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Yildiz G, Perdecioglu GRG, Yuruk D, Can E, Akkaya OT. Comparison of tibial nerve pulsed radiofrequency and intralesional radiofrequency thermocoagulation in the treatment of painful calcaneal spur and plantar fasciitis: a randomized clinical trial. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:493-499. [PMID: 38652568 DOI: 10.1093/pm/pnae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/07/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Ultrasound-guided tibial nerve pulsed radiofrequency (US-guided TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-guided intralesional RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur and plantar fasciitis. This study aimed to compare the effectiveness of the two procedures. DESIGN A prospective, randomized, single-blind study. SETTING Single-center pain clinic. SUBJECTS Forty-nine patients who met the inclusion criteria were randomized into two groups. METHODS Group U (25 patients) received US-guided TN PRF at 42°C for 240 s, whereas Group F (24 patients) received FL-guided intralesional RFT at 80°C for 90 s. The most severe numeric rating scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness via the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. RESULTS NRS and AOFAS scores significantly improved in Groups U and F at 1 and 3 months compared with baseline (P < .05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in Group U and 75% of patients in Group F. No significant difference was observed in the incidence of mild adverse events between the groups. CONCLUSIONS US-guided TN PRF and FL-guided intralesional RFT have shown significant effectiveness in the treatment of painful calcaneal spur and plantar fasciitis. Larger randomized controlled trials are needed. CLINICAL TRIAL NUMBER NCT06240507.
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Affiliation(s)
- Gokhan Yildiz
- Department of Algology, Ankara Etlik City Hospital, 6010 Ankara, Turkey
| | | | - Damla Yuruk
- Department of Algology, Ankara Etlik City Hospital, 6010 Ankara, Turkey
| | - Ezgi Can
- Department of Algology, Ankara Etlik City Hospital, 6010 Ankara, Turkey
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Tas NP, Kaya O. Treatment of Plantar Fasciitis in Patients with Calcaneal Spurs: Radiofrequency Thermal Ablation or Extracorporeal Shock Wave Therapy? J Clin Med 2023; 12:6503. [PMID: 37892641 PMCID: PMC10607467 DOI: 10.3390/jcm12206503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to compare the effectiveness of ESWT (Extracorporeal Shock Wave Therapy) and RFA (Radiofrequency Thermal Ablation) on pain, disability, and activity limitation in the treatment of plantar fasciitis in patients with calcaneal spurs. MATERIALS AND METHODS Patients who apply to Orthopedics and Traumatology and Physical Medicine and Rehabilitation departments with a complaint of heel pain are included in this retrospective study. We included patients diagnosed with calcaneal spurs who received treatment with ESWT (n = 80) and RFA (n = 79) between 1 August 2021 and 1 September 2022. All patients were evaluated using the Visual Analog Scale (VAS), Foot Function Index (FFI), and the Roles and Maudsley score (RM) before and after treatment. An evaluation was performed on average 6 months after treatment. RESULTS This study included 79 RFA patients (34 females and 45 males) with a mean age of 55.8 ± 9.6 years and 80 ESWT patients (20 females and 60 males) with a mean age of 49.1 ± 9.5 years. There was a significant decrease in VAS scores after treatment in both the RFA and ESWT groups (z: -4.98, z: -5.18, respectively, p < 0.001). The reductions in FFI pain, FFI activity restriction, FFI disability, and RM scores were significant in both groups, although the scores after treatment were lower in the RFA group. CONCLUSIONS This study demonstrates that ESWT and RFA significantly reduced pain, disability, and activity restriction in the treatment of plantar fasciitis in patients with calcaneal spurs. ESWT proved particularly effective in alleviating pain, whereas RFA had more pronounced effects on reducing disability and activity limitations. The choice of treatment should be based on the patient's specific complaints.
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Affiliation(s)
- Nevsun Pihtili Tas
- Department of Physical Medicine and Rehabilitation, Health Sciences University Elazig Fethi Sekin City Hospital, Elazıg 23280, Turkey
| | - Oğuz Kaya
- Department of Orthopedics and Traumatology, Elazig Fethi Sekin City Hospital, Elazıg 23280, Turkey;
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Şahin R, Sabri Balik M. Does the slope and length of the plantar calcaneal spur affect the clinic? Acta Orthop Belg 2023; 89:146-151. [PMID: 37294999 DOI: 10.52628/89.1.10881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Since some of the patients with plantar calcaneal spur (PCS) do not have pain, we aimed to investigate the effect of the slope and length of the spur on this situation. The length and slope of PCS were measured by examining the radiological images of 50 patients in this prospective study. VAS, AOFAS and FFI scores of the patients were determined. Patients were divided into groups according to PCS length and slope. According to the slope of the spur, the mean AOFAS, FFI and VAS scores were, respectively; 94, 38, 1.3 in below 20 degrees; 80.1, 86.8, 4.8 in 20-30 degrees; and 70.1, 106, 6.7 in above 30 degrees. According to the length of the spur, the mean AOFAS, FFI and VAS scores were respectively; 84.9, 68.2, 3.7 in those with length 0-5 mm; 81.1, 81.7, 4.5 in those with a length of 5-10 mm; and 71.7, 102.5, 6.4 in those with a length of >10 mm. A significant correlation was found between the angle and length of the PCS with the values of VAS, AOFAS and FFI (p<0.05). We observed that PCSs with a slope of less than 30 degrees and shorter than 10 mm do not create a serious clinical picture. If there is severe pain and functional impairment in individuals with this characteristic spur, investigation of other possible causes of heel pain must be considered.
