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Simental-Mendía M, Simental-Mendía LE, Sánchez-García A, Sahebkar A, Jamialahmadi T, Vilchez-Cavazos F, Peña-Martínez VM, Acosta-Olivo C. Effect of extracorporeal shockwave therapy on plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05464-6. [PMID: 39023569 DOI: 10.1007/s00402-024-05464-6] [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] [Received: 11/04/2022] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Extracorporeal shockwave therapy (ESWT) has been used as a therapeutic option for plantar fasciitis. The objective was to investigate the effect of ESWT over the plantar fascia thickness. METHODS MEDLINE, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials evaluating the effect of ESWT in patients with plantar fasciitis, comparing ESWT with another treatment. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. Meta-regression and subgroup analyses were also carried out. RESULTS A total of 14 studies (867 participants) were included. ESWT significantly decreased plantar fascia thickness (weighted mean difference [WMD], -0.21 mm [95% CI -0.39, -0.02]; p = 0.03). No significant improvement in pain was observed (WMD, -0.51 cm [95% CI -1.04, 0.01]; p = 0.06) compared with non-surgical interventions. CONCLUSIONS Our results suggest that plantar fascia thickness is significantly decreased after ESWT intervention in patients with plantar fasciitis. However, pain relief was not significantly improved compared to other non-surgical interventions.
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Affiliation(s)
- Mario Simental-Mendía
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico
| | - Luis E Simental-Mendía
- Biomedical Research Unit, Delegación Durango, Instituto Mexicano del Seguro Social, Durango, Mexico
| | - Adriana Sánchez-García
- Endocrinology Division, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tannaz Jamialahmadi
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Félix Vilchez-Cavazos
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico
| | - Víctor M Peña-Martínez
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico
| | - Carlos Acosta-Olivo
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico.
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Costello C, Chatzistergos P, Branthwaite H, Chockalingam N. The Importance of Preconditioning for the Sonographic Assessment of Plantar Fascia Thickness and Shear Wave Velocity. SENSORS (BASEL, SWITZERLAND) 2024; 24:4552. [PMID: 39065950 PMCID: PMC11280931 DOI: 10.3390/s24144552] [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: 05/25/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
Plantar fasciopathy is a very common musculoskeletal complaint that leads to reduced physical activity and undermines the quality of life of patients. It is associated with changes in plantar fascia structure and biomechanics which are most often observed between the tissue's middle portion and the calcaneal insertion. Sonographic measurements of thickness and shear wave (SW) elastography are useful tools for detecting such changes and guide clinical decision making. However, their accuracy can be compromised by variability in the tissue's loading history. This study investigates the effect of loading history on plantar fascia measurements to conclude whether mitigation measures are needed for more accurate diagnosis. The plantar fasciae of 29 healthy participants were imaged at baseline and after different clinically relevant loading scenarios. The average (±standard deviation) SW velocity was 6.5 m/s (±1.5 m/s) and it significantly increased with loading. Indicatively, five minutes walking increased SW velocity by 14% (95% CI: -1.192, -0.298, t(27), p = 0.005). Thickness between the calcaneal insertion and the middle of the plantar fascia did not change with the tissues' loading history. These findings suggest that preconditioning protocols are crucial for accurate SW elastography assessments of plantar fasciae and have wider implications for the diagnosis and management of plantar fasciopathy.
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Affiliation(s)
- Conor Costello
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DF, UK or (C.C.); (H.B.); (N.C.)
- Tameside and Glossop Integrated Care NHS Foundation Trust, MSK Podiatry Clinic, Ashton Primary Care Centre, 193 Old Street, Ashton-under-Lyne OL6 7SR, UK
| | - Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DF, UK or (C.C.); (H.B.); (N.C.)
| | - Helen Branthwaite
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DF, UK or (C.C.); (H.B.); (N.C.)
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DF, UK or (C.C.); (H.B.); (N.C.)
