Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound

Outcomes of platelet-rich plasma for plantar fasciopathy: a best-evidence synthesis

BACKGROUND

Plantar fasciopathy (PF) is a very common disease, affecting about 1/10 people in their lifetime. Platelet-rich plasma (PRP) had been demonstrated to be useful in achieving helpful effects for plantar fasciopathy. The purpose of this study was to compare the pain and functional outcomes between PRP and corticosteroid (CS) or placebo for plantar fasciopathy through meta-analysis and provide the best evidence.

METHODS

Literature was searched systematically to explore related studies that were published in Cochrane Library, PubMed, Embase, Medline, SpringerLink, OVID, and ClinicalTrials.gov . Articles regarding comparative research about the outcomes of PRP therapy and CS or placebo injection were selected. Data of pain and functional outcomes was extracted and imported into Reviewer Manager 5.3 to analyze.

RESULTS

Thirteen RCTs were included and analyzed. Analysis results showed significant superiority of PRP in outcome scores when compared with CS (VAS: MD = - 0.85, P < 0.0001, I² = 85%; AOFAS: MD = 10.05, P < 0.0001, I² = 85%), whereas there is no statistical difference in well-designed double-blind trials (VAS: MD = 0.15, P = 0.72, I² = 1%; AOFAS: MD = 2.71, P = 0.17, I² = 0%). In the comparison of the PRP and the placebo, the pooled mean difference was - 3.76 (P < 0.0001, 95% CI = - 4.34 to - 3.18).

CONCLUSIONS

No superiority of PRP had been found in well-designed double-blind studies, whereas it is implied that the outcomes of PRP are better than placebo based on available evidence.

Impact of plantar fasciitis on the quality of life of male and female patients according to the Foot Health Status Questionnaire

Background and purpose

Plantar fasciitis (PF) is a foot disorder in adults secondary to an inflammatory response caused by repetitive micro-trauma. We evaluated and compared the impact on quality of life (QoL) related to foot health and general health between males and females with PF.

Methods

In this cross-sectional descriptive study, patients with PF were recruited from a podiatry clinic. Physical examination, sociodemographic data, and the self-reported Foot Health Status Questionnaire (FHSQ) were recorded. The FHSQ has three sections and provides two composite scores from 0 to 100. Higher scores (close to 100) reflect better QoL related to foot health and health in general; lower scores (close to 0) denote a worse QoL related to these health items.

Results

One hundred patients (49 males [42.38 ± 14.065 years old] and 51 females [43.90 ± 14.305 years old]) were recruited. Section one of the FHSQ evaluates four foot domains, and significant differences (P<0.05) were shown for foot pain and footwear, with males having higher scores than females, but not for foot function and general foot health (P>0.05). Section two assesses four domains of general wellbeing, and significant differences (P<0.05) were shown for overall health, physical function, social capacity, and vigor, with males having higher scores than females.

Conclusion

Females with PF showed a worse health-related QoL for foot pain, foot function, footwear, and general foot health than males. A better health-related QoL was also shown for males with PF than for females with regard to general health, physical activity, social capacity, and vigor.

Quantitative analysis of patellar tendon size and structure in asymptomatic professional players: sonographic study

Background

Ultrasonographic abnormalities of the patellar tendon frequently occur in asymptomatic athletes and it is not always clear whether they precede (and may predict) the development of tendinopathy.

Objective

This study aimed to investigate by ultrasonography the prevalence of patellar tendon abnormalities in players of "pallapugno" and to establish whether structural tendon abnormalities predict tendinopathy development.

Methods

Ultrasound B-mode images of the patellar tendon of both sides were acquired in fourteen throwers. Qualitative assessments of tendon structure and neovascularization and quantitative assessments of tendon thickness, cross sectional area (CSA), and echo-intensity were performed.

Results

Qualitative assessments showed a subclinical tendinopathy of the non-dominant tendon in 5 out of 14 throwers (35% of cases), while quantitative assessments showed abnormalities of the non-dominant tendon in 8 out of 14 players (57% of cases). Echo-intensity and CSA were the quantitative variables most discriminant between asymptomatic players without structural tendon abnormalities and those with tendon abnormalities. Two players (2 out of 8 cases: 25%) developed a clinical tendinopathy after a follow-up of six months.

Conclusion

The prevalence of subclinical tendinopathy in the non-dominant patellar tendon of throwers was high. Patellar tendon abnormalities at baseline seem to increase the risk of development of subsequent patellar tendinopathy.

Level of evidence

II b (individual cohort study).

Percutaneous release of the plantar fascia. New surgical procedure

Background

Plantar fasciopathy presents with pain at the plantar and medial aspect of the heel. If chronic, it can negatively impact on quality of life. Plantar fasciopathy is not always self-limiting, and can be debilitating.

Methods

Surgical management involves different procedures. We describe a percutaneous plantar fascia release. A minimally invasive access to the plantar tuberosity of the calcaneus is performed, and a small scalpel blade is used to release the fascia.

Conclusion

With this procedure, skin healing problems, nerve injuries, infection and prolonged recovery time are minimised, allowing early return to normal activities.

Level of Evidence

V.

Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review

BACKGROUND

Plantar fasciitis (PF) is reported in different sports mainly in running and soccer athletes. Purpose of this study is to conduct a systematic review of published literature concerning the diagnosis and treatment of PF in both recreational and élite athletes. The review was conducted and reported in accordance with the PRISMA statement.

METHODS

The following electronic databases were searched: PubMed, Cochrane Library and Scopus. As far as PF diagnosis, we investigated the electronic databases from January 2006 to June 2016, whereas in considering treatments all data in literature were investigated.

RESULTS

For both diagnosis and treatment, 17 studies matched inclusion criteria. The results have highlighted that the most frequently used diagnostic techniques were Ultrasonography and Magnetic Resonance Imaging. Conventional, complementary, and alternative treatment approaches were assessed.

CONCLUSIONS

In reviewing literature, we were unable to find any specific diagnostic algorithm for PF in athletes, due to the fact that no different diagnostic strategies were used for athletes and non-athletes. As for treatment, a few literature data are available and it makes difficult to suggest practice guidelines. Specific studies are necessary to define the best treatment algorithm for both recreational and élite athletes.

LEVEL OF EVIDENCE

Ib.