Comparison between customised foot orthoses and insole combined with the use of extracorporeal shock wave therapy in plantar fasciitis, medium-term follow-up results: A randomised controlled trial

Effects on pain of kinesiology tape in patients with plantar fasciitis: a randomized controlled study

PURPOSE.

Plantar fasciitis is the most frequent cause of heel pain. Custom-made plantar supports are a common treatment solution, while the application of kinesiology tape (KT) can be an effective measure to alleviate pain. The objective was to evaluate the effects of KT on the pain of patients with plantar fasciitis.

METHODS.

Randomized controlled trial including participants with plantar fasciitis. There was an experimental group (n = 17), whose participants underwent a KT treatment, and a control (sham tape) group (n = 17). The pain, measured with a visual analog scale (VAS), was the primary outcome and was assessed daily until the fifth day of wearing the tape and 24 h after removing it. Inferential statistics looked for time, group, and time per group differences with CI at 95%.

RESULTS.

The greatest between-group VAS difference was 3.5 points, and occurred at the 2-day follow-up assessment. Then, pain differences decreased over time until the last assessment point. Statistically significant time, group, and time*group differences were found with p < 0.001.

CONCLUSION.

This study supports that KT is effective in reducing pain in the short term in patients with plantar fasciitis, and more effective than a sham intervention with tape.

Effectiveness of Shoe Rotation in Managing Plantar Fasciitis in Patients

Background/Objectives: Plantar fasciitis (PF) is a common condition that causes heel pain. While various conservative treatment modalities for PF exist, no previous studies have investigated the effectiveness of shoe rotation (ShR) in patients with PF pain. This study aimed to compare the therapeutic effectiveness of ShR with that of two conventional treatments for PF-namely, foot orthosis (FO) and physical therapy (PT). Methods: Charts of 42 patients with heel pain were retrospectively reviewed. Participants were allocated to one of three treatment groups: the ShR group, the customized FO group, and the PT group. Pain and functional outcomes were assessed using the Visual Analog Scale (VAS), Digital Pain Scale (DPS), Foot Function Index (FFI), Foot Pain and Function Scale (FPFS), and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) at baseline and at 4 and 12 weeks after the intervention. Results: The ShR, FO, and PT groups all showed improvements, with statistically significant decreases in VAS, DPS, and FFI scores and significant increases in FPFS and AOFAS-AHS scores over time (p < 0.05). All three interventions resulted in significant improvements from baseline to 4 weeks and further to 12 weeks (p < 0.05). The ShR group exhibited a slightly larger effect on all measurements than the other groups. Conclusions: ShR, FO, and PT contributed to pain reduction and functional improvement, and alternating the shoes alleviated PF pain. These results suggest a new approach to managing PF and serve as a basis for providing convenient treatment for patients with PF.

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.

Comparison of the Short-Term Effect between Iontophoresis and Radial Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial

Conservative treatments for plantar fasciitis have different levels of effectiveness, so it is necessary to personalize the therapeutic modality that improves the patients' symptoms.

METHODS

A double-blinded randomized clinical trial was designed to evaluate the short-term efficacy of a physical treatment in chronic plantar fasciitis, namely iontophoresis, compared with radial shockwave therapy. Heel pain, health status using the EuroQol-5D questionnaire, and fascia thickness measured with ultrasound were evaluated. In total, 127 patients were randomly selected for group A and treated with iontophoresis therapy (lidocaine 0.4% and dexamethasone 0.5%), or for group B, in which they were treated with radial shockwave therapy (EWST). Measurements were taken at baseline and at follow-up during the 5 weeks of the study.

RESULTS

Statistically significant differences were observed to the shockwave therapy group in respect to the final fascia thickness, and the VAS scale (p = 0.001). The differences between groups A and B showed that the shockwave group follow-up after 3 weeks experienced complete pain remission (1.0 ± 0.9; 95%CI 0.8-1.2) and after the 6-week follow-up, complete pain remission of plantar fasciitis was observed for both therapies. Patients had a better perception of the use of EWST at the end of the treatment, although in both groups it was satisfactory (p = 0.001).