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Okçu M, Tuncay F, Koçak FA, Erden Y, Ayhan MY, Kaya SS. Do the presence, size, and shape of plantar calcaneal spurs have any significance in terms of pain and treatment outcomes in patients with plantar fasciitis? Turk J Med Sci 2023; 53:413-419. [PMID: 36945957 PMCID: PMC10387834 DOI: 10.55730/1300-0144.5598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/26/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : The purpose of this study was to determine the effect of the presence, size, or type of calcaneal spurs on pain or the outcomes of extracorporeal shock wave therapy (ESWT) therapy in patients with plantar fasciitis. METHODS Seventy-four patients with unilateral plantar fasciitis who had no pain in the contralateral foot, either currently or in the past, were included in the study. The length, base width, type, and presence of plantar calcaneal spurs in both heels of the patients were determined using radiography. A total of five sessions of ESWT (3 bar, 2000 shocks/session, 12 Hz frequency) with an interval of 3 days were performed on the painful sides of the patients. Symptom duration and numerical rating scale (NRS) scores were recorded pretreatment and 1 week and 12 weeks after treatment. RESULTS : Spurs were detected in 85.1% of painful feet and 71.6% of painless feet, this difference was statistically significant (p = 0.046). There was no significant correlation between the type of the spurs and whether the foot was painful. Patients with spur sizes of >5 mm or with horizontal and hooked spurs had a higher NRS decrease than patients with spur sizes of ≤5 mm or with a vertical spur. Symptom duration, spur length, and base width were found to be correlated with pretreatment NRS scores. DISCUSSION The presence and size of calcaneal spurs are associated with pain. However, it should be kept in mind that a high rate of spurs can also be found in painless feet, so spur is not the only factor that causes pain. Patients with a spur size of ≤5 mm or a vertical spur have less pain relief with ESWT.
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Affiliation(s)
- Mehmet Okçu
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Figen Tuncay
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Fatmanur Aybala Koçak
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Yakup Erden
- Department of Physical Medicine and Rehabilitation, İzzet Baysal Physical Treatment Training and Research Hospital, Bolu, Turkey
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Muacevic A, Adler JR, Lapçin O. Comparison of Isolated Calcaneal Spur Excision and Plantar Fasciotomy in Addition to Spur Excision in Patients With Plantar Heel Pain Accompanied by Calcaneal Spur. Cureus 2022; 14:e31768. [PMID: 36569683 PMCID: PMC9772710 DOI: 10.7759/cureus.31768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aim of this study is to clinically compare isolated calcaneal spur excision and plantar fascia release in addition to spur excision in patients with plantar heel pain accompanied by a calcaneal spur. METHOD Patients who did not benefit from conservative treatment and underwent surgical excision of the calcaneal spur and/or plantar fasciotomy were retrospectively evaluated. The patients were divided into two groups according to the surgical procedure performed. The evaluation was done according to the pre- and postoperative foot function index (FFI) using pain and functional evaluation. Pain, disability, and activity restriction were evaluated with FFI. The radiological results and FFI scores of both groups were measured before and after surgery, and the difference between the groups was compared. RESULTS Of the 46 patients in our study group, 30 (65.2%) were female, and 16 (34.8%) were male. The average age was 41.2 years. There was a significant improvement in postoperative FFI scores in both groups. There was no significant difference in postoperative functional results when the groups were compared. CONCLUSION In patients whose plantar heel pain associated with calcaneal spur does not improve despite conservative treatments, both isolated spur excision and plantar fascia release in addition to spur excision may be effective treatment modalities that improve foot functions.
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Alessio-Mazzola M, Stambazzi C, Ursino C, Tagliafico A, Trentini R, Formica M. Ultrasound-Guided Autologous Platelet-Rich Plasma Injections Versus Focal Ultrasound-Guided Extracorporeal Shockwave Therapy for Plantar Fasciitis in Athletes and Nonathletes: A Retrospective Comparative Study With Minimum 2-Year Follow-Up. J Foot Ankle Surg 2022; 62:417-421. [PMID: 36396549 DOI: 10.1053/j.jfas.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
Plantar fasciitis is often cause of heel pain, especially in sporting-related activities. Different conservative measures for the management of plantar fasciitis were compared in several researches. The purpose of this retrospective study was to evaluate and compare clinical outcomes of chronic plantar fasciitis treated with ultrasound-guided platelet-rich plasma (PRP) and focal ultrasound-guided extracorporeal shockwave therapy (ESW). Secondarily, results on subpopulation of athletes were recorded. Fifty-five patients treated for plantar fasciitis were included, 24 among them were competitive or recreational athletes. Treatment outcomes were assessed using Visual Analog Scale and Foot Function Index before and after treatment. Time to return to sport among patients practicing sporting activities was recorded. Before treatment, no differences were observed between groups in terms of age, gender, body mass index, and months of follow up. From baseline to final follow-up assessment, significant improvement was observed in all the outcomes measures. The subgroup analysis showed no differences between patients stratified for type of treatment and sport/nonsport practitioners. The overall failure rate was higher, although not significant, in patients who underwent ESW therapy and they required a higher number of orthopedic visits. Among sports practitioners the mean time to return to sport (months) was faster in PRP group than ESW group (p = .044). PRP and ESW represent both reliable solutions for plantar fasciitis leading to good results in terms of patients' satisfaction, pain, and clinical outcomes. However, after treatment with PRP injections less recurrences in overall population and faster return to sporting activities in sports practitioners were observed.
