roll under the feet, MCR footwear to invasive techniques such as local steroid injection or platelet-rich plasma infiltration to surgical excision of the spur in cases which are not responding to any other alternative methods. [15][16][17][18] Our study was to assess the functional outcome of surgical excision of calcaneal spurs coupled with a dose of autologous plateletrich plasma injection in symptomatic patients who are recalcitrant to conservative methods of treatment. ...
Article
The calcaneal spur is also known as an enthesophyte which is a bony outgrowth from the calcaneum at the plantar fascia insertion. Treatment aspect ranges from initial conservative methods, invasive techniques to surgical excision of the spur in cases which are not responding to any other alternative methods. This article aims in evaluating the functional outcome of calcaneal spur excision coupled with a dose of autologous platelet-rich plasma injection in recalcitrant cases of the calcaneal spur. A total of 42 cases of confirmed calcaneal spur cases were recruited for the study. All participants were offered with calcaneal excision with a dose of autologous platelet-rich plasma injection. All patients were evaluated preoperatively and post-operatively with VAS and FFI scores at the end of the 1, 3 and 6 months. The patients who received calcaneal spur excision along with a single dose of autologous platelet-rich plasma injection reported statistically significant pain relief at the end of 6 months while comparing with the pre-operative VAS score (p = 0.003) and FFI score showed a statistically significant functional outcome between both groups at the end of 6 months (p <0.001). Surgical removal of calcaneal spur along with a dose of an autologous platelet-rich plasma injection serve the better management for calcaneal spur and improves the functional quality of life.
... Choudhary and Kunal supported the consideration that PF is an overuse injury, due to the repeated trauma etiology [1]. In this context, muscle and soft tissue inflammation episodes could be associated with one another, but their presence remains doubted and understudied [6,7]. Individuals with PF reported that they experience severe pain when they wake up or following non-activity periods (e.g., sleeping or working sitting down) [8]. ...
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Objective: The primary aim of the present study was to compare the echo intensity (EI) and echovariation (EV) of the intrinsic foot muscles (IFMs) between individuals with and without plantar fasciitis (PF), using ultrasound imaging. The secondary objective was to study the intra-rater reliability of the echotexture variables. Methods: A case-control study was conducted with 64 participants, who were divided into the following two groups: A, the PF group (n = 32); B, the healthy group (n = 32). Results: The comparison between the two groups did not identify significant differences (p > 0.05) between the flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), quadratus plantae (QP) and abductor hallucis brevis (AHB) variables for the EI and EV. Moreover, excellent intra-rater reliability was reported for the following ultrasound imaging EI variables: ABH (ICC = 0.951), FHB (ICC = 0.949), FDB (ICC = 0.981) and QP (ICC = 0.984). Conclusions: The muscle quality assessment using the EI and EV variables did not identify differences in the FHB, FDB, AHB and QP muscles between individuals with and without PF through USI evaluation. The reliability of all the IFM measurements was reported to be excellent.
... However, many other causes of plantar fasciitis have been advocated for, including nerve trap, bone bruise of the calcaneus, plantar fascia tightening, gastrocnemius contracture, neurogenesis, chronic degenerative changes in the plantar fascia origin, 3,4 microtears of the plantar fascia, and collagen necrosis. 23 Moreover, in the case of plantar fasciitis without calcaneal spur, the causes of pain may differ from those of plantar fasciitis with calcaneal spur. Further studies are necessary to understand how these causes are related. ...
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Background Studies on endoscopic calcaneal spur resection (CSR) without plantar fascial release (PFR) are limited. This study aimed to review the data of patients who underwent fluoroscopic and endoscopic CSR without PFR for plantar fasciitis with a calcaneal spur to assess the effectiveness of CSR. Methods Medical records of consecutive patients with plantar fasciitis with ≥2 mm calcaneal spur who underwent endoscopic CSR without PFR from November 2017 to December 2019 were reviewed. Patients with ≥2 years of follow-up were included, whereas those who underwent another surgery on the operated foot were excluded. Age, body mass index (BMI), follow-up duration, calcaneal spur length, duration to full weightbearing postoperatively, Japanese Society for Surgery of the Foot (JSSF) score, visual analog scale (VAS) score for pain, and complications were assessed. Results The mean follow-up duration was 2.7 years. A total of 47 patients (31 female, 16 male; mean age, 56.4 years; mean BMI, 25.5) were included. The mean calcaneal spur length was 5.7 mm. The VAS score improved from 79.6 ± 12.9 mm preoperatively to 5.3 ± 7.3 mm postoperatively. The JSSF score improved from 54.0 ± 19.1 points preoperatively to 97.5 ± 5.7 points postoperatively (Wilcoxon signed-rank test, P < .001, respectively). The mean duration to full weightbearing postoperatively was 4.4 ± 4.2 days. Two patients presented with tenderness, and one presented with hypesthesia at the portal site. Conclusion Endoscopic CSR without PFR resulted in good outcomes, early return to full weightbearing, and few complications in patients with plantar fasciitis with ≥2 mm calcaneal spur. The results suggested that CSR was sufficient to relieve symtoms and improve function. PFR may not be necessary for treating plantar fasciitis with calcaneal spur. Level of Evidence Level IV, retrospective case series.
... Plantar fasciitis has an unclear pathophysiology. Plantar fasciitis, according to Lemont et al., is a degenerative alteration dominated by metatarsal fascia degradation [5]. Heel discomfort, according to Nery et al., is caused by chronic metatarsal fascia tension, which is subsequent to aseptic inflammation induced by microtears caused by repetitive microinjury [6]. ...