CONCLUSIONS

The results of this study showed a shorter-term effectiveness of shockwave treatment compared with the use of iontophoresis. However, both techniques were effective in satisfactorily reducing pain in this short period.

Comparing the effectiveness of computer-aided design/computer-aided manufacturing (CAD/CAM) of insoles manufactured from foam box cast versus direct scans on patient-reported outcome measures: a protocol for a double-blinded, randomised controlled trial

INTRODUCTION

Custom insoles are a routine treatment for many foot pathologies, and the use of computer-aided design and computer-aided manufacturing (CAD/CAM) is well established within clinical practice in the UK. The method of foot shape capture used to produce insoles varies throughout orthotic services. This trial aims to investigate the effectiveness of two common shape-capture techniques on patient-reported outcomes in people who require insoles for a foot or ankle pathology.

METHODS AND ANALYSIS

This double-blinded randomised controlled trial will involve two intervention groups recruited from a National Health Service orthotic service. Participants will be randomly assigned to receive a pair of custom CAD/CAM insoles, manufactured either from a direct digital scan or a foam box cast of their feet and asked to wear the insoles for 12 weeks. The primary outcome measure will be the Foot Health Status Questionnaire (FHSQ) pain subdomain, recorded at baseline (immediately after receiving the intervention), 4, 8 and 12 weeks post intervention. Secondary outcome measures will include FHSQ foot function and foot health subdomains recorded at baseline, 4, 8 and 12 weeks. The Orthotic and Prosthetic User Survey Satisfaction with Device will be recorded at 12 weeks. The transit times associated with each arm will be measured as the number of days for each insole to be delivered after foot shape capture. Tertiary outcome measures will include participant recruitment and dropout rates, and intervention adherence measured as the daily usage of the insoles over 12 weeks. The change in FHSQ scores for the subdomains and insole usage will be compared between the groups and time points, and between group differences in time in transit, cost-time analysis and environmental impact will be compared.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Health Research Authority, London Stanmore Research Ethics Committee (22/LO/0579). Study findings will be submitted for publication in peer-reviewed journals, conference presentations and webinars.

TRIAL REGISTRATION NUMBER

NCT05444192.

Comprehensive Physiotherapy Rehabilitation Protocol of Plantar Fasciitis for a 45-Year-Old Female: A Case Report

Plantar fasciitis is stated to arise because of inadequate accumulated tension at the plantar fascia's enthesis. Tensile load and prolonged strain cause tiny rips in the fascia, which trigger a chronic inflammation process of healing. This case report shows the diagnostic evaluations, assessment of the condition, and physical rehabilitation management for a 45-year-old female nurse working in the neurosurgical critical care unit who had been experiencing plantar medial and posterior heel pain, as well as discomfort at the calcaneal tuberosity, for the previous six months. To increase functional mobility and alleviate symptoms, the patient sought out physiotherapy intervention. In this case, a physiotherapeutic program was implemented to treat plantar fasciitis, enhance mobility, and encourage long-term recovery. The evaluation included a detailed review of the patient's gait, biomechanics, and circumstances that may have contributed to the ongoing problems. The multimodal strategy used in the intervention plan included manual therapy, strengthening and stretching exercises, as well as patient education and counselling on self-management techniques. The patient's functional mobility increased along with a steady reduction in discomfort during the duration of the physiotherapy sessions. The instance emphasises how important it is to manage persistent plantar fasciitis with a customised physical therapy strategy that takes the patient's specific requirements into account and addresses contributory variables. The present study adds to the extant literature on efficacious physiotherapeutic approaches for plantar fasciitis, highlighting the need for a holistic approach in attaining favourable results for individuals enduring heel discomfort.