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Affiliation(s)
| | - Chiara Stambazzi
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Ursino
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy
| | - Alberto Tagliafico
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy
| | - Roberto Trentini
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Matteo Formica
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy
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Velagala VR, Velagala NR, Kumar T, Singh A, Mehendale AM. Calcaneal Spurs: A Potentially Debilitating Disorder. Cureus 2022; 14:e28497. [PMID: 36185871 PMCID: PMC9514376 DOI: 10.7759/cureus.28497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022] Open
Abstract
Feet are often the most neglected part of the body, all the while being the highly dependent part of daily work and mobility. The lack of attention to them can lead to painful conditions such as calcaneal spurs and associated conditions. Calcaneal spurs are bony projections that form around the calcaneal bone, the strongest, most significant, and posterior-most bone in the feet. The classic symptom of the calcaneal spur is talalgia, commonly known as heel pain. There are many causes of heel pain, which are usually associated with calcaneal spurs. Hence it becomes imperative to diagnose and treat them effectively. The development of calcaneal spur is shrouded in mystery, and why a few individuals are more prone to developing the condition than others depends on their gender, age, occupation, and lifestyle. Calcaneal spurs are seen in association with many diseases. It is also regarded as the etiological factor in plantar fasciitis and increasing body weight and as a complication in arthropathies, Gout, pes cavus, and pes planus. This review article aims to highlight a relationship between those factors while also summarizing the treatment modalities present today. Hence, it promotes the usage of a model for administering treatment based on a tier-wise follow-up procedure, where the response to a particular treatment is recorded. If it does not resolve the spur, the treatment progresses to the next tier. This review article hopes to shed light on the understanding and treatment of calcaneal spurs.
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Ribeiro AP, de Souza BL, João SMA. Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial. BMC Musculoskelet Disord 2022; 23:773. [PMID: 35964021 PMCID: PMC9375309 DOI: 10.1186/s12891-022-05729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
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).
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Affiliation(s)
- Ana Paula Ribeiro
- Physical Therapy Department, Post-Graduate Department, School of Medicine, University of São Paulo, R: Cipotânea, 51, Campus Universitário, São Paulo/SP, Brazil. .,School of Medicine, Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, São Paulo, Brazil.
| | - Brenda Luciano de Souza
- School of Medicine, Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, São Paulo, Brazil
| | - Silvia Maria Amado João
- Physical Therapy Department, Post-Graduate Department, School of Medicine, University of São Paulo, R: Cipotânea, 51, Campus Universitário, São Paulo/SP, Brazil
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Kaya E, Görmez S. Quality and readability of online information on plantar fasciitis and calcaneal spur. Rheumatol Int 2022; 42:1965-1972. [PMID: 35763090 DOI: 10.1007/s00296-022-05165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
Plantar fasciitis and calcaneal spur are common causes of heel pain in the community. People use the Internet to obtain medical information about diseases. We reviewed Internet information sources on plantar fasciitis and calcaneal spur for quality and readability. The first 50 websites for each search term ("calcaneal spur", "heel spur", and "plantar fasciitis") were scanned on www.google.com . Six different valid tools were used for information quality and readability assessment. We searched for HONCode (Health On the Net Foundation Code) stamps on included websites. The total mean points for DISCERN were 50.52 ± 14.62, and the total mean points for JAMA (Journal of the American Medical Association) were 2.42 ± 1.26. In total, 25.72% of 97 websites had HONCode stamps. The average scores for the readability indicators were calculated to be Flesch-Kincaid Grade Level (FKGL): 7.27 ± 1.71, Gunning Fog: 8.46 ± 2.17, Simple Measure of Gobbledygook (SMOG): 6.89 ± 1.24, and Coleman Liau Index: 15.56 ± 1.85. In our study, when the website resources were examined, there were profit websites the most and website quality and readability were moderate level. A significant proportion of the websites have a financial bias and provide low-quality information. A mechanism for monitoring the quality and readability of online information must be established and managed systematically.
