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Sharma R, Chaudhary NK, Karki M, Sunuwar DR, Singh DR, Pradhan PMS, Gyawali P, Duwal Shrestha SK, Bhandari KK. Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial. BMC Musculoskelet Disord 2023; 24:172. [PMID: 36882804 PMCID: PMC9989576 DOI: 10.1186/s12891-023-06277-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Plantar fasciitis (PF) is a common orthopaedic problem, with heel pain worsening the quality of life. Although steroid injection is often used if the conservative treatment fails, Platelet-Rich Plasma (PRP) injection is gaining popularity due to its safety and long-lasting effect. However, the effect of PRP versus steroid injection in PF has not been studied yet in Nepal. Therefore, this study aimed to assess the effect of PRP compared with steroid injection in the treatment of PF. METHODS This study was a single-center, hospital-based, open-label, parallel-group randomized clinical trial to compare the effect of PRP injection with steroid injection in plantar fasciitis between August 2020 and March 2022. A total of 90 randomly selected participants aged 18 to 60 years suffering from plantar fasciitis with failed conservative treatment were intervened. The American Orthopaedic Foot and Ankle Society (AOFAS) and the Visual Analog Scale (VAS) scoring system were used to evaluate functional mobility and pain before and after the intervention for three and six months, respectively. Statistical analyses were performed using a Student's two-sample t-test. P-value < 0.05 was considered statistically significant. RESULTS The PRP injection showed a better outcome than the steroid injection in six months follow-up. The mean (± SD) VAS score was significantly decreased in the PRP group (1.97 + 1.13) than in the steroid group (2.71 ± 0.94) with the group difference of -0.73 (95% CI: -1.18 to -0.28) at six months. Similarly, there was a significant increase in the AOFAS scores in the PRP group (86.04 ± 7.45) compared to the steroid group (81.23 ± 9.60) at six months of follow-up with a group difference of 4.80 (95% CI: 1.15 to 8.45). There was also a significant reduction of plantar fascia thickness in the PRP group compared to that of the steroid group (3.53 ± 0.81 versus 4.58 ± 1.02) at six months of follow-up with the group difference of -1.04 (95% CI: -1.44 to -0.65). CONCLUSION The PRP injection showed better outcomes than steroid injection in plantar fasciitis treatment over the course of six months. Further research with a larger population and longer follow-up than six months is needed to generalize the findings and their long-term efficacy. TRIAL REGISTRATION NCT04985396. First registered on 02 August 2021. ( https://clinicaltrials.gov/ct2/show/NCT04985396 ).
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Affiliation(s)
| | | | | | - Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Pranil Man Singh Pradhan
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Tribhuvan, Nepal
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Bukhari KA, Khan IA, Ishaq S, Iqbal MO, Alqahtani AM, Alqahtani T, Menaa F. Formulation and Evaluation of Diclofenac Potassium Gel in Sports Injuries with and without Phonophoresis. Gels 2022; 8:612. [PMID: 36286113 PMCID: PMC9601609 DOI: 10.3390/gels8100612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 08/30/2023] Open
Abstract
Background: Pain remains a global public heath priority. Phonophoresis, also known as sonophoresis or ultrasonophoresis, is when an ultrasound is used to maximize the effects of a topical drug. Purpose: The objective of this study was to test, in patients injured in sports or accidents (N = 200), the efficacy of diclofenac potassium (DK) 6%, 4%, and 2% formulated gels with and without phonophoresis in comparison with market available standard diclofenac sodium (DS or DN) gel. Methods: The patients were enrolled after informed consent. By using the lottery method, 100 patients were randomly segregated into five groups without phonophoresis and repeated similarly with phonophoresis at a frequency of 0.8 MHz, an intensity of about 1.5 W/cm2, and at continuous mode (2:1). Group-1 was treated with 6% DK gel, group-2 was treated with 4% DK gel, group-3 was treated with 2% DK gel, group-4 was treated with 4% DS gel and group-5 was given control gel three to four times a week for 4 weeks. The patients were screened by using NPRS and WOMAC scales. They were assessed on the baseline, 4th session, 8th session, 12th session, and 16th session. Results: Significant dose-dependently relief was observed in NPRS (Numeric Pain Rating Scale) and the WOMAC (Western Ontario McMaster Osteo-Arthritis) index for pain in disability and stiffness for each group treated with DK gel compared to DS gel. Phonophoresis increased these benefits significantly when used after topical application of DK gel or DS gel, and the dose-dependent effects of DK gel plus phonophoresis were stronger than the dose-dependent effects of DS gel plus phonophoresis. The faster and profounder relief was due to phonophoresis, which allows more penetration of the DK gel into the skin as compared to the direct application of DK gel in acute, uncomplicated soft tissue injury, such as plantar fasciitis, bursitis stress injuries, and tendinitis. In addition, DK gel with phonophoresis was well tolerated. Thus, in this personalized clinical setting, according to the degree of inflammation or injured-induced pain, disability, and stiffness, DK gel 6% with phonophoresis appeared more effective and thus more recommendable than DS gel 6% alone or DS gel 6% combined to phonophoresis.