Article
Introduction One of the most prevalent ailments for which people seek treatment at a foot and ankle surgery facility is heel discomfort. Plantar fasciitis (PF) is one of the most common causes of adult heel pain and accounts for 11 to 15 % of all foot illnesses requiring medical care. The major symptom is pain and soreness at the heel where the plantar fascia is attached while starting weight- bearing after lengthy periods of rest. Rest, non-steroidal anti-inflammatory drugs (NSAIDs), stretching of the plantar fascia, physical therapy, foot cushioning, and orthotic devices, which may be utilized to meet the patient's demands, are some of the current conservative therapies for PF(planter fasciitis). In intractable instances of plantar fasciitis, where conservative therapy have failed to provide relief, steroid injections into the plantar fascia are often employed. Other treatment options for PF, including extracorporeal shockwave therapy (ESWT) are advised if patients do not react to conservative therapies. Patients and methods This study included 50 patients with chronic PF who had failed to react to conservative treatments such as physical therapy, NSAIDs, stretching exercises, and heel cushions for at least 6 months, and who did not have flatfeet or gastrocnemius contracture met the inclusion criteria. Patients were randomly divided into 2 groups: 25 patients received radial extracorporeal shockwave therapy (ESWT) once a week for six weeks (Group I); 25 patients got a single local corticosteroid injection at the plantar fascia's origin (40 mg / 2 ml of methylprednisolone together with 1 ml of local anesthesia, once) (Group II). Assessment of heel pain was done at the start of the trial and before each session using VAS score which was the primary outcome measure at 1, 3 and 6 months. Results A total of 50 individuals with persistent planter fasciitis (PF) were included in this investigation. Their age varied from 25 to 45 years old. Females made up 70 % of the sample, while males made up 30 %. Group I: 25 patients with PF who got extracorporeal shockwave treatment for 6 weeks at a time (once a week). There were 17 females (68 %) and 8 males (32 %), in the age ranging from 28 to 44 (mean SD 18.2).Group II: consisted of 25 individuals with PF who were given a local corticosteroid injection. There were 18 females (86.7 percent) and 7 males (13.3 percent) with ages ranging from 25 to 45 years (mean SD 21.9). Group I included 20 patients (80 %) and group II had 22 patients (88 %) who had pain in one foot, whereas 5 (20 %) patients and 3 (12 %) patients had pain in both feet, with no statistically significant difference. There was no significant difference between the groups in terms of the VAS score at the start of the trial (p = 0.26), the mean VAS scores were 6.4 and 6.2 in groups I and II, respectively. At one month, the mean VAS scores were 1.6 and 1.2 in group I and II, respectively. At 3 months, the mean VAS score were 2.2 and 1.7, at 6 months 5.1 and 2.3 for groups I and II, respectively. Conclusion ESWT and local corticosteroid injection therapies are safe and effective but local corticosteroid injection is more effective than ESWT in the treatment of chronic plantar fasciitis.
... Plantar fasciitis results when plantar fascia cellular damages overcome the repair process and plantar fascia remains unable to heal. This nonhealing is accompanied by altered collagen synthesis and disrupted collagen repair leads to hyperirritable tender points in plantar fascia [43,44]. Along with microtears in plantar fascia, cell death (apoptosis) and collagen and tissue breakdown near the calcaneum accompanied with inflammation in early stage but not in later also contribute to plantar fasciitis [45]. ...
Article
Plantar fasciitis or the inflammation of the fascial lining on the plantar aspect of the foot continues to be the leading cause of heel pain for many Americans. Common causes can range from anatomical deformities such as pes planus or flat foot, biomechanical etiology such as excessive pronation of the subtalar joint, or chronic diseases such as obesity and diabetes mellitus. The pathophysiology of plantar fasciitis can be either inflammatory due to vasodilation and immune system activation or non-inflammatory involving fibroblastic hypertrophy. Worsening pain of the inferior and medial heel after periods of prolonged rest and late in the day after hours of ambulation and weight-bearing activities is the most common symptom of plantar fasciitis. Common treatments for plantar fasciitis include plantar fascia stretching, physical therapy, orthotics, corticosteroid injections, and even surgery. Despite these treatment strategies, fasciitis remains a clinical problem and better treatment modalities are warranted. Late diagnosis is a common issue for prolonged and equivocal treatment and early diagnostic measures might be beneficial. In this concise review, we discussed the etiology, immunopathogenesis, current treatments of plantar fasciitis and potentially preventative measures prior to the onset of chronic treatment resistant condition.
... There is also a positive correlation between the presence of heel pain and flatfoot [5,6]. This model of causation is not supported due to factors such as firstly, the direction of trabeculae is vertical-indicative of vertical compression; secondly, excision of the spur is followed by reformation and thirdly, there are no signs of inflammation seen at the site after histological examination in surgical excision [7,8]. ...
... As noted above, PF is considered an overuse injury, being repetitive trauma or load mismanagements the main etiology factors for its development [15]. In addition, episodes might be accompanied with or without inflammation [16]. Cotchett et al. argued that individuals with PF feel pain within the first steps in the morning or after inactive periods [17]. ...
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The present study aimed to compare by ultrasound imaging (USI) the tibial posterior (TP), medial gastrocnemius (MG) and soleus muscle in patients with and without plantar fasciitis (PF). A sample of 42 individuals was recruited and divided into two groups: PF and a healthy group. The thickness, cross-sectional area (CSA), echointensity and echovariation were assessed in both groups by USI. TP, soleus and MG variables did not report differences (p > 0.05) for thickness and CSA. For the echotexture parameters significant differences were found for MG echointensity (p = 0.002), MG echovariation (p = 0.002) and soleus echointensity (p = 0.012). Non-significant differences (p > 0.05) were reported for soleus echovariation, TP echointensity and TP echovariation variables. The thickness and CSA of the TP, GM and soleus muscle did not show significant differences between individuals with and without PF measured by USI. Muscle quality assessment reported an increase of the MG echointensity and echovariation, as well as a decrease of echointensity of the soleus muscle in the PF group with respect to the healthy group. Therefore, the evaluation of the structure and muscle quality of the extrinsic foot muscles may be beneficial for the diagnosis and monitoring the physical therapy interventions.