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Affiliation(s)
- Erhan Kaya
- Department of Public Health, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
| | - Sinan Görmez
- Department of Orthopedics and Traumatology, Bulancak State Hospital, Giresun, Turkey
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Öncü M, Genç E. The co-occurrence of calcaneal spur and hallux valgus: A radiological evaluation. J Back Musculoskelet Rehabil 2022; 35:539-544. [PMID: 34542057 DOI: 10.3233/bmr-200140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Calcaneal spur and hallux valgus are common foot deformities and both conditions have been shown to disrupt foot biomechanics. OBJECTIVES This study aimed to investigate the association between calcaneal spur and hallux valgus using radiographic and demographic data. METHODS A total of 1375 patients (1083 women; mean age: 45.5 years) with standard ankle lateral and foot conventional anteroposterior radiographs were evaluated. The following data were obtained: age, gender, laterality, hallux valgus angle (HVA), intermetatarsal angle (IMA), and calcaneal spur. Patients with a HVA of 15∘ and above were considered to have hallux valgus. Patients with hallux valgus were classified into three different groups according to the HVA. RESULTS The prevalence of calcaneal spur was higher in older age and women (45.8%, 30.2%; p< 0.01, p< 0.01, respectively). Subjects with and without calcaneal spurs had similarities in terms of their laterality, having a HVA of ⩾ 15∘ and an IMA of ⩾ 11∘ (p> 0.05). Hallux valgus severity was not associated with calcaneal spur (p> 0.05). In addition, the hallux valgus prevalence was higher in patients who were over 50 years old (58.2%, p= 0.046). CONCLUSIONS The presence of calcaneal spurs does not affect the prevalence of hallux valgus. The severity of hallux valgus determined according to the HVA was similar in patients with and without calcaneal spurs. In addition, female gender and older age were identified as risk factors for calcaneal spurs, while only older age was a risk factor for hallux valgus.
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Affiliation(s)
- Mehmet Öncü
- Department of Radiology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erdinç Genç
- Department of Orthopaedics and Traumatology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Cho BW, Choi JH, Han HS, Choi WY, Lee KM. Age, Body Mass Index, and Spur Size Associated with Patients’ Symptoms in Plantar Fasciitis. Clin Orthop Surg 2022; 14:458-465. [PMID: 36061842 PMCID: PMC9393285 DOI: 10.4055/cios21263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Plantar fasciitis is a common cause of heel pain affecting 10% of the general population. This study aimed to investigate the specific symptoms in patients with plantar fasciitis using the Foot and Ankle Outcome Score (FAOS) questionnaire and their relationship with demographic and radiographic factors. Methods We retrospectively analyzed 73 consecutive patients (mean age, 53.8 ± 10.0 years; 20 men and 53 women) with plantar fasciitis who had visited our foot and ankle clinic and undergone weight-bearing foot X-ray examinations. Their demographic data, anteroposterior and lateral talo-first metatarsal angles, intermetatarsal and hallux valgus angles, and responses to the FAOS questionnaire were recorded. Results The quality-of-life subscale showed the lowest score of all FAOS subscales. Age was significantly correlated with quality of life (r = 0.297, p = 0.011), and body mass index was correlated with the function in sports and recreational activities (r = –0.251, p = 0.032). Age and body mass index were statistically significantly correlated with calcaneal spur size (r = 0.274, p = 0.027 and r = 0.324, p = 0.008, respectively). The calcaneal spur size was significantly correlated with pain (r = –0.348, p = 0.004), function in daily living (r = –0.410, p = 0.001), and function in sports and recreational activities (r = –0.439, p < 0.001). Conclusions Demographic factors were associated with specific symptoms in patients with plantar fasciitis. Calcaneal spur size was the only radiographic parameter correlated with symptoms. These findings help communicate with patients, set appropriate treatment goals, and evaluate treatment effectiveness.
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Affiliation(s)
- Bong Wan Cho
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Hye Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee Soo Han
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woo-Young Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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A Design Study of Orthotic Shoe Based on Pain Pressure Measurement Using Algometer for Calcaneal Spur Patients. TECHNOLOGIES 2021. [DOI: 10.3390/technologies9030062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pressure pain threshold (PPT) is a useful tool for evaluating mechanical sensitivity in individuals suffering from various musculoskeletal disorders. The aim of this study is to investigate PPT at the heel area in order to assist in the design of orthotic shoes for sufferers of heel pain due to a calcaneal spur. The size and location of the calcaneal spur was determined by x-ray images, with PPT data measured around the spur at five points by using algometer FDIX 25. The pain test experiment was conducted by pressing each point to obtain the pain minimum compressive pressure (PMCP) and its location. The information of shoe size, spur location and dimensions, and the PMCP location for each individual is used to obtain the exact point location for applying a softer material to the shoe in-sole, in order to reduce heel pain. The results are significant as it can be used by designers to design appropriate shoe in-soles for individuals suffering from heel pain.
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Abstract
Many randomized controlled trials demonstrate the effectiveness of conservative treatment of plantar fasciitis. Patients with acute plantar fasciitis generally respond to treatment more rapidly and more predictably than patients with chronic plantar fasciitis. If conservative treatment fails, endoscopic plantar fasciotomy offers patients a more prompt return to activity compared with open procedures.
