Effectiveness of Mechanical Treatment for Plantar Fasciitis: A Systematic Review

Effects of insoles adapted in flip-flop sandals in patients with persistent plantar heel pain: A sham-controlled randomised trial

OBJECTIVE

To evaluate the use of custom-made insoles adapted to flip-flops on pain intensity, foot function, and functional walking ability in individuals with persistent plantar heel pain in the short and medium term.

DESIGN

Randomised controlled trial.

SETTING

Flip-flop sandals in patients with persistent plantar heel pain.

MAIN MEASURES

Participants (n = 80) were assessed at baseline, six and 12 weeks after the intervention, and 4 weeks post-intervention.

RESULTS

For the primary outcomes, after 6 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.4 (95% confidence intervals = -1.5 to 0.8). Similarly, after 12 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.7 (95% confidence intervals = -1.9 to 0.6). Finally, at 4 weeks after the end of the intervention, there was no between-group difference in morning pain or pain on walking, mean difference = 0.01 (95% confidence intervals = -1.4 to 1.4). All differences and confidence intervals were smaller than the minimum clinically important difference for pain (2 points). There were no differences between the groups for the secondary outcomes. In addition, the mean differences were smaller than the minimum clinically important differences for pain intensity, foot function and functional walking ability.

CONCLUSION

Custom-made insoles fitted to flip-flops did not differ from flip-flops with sham insoles in improving pain intensity, foot function and functional walking ability in people with persistent heel pain.Trial registration: ClinicalTrials.gov (Identifier: NCT04784598). Data of registration: 2023-01-20.

Physicians' experiences with indications and prescriptions of foot orthoses-A cross-sectional study in northern Germany

Background

Foot orthoses (FOs) are prescribed by general practitioners (GPs) and orthopedic surgeons for various complaints. As there are very limited medical guidelines and checklists, the prescription of FOs is often inconsistent. Therefore, our study to evaluate the general prescription behavior and indication experiences with FOs from the perspective of GPs and orthopedists.

Methods

A survey was carried out using a questionnaire from October to December 2021. GPs and orthopedic surgeons in northern Germany were included. The focus of the survey was to examine which foot problems would lead GPs and orthopedic surgeons to prescribe FOs and to evaluate what factors these physicians included in their diagnostic analysis. Apart from descriptive analyses, a stepwise linear regression analysis was performed to explore potential associations of the primary outcome variable 'specific effect on the prescription of FOs', which was introduced to shed light upon the estimated added value of the prescription of FOs.

Results

Out of the 790 questionnaires distributed, 184 questionnaires were returned by GPs (n = 95) and orthopedic surgeons (n = 74) (response rate 23 %). FOs were most frequently prescribed for talipes valgus (96 %) and heel spur (54 %). Diagnostic analysis was mainly carried out clinically. Custom-made FOs (82 %) were prescribed more frequently than prefabricated FOs (6 %). Regular interaction within the prescription process was most commonly with orthopedic technicians (61 %). The estimation of the specific effect on FO prescription was assessed by a mean of 66 % of the participants, 82 % recommended self-exercises as an additional therapy.

Conclusions

FOs are a specific and well-established aid prescribed by many GPs and orthopedic surgeons for a variety of foot complaints. Despite being one of the most frequently prescribed orthopedic devices, the utilization of FOs is predominantly explorative due to a growing but nevertheless still deficient body of well-researched evidence. There is a clear need for a uniform approach to the indication and prescription of FOs among physicians.

Clinical Study of a Four-Step Program for the Treatment of Plantar Fasciitis with Bone Spurs

OBJECTIVE

The most common causes of plantar and heel pain are plantar fasciitis and calcaneal spurs, and they often co-exist. Surgery is a recognized treatment for refractory plantar fasciitis. However, few studies have proposed treatment options for patients with metatarsophalangeal fasciitis with bone spurs. Accordingly, this study's purpose was to propose a four-step surgical regimen, and to improve the surgical outcome of plantar fasciitis with osteophytes and to establish a procedure for surgical treatment.