... The pathophysiology and etiology of PCS is poorly understood and several theories have been proposed [1,12]. Traditional explanation, suggests that repetitive traction, due tension force on plantar fascia leads to inflammation and reactive ossification with formation of bone spurs [13][14][15][16]. Evidence to support this hypothesis can be derived from studies, which have shown that plantar fascia tension increases with reduction longitudinal arch, i.e., pronation feet in patients with PCS [11,12,17,18] and that the heel pain are more likely to be flatfooted [19][20][21]. ...
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Backround Calcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression. Objective Investigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur. Methods Design: A single-blinded, randomized and controlled trial. Setting: Biomechanics laboratory. Participants: Forty-three women, 29 with calcaneal spur and 14 control. Intervention Gait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 ± 9.4, height: 1.61 ± 0.1, BMI: 32.1 ± 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 ± 5.8, height: 1.62 ± 0.1, BMI: 32.2 ± 4.3) and control (CG n = 14, age: 47.8 ± 8.6, height: 1.63 ± 0.1, BMI: 27.5 ± 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h per week (six hours a day, seven days a week). Outcome primary were calcaneus pain (visual analogue scale), Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br) and 6-min walk test (6MWT). Secondary was plantar pressure distribution by a pressure platform system during gait and static index foot posture (FPI). Statistical analysis: analysis of variance for repeated measure and between groups were used to detect treatment-time interactions (α = 5%). Effect size with D Cohen’s also was used between T0 and after six (T6) months of intervention. Results The MFG and COIG were effective at reducing pain after six months (MFG: 2.5–4.5 CI, p = 0.001; COIG: 1.5–3.5 CI, p = 0.011). The FFI and FHSQ-Br showed improvements with MFG and COIG after T6 (MFG: 13.7–15.4 CI, p = 0.010; COIG: 11.3–15.0 CI, p = 0.001). The 6MWT increased with MFG (589.3–622.7 CI) and COIG (401.3–644.7 CI) and foot pronation was decreased after T3 and T6 MFG (FPI Right: 4.2–5.4 CI; Left: 3.6–5.4 CI) COIG (FPI Right: 3.4–6.8 CI; Left: 3.3–5.7 CI). The contact area reduced on forefoot and rearfoot with MFG and GOIG and midfoot and rearfoot with MFG. Maximum force was reduced on foot with MFG after T3 and T6. The peak pressure was reduced on the forefoot with MFG and COIG and on midfoot and rearfoot with MFG. Conclusions The mechanical treatment with customized insole and minimalist flexible footwear during gait training program during six months in women with calcaneal spur reduced the calcaneus pain, increased function and health feet and reduced plantar load on the rearfoot, midfoot and forefoot. However, the footwear alone was more effective than when combined customized insole, given the greater efficacy on clinical and biomechanical aspects. Trial registration ClinicalTrials.gov NCT03040557 (date of first registration: 02/02/2017).
Chapter
Stress fractures of the foot and ankle in athletes represent a challenging problem for the orthopedic surgeon, as they are associated with high rates of reoccurrence and long-lasting absence from daily sport activities. In elite sports, stress fractures most commonly occur in the lower extremity.
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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.
Chapter
Plantar fasciitis is one of the most common disorders in runners and it can reduce a player’s running ability. Reliable diagnosis with the patient’s history, physical examination, and imaging is required in planning treatment. The thickness of the proximal plantar fascia is considered to reflect the pathology of plantar fasciitis, and ultrasonography can be a reliable method for the measurement of plantar fascia thickness. In runners, treatments that can degrade performance should be avoided. Most patients will respond to conservative modalities including manipulation and stretching, extracorporeal shockwave therapy, and local injection of platelet-rich plasma, which are considered as the first line treatment. When conservative treatment has failed, endoscopic partial fasciotomy is one of the options. The authors recommend endoscopic partial fasciotomy with resection of calcaneal spurs using the deep fascial approach, which enables a wider field of vision and a large working space.
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Ankle sprains and instability are among the most common musculoskeletal disorders in track and field athletes. They are associated with pain, loss of function, inability to sport, and loss of performance. Adequate diagnosis and treatment of ankle sprains will minimize the risk of long-term consequences including chronic instability and cartilage degeneration. The current chapter serves as a comprehensive overview of the most important aspects of diagnosis and treatment of lateral ankle sprains and instability with a special consideration for this type of injury in track and field athletes.