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Yin M, Yan Y, Tong Z, Xu C, Qiao J, Zhou X, Ye J, Mo W. Development and Validation of a Novel Scoring System for Severity of Plantar Fasciitis. Orthop Surg 2020; 12:1882-1889. [PMID: 33112035 PMCID: PMC7767669 DOI: 10.1111/os.12827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Plantar fasciitis (PF) is the most common cause of heel pain. Though PF is self-limited, it can develop into chronic pain and thus treatment is needed. Early and accurate prognostic assessment of patients with PF is critically important for selecting the optimal treatment pathway. Nevertheless, there is no scoring system to determine the severity of PF and no prognostic model in choosing between conservative or surgical treatment. The study aimed to develop a novel scoring system to evaluate the severity of plantar fasciitis and predict the prognosis of conservative treatment. METHODS Data of consecutive patients treated from 2014 to 2018 were retrospectively collected. One hundred and eighty patients were eligible for the study. The demographics and clinical characteristics served as independent variables. The least follow-up time was 6 months. A minimal reduction of 60% in the visual analog scale (VAS) score from baseline was considered as minimal clinically important difference (MCID). Those factors significantly associated with achieving MCID in univariate analyses were further analyzed by multivariate logistic regression. A novel scoring system was developed using the best available literature and expert-opinion consensus. Inter-observer reliability and intra-observer reproducibility were evaluated. The appropriate cut-off points for the novel score system were obtained using receiver operating characteristic (ROC) curves. RESULTS The system score = VAS (0-3 point = 1; 3.1-7 point = 3; 7.1-10 point = 5) + duration of symptoms (<6 months = 1; ≥1 6 months = 2) + ability to walk without pain (>1 h = 1; ≤1 h = 4) + heel spur in X-ray (No = 0; Yes = 2) + high intensity zone (HIZ) in MRI (No = 0; Yes = 2). The total score was divided in four categories of severity: mild (2-4 points), moderate (5-8 points), severe (9-12 points), and critical (13-15 points). Inter-observer agreement with a value of 0.84 was considered as perfect reliability. Intra-observer reproducibility with a value of 0.92 was considered as perfect reproducibility. The optimum cut-off value was 10 points. The sensitivity of predictive factors was 86.37%, 84.21%, 91.22%, 84.12%, and 89.32%, respectively; the specificity was 64.21%, 53.27%, 67.76%, 62.37%, and 79.58%, respectively; the area under curve was 0.75, 0.71, 0.72, 0.87, and 0.77, respectively. The Hosmer-Lemeshow test showed a good fitting of the score system with an overall accuracy of 90.6%. CONCLUSIONS Based on prognostic factors, the present study establishes a novel scoring system which is highly comprehensible, reliable, and reproducible. This score system can be used to identify the severity of plantar fasciitis and predict the prognosis of conservative treatment accurately. The application of this scoring system in clinical settings can significantly improve the decision-making process.
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Affiliation(s)
- Meng‐chen Yin
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yin‐jie Yan
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Zheng‐yi Tong
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Chong‐qin Xu
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jiao‐jiao Qiao
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Xiao‐ning Zhou
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jie Ye
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Wen Mo
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
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The Relationship between Calcaneal Spur Type and Plantar Fasciitis in Chinese Population. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5679629. [PMID: 32596331 PMCID: PMC7293741 DOI: 10.1155/2020/5679629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/22/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023]
Abstract
Plantar heel pain is a common disease with a high incidence in different races. It significantly reduced the quality of life of patients. However, the cause of PHP is still controversial and there were varieties of physiological factors associated with PHP. The most common pathological factor in the population was plantar fasciitis. Some existing research studies had found a correlation between calcaneal spurs and plantar fasciitis, and this study had found the correlation in Chinese population. It is invaluable not only to understand the relationship between different types of plantar calcaneal spurs and plantar fasciitis but also to identify the most appropriate treatment strategies. A total of 71 patients with calcaneal spurs were chosen from the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. All 71 patients had completed X-rays and MRI scans; then, surgeons had removed their plantar calcaneal spurs. After surgery, all patients were followed up for 12 months; their prognosis was tested by the VAS and AOFAS scores. Type II (29, 40.8%) had the highest incidence in Chinese population, followed with type I (24, 33.8%) and type III (18, 25.4%). Preoperative VAS scores showed that type II (7.72 ± 1.10) was significantly higher than the other two types (P < 0.001). Postoperative VAS scores of type II were higher than those of type I and type III (P < 0.001). Postoperative AOFAS scores of type II were the lowest (P < 0.001). Researchers had proved that type II was more likely to cause PF.
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Gariani K, Waibel FWA, Viehöfer AF, Uçkay I. Plantar Fasciitis in Diabetic Foot Patients: Risk Factors, Pathophysiology, Diagnosis, and Management. Diabetes Metab Syndr Obes 2020; 13:1271-1279. [PMID: 32368120 PMCID: PMC7183784 DOI: 10.2147/dmso.s184259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Abstract
Plantar fasciitis (PF) is a common degenerative disorder and a frequent cause of heel pain, mostly affecting patients in their fourth and fifth decades. Diabetic patients are particularly at risk due to the presence of common risks and co-morbidities such as obesity or a sedentary lifestyle. The diagnosis of PF is mainly clinical. Imaging is not recommended for the initial approach. The initial management is conservative and should include physiotherapy, off-loading, stretching exercises, and nonsteroidal anti-inflammatory drugs. Glucocorticoid injections or surgery is an option at a later stage in recalcitrant cases. The overall management of PF does not differ between patients with diabetic foot problems and non-diabetic patients, although the details can differ. This narrative review summarizes the state of the art in terms of the risk factors, pathophysiology, diagnosis, assessment, and management of PF in diabetic patients.