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Peña-Martínez VM, Acosta-Olivo C, Simental-Mendía LE, Sánchez-García A, Jamialahmadi T, Sahebkar A, Vilchez-Cavazos F, Simental-Mendía M. Effect of corticosteroids over plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis. PHYSICIAN SPORTSMED 2024; 52:217-228. [PMID: 37293970 DOI: 10.1080/00913847.2023.2223673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Corticosteroid injections have been typically used for the management of plantar fasciitis with apparently good clinical outcomes; however, there is no information of the effect of corticosteroids on the thickness of the plantar fascia which is typically altered in this pathology. We aimed determine whether treatment with corticosteroid injections induces plantar fascia thickness changes in plantar fasciitis. METHODS MEDLINE, Embase, Web of Science, and Scopus databases were searched for randomized controlled trials (RCT) reporting the use of corticosteroid injection to treat plantar fasciitis to July 2022. Studies must have reported plantar fascia thickness measurement. The risk of bias in all studies was assessed with the Cochrane Risk of Bias 2.0 tool. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. RESULTS Data from 17 RCT (including 1109 subjects) were collected. The follow-up period ranged from one to six months. Most studies measured the thickness of the plantar fascia at the insertion into the calcaneus using ultrasound. Pooled analysis revealed that corticosteroid injections had no significant effect on plantar fascia thickness (weighted mean differences [WMD], 0.06 mm [95% CI: -0.17, 0.29]; p = 0.61) or pain relief (WMD, 0.12 cm [95% CI: -0.36, 0.61]; p = 0.62) above active controls. CONCLUSION Corticosteroid injections do not perform better than other common interventions in terms of a decrease of plantar fascia thickness and pain relief for plantar fasciitis.
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Affiliation(s)
- Víctor M Peña-Martínez
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", Monterrey, México
| | - Carlos Acosta-Olivo
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", Monterrey, México
| | | | - Adriana Sánchez-García
- Universidad Autonoma de Nuevo Leon, Endocrinology Division, University Hospital "Dr. José Eleuterio González", Monterrey, México
| | - Tannaz Jamialahmadi
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Félix Vilchez-Cavazos
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", Monterrey, México
| | - Mario Simental-Mendía
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", Monterrey, México
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Mansur H, Ferreira GF, Ferreira-Junior JB, de Araújo BAS, Maranho DA. Leg length discrepancy is not a risk factor for plantar fasciitis. Arch Orthop Trauma Surg 2024; 144:1485-1490. [PMID: 38285221 DOI: 10.1007/s00402-024-05197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Plantar fasciitis (PF) is a main source of heel pain, and only about one-third of patients have bilateral symptomatic involvement, although age, body mass index (BMI), and physical activities are known risk factors. The high prevalence of unilateral involvement is poorly understood. We aimed to assess the potential association between PF and the leg length discrepancy (LLD) in unilateral PF. METHODS A transversal case-control study was conducted from January 2019 to December 2020, including 120 participants allocated to two groups matched by BMI and sex: cases (with a diagnosis of PF; 50 ± 13 years) and control (without foot pain; 40 ± 15 years). For both groups, a difference greater than 0.64 cm in the scanometry determined the criteria for the presence of LLD. RESULTS The multivariate logistic regression analysis showed an independent association of PF only with age (p < 0.001), and no association with LLD. We did not observe differences in the mean discrepancy (1.37 ± 0.83 cm in the PF group in comparison with 1.13 ± 0.37 cm in the control group, [p > 0.05]) or in the prevalence of LLD between groups (48% [n = 29] in the PF group compared with 42% [n = 25] in the control group, [p > 0.05]). In the PF group, 80% of the participants reported unilateral pain. We observed a higher prevalence of pain in the shorter limb (p < 0.05). CONCLUSION Age was the only factor associated with the diagnosis of PF when groups were matched by sex and BMI. LLD was not an independent factor associated with the diagnosis of PF. However, when PF is unilateral, the shorter limb is more affected with 70% of prevalence. LEVEL OF EVIDENCE Level III, case-control.