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Background: Lower-limb running injuries are common. Running shoes have been proposed as one means of reducing injury risk. However, there is uncertainty as to how effective running shoes are for the prevention of injury. It is also unclear how the effects of different characteristics of running shoes prevent injury. Objectives: To assess the effects (benefits and harms) of running shoes for preventing lower-limb running injuries in adult runners. Search methods: We searched the following databases: CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus and SPORTDiscus plus trial registers WHO ICTRP and ClinicalTrials.gov. We also searched additional sources for published and unpublished trials. The date of the search was June 2021. Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs involving runners or military personnel in basic training that either compared a) a running shoe with a non-running shoe; b) different types of running shoes (minimalist, neutral/cushioned, motion control, stability, soft midsole, hard midsole); or c) footwear recommended and selected on foot posture versus footwear not recommended and not selected on foot posture for preventing lower-limb running injuries. Our primary outcomes were number of people sustaining a lower-limb running injury and number of lower-limb running injuries. Our secondary outcomes were number of runners who failed to return to running or their previous level of running, runner satisfaction with footwear, adverse events other than musculoskeletal injuries, and number of runners requiring hospital admission or surgery, or both, for musculoskeletal injury or adverse event. Data collection and analysis: Two review authors independently assessed study eligibility and performed data extraction and risk of bias assessment. The certainty of the included evidence was assessed using GRADE methodology. Main results: We included 12 trials in the analysis which included a total of 11,240 participants, in trials that lasted from 6 to 26 weeks and were carried out in North America, Europe, Australia and South Africa. Most of the evidence was low or very low certainty as it was not possible to blind runners to their allocated running shoe, there was variation in the definition of an injury and characteristics of footwear, and there were too few studies for most comparisons. We did not find any trials that compared running shoes with non-running shoes. Neutral/cushioned versus minimalist (5 studies, 766 participants) Neutral/cushioned shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with minimalist shoes (low-certainty evidence) (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.59 to 1.01). One trial reported that 67% and 92% of runners were satisfied with their neutral/cushioned or minimalist running shoes, respectively (RR 0.73, 95% CI 0.47 to 1.12). Another trial reported mean satisfaction scores ranged from 4.0 to 4.3 in the neutral/ cushioned group and 3.6 to 3.9 in the minimalist running shoe group out of a total of 5. Hence neutral/cushioned running shoes may make little or no difference to runner satisfaction with footwear (low-certainty evidence). Motion control versus neutral / cushioned (2 studies, 421 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral / cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.92, 95% CI 0.30 to 2.81). Soft midsole versus hard midsole (2 studies, 1095 participants) Soft midsole shoes may make little or no difference to the number of runners sustaining a lower-limb running injuries when compared with hard midsole shoes (low-certainty of evidence) (RR 0.82, 95% CI 0.61 to 1.10). Stability versus neutral / cushioned (1 study, 57 participants) It is uncertain whether or not stability shoes reduce the number of runners sustaining a lower-limb running injuries when compared with neutral/cushioned shoes because the quality of the evidence has been assessed as very low certainty (RR 0.49, 95% CI 0.18 to 1.31). Motion control versus stability (1 study, 56 participants) It is uncertain whether or not motion control shoes reduce the number of runners sustaining a lower-limb running injuries when compared with stability shoes because the quality of the evidence has been assessed as very low certainty (RR 3.47, 95% CI 1.43 to 8.40). Running shoes prescribed and selected on foot posture (3 studies, 7203 participants) There was no evidence that running shoes prescribed based on static foot posture reduced the number of injuries compared with those who received a shoe not prescribed based on foot posture in military recruits (Rate Ratio 1.03, 95% CI 0.94 to 1.13). Subgroup analysis confirmed these findings were consistent between males and females. Therefore, prescribing running shoes and selecting on foot posture probably makes little or no difference to lower-limb running injuries (moderate-certainty evidence). Data were not available for all other review outcomes. Authors' conclusions: Most evidence demonstrates no reduction in lower-limb running injuries in adults when comparing different types of running shoes. Overall, the certainty of the evidence determining whether different types of running shoes influence running injury rates was very low to low, and as such we are uncertain as to the true effects of different types of running shoes upon injury rates. There is no evidence that prescribing footwear based on foot type reduces running-related lower-limb injures in adults. The evidence for this comparison was rated as moderate and as such we can have more certainty when interpreting these findings. However, all three trials included in this comparison used military populations and as such the findings may differ in recreational runners. Future researchers should develop a consensus definition of running shoe design to help standardise classification. The definition of a running injury should also be used consistently and confirmed via health practitioners. More researchers should consider a RCT design to increase the evidence in this area. Lastly, future work should look to explore the influence of different types or running shoes upon injury rates in specific subgroups.
Article
Background Currently, there is limited evidence on outcomes for plantar fascia radiofrequency microtenotomy. We aim to provide an evidence-based systematic review and meta-analysis for outcomes of radiofrequency microtenotomy for the treatment of plantar fasciitis. Methods A comprehensive evidence-based literature review of PubMed and Cochrane Databases was conducted in March 2019, which identified 11 relevant articles assessing the efficacy of plantar fascia radiofrequency microtenotomy. The studies were then assigned to a level of evidence (I-IV). Individual studies were reviewed to provide a grade of recommendation (A-C, I) according to the Wright classification in support of or against endoscopic plantar fascia release. Meta-analysis was performed for 7 of the studies that measured AOFAS scores. Results Based on the results of this evidence-based review, there was fair (grade B) evidence to support plantar fascia radiofrequency microtenotomy. There was a statistically significant mean increase of 40.9 in AOFAS scores post procedure. Conclusion There was fair (grade B) evidence to recommend radiofrequency microtenotomy for plantar fasciitis. There is a need for more high quality level I randomized controlled trials with validated outcome measures to allow for stronger recommendations to be made. Level of Evidence Level II, systematic review of Level II studies.
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Background The biggest challenge in treating this diagnosis is the lack of literature focusing on regional interdependence. The current literature suggests a narrow and localized approach targeting plantar fascia and ankle/foot complex. The literature available on conservative treatment focused on utilizing various inflammatory modalities such as injections and extracorporeal shockwave therapy. The surgical approach targets Baxter’s nerve decompression techniques and releases techniques to the gastrocnemius and plantar fascia. The article focuses on utilizing manual therapy techniques to the lumbosacral spine and plantar fascia. In addition, the neurodynamic flossing targeted lateral plantar nerve mobility. Case presentation The patient is a 54-year-old African American female seen for right heel pain at Texas’s outpatient orthopedic physical therapy clinic. The patient had the diagnosis of plantar fasciopathy with negative Windlass testing. The patient was provided manual therapy interventions to the lumbosacral spine and plantar fascia to improve weight-bearing patterns and overall functional outcomes. Conclusion The manual therapy interventions to the lumbosacral spine and plantar fascia and flossing techniques to the lateral plantar nerve improved symptoms of heel pain. The patient showed improved outcomes with this approach.