Heel Pain - Plantar Fasciitis: Revision 2023

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

Physiotherapeutic Interventions for Individuals Suffering From Plantar Fasciitis: A Systematic Review

The foot and the lower leg comprise the ankle joint complex. The foot is crucial for the maintenance of posture. Frequently, overuse or repeated microtrauma to the fascia causes plantar fasciitis. This review aims to suggest the efficacy of various plantar fasciitis (PF) interventions based on modifications in clinical results. This review included studies from 2019 to March 2023 identified through a systematic literature search. The measures used to predict improvement in pain, discomfort, and foot function symptoms included the Visual Analog scale, Numerical Pain Rating Scale, Pressure Point Threshold by algometer, Weight-Bearing Lunge Test by inch tape, and range of motion. The review included 20 studies that fulfilled the inclusion criteria. Therapeutic interventions included insoles, foot orthosis, foam roller stretching, manual stretching, muscle strengthening, intrinsic muscle activities, extracorporeal shock wave lithotripsy, dry needling, laser, ultrasound, and others, which resulted in pain reduction, improved foot function, and ease of everyday routine. All therapeutic strategies used impacts resulting from minimal to maximal recovery. Various advanced approaches are more effective than conventional physical therapy. In conclusion, conservative therapeutic strategies with manual techniques, orthoses, and alternative intervention strategies can be combined to effectively relieve pain and improve function and overall results. Further high-quality studies are essential to learn more about the ideal dose, treatment approaches, and long-term impacts of these therapies.

Effects of therapeutic interventions on pain due to plantar fasciitis: A systematic review and meta-analysis

OBJECTIVE

To determine the effects of different therapeutic interventions that have ever been evaluated in randomized controlled trials on pain due to plantar fasciitis.

METHODS

We searched different electronic databases until September 2022. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the overall certainty evidence.

RESULTS

A total of 236 studies met the study criteria, including 15,401 patients. Botulinum toxin MD -2.14 (CI: -4.15, -0.14), micronized dehydrated human amnion/chorion membrane injection MD -3.31 (CI: -5.54, -1.08), dry needling MD -2.34 (CI: -4.64, -0.04), low-dye taping MD -3.60 (CI: -4.16, -3.03), low-level laser therapy MD -2.09 (CI: -2.28, -1.90), myofascial releases MD -1.79 (CI: -2.63, -0.94), platelet-rich plasma MD -2.40 (CI: -4.16, -0.63), radiofrequency MD -2.47 (CI: -4.65, -0.29), and stretching MD -1.14 (CI: -2.02, -0.26) resulted in being effective treatments for pain when compared to the control in the short term. In the medium and long term, only extracorporeal shock wave therapy MD -0.97 (CI: -1.13, -0.81)/MD -2.49 (CI: -3.17, -1.82) was effective for improving pain when compared to the control.

CONCLUSIONS

Considering the available studies, this systematic review and meta-analysis showed that different therapeutic interventions seem to be useful strategies for improving pain in patients with plantar fasciitis. In the medium and long term, only extracorporeal shock wave therapy was effective in improving pain when compared to the control.

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.

Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial

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).

Influence of a novel elastic foot orthosis in foot motion during locomotion in adults with mild flatfoot

BACKGROUND

Collapse of the foot arch is a one of the risk factors in medial tibial stress syndrome. Custom-made foot orthoses are used to reduce the collapse of foot arch, but the orthoses are designed for a specific shoe and cannot be used in other shoes. We developed an elastic foot orthosis that is highly fitted on the foot using thin films, is lightweight, and can be used with any shoe or without shoes. The purpose of this study was to investigate foot kinematics with our elastic foot orthosis during walking and running.

METHODS

We recruited 30 participants with asymptomatic flatfoot for this study. Foot kinematic data were recorded for treadmill walking, treadmill running, and over-ground walking. Foot kinematics were recorded in three conditions, barefoot (BF), with the elastic foot orthosis (EFO), and with sham foot orthosis (SFO), and foot strain was measured using a stretch strain sensor. The difference in foot strain from initial contact to maximum strain during gait was calculated as loading arch strain, which was reflected as forefoot eversion excursion. A one-way analysis of variance with Bonferroni test was performed to compare the loading arch strain among the three conditions.

RESULTS

In all tasks, loading arch strain with the EFO was significantly less than that in the BF and SFO conditions. Loading arch strain with the SFO was significantly more than that of BF in the treadmill gait condition.

CONCLUSION

Our results indicate that the EFO decreased foot strain during locomotion compared to without the EFO and is capable of supporting the foot arch during locomotion.