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Affiliation(s)
- Henrique Mansur
- Orthopedic and Traumatology Department, Return to Play Institute, Brasília, DF, Brazil.
| | - Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopedics and Traumatology Unit, Prevent Senior, São Paulo, SP, Brazil
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García-Gomariz C, Hernández-Guillén D, Nieto-Gil P, Blasco-García C, Alcahuz-Griñán M, Blasco JM. Effects of Kinesiotape versus Low-Dye Tape on Pain and Comfort Measures in Patients with Plantar Fasciitis: A Randomized Clinical Trial. Life (Basel) 2024; 14:249. [PMID: 38398758 PMCID: PMC10890258 DOI: 10.3390/life14020249] [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: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Bandages are commonly used to relieve pain in patients with plantar fasciitis. The goal was to compare the effects of using kinesiotape versus low-dye tape in the acute phase of plantar fasciitis on pain and comfort measures. METHODS Forty individuals with plantar fasciitis were allocated to the kinesiotape or low-dye tape interventions. The patients were assessed at baseline and every 24 h until the fifth day. The primary measure was a visual analog scale of pain. The other measures were comfort, mobility, durability, personal hygiene, sweating, and allergies. The effects were compared with an ANOVA test, 95% CI. RESULTS Kinesiotape was more effective in reducing pain; the greater effect occurred during the first day, with a between-group difference of 2.0 (95% CI: 1.8 to 2.2). The pain differences between the treatments progressively reduced each day from the second day. Kinesiotape offered significantly higher performance than low-dye tape in mobility, comfort, and comfort in hygiene, sweating, and durability, with a large effect size d > 0.8. CONCLUSIONS Kinesiotape could be more effective than low-dye tape in relieving pain in patients with plantar fasciitis, with a significant clinical impact on the first day of treatment. Kinesiotape can also provide higher performance in terms of comfort.
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Affiliation(s)
- Carmen García-Gomariz
- Department of Nursing, University of Valencia, Menéndez y Pelayo Av S/N, 46010 Valencia, Spain; (C.G.-G.); (P.N.-G.); (C.B.-G.); (M.A.-G.)
- Group of Physiotherapy in the Ageing Process: Social and Health Care Strategies, Department of Physiotherapy, University of Valencia, Gascó Oliag 5, 46010 Valencia, Spain;
| | - David Hernández-Guillén
- Group of Physiotherapy in the Ageing Process: Social and Health Care Strategies, Department of Physiotherapy, University of Valencia, Gascó Oliag 5, 46010 Valencia, Spain;
- Department of Physiotherapy, University of Valencia, Dr. Moliner 50 Av., 46100 Burjassot, Spain
| | - Pilar Nieto-Gil
- Department of Nursing, University of Valencia, Menéndez y Pelayo Av S/N, 46010 Valencia, Spain; (C.G.-G.); (P.N.-G.); (C.B.-G.); (M.A.-G.)
| | - Carlos Blasco-García
- Department of Nursing, University of Valencia, Menéndez y Pelayo Av S/N, 46010 Valencia, Spain; (C.G.-G.); (P.N.-G.); (C.B.-G.); (M.A.-G.)
| | - Montse Alcahuz-Griñán
- Department of Nursing, University of Valencia, Menéndez y Pelayo Av S/N, 46010 Valencia, Spain; (C.G.-G.); (P.N.-G.); (C.B.-G.); (M.A.-G.)
| | - José-María Blasco
- Group of Physiotherapy in the Ageing Process: Social and Health Care Strategies, Department of Physiotherapy, University of Valencia, Gascó Oliag 5, 46010 Valencia, Spain;
- Department of Physiotherapy, University of Valencia, Dr. Moliner 50 Av., 46100 Burjassot, Spain
- IRIMED Joint Research Unit (IIS-LaFe—UV), Dr. Moliner 50 Av., 46100 Burjassot, Spain
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Ruiz-Hernández IM, Gascó-Adrien J, Buen-Ruiz C, Perelló-Moreno L, Tornero-Prieto C, Barrantes-Delgado G, García-Gutiérrez M, Rapariz-González JM, Tejada-Gavela S. Botulinum toxin A versus platelet rich plasma ultrasound-guided injection in the treatment of plantar fasciitis: A randomised controlled trial. Foot Ankle Surg 2024; 30:117-122. [PMID: 37949704 DOI: 10.1016/j.fas.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/14/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) and botulinum toxin type A (BTX-A) injections have proven effective in clinical trials for plantar fasciitis treatment but have not been directly compared. We aimed to compare clinical outcomes in patients undergoing PRP or BTX-A injections. METHODS We performed a randomised controlled trial (59 patients; 1-year follow-up) to assess efficacy, using pain and functional scales (VAS, AOFAS Hindfoot-scale and FAAM questionnaire) and fascia thickness reduction, in control and single ultrasound-guided BTX-A or PRP injection groups. RESULTS The BTX-A group showed better results at 1-month after treatment. Conversely, the PRP injection was more effective in the long-term, with significant pain reduction and functional improvement. Plantar fascia thickness significantly reduced from months 1 and 3 in the PRP and BTX-A groups, respectively. CONCLUSION PRP and BTX-A injections are effective in patients with plantar fasciitis with BTX-A achieving better short-term pain reduction and PRP better long-term results. LEVEL OF EVIDENCE Level I; Randomised Controlled Trial.