METHODS

Retrospective analysis of 45 patients suffering from plantar fasciitis with bone spurs from 2020 to 2023. All patients underwent a four-step procedure, including plantar fascia release, calcaneal spur grinding, inflammatory tissue removal, and calcaneal burr decompression. The imaging parameters and functional scores were recorded before and after the operation. The objective evaluation included the measurement of calcaneal spur length on radiographs. Clinical evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS), the Visual Analog Scale (VAS), and the Foot and Ankle Outcome Scale (FAOS). Measurement data that conformed to normal distribution were expressed as (x2 ± s), and pre-and postoperative AOFAS, FAOS, and VAS scores were compared using repeated-measures ANOVA, and preoperative and postoperative spur lengths were compared using paired t-tests.

RESULTS

The 45 patients were followed up for 3 to 30 months, (17.72 ± 8.53) months, at final follow-up, the patient's AOFAS score improved from preoperative (74.93 ± 5.56) to (94.78 ± 3.98), FAOS score increased from preoperative (76.42 ± 3.37) to (96.16 ± 2.74), the VAS score decreased from (3.18 ± 0.54) to (1.07 ± 1.20) (p < 0.05), the length of spur decreased from (0.72 ± 1.81) cm to (0.23 ± 1.19) cm, and there were significant differences before and after operation (p < 0.05).

CONCLUSION

The four-step surgical regimen is an appropriate and effective surgical procedure to treat plantar fasciitis with bone spurs.

Comparison of the effectiveness of peloid therapy and kinesiotaping in patients with unilateral plantar fasciitis: A prospective, randomized controlled study

Objectives

This study aimed to compare the efficacy of peloid therapy and kinesiotaping for unilateral plantar fasciitis (PF).

Patients and methods

In the randomized controlled study, a total of 114 patients (89 females, 25 males; mean age: 45.1±8.3 years; range, 27 to 65 years) diagnosed with unilateral PF between January 2021 and March 2023 were randomly divided into three equal groups: the peloid group (peloid therapy and home-based exercise + heel pad), the kinesiotaping group (kinesiotaping and home-based exercise + heel pad), and the control group (home-based exercise + heel pad). Peloid therapy was performed over two weeks for a total of 10 sessions. Kinesiotaping was applied four times over two weeks. Plantar fascia, calf, and Achilles stretching exercises and foot strengthening exercises were performed, and prefabricated silicone heel insoles were used daily for six weeks. Patients were evaluated three times with clinical assessment scales for pain, the Heel Tenderness Index, and the Foot and Ankle Outcome Score before treatment, at the end of treatment, and in the first month after treatment.

Results

Statistically significant improvements were observed for all parameters at the end of treatment and in the first month after treatment compared to the baseline in every group (p<0.001). No superiority was found between the groups.

Conclusion

Peloid therapy or kinesiotaping, given as adjuncts to home-based exercise therapy and shoe insoles in patients with unilateral PF, did not result in additional benefits.

Efficacy of extracorporeal shockwave therapy, compared to corticosteroid injections, on pain, plantar fascia thickness and foot function in patients with plantar fasciitis: A systematic review and meta-analysis

OBJECTIVE

To compare the efficacy of extracorporeal shock waves versus corticosteroids injections on pain, thickness of plantar fascia and foot function in patients with plantar fasciitis. Secondarily, to assess the efficacy of radial and focused extracorporeal shock waves and the most appropriated intensity (high, medium or low).

DATA SOURCES

PubMed, SCOPUS, CINAHL and PEDro, until April 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

REVIEW METHODS

Randomized controlled trials comparing the efficacy of extracorporeal shock waves versus corticosteroids injections on pain intensity and sensitivity, thickness of plantar fascia and foot function in patients with plantar fasciitis. Methodological quality and risk of bias were assessed using PEDro Scale and Cochrane Risk of Bias Tool. Pooled effect was calculated using the standardized mean difference (SMD) and its 95% confidence interval (95%CI).

RESULTS

Sixteen studies involving 1121 patients, showing a mean of 6 points in PEDro scale, were included. At three months, extracorporeal shock waves were better than corticosteroids injections in reducing pain (SMD -0.6; 95%CI -1.1 to -0.11) and thickness of the plantar fascia (SMD -0.4; 95%CI -0.8 to -0.01) and increasing foot function (SMD 0.27; 95%CI 0.12-0.44). At six months, extracorporeal shock waves are more effective in reducing pain (SMD -0.81; 95%CI -1.6 to -0.06) and increasing foot function (SMD 0.67; 95%CI 0.45-0.89). Local pain and slight erythema were the most frequent adverse events.