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Plantar medial inferior heel pain is a common complaint in athletes and is frequently caused by plantar fasciitis and/or distal tarsal tunnel syndrome (Baxter's neuropathy). Obtaining an accurate diagnosis is crucial but may be challenging due to a similar site of pain and overlapping symptoms. While both conditions often resolve with nonoperative management, they may present with a prolonged symptomatic course that can last 10 - 12 months. Consequently, providers treating athletes should understand the various therapies proposed to address these pathologies as no one optimal treatment strategy has emerged. Stretching exercises, orthotic devices, extracorporeal shock wave therapy (ESWT), plasma-rich protein (PRP) injections, and endoscopic plantar fascia release have garnered the most attention for the management of plantar fasciitis. Rest, non-steroidal anti-inflammatories (NSAIDs), and open distal tarsal tunnel release have been employed for the treatment of Baxter's neuropathy. This review summarizes recent literature on the diagnosis, numerous nonoperative treatment options, and surgical management of plantar fasciitis and distal tarsal tunnel syndrome.
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Acute and chronic hamstring injuries are common in athletics. Acute injuries account for 17.1% of all injuries. Chronic injuries (proximal hamstring tendinopathy) are seen less frequently, however, but true incidences are unknown. Acute injuries occur at the (from most frequent to less frequent) musculotendinous junction (MTJ), the intramuscular tendon and the free tendons (partial- or full-thickness injury). Proximal hamstring tendinopathy occurs in the proximal hamstring free tendons. Diagnosis of these injuries is mostly clinical but can be supported by imaging such as magnetic resonance imaging or ultrasound. Treatment for partial-thickness MTJ acute hamstring injuries is informed by 14 RCTs. For proximal hamstring tendinopathy and partial- or full-thickness free tendon injuries, there is little evidence to guide treatment. Cornerstone of treatment is physiotherapy-based interventions with progressive (eccentric) loading and activity modification, combined with expectation management. Surgery is usually reserved for full-thickness free tendon injuries. Other treatments such as platelet-rich plasma injections, corticosteroid injections and non-steroidal anti-inflammatory medication have little supportive evidence and should be avoided.
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Muscle injuries are the most common injuries in professional athletes forced to high-intensity sprinting efforts. Due to a high recurrence rate and possible consequences for elite athletes, it is one of the most challenging tasks for a sports medicine team to prepare a professional athlete to return to performance. This results in an ongoing search for new treatments to improve and accelerate muscle healing. In this chapter, we describe the principle of muscle healing and discuss the contemporary biological therapies with the available scientific evidence on their efficacy and safety.
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Introduction: Infrared thermography is a safe, non-invasive and low-cost technique that allows for the fast recording of skin temperature. Plantar fasciopathy is the result of degenerative irritation of the plantar fascia and one of the most common musculoskeletal disorders. The aim of the study was to determine if plantar fasciopathy patients have a specific foot sole thermal profile that might be detect by infrared thermography. Patients and methods: 32 feet of 16 subjects with unilateral plantar fasciitis were analyzed. The nonsymptomatic foot was taken as control. Foot sole temperatures were divided in 9 regions of interest and extracted by specific software to obtain thermal asymmetries between right and left foot sole regions. T-student test was used to determine significant statistical differences between feet and regions. Results: Subjects with plantar fasciopathy showed significantly higher temperatures in the injured sole of the foot, mainly in the arch and heel regions (with asymmetries ranging from 0.28 °C to 0.55 °C [p < 0.05]). Conclusions: Patients with plantar fasciopathy present a specific thermal profile with significant hyperthermia in the sole of the injured foot. Such asymmetry can be effectively detected by using infrared thermography to evaluate and diagnose this pathology.
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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.
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Plantar fasciitis is one of the most common causes of foot pain. It results from sustained stress of weight bearing - hopping, jumping, running -which results in micro trauma to plantar fascia which further leads to plantar fasciitis. It constitutes 11% to 15% of all foot symptoms. Its prevalence is 8% to 10% in general population. It commonly affects at the age of 40 to 60 years. Recently platelet rich plasma was used in treating in degeneration, muscle and tendon injuries. Hence, the present study aimed to assess the treatment outcome of autologous platelet rich plasma injection in treatment of plantar fasciitis. In this prospective study, we enrolled 35 patients with plantar fasciitis coming to OPD or casualty. Patients satisfying inclusion criteria were selected based on consecutive sampling. 11 patients responded well to conservative management and 3 patients had loss of follow up. The different scoring systems were adopted such as VAS and AOFAS for pain assessment. The thickness of plantar fascia was determined by ultrasound technique. Autologous platelet rich plasma was prepared and the same was injected. The outcome analysis was done at 2 weeks, 3 months, and 6 months; and compared with pre injection values. From pre-injection to up to post-6 months period, the VAS reduction was statistically significant (P<0.0001). All the time interval, the AOFAS was increased which was statistically significant (P<0.001). The injection was effective in reducing the thickness of plantar fascia, which was found to be statistically significant at all the time intervals (P<0.001). Autologous PRP injection for chronic plantar fasciitis was found to be an effective treatment modality for chronic plantar fasciitis.