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Affiliation(s)
- Karim Gariani
- Service of Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals, Geneva, Switzerland
- Correspondence: Karim Gariani Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals, Geneva, Switzerland Email
| | - Felix W A Waibel
- Foot and Ankle Service, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Arnd F Viehöfer
- Foot and Ankle Service, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Ilker Uçkay
- Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
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Malahias MA, Cantiller EB, Kadu VV, Müller S. The clinical outcome of endoscopic plantar fascia release: A current concept review. Foot Ankle Surg 2020; 26:19-24. [PMID: 30665823 DOI: 10.1016/j.fas.2018.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/12/2018] [Accepted: 12/14/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To clarify whether endoscopic plantar fascia release is safe and effective in the treatment of chronic plantar fasciitis. Secondary goals were a. to compare the clinical outcome between EPFR and non-operative treatment and b. to describe the various EPFR surgical approaches and their outcomes. MATERIALS AND METHODS Two reviewers (MM and EBC) independently conducted the search using the MEDLINE/PubMed database. This database was queried with the terms 'endoscopic plantar fascia release' and 'endoscopic plantar fasciotomy'. To maximize the search, backward chaining of reference lists from retrieved papers was also undertaken. RESULTS From the initial 63 studies we finally chose and assessed 15 studies which were eligible to our inclusion-exclusion criteria. A total number of 535 patients (576 feet) were reported, with a slightly higher female rate. The vast majority of the studies were case series (66.7% of all), while two papers were randomized controlled trials (13.3%), two were case control studies (13.3%), and one was cohort study (6.7%). The overall quality of the studies included in this review, as it was evaluated according to the GRADE Working Group guidelines, was low, while it ranged from very low to high. All studies showed that the postoperative clinical and functional subjective scores were significantly improved with the use of EPFR. Overall, the postoperative complications' rate was 11.0%. The most common complications which were recorded were persistent heel pain (5.6%), paresthesias or numbness (4.3%), soft tissue healing problems (1.7%), and superficial infection (0.4%). CONCLUSIONS There was weak evidence to support that endoscopic plantar fascia release was safe and effective for the treatment of chronic plantar fasciitis.
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Affiliation(s)
| | - Erwin Brian Cantiller
- International Center for Hip, Knee and Foot Surgery, ATOS Clinic, Heidelberg, Germany
| | - Vikram V Kadu
- Sancheti institute of Orthopaedics and rehabilitation, Pune, India
| | - Sebastian Müller
- International Center for Hip, Knee and Foot Surgery, ATOS Clinic, Heidelberg, Germany.
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Mao DW, Chandrakumara D, Zheng Q, Kam C, Kon Kam King C. Endoscopic plantar fasciotomy for plantar fasciitis: A systematic review and network meta-analysis of the English literature. Foot (Edinb) 2019; 41:63-73. [PMID: 31706064 DOI: 10.1016/j.foot.2019.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/16/2019] [Accepted: 08/18/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Currently, there is limited evidence on outcomes for endoscopic plantar fasciotomy. OBJECTIVES An evidence-based literature review for outcomes of endoscopic plantar fasciotomy for the treatment of plantar fasciitis is provided. METHODS A comprehensive evidence-based literature review of PubMed and Cochrane databases was conducted on 9th March 2019, which identified 12 relevant articles assessing the efficacy of endoscopic plantar fasciotomy. 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. RESULTS Based on the results of this evidence-based review, there is poor evidence (grade C) to support endoscopic plantar fascia release. Release of the medial 2/3 of the plantar fascia in endoscopic plantar fasciotomy was associated with higher AOFAS score. CONCLUSION Although the majority of the level of evidence was low (level IV) and grade of recommendation was poor (grade C), there seemed to be good outcomes for endoscopic plantar fasciotomy. 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.
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Affiliation(s)
- David Weijia Mao
- Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, 529889, Singapore.