CONCLUSIONS

Extracorporeal shock waves are a safe therapy, presenting more efficacy than corticosteroids injections in improving pain, thickness of plantar fascia and foot function at mid-term.

Role of insole material in treatment of plantar fasciitis: A randomized clinical trial

BACKGROUND

In this randomized clinical trial, we compared the early effects of polyethylene (PE), polyurethane (PU), and Carbon Fiber insoles in the treatment of PF using a set of patient-reported outcomes.

METHODS

Patients were randomly allocated one of the three prefabricated insoles - Carbon Fiber (n = 14), PU (n = 14), or PE (n = 17) for regular use. Their response was recorded using PROMIS 3a (for pain intensity), PROMIS 4a (for pain interference), FAOS (Foot and Ankle Outcome Score), and VAS for pain at baseline, two, six, and twelve weeks.

RESULTS

The PROMIS pain intensity scores improved in both the Carbon Fiber and the PE groups starting at the 6th week (p = 0.04) and 2nd week (p = 0.002), respectively. PROMIS pain interference scores also showed positive trends in these two groups (p = 0.02, p = 0.004, respectively).

CONCLUSION

Prefabricated Carbon Fiber and PE insoles showed significant pain-reducing effects in patients with PF.

LEVELS OF EVIDENCE

Level I, Randomized controlled trial.

Barefoot walking is beneficial for individuals with persistent plantar heel pain: A single-blind randomized controlled trial

BACKGROUND

A lack of data exist about the effectiveness of active treatments for persistent plantar heel pain (PPHP).

OBJECTIVES

To compare short-term functional and clinical effects of a 4-week barefoot or shod treadmill walking program for people with PPHP.

METHODS

A single-blinded clinical trial randomized 52 participants with PPHP into either a barefoot walking group (BWG), or a shod walking group (SWG). All participants received therapeutic ultrasound. Outcomes were measured at baseline (t0), following 4 weeks of treatment (t1), and at 1-month follow-up (t2). The SF-36 functional questionnaire score was the main outcome. Secondary outcomes were self-reported and clinically-assessed pain provocation levels, pressure pain thresholds and pain tolerance. Treadmill walking time and speed were measured at t0 and t1; people also recorded the time spent walking each day in a diary.

RESULTS

The BWG exhibited significant improvements in all SF-36 items (except "emotional well-being") (P < 0.05), whereas the SWG exhibited improvements only in "pain" and "health change" items (P = 0.0001; effect size 0.13-0.94). Greater improvements were observed in the BWG than the SWG for "physical function" (P = 0.019) and "role limitations due to physical health" items (P = 0.035). Both groups demonstrated significant improvements in pain, with greater improvements in the BWG (P = 0.0001; effect size 0.89). Only the BWG showed significant improvements in pain pressure thresholds (P < 0.05; effect size 0.70) and pain tolerance (P < 0.001; effect size 0.67). Both groups significantly increased their speed and time spent walking on the treadmill (BWG Δ=19.7 min and Δ=1.7 km/h; SWG Δ=16.7 min and Δ=1.1 km/h) and time outdoors (SWG ∆=38.2 min/week; BWG mean ∆=48.5 min/week) (P < 0.001). All clinical tests of pain were significantly less positive in the BWG at all time points (P < 0.05).

CONCLUSIONS

Both walking programs benefited people with PPHP by alleviating pain and improving function and quality of life. Greater improvements were observed in the BWG than the SWG overall.

Consensus statements and guideline for the diagnosis and management of plantar fasciitis in Singapore

Introduction

Plantar fasciitis (PF) is a common cause of heel pain among the general population. The lack of standard practice guideline in Singapore presents challenges in education and clinical practice for this painful condition. These consensus statements and guideline were developed to streamline and improve the management of PF, covering key aspects such as diagnosis, investigations, risk factors, treatment modalities, monitoring and return to work/play.