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El objetivo de este artículo es analizar las distintas opciones de tratamiento. Se realizó una encuesta virtual a diferentes traumatólogos especialistas en pierna y pie, sobre el tratamiento de la fascitis plantar. Los resultados fueron variados, lo que demuestra que no hay una respuesta concreta ante el tratamiento crónico. Conclusiones: La fascitis plantar es un cuadro doloroso frecuente. Su origen es desconocido, pero está relacionada con múltiples factores. Se han recomendado muchas modalidades terapéuticas, como fármacos, fisioterapia, ortesis y cirugía, pero no existe un estudio que analice la eficacia de cada una de ellas por separado ni que confirme categóricamente su utilidad.
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This chapter covers the characteristics of plantar aponeurosis (PA) (or plantar fascia). The anatomical features of aponeurosis are presented in a didactic manner with emphasis on insertion, thickness, etc. The biomechanics and interaction of aponeurosis is reviewed with the Achilles tendon. All the frequent pathologies of the PA, such as tear, inflammation, fibrosis, and fibromatosis, are described in detail along with their pathophysiology. The prevalence of these pathological conditions in diabetic patients with Charcot neuroarthropathy is discussed. The imaging modalities used to assess the PA are also reviewed in this chapter.
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Introduction: The deep fascia is a three-dimensional continuum of connective tissue surrounding the bones, muscles, nerves and blood vessels throughout our body. Its importance in chronically debilitating conditions has recently been brought to light. This work investigates changes in these tissues in pathological settings. Materials and methods: A state-of-the-art review was conducted in PubMed and Google Scholar following a two-stage process. A first search was performed to identify main types of deep fasciae. A second search was performed to identify studies considering a deep fascia, common pathologies of this deep fascia and the associated alterations in tissue anatomy. Results: We find that five main deep fasciae pathologies are chronic low back pain, chronic neck pain, Dupuytren's disease, plantar fasciitis and iliotibial band syndrome. The corresponding fasciae are respectively the thoracolumbar fascia, the cervical fascia, the palmar fascia, the plantar fascia and the iliotibial tract. Pathological fascia is characterized by increased tissue stiffness along with alterations in myofibroblast activity and the extra-cellular matrix, both in terms of collagen and Matrix Metalloproteases (MMP) levels. Innervation changes such as increased density and sensitization of nociceptive nerve fibers are observed. Additionally, markers of inflammation such as pro-inflammatory cytokines and immune cells are documented. Pain originating from the deep fascia likely results from a combination of increased nerve density, sensitization and chronic nociceptive stimulation, whether physical or chemical. Conclusions: The pathological fascia is characterized by changes in innervation, immunology and tissue contracture. Further investigation is required to best benefit both research opportunities and patient care.
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Objective: To systematically investigate the efficacy and safety of dextrose prolotherapy for treating chronic plantar fasciitis. Literature survey: EMBASE, PubMed, Scopus, and Google Scholar (from inception to December the 9th, 2021) METHODOLOGY: Comprehensive review of randomized controlled trials investigating dextrose prolotherapy for chronic plantar fasciitis was done. Two investigators independently screened the titles, abstracts, and full texts and extracted data from eligible studies. The change in visual analog scale (VAS) pain score, foot function index (FFI), American Orthopaedic Foot and Ankle Society (AOFAS) score, and plantar fascia thickness were analyzed. Reports of complications of the procedure were collected. Synthesis: Eight randomized controlled trials (RCTs) were included in the meta-analysis, analyzing 444 patients in total. The subgroup analysis showed that at short-term follow-up (<6 months) dextrose prolotherapy was more effective in reducing VAS pain score compared to non-active treatment control group including exercise and NSS injection. However, there was no difference in the change of VAS pain score between dextrose prolotherapy and active treatment control group, which include ESWT, steroid injection, and PRP injection. Dextrose prolotherapy was more effective in reducing FFI, increasing AOFAS score and reducing plantar fascia thickness at short-term (<6 months) follow-up compared to other comparators. For long-term (≥6 months) follow-up, there was no significant difference in the change in VAS pain score and FFI between the dextrose prolotherapy group and other comparators. No serious complication was reported. Conclusions: Dextrose prolotherapy is an effective treatment of chronic plantar fasciitis to reduce pain, improve foot functional score and decrease plantar fascia thickness at short-term follow-up. Further studies in larger populations are needed to identify the optimal treatment regimen including dextrose concentration, volume, injection site, injection technique, and the number of injections required. The long-term effects of these treatments also require further examination. This article is protected by copyright. All rights reserved.