| | - Darshana Chandrakumara
- Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, 529889, Singapore
| | - Qishi Zheng
- Department of Epidemiology, Singapore Clinical Research Institute, 31 Biopolis Way, 138669, Singapore
| | - Carmen Kam
- Clinical Trials & Research Unit, Changi General Hospital, 2 Simei St 3, 529889, Singapore
| | - Charles Kon Kam King
- Department of Orthopaedic Surgery, Changi General Hospital, 2 Simei St 3, 529889, Singapore
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Johannsen F, Konradsen L, Herzog R, Rindom Krogsgaard M. Plantar fasciitis treated with endoscopic partial plantar fasciotomy-One-year clinical and ultrasonographic follow-up. Foot (Edinb) 2019; 39:50-54. [PMID: 30974340 DOI: 10.1016/j.foot.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/04/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic operations for plantar fasciitis generally have good clinical outcome. The aim of this study was to record the effect of endoscopic partial fasciotomy and heel spur removal and evaluate by ultrasonography whether the fascia regenerates and the heel spur reforms. METHODS Eleven consecutive patients were evaluated before and 3, 6 and 12 months after surgery. Operations were performed endoscopically using a deep fascial approach with a medial and a lateral portal. Bony spurs were removed and the medial half of the plantar fascia was transected. All patients followed a standardized rehabilitation program. RESULTS Median Foot Function Index values decreased from 119 pre-surgery to 69 and 12 (p=0.004), at 3 months and 1year post-operatively respectively. Median VAS-score for first step pain was likewise reduced from median 71mm to 29mm and 7mm (p=0.004), respectively. Median fascial thickness at the medial insertion was 6.0mm (range 4.6-6.8mm) pre-operatively. A heel spur was present in 9 cases. One year postoperatively a well-defined fascia in the area of resection was demonstrated in 8 cases. In the rest of the cases scar tissue made it impossible to clearly outline the fascia. Nine of the feet showed good medial fascial tensioning. There was no evidence of recurrence of the bony spur. CONCLUSIONS Endoscopic partial plantar fascia resection reduced pain symptoms and increased function significantly 3 months after operation, with additional effect achieved 12 months after surgery. Based on ultrasonography the resected fascia regenerated/healed, and a calcaneal spur did not recur.
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Affiliation(s)
- Finn Johannsen
- Institute of Sports Medicine, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Lars Konradsen
- Section for Sports Traumatology M51, Department of Orthopedic Surgery, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.
| | - Robert Herzog
- Department of Physiotherapy, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology M51, Department of Orthopedic Surgery, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
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Effect of In-Shoe Foot Orthosis Contours on Heel Pain Due to Calcaneal Spurs. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9030495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study is to investigate the effect of contouring the shoe insole on calcaneal pressure and heel pain in calcaneal spur patients. Calcaneal pressure was measured using three force sensors from 13 patients including three males and 10 females. These patients have plantar heel pain due to calcaneal spurs, and we examined five customized contour insole foot areas (0–100%). Sensors were attached at the central heel (CH), lateral heel (LH) and medial heel (MH) of the foot. The pain was measured using an algometer and evaluated by the pain minimum compressive pressure (PMCP). In this study, it was observed that the calcaneal pressure decreased with increasing insole foot area. In addition, increasing the insole foot area from 25% to 50% can reduce the calcaneal pressure approximately 17.4% at the LH and 30.9% at the MH, which are smaller than the PMCP, while at the MH, pressure reduced 6.9%, which is greater than the PMCP. Therefore, to reduce pain, one can use 50% insole foot area, even though at MH it is still 19.3% greater than the PMCP. Excellent pain relief was observed when using 100% insole foot area, as the pressures in those three areas are lower than the PMCPs, but it is not recommended because it requires large production costs.
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Alatassi R, Alajlan A, Almalki T. Bizarre calcaneal spur: A case report. Int J Surg Case Rep 2018; 49:37-39. [PMID: 29957453 PMCID: PMC6039697 DOI: 10.1016/j.ijscr.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/07/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION A calcaneal spur, also known as enthesophyte, is an abnormal bone outgrowth at the inferior part of the calcaneus, which is the most common site of bony spur occurrence. Although there is consensus that a calcaneal spur is a common cause of heel pain, approximately 20% of calcaneal spurs are asymptomatic and its pathology remains not fully understood. PRESENTATION OF CASE In this report, we present a rare case of a very large and bizarre calcaneal spur in a young adult man. The calcaneal spur was painful, which affected his foot function and was associated with plantar fasciitis. The spur length was measured in the radiograph and exhibited the longest calcaneal spur reported in the literature. The patient was treated conservatively, and he fully recovered his foot function. DISCUSSION This case was unique because although the patient presented with an extremely large unilateral calcaneal spur, he was young and did not have any chronic disease; hence, he was treated conservatively. The pain subsided and he regained full function of his foot. This case questions the association between calcaneal spur length and plantar fasciitis symptoms. CONCLUSION This case confirms that the length of calcaneal spurs, even extremely long ones, is not associated with the pathology of plantar fasciitis and that surgical treatment is not necessary.
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Affiliation(s)
- Raheef Alatassi
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia.