Method

A multidisciplinary expert panel consisting of 6 sports physicians, 2 orthopaedic surgeons, 2 podiatrists and 1 physiotherapist from SingHealth Duke-NUS Sport & Exercise Medicine Centre (SDSC) was convened based on their clinical and academic experience with PF. The Grading of Recommen-dations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of the evidence and subsequently prepare a set of clinical recommen-dations pertaining to the manage-ment of PF. A modified Delphi process was used to reach consensus.

Results

Eighteen consensus statements were developed to cover key components of PF management, from initial diagnosis to treatment modalities and finally, clinical progression. They were subsequently consolidated under a proposed treatment pathway guideline for PF.

Conclusion

The SDSC consensus statements and guideline provide concise recommendations for the management of PF in Singapore.

For plantar taping, direction of elasticity matters

Plantar taping has been used in clinical settings as a short-term conservative treatment for plantar heel pain and related pathologies. The rise of at-home taping methods may offer patients more independence, but effectiveness has not been established. The purpose of this study was to evaluate the effects of plantar taping on foot mechanics during gait. We hypothesized that material compliance would drive mechanical effectiveness, with longitudinally inelastic tape reducing medial longitudinal arch (MLA) motion and anterior/posterior (A/P) plantar tissue spreading forces, and laterally inelastic tape reducing medial/lateral (M/L) tissue spreading. We also hypothesized that these effects would be influenced by foot structure. Fifteen healthy participants were tested in a randomized cross-over study design. Barefoot (BF) plus four taping methods were evaluated, including two inelastic tapes (Low-Dye, LD, and FasciaDerm, FD) along with longitudinally elastic kinesiology tape (KT) and a novel laterally elastic kinesiology tape (FAST, FS). Participants' arch height and flexibility were measured followed by instrumented gait analysis with a multi-segment foot model. Ankle eversion and MLA drop/rise were calculated from rearfoot and forefoot reference frames, while plantar tissue spreading was calculated from shear stresses. ANOVAs with Holm pairwise tests evaluated tape effects while correlations connected arch structure and taping effectiveness (α = 0.05). The three longitudinally inelastic tapes (LD, FD, FS) reduced MLA drop by 11-15% compared with KT and BF. In late stance, these tapes also inhibited MLA rise (LD by 29%, FD and FS by 10-15%). FS and FD reduced A/P spreading forces, while FD reduced M/L spreading forces compared with all other conditions. Arch height had a moderately strong correlation (r = -0.67) with the difference in MLA drop between BF and FS. At-home plantar taping can affect the mechanical function of the foot, but tape elasticity direction matters. Longitudinally elastic kinesiology tape has little effect on mechanics, while inelastic tapes control MLA drop but also restrict MLA rise in late stance. Lateral elasticity does not limit tissue spreading and may increase comfort without sacrificing MLA control. At-home taping has the potential to broaden conservative treatment of plantar heel pain, flat foot deformity, and related pathologies, but additional studies are needed to connect mechanics with symptom relief.

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

OBJECTIVE

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

DESIGN

Systematic review of randomised controlled trials (RCTs).

DATA SOURCES

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

ELIGIBILITY CRITERIA

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

RESULTS

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

CONCLUSIONS

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

PROSPERO REGISTRATION NUMBER

CRD42021224416.

The effects of a custom foot orthosis on dynamic plantar pressure in patients with chronic plantar fasciitis: A randomized controlled trial

BACKGROUND

Plantar fasciitis is one of the most common causes of heel pain. The plantar fascia supports the longitudinal arch and absorbs ground reaction forces during the static and dynamic phase(s) of weight-bearing. The purpose of this randomized controlled trial study was to determine the effects of CAD/CAM foot orthoses that were designed based on the dynamic plantar pressure in patients with plantar fasciitis.

METHODS

This study was performed on 34 patients with plantar fasciitis. Outcomes were compared based on plantar fascia thickness; peak pressure, mean pressure, and maximum force; and pain, activity of daily living, quality of life, and sports activity that were evaluated by ultrasound, plantar pressure platform, and the Foot and Ankle Outcome Score, respectively. The patients were randomly assigned into two groups: the experimental group (CAD/CAM orthoses and night splint) and the control group (night splint only). All data were recorded again after 4 weeks.