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Introduction: Plantar Fasciitis (PF) is one of the most common chronic degenerative foot condition associated with pain in the bottom of the foot (enthesopathy), encountered by an orthopaedic practitioner. Various treatment options have been implicated and it has been frustrating problem for both patients and treating doctors. Very limited studies are available showing the variable effects of Platelet Rich Plasma (PRP), the autologous conditioned plasma, in human tissues. Aim: To determine the role of PRP in the management of patients with PF. Materials and Methods: This prospective interventional study was conducted in the Department of Orthopaedics in collaboration with blood bank in SRM Medical College and Hospital, Potheri, Chengalpet district, Tamil Nadu, India, between November 2017 to April 2019. In this study, 70 patients with PF were treated with single dose of local injection of 3 mL autologous PRP. These patients were assessed for pain relief using the Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM). In addition ultrasonographic evaluation of thickness of plantar fascia was done six months after treatment. The statistical analysis of each clinical outcomes was analysed individually, using Statistical Package for the Social Sciences (SPSS) version 22.0. Statistical significance was done with student’s t-test and p-value
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BACKGROUND: Plantar fasciitis is one of the most common conditions of heel pain among adults. Most common affected age group being 40-60 years and it is a leading cause of occupational impairment. Non-invasive and invasive modalities are the two basic types of treatment. Invasive treatment modalilities like local injections, surgical treatment are advised for patients non-responding to non-invasive conservative treatment modalities. Local Steroid Injection (LSI) is the most common invasive treatment used whereas Dry Needling (DN) is proposed as a new modality of treatment recently. OBJECTIVES: The aim of this study is to evaluate the effectiveness of Dry Needling versus Local Steroid Injection for Plantar Fasciitis using short form of Foot Function Index Revised (FFI-R). METHODS:This is prospective randomized, single blind, controlled study. Fifty patients who were clinically and radiologically (USG) conrmed to have idiopathic plantar fasciitis were enrolled in the study after informed consent. Patients were randomized and assigned into 2 groups of 25 patients each. Group I was managed by Local Steroid Injection (LSI) and Group II was managed by Dry Needling (DN). Patients were followed every 4 weeks up to 12 weeks. They were assessed clinically and functionally based on short form of FFI-R CONCLUSION: Short form of Foot Function Index Revised (FFI-R) is a quick, reliable and patient friendly outcome measurement tool for plantar fasciitis. Both Local Corticosteroid Injection and Dry Needling are effective treatment in refractory cases of Plantar Fasciitis in adjunct to non-invasive conservative treatment modalities. Dry Needling is a safe and reliable procedure for treating refractory cases of Plantar Fasciitis. Even though corticosteroid injection is the most effective treatment for short term symptomatic relief (at 4 weeks), it is found that outcomes of Dry Needling are comparable with the efcacy of corticosteroid injection in the medium term follow-up (12 weeks). Dry Needling has greater physiological compatibility than corticosteroid injection in terms of ability to induce possible healing process in plantar fasciitis and devoid of any long term complication associated with corticosteroid injection.
Article
Plantar fasciitis affects 2 million patients per year. Ten percent of cases are chronic, with thickened plantar fascia. Treatment may lead to prolonged recovery, foot instability, and scar. The authors hypothesized that perforating fat injections would decrease plantar fascia thickness, reduce pain, and improve quality of life. Adults with plantar fascia greater than 4 mm for whom standard treatment had failed were included in a prospective, randomized, crossover pilot study. Group 1 (intervention) was followed for 12 months. Group 2 was observed for 6 months, injected, and then followed for 6 months. Validated patient reported outcome measures, ultrasound, and complications were assessed. Group 1 had nine female patients and group 2 had five patients. A total of 2.6 ± 1.6 ml of fat was injected per foot at one to two sites. In group 1, plantar fascia thickness decreased from screening at 6 and 12 months (p < 0.05). Group 2 had decreased plantar fascia thickness from screening to 6 months after injection (p < 0.05). Group 1 had pain improvements at 6 and 12 months compared with screening (p < 0.01). Group 2 reported no pain difference after injections (p > 0.05). Group 1 had improved activities of daily living and sports activity at 6 and 12 months compared with screening (p < 0.003). Group 2 noted increased sports activity 6 months after injection compared with screening (p < 0.03). In conclusion, perforating fat injections for chronic plantar fasciitis demonstrate significant improvement in pain, function, and plantar fascia thickness. Clinical question/level of evidence: Therapeutic, II.
Article
From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.
Article
Symptoms resembling those of plantar fasciitis were seen in six athletes who were thought to have a partial rupture of the plantar fascia. Treatment, which included the use of crutches, anti-inflammatory agents, strapping of the arch, and ice packs, was successful in all but one patient who had a painful mass in the area of the previous rupture. After surgical excision of the painful mass and release of the fascia, he recovered. Five of the six athletes had been previously treated with repeated local injections of steroid.
Article
Plantar fasciitis is a common orthopedic syndrome among athletes and nonathletes. The etiology of the pain is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. The majority of patients will respond to conservative measures. Surgical treatment is reserved for those patients who do not respond. A complete plantar fascia release is performed through a medial longitudinal incision. Prominent heel spurs and degenerated areas in the plantar fascia are resected. Of 27 surgically treated cases followed from one to three years, satisfactory results were obtained in 24 cases. Histologically, localized fibrosis or granulomatous changes or both were noted in several cases.
Article
The clinical syndrome of plantar fasciitis is characterized by pain inflammation caused by strain or tearing of the plantar aponeurosis at its attachment to the medical calcaneal tubercle. Plantar fasciitis is commonly associated with heel spur formation, but heel spurs are also found with no symptomology. The most significant finding in plantar fasciitis and heel spur syndrome is point tenderness at the insertion of the fascia to the anterior edge of the medial calcaneal tuberosity. History typically reveals pain on rising in the morning which subsides during the day but returns after periods of nonweight-bearing. The plantar aponeurosis functions to maintain the medial longitudinal arch of the foot and assists in absorbing forces in the midtarsal joints. Abnormal biomechanical factors can influence the stresses on the plantar fascia. Factors include a cavus foot type, excessive foot pronation, and ankle equinus. Plantar fasciitis usually presents unilaterally; however, bilateral involvement can occur and should cause the clinician to suspect the probability of systemic disease. The systemic diseases include seronegative arthridities, rheumatoid arthritis, gout, and Paget's disease. Other etiologies for subcalcaneal pain include calcaneal stress fractures, apophysitis, and nerve entrapment. Conservative therapy yields a high success rate in the treatment of heel spur syndrome and plantar fasciitis. Treatment consists of padding, strapping, orthotics, nonsteroidal anti-inflammatory drugs, and local synthetic steroid injections. If chronic heel pain is not responsive to these treatment regimens, then surgical intervention is considered.