| | - Ahmad Alajlan
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia
| | - Talal Almalki
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia
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Boakye L, Chambers MC, Carney D, Yan A, Hogan MV, Ewalefo SO. Management of Symptomatic Plantar Fasciitis. ACTA ACUST UNITED AC 2018. [DOI: 10.1053/j.oto.2018.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights Imaging 2016; 8:69-78. [PMID: 27957702 PMCID: PMC5265197 DOI: 10.1007/s13244-016-0533-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/02/2016] [Accepted: 11/15/2016] [Indexed: 01/16/2023] Open
Abstract
Plantar fascia (PF) disorders commonly cause heel pain and disability in the general population. Imaging is often required to confirm diagnosis. This review article aims to provide simple and systematic guidelines for imaging assessment of PF disease, focussing on key findings detectable on plain radiography, ultrasound and magnetic resonance imaging (MRI). Sonographic characteristics of plantar fasciitis include PF thickening, loss of fibrillar structure, perifascial collections, calcifications and hyperaemia on Doppler imaging. Thickening and signal changes in the PF as well as oedema of adjacent soft tissues and bone marrow can be assessed on MRI. Radiographic findings of plantar fasciitis include PF thickening, cortical irregularities and abnormalities in the fat pad located deep below the PF. Plantar fibromatosis appears as well-demarcated, nodular thickenings that are iso-hypoechoic on ultrasound and show low-signal intensity on MRI. PF tears present with partial or complete fibre interruption on both ultrasound and MRI. Imaging description of further PF disorders, including xanthoma, diabetic fascial disease, foreign-body reactions and plantar infections, is detailed in the main text. Ultrasound and MRI should be considered as first- and second-line modalities for assessment of PF disorders, respectively. Indirect findings of PF disease can be ruled out on plain radiography. Teaching Points • PF disorders commonly cause heel pain and disability in the general population. • Imaging is often required to confirm diagnosis or reveal concomitant injuries. • Ultrasound and MRI respectively represent the first- and second-line modalities for diagnosis. • Indirect findings of PF disease can be ruled out on plain radiography.
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Ahmad J, Karim A, Daniel JN. Relationship and Classification of Plantar Heel Spurs in Patients With Plantar Fasciitis. Foot Ankle Int 2016; 37:994-1000. [PMID: 27177888 DOI: 10.1177/1071100716649925] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study classified plantar heel spurs and their relationship to plantar fasciitis. METHODS Patients included those with plantar fasciitis who were treated from 2012 through 2013. Plantar heel spur shape and size were assessed radiographically and correlated to function and pain before and after treatment. Function and pain were scored with the Foot and Ankle Ability Measures and a visual analog scale, respectively. This study included 109 patients with plantar fasciitis. RESULTS The plantar heel spur shape was classified as 0/absent in 26 patients, 1/horizontal in 66 patients, 2/vertical in 4 patients, and 3/hooked in 13 patients. The plantar heel spur size was less than 5 mm in 75 patients, 5-10 mm in 28 patients, and greater than 10 mm in 6 patients. Initially, patients with any shape or size to their spur had no difference in function and pain. With treatment, patients with horizontal and hooked spurs had the greatest improvement in function and pain (P < .05). With treatment, patients with larger spurs had the greatest improvement in function and pain (P < .05). CONCLUSION Plantar heel spurs can be classified by shape and size in patients with plantar fasciitis. Before treatment, neither the spur shape nor size significantly correlated with symptoms. After treatment, patients with larger horizontal or hooked spurs had the greatest improvement in function and pain. These findings may be important when educating patients about the role of heel spurs with plantar fasciitis and the effect of nonsurgical treatment with certain spurs. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Jamal Ahmad
- Orthopaedic Foot and Ankle Surgery, Rothman Institute Orthopaedics, Philadelphia, PA, USA
| | - Ammar Karim
- Rowan University School of Osteopathic Medicine, Department of Orthopaedic Surgery, Stratford, NJ, USA
| | - Joseph N Daniel
- Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Hayta E, Salk I, Gumus C, Tuncay MS, Cetin A. Extracorporeal shock-wave therapy effectively reduces calcaneal spur length and spur-related pain in overweight and obese patients. J Back Musculoskelet Rehabil 2016; 30:BMR708. [PMID: 27232085 DOI: 10.3233/bmr-160708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We aimed to evaluate the effects of extra corporeal shock-wave therapy (ESWT) on the calcaneal spur length and pain severity in overweight and obese patients with symptomatic calcaneal spur. METHODS In eighty patients with symptomatic calcaneal spur, ESWT was administered on days 0 and 7, and visual analog scale (VAS) scores and calcaneal spur lengths (CSLs) before and 3 months later after treatment were recorded. A lateral heel radiograph was used for computer-aided linear measurements of CSL. RESULTS Of 80 patients, 59 (73.7%) were female and 21 were male (26.3%); age was 45.9 ± 8.3 years; BMI was 31.6 ± 4.4 kg/m2; and symptom duration was 2.3 ± 2.4 years. The CSL and VAS score after treatment were significantly lower than those before treatment (CSL before vs. after: 5.7 ± 1.0 vs. 4.4 ± 0.9, p = 0.001; VAS score before vs. after: 8.3 ± 1.4 vs. 4.6 ± 2.2; p = 0.03). The CSLs before and after treatment had a significant strong correlation (r = 0.832, p = 0.001). The VAS scores before and after treatment presented a significant mild correlation (r = 0.242, p = 0.03). CONCLUSIONS In overweight and obese patients with symptomatic calcaneal spur, ESWT reduces the CSL and pain severity during a follow-up of three-month duration.
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Affiliation(s)
- Emrullah Hayta
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ismail Salk
- Department of Radiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Cesur Gumus
- Department of Radiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Mehmet Siddik Tuncay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ali Cetin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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