RESULTS

Pain ( P = 0.002) and plantar fascia thickness ( P = 0.001) decreased significantly after 1 month of intervention. Activity of daily living ( P = 0.044) and quality of life ( P = 0.001) showed a significant increase. There was a trend in increasing peak pressure in all masking regions in both groups. The maximum force remarkably reduced in the experimental group in all regions.

CONCLUSIONS

The results demonstrated that CAD/CAM foot orthoses designed based on dynamic plantar pressure with night splint can reduce the plantar fascia thickness and pain associated with plantar fasciitis and increase the activity of daily living, quality of life, and sports activity.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effects of insoles adapted in flip-flop sandals for persistent heel pain: a protocol for a sham-controlled randomised trial

INTRODUCTION

Persistent heel pain is a prevalent complaint affecting up to 10% of the population. Insoles adapted in flip-flop sandals are an alternative treatment for pain and function of individuals with persistent heel pain, showing improvement within 12 weeks of treatment. Most studies considered foot posture and biomechanics to prescribe insoles for persistent heel pain, but few verified the effects of a 12-week treatment on pain catastrophising. This study will investigate the effects of insoles adapted in flip-flop sandals on pain intensity, function, functional walking capacity and pain catastrophising of individuals with persistent heel pain.

METHODS AND ANALYSIS

This is a protocol for a sham-controlled randomised trial. Eighty individuals with persistent heel pain will be assessed and randomised into two intervention groups: insoles adapted in flip-flop sandals and flip-flop sandals with sham (ie, flat) insoles. Assessments will be conducted at baseline (T0), after 6 weeks (T6), 12 weeks postintervention (T12) and after a 4-week follow-up (T16). The primary outcome will be the pain intensity, and secondary outcomes will be foot function, functional walking capacity and pain catastrophising. Analysis of variance with mixed design (if normal distribution) or Friedman's test (if not normal distribution) will verify intergroup and intragroup differences. Bonferroni post hoc tests will be performed in case of significant group or time interaction. Intent-to-treat analysis will be used, and a significance level of 5% and 95% CIs will be considered.

ETHICS AND DISSEMINATION

This study was approved by the research ethics committee of the Federal University of Rio Grande do Norte (registry no. 4,018,821). Results will be disseminated to individuals, submitted to a peer-reviewed journal and disclosed in scientific meetings.

TRIAL REGISTRATION NUMBER

NCT04784598.

The Effect of Short and Long-Term Therapeutic Treatment with Insoles and Shoes on Pain, Function, and Plantar Load Parameters of Women with Plantar Fasciitis: A Randomized Controlled Trial

Background and Objectives: Plantar fasciitis (PF) is a prevalent musculoskeletal disease, with inflammation at the origin of the plantar fascia, that affects sedentary people, particularly middle-aged women. Foot pain and functional limitations lead patients to seek treatment. Investigate the therapeutic effect of conservative treatment combining a custom insole with minimalist flexible shoes and the shoes alone in a gait-training protocol, in the short and long term, in women with PF. Materials and Methods: Design: A randomized, controlled, and single-blind trial.

SETTING

Biomechanics laboratory.

PARTICIPANTS

36 women, 26 with acute PF and 10 controls.

INTERVENTION

Gait-training protocol wearing the minimalist shoes alone (SG, n = 12, age: 46.4 ± 9.6, height: 1.60 ± 0.2, BMI: 28.8 ± 4.2), with a custom insole in the shoes (CIG, n = 14, age: 48.9 ± 9.8, height: 1.60 ± 0.1, BMI: 26.7 ± 5.6), and control (CG, n = 10, age: 46.1 ± 10.7, height: 1.61 ± 0.2, BMI: 26.4 ± 4.8). Evaluations were performed at baseline (T0) and after three (T3) and six (T6) months. The intervention had a duration of six months (six hours a day, seven days a week). Primary outcomes were rearfoot pain (visual analogue scale), the Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br), and 6 min walk test (6MWT). The secondary outcomes were plantar pressure distribution during gait, measured by the pressure platform, and foot posture. Results: The CIG was effective for reducing pain and improving the FPI after T6 compared to CG. The FPI, FHSQ-Br and 6MWT demonstrated improvements after T6 in both the CIG and SG, compared to the CG. After T6, contact area (rearfoot) and maximum force (forefoot) reduced with CIG. Maximum force (midfoot and rearfoot) reduced with CIG and SG, as did peak pressure (forefoot and midfoot) in relation to CG. Conclusions: A customized insole associated with minimalist flexible shoes during a gait-training protocol can be recommended as a more effective treatment than minimalist flexible shoes alone over the short and long term, for reduction in calcaneus pain, increased function and foot health, and improved walking through reduced plantar load in women with PF.