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Affiliation(s)
- Komal Ammar Bukhari
- Ali-Ul-Murtaza, Department of Rehabilitation Sciences, Muhammad Institute of Medical and Allied Sciences, Multan 60000, Pakistan
| | - Imran Ahmad Khan
- Ali-Ul-Murtaza, Department of Rehabilitation Sciences, Muhammad Institute of Medical and Allied Sciences, Multan 60000, Pakistan
- Department of Pharmacology and Physiology, MNS University of Agriculture, Multan 60000, Pakistan
| | - Shahid Ishaq
- Department of Rehabilitation, Bakhtawar Amin Medical and Dental College, Multan 60000, Pakistan
| | - Muhammad Omer Iqbal
- Shandong Provincial Key Laboratory of Glycoscience and Glycoengineering, School of Medicine and Pharmacy, Ocean University of China, Qingdao 266100, China
- Royal Institute of Medical Sciences (RIMS), Multan 60000, Pakistan
| | - Ali M. Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
| | - Taha Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia
| | - Farid Menaa
- Departments of Internal Medicine and Nanomedicine, California Innovations Corporation, San Diego, CA 92037, USA
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Salehi S, Shadmehr A, Olyaei G, Bashardoust Tajali S, Mir SM, Sobhani V. Ultrasonographic measurements of plantar fascia thickness and echogenicity in individuals with and without plantar fasciitis: Reliability and group differences. Foot (Edinb) 2021; 49:101849. [PMID: 34597921 DOI: 10.1016/j.foot.2021.101849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/05/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Imaging techniques such as ultrasonography are beneficial for diagnosis of plantar fasciitis. The purpose of this study was to investigate intra-rater reliability of plantar fascia thickness and echogenicity in subjects with and without plantar fasciitis and to compare the measurements between the two groups. DESIGN Sonographic evaluation of the plantar fascia was performed in prone position in 20 subjects without plantar fasciitis and 20 subjects with plantar fasciitis. The outcome measures extracted from the ultrasound images included plantar fascia thickness at the insertion, 1 cm and 3 cm distal from the insertion and plantar fascia echogenicity. The reliability of outcome measures was estimated for both groups using absolute and relative reliability variables. The two groups were compared using analysis of variance (ANOVA). RESULTS ICCs (3, 3) for intra-rater reliability of plantar fascia thickness and echogenicity were, respectively, ≥0.89 and ≥0.89 in the healthy controls and 0.87≥ and 0.90≥ in the plantar fasciitis group. The subjects with plantar fasciitis showed a thicker plantar fascia with lower echogenicity in all of measurement stations of plantar fascia compared to the healthy controls. CONCLUSION The results of the present study indicated that ultrasonography is a reliable method to measure plantar fascia thickness and echogenicity. Furthermore, the findings showed that plantar fascia is affected not only at its insertion but also in other points remote from the insertion in patients with plantar fasciitis. These findings support the diagnostic value of ultrasonography in therapy and research of the patients with plantar fasciitis.