Article
Plantar fascia release has been suggested to be of benefit for patients with symptoms of chronic unresponsive plantar fasciitis. However, results of this procedure have not been published. We performed 11 releases in 9 long-distance runners whose symptoms had been present for an average of 20 months and had not responded to nonsurgical treatment. The results of these operations were excellent in 10 feet and good in 1 foot at an average follow-up time of 25 months. Eight out of nine patients returned to desired full training at an average time of 4.5 months. Histologic examination of surgical biopsy specimens from these patients showed collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, and matrix calcification. Plantar fascia release was an effective procedure for these patients.
Article
We have found that Tc-99m methylene diphosphonate imaging of the heel is of diagnostic value in the "painful heel syndrome," permitting positive identification of the site of inflammation in cases where radiography is unhelpful. With this technique, tracer uptake in the heel is susceptible to quantification, allowing a serial and objective assessment of response to therapy.
Article
A series of 37 patients, all with a presumptive diagnosis of plantar fascia rupture, is presented. All had had prior heel pain diagnosed as plantar fasciitis, and all had been treated with corticosteroid injection into the calcaneal origin of the fascia. One third described a sudden tearing episode in the heel, while the rest had a gradual change in symptoms. Most of the patients had relief of the original heel pain, which had been replaced by a variety of new foot problems, including dorsal and lateral midfoot pain, swelling, foot weakness, metatarsal pain, and metatarsal fracture. In all 37 patients, there was a palpable diminution in the tension of the plantar fascia on the involved side, and footprints often showed a flattening of the involved arch. Magnetic resonance imaging done on one patient showed attenuation of the plantar fascia. From these observations and data, the author concluded that plantar fascia rupture had occurred. Treatment following rupture included supportive shoes, orthoses, and time. The majority had resolution of their new symptoms, but this often took 6 to 12 months to occur. In the remainder, there were persisting symptoms. Corticosteroid injections, although helpful in the treatment of plantar fasciitis, appear to predispose to plantar fascia rupture.
Article
Twenty of 21 consecutive patients (21 heels) with subcalcaneal pain retractory to conservative treatment managed by resection of the proximal attachment of the plantar fascia and the heel spur, if present, were reviewed retrospectively. The results, at a mean followup of 40 months (range, 12-102 months), using a 100 point scoring system, rated excellent in 8 patients, good in 10, fair in 1, and poor in 1 (90% satisfactory outcome). Time to maximal improvement often was prolonged, yet once reached was maintained over time. The only complication encountered was 1 superficial wound infection. Radiographically it was noted that, despite complete excision, subcalcaneal exostoses often reformed and the fascial transection never did precipitate collapse of the longitudinal arch of the foot. A combination of mucoid and fibrinoid degeneration of the plantar fascia, an acceleration of an age related process, was the principal histopathologic finding. It was concluded that the subcalcaneal pain unresponsive to conservative modalities can be treated effectively by the index procedure. The radiographic and histologic findings of this study suggest that changes within the fascia, rather than the spur, are primarily responsible for the pathogenesis of the syndrome.
Article
Heel pain or calcaneodynia is a common clinical complaint which has a myriad of causes ranging from plantar fasciitis to stress fracture. In many instances, the etiology of the heel pain is difficult to ascertain simply on the basis of history and physical examination. Therefore, the clinician may enlist various diagnostic imaging modalities to clarify the source of pain. Of all the imaging techniques, magnetic resonance imaging (MRI) has proven its worth in the diagnosis of heel pain. This article outlines the various causes of heel pain and their associated imaging findings.
Article
Objective: We sought to evaluate various MR imaging signs of plantar fasciitis and to determine if a difference in these findings exists between clinically typical and atypical patients with chronic symptoms resistant to conservative treatment. Conclusion: We found signs on MR imaging that, to our knowledge, have not been described in the scientific literature for patients with plantar fasciitis. These signs included occult marrow edema and fascial tears. Patients with these manifestations seemed to respond to treatment in a manner similar to that of patients in whom MR imaging revealed more benign findings.
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This article presents a mechanical model that can be used to understand the foot, to help develop methods of treatment of foot pathology, and to provide direction for future research in foot mechanics and pathology. The anatomy and mechanical function of the windlass mechanism of the foot are analyzed using principles of mechanical engineering. The principles of force couples and free-body diagrams are explained and then applied to the foot. The relationship of the windlass mechanism to plantar fasciitis or heel spur syndrome, hallux abducto valgus, and hallux limitus is discussed.
Painful heel: report of 323 patients with 364 painful heels Cited by: CAMPBELL W: " Disorders of Tendons and Fascia, " in Campbell's Operative Orthopaedics
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LAPIDUS PW, GUIDOTTI FP: Painful heel: report of 323 patients with 364 painful heels. Clin Orthop 39: 178, 1965. Cited by: CAMPBELL W: " Disorders of Tendons and Fascia, " in Campbell's Operative Orthopaedics, 9th Ed, Vol 2, ed by ST Canale, p 1912, CV Mosby, St Louis, 1998.
MR imaging of plantar fasciitis: edema, tears, and occult marrow abnormalities correlated with outcome
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GRASEL RP, SCHWEITZER ME, KOVALOVICH AM, ET AL: MR imaging of plantar fasciitis: edema, tears, and occult marrow abnormalities correlated with outcome. AJR Am J Roentgenol 173: 699, 1999.
Acute and Chronic Inflammation in Robbins Pathologic Basis of Disease
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ROBBINS S: " Acute and Chronic Inflammation, " in Robbins Pathologic Basis of Disease, 6th Ed, ed by RS Cotran, V Kumar, T Collins, et al, p 51, WB Saunders, Philadelphia, 1999.