Immunopathogenesis, early Detection, current therapies and prevention of plantar Fasciitis: A concise review

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.

Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice

Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.

The Efficacy of Acupuncture on Foot and Ankle for Pain Intensity, Functional Status, and General Quality of Life in Adults: A Systematic Review

Objective: To assess the effect of acupuncture on foot and ankle pain intensity, functional status, quality of life, and incidence of adverse events in adults. Methods: Randomized controlled trials (RCTs) were obtained from a systematic search of 6 major English databases, and a manual search of relevant systematic reviews using Google Scholar. RCTs that compared acupuncture with various forms of sham acupuncture, nonactive and waitlist controls for pain intensity, functional status, and general quality of life were included. Study screening, data extraction, risk of bias assessment, and quality assessment were all performed independently. A narrative synthesis was performed when quantitative pooling was inappropriate. Results: Four RCTs were included, encompassing a total of 211 participants. Due to clinical heterogeneity for all outcomes, quantitative analysis was not appropriate. Our Grades of Recommendation, Assessment, Development and Evaluation rated all outcomes to have either low or very low quality of evidence. With low-quality evidence, acupuncture was shown to be efficacious for participants with plantar fasciitis for pain relief and functional status improvement at short- and intermediate-term follow-ups. Acupuncture was also shown to be efficacious for participants with Achilles tendinopathy for pain relief at short- and intermediate-term follow-ups. No adverse events were reported. Conclusion: There is some evidence to suggest acupuncture to be a safe and efficacious treatment for relieving pain and improving functional status for the foot and ankle. The results of this systematic review should be interpreted with caution due to the limited evidence. Future research should take into consideration the findings of this systematic review.

A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis

The number of systematic review and meta-analyses on plantar fasciitis is expanding. The purpose of this review was to provide a comprehensive summary of reviews on the topic pertaining to plantar fasciitis, identify any conflicting and inconsistent results, and propose future research direction. A qualitative review of all systematic reviews and meta-analyses related to plantar fasciitis up to February 2021 was performed using PubMed, Embase, Web of Science, and the Cochrane Database. A total of 1052 articles were initially identified and 96 met the inclusion criteria. Included articles were summarized and divided into the following topics: epidemiology, diagnosis, and treatment. While the majority of reviews had high level of heterogeneity and included a small number of studies, there was general consensus on certain topics, such as BMI as a risk factor for plantar fasciitis and extracorporeal shockwave therapy as an effective mode of therapy. A qualitative summary of systematic reviews and meta-analyses published on plantar fasciitis provides a single source of updated information for clinicians. Evidence on topics such as the epidemiology, exercise therapy, or cost-effectiveness of treatment options for plantar fasciitis are lacking and warrant future research.

Effects of rocker radii with two longitudinal bending stiffnesses on plantar pressure distribution in the forefoot

INTRODUCTION

Outsole parameters of the shoe can be adapted to offload regions of pain or region of high pressures. Previous studies already showed reduced plantar pressures in the forefoot due to a proximally placed apex position and higher longitudinal bending stiffness (LBS). The aim of this study was to determine the effect of changes in rocker radii and high LBS on the plantar pressure profile during gait.

METHOD

10 participants walked in seven shoe conditions of which one control shoe and six rocker shoes with small, medium and large rocker radii and low and high longitudinal bending stiffness. Pedar in-shoe plantar pressure measuring system was used to quantify plantar pressures while walking on a treadmill at self-selected walking speed. Peak plantar pressure, maximum mean pressure and force-time integral were analyzed with Generalized Estimated Equation (GEE) and Tukey post hoc correction (α = .05).