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Affiliation(s)
- Saman Salehi
- Dept. of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Shadmehr
- Dept. of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gholamreza Olyaei
- Dept. of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Siamak Bashardoust Tajali
- Dept. of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohsen Mir
- Dept. of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Vahid Sobhani
- Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Boucher J, Mooney S, Dewey T, Kirtley RG, Walker T, Rabago D. Manual Therapy Informed by the Fascial Distortion Model for Plantar Heel Pain: Results of a Single-Arm Prospective Effectiveness Study. J Altern Complement Med 2021; 27:697-705. [PMID: 34185582 DOI: 10.1089/acm.2020.0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: Plantar heel pain (PHP) is the most common cause of heel pain and can be debilitating; 20% of patients are refractory to standard of care. The Fascial Distortion Model (FDM), a novel manual diagnostic and treatment strategy, is purported to be effective for chronic pain; however, no rigorous studies document its effectiveness. We assessed the FDM for care of PHP. Design: Single arm prospective effectiveness study. Settings/Location: Outpatient primary care clinic; Fort Gordon, GA. Subjects: Outpatient adults. Interventions: Participants received an FDM-informed diagnostic and treatment strategy to identify fascial "distortions" at the foot based on patient-reported pain patterns and palpatory examination and then to provide distortion-specific manual therapy at baseline and 1 week. Outcome Measures: Primary outcome measure (0, 1, and 16 weeks): the Foot Pain subscale on the validated Foot Health Status Questionnaire (FHSQ; 0-100 points on each of eight separate subscales); secondary outcome measures (0, 1, and 16 weeks): the seven remaining subscales on the FHSQ, visual analog pain scale (VAS, 0-100 points), and plantar fascia thickness of the most effected foot assessed by ultrasound (0 and 16 weeks). Analysis was performed per protocol using repeated-measures analysis of variance. Results: One hundred and ninety-seven participants were screened; 33 were enrolled. Twenty-eight participants received two FDM procedures. Compared with baseline, improvement on the FHSQ Foot Pain (33.8-23.6 points) and Foot Function (23.9-19.8 points) subscales and VAS (44.7-27.7 points) at 16 weeks was statistically significant (all p's < 0.001) and clinically important representing large effect sizes. Relative to baseline, 16-week ultrasound demonstrated reduced average plantar fascia thickness (0.6-0.9 mm [p = 0.001]). Demographic characteristics were unrelated to response. Satisfaction was high. There were no serious adverse events; side effects included consistent mild-to-moderate self-limited pain. Conclusions: Participants with PHP who received FDM-informed care reported significant and sustained improvement on validated foot pain and foot function measures; additional findings included decreased plantar fascial thickness. These results require corroboration in a larger randomized controlled study. Clinical Trial Registration No: DDEAMC17005.
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Affiliation(s)
- Joshua Boucher
- Department of Family Medicine, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Scott Mooney
- Neuroscience & Rehabilitation Center, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | | | - Robert G Kirtley
- Physical Medicine & Rehabilitation, Musculoskeletal Ultrasound, Interdisciplinary Pain Management Center, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - Tyler Walker
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | - David Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, University Park, PA, USA
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Evaluation of plantar fascia using high-resolution ultrasonography in clinically diagnosed cases of plantar fasciitis. Pol J Radiol 2020; 85:e375-e380. [PMID: 32817771 PMCID: PMC7425221 DOI: 10.5114/pjr.2020.97955] [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] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/30/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose The aim of this study was to assess the efficacy of high-resolution ultrasonography in the assessment of plantar fascia in individuals with heel pain, before and after treatment. Material and methods This study was conducted from 2016 to 2019, during which time 44 clinically diagnosed patients of plantar fasciitis were compared to 50 normal volunteers. There were 25 males and 25 females in the control group and 42 females and two males in the study group. Thirty-eight patients had unilateral disease, and six patients had bilateral disease. The thickness of the plantar fascia was measured just anterior to its calcaneal attachment using ultrasonography. Body mass index (BMI) was also calculated in both groups. Results The plantar fascia was 2-4 mm thick in the control group whereas it was > 4 mm thick in 48 heels in the study group. With cut-off of > 4 mm as diagnostic of plantar fasciitis, this study had a sensitivity of 96%, specificity of 100%, and accuracy of 98%. BMI was increased in 60% of female patients. All patients were treated with local infiltration of corticosteroid. In 37/42 patients (43 heels) who had improved clinically, the thickness of plantar fascia was reduced to < 4 mm when assessed after six weeks of corticosteroid injection. Conclusions Diagnosis of plantar fasciitis can be easily verified by ultrasonography with plantar fascia thickness > 4 mm being suggestive of plantar fasciitis. Ultrasound can also be used to evaluate treatment response. Ultrasono-graphy helps the clinician in confirming the diagnosis of plantar fasciitis and also in assessing the response to treatment.
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Effect of Dextrose Prolotherapy on Pain Intensity, Disability, and Plantar Fascia Thickness in Unilateral Plantar Fasciitis. Am J Phys Med Rehabil 2019; 99:318-324. [DOI: 10.1097/phm.0000000000001330] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Technical report: dynamic assessment of plantar fasciitis and plantar fascia tears utilising dorsiflexion of the great toe. J Ultrasound 2019; 23:397-400. [PMID: 31721101 DOI: 10.1007/s40477-019-00411-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022] Open
Abstract
Discrimination between plantar fasciitis and partial tears of the plantar fascia can be difficult on ultrasound given laxity of the plantar fascia in the region of its calcaneal insertion and anisotropy. Dynamic assessment with great toe dorsiflexion can improve visualisation of the proximal portion of the plantar fascia on ultrasound, by straightening the plantar fascia due to the windlass mechanism. This article describes the technique and its anatomical basis.
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Intra- and Inter-Rater Reliability of Ultrasound in Plantar Fascia Thickness Measurement. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol.59022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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