RESULTS

Significantly lower plantar pressures were found in the first toe, toes 2-5, distal and proximal forefoot in all rocker shoe conditions as compared to the control shoe. Plantar pressures in the first toe and toes 2-5 were significantly lower in the small radius compared to medium and large radii. For the distal forefoot both small and medium radii significantly reduced plantar pressure compared to large radii. Low LBS reduced plantar pressure at the first toe significantly compared to high LBS independent of the rocker radius. Plantar pressures in the distal forefoot and toes 2-5 were lower in high LBS compared to low LBS.

CONCLUSION

Manipulation of the rocker radius and LBS can effectively reduce peak plantar pressures in the forefoot region during gait. In line with previous studies, we showed that depending on the exact target location for offloading, different combinations of rocker radius and LBS need to be adopted to maximize treatment effects.

Percutaneous plantar fasciotomy: radiological evolution of medial longitudinal arch and clinical results after one year

PURPOSE

Plantar fasciitis (PF) is the most common cause of plantar heel pain. Conservative treatment and corrections of risks factors are the first line of care. For the 10% of patients who do not respond to conservative treatment, surgical release can offer relief of symptoms. Due to the critical role of the PF in the function of the foot and its architectural maintenance, its surgical release could cause a collapse of the internal arch of the foot and an alteration of its function. With the hypothesis that an isolated percutaneous PF release may not lead to these alterations of the foot while providing relief to the patients, we evaluated the radiological evolution and clinical results of this surgery after one year.

MATERIAL AND METHOD

Between January 2013 and Augustus 2017, we conducted a single arm monocentric prospective study on 22 patients (25 feet) aged from 33 to 84 years, with plantar fasciitis and failure of conservative management who benefited a percutaneous total plantar fasciotomy through a plantar approach. The American Orthopedic Foot and Ankle Score (AOFAS) and the Djian-Annonier's angle were evaluated preoperatively and postoperatively.

RESULTS

Among the 22 patients, sixteen patients were female and six patients were male. Three patients (2 females and 1 male) for six feet were operated for bilateral plantar fasciitis. The mean pre-operative Djian-Annonier's angle was 117.6° (range 101-132.9°), and the mean post-operative angle was 119.3° (range 102-137°). There was no statistically significant difference in Djian-Annonier's angle before and after surgery. The mean pre-operative AOFAS was 42.8 (range 32-51). The scores at 15 days, six weeks, and three months show a gradual increase up to 89.9 in the results with significant differences between the groups (p < 0.05). There was no difference between the scores after three months.

CONCLUSION

Complete percutaneous plantar fasciotomy is simple and safe and allows a quick recovery to activity without impacting the MLA.

A Radiographic Study of Biomechanical Relationship between the Achilles Tendon and Plantar Fascia

Background

Previously, scholars have concluded that the Achilles tendon and the plantar fascia were closely biomechanically related, although there is little clinical evidence of the relationship between the two. To investigate the biomechanical relationship between the Achilles tendon and the plantar fascia, the author used standing lateral ankle radiographs of patients with insertional Achilles tendonitis to determine the biomechanical relationship between the Achilles tendon and plantar fascia.

Methods

The author collected standing lateral ankle radiographs from patients with insertional Achilles tendonitis who accepted surgical treatment in the author's hospital from March 2009 to July 2018. According to whether there were bone spurs on the posterior side of the calcaneus, patients were divided into group A (spur present on the posterior side) and group B (spur not present on the posterior side). The positive rates of spurs on the plantar side of the calcaneus were determined in group A and group B. The chi-square test was used to compare the measurement results between the two groups.

Results

In group A, 13 heels were positive for calcaneal bone spurs, and the positive rate was 65.0%. In group B, 3 heels were positive for plantar calcaneal spurs, and the positive rate was 12%. Among all 16 patients with positive plantar calcaneal spurs, 13 had posterior calcaneal spurs (accounting for 81.3%), and 3 had negative results, accounting for 18.7%. There was a significant difference between the results in groups A and B (P < 0.05).

Conclusion

There is a relationship between posterior calcaneal spurs and plantar calcaneal spurs in patients with insertional Achilles tendonitis, which can be inferred as resulting from the increasing tension in the biomechanically complex relationship between the Achilles tendon and the plantar fascia.