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Affiliation(s)
- Isabel M Ruiz-Hernández
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain; Foot and Ankle Unit (Pieytobillo.es), Hospital Quironsalud Rotger, Calle Santiago Rusiñol, 9, 07012 Palma, Baleares, Spain.
| | - Javier Gascó-Adrien
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain; Foot and Ankle Unit (Pieytobillo.es), Hospital Quironsalud Rotger, Calle Santiago Rusiñol, 9, 07012 Palma, Baleares, Spain
| | - Carmen Buen-Ruiz
- Department of Physical Therapy and Rehabilitation, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - Laura Perelló-Moreno
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - Carmen Tornero-Prieto
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - Gonzalo Barrantes-Delgado
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain; Foot and Ankle Unit (Pieytobillo.es), Hospital Quironsalud Rotger, Calle Santiago Rusiñol, 9, 07012 Palma, Baleares, Spain
| | - Mireia García-Gutiérrez
- Department of Physical Therapy and Rehabilitation, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - J M Rapariz-González
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - S Tejada-Gavela
- Department of Biology, Universitat de les Illes Balears, Cra. de Valldemossa, km 7.5, 07122 Palma, Baleares, Spain
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Riiser MO, Husebye EE, Hellesnes J, Molund M. Outcomes After Proximal Medial Gastrocnemius Recession and Stretching vs Stretching as Treatment of Chronic Plantar Fasciitis at 6-Year Follow-up. Foot Ankle Int 2024; 45:1-9. [PMID: 37902240 PMCID: PMC10822063 DOI: 10.1177/10711007231205559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Evidence from prospective short-term studies suggest that proximal medial gastrocnemius recession is a safe and efficient procedure to treat chronic plantar fasciitis resistant to nonoperative treatment. The aim of this study was to evaluate the long-term clinical outcomes of proximal medial gastrocnemius recession and stretching compared to a stretching exercise protocol for patients with chronic plantar fasciitis and an isolated gastrocnemius contracture (IGC). METHODS Forty patients with plantar fasciitis lasting more than 1 year were prospectively randomized to a home stretching exercise program only, or to proximal medial gastrocnemius recession in addition to the stretching program. Clinical and functional data in this study were obtained at baseline and 6-year follow-up. The main outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Secondary outcomes were the visual analog scale (VAS) for pain, the Manchester Oxford Foot Questionnaire (MOxFQ), ankle dorsiflexion, and Achilles complex performance. RESULTS Thirty-three of 40 patients completed the 6-year follow-up. Seven patients had crossed over from nonoperative treatment to operative treatment. At 6 years, the operative group demonstrated significantly better outcomes with AOFAS (88.9 vs 78.6, P = .012), for pain measured by VAS (2.5 vs 5.5, P < .001) and with the MOxFQ total score (24.4 vs 45.9, P = .05) (per protocol analysis excluding crossovers). No between-group differences were observed for ankle dorsiflexion or Achilles complex performance at 6 years. CONCLUSION This study demonstrates that the improved function and reduced level of pain by proximal medial gastrocnemius recession and stretching is better compared to stretching alone after 6 years of follow-up for patients with chronic plantar fasciitis and a concomitant isolated gastrocnemius contracture. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Martin Okelsrud Riiser
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Elisabeth Ellingsen Husebye
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Jan Hellesnes
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Marius Molund
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
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Escalada Barrado J, Saiz Modol C, Llombart Blanco R. Medial gastrocnemius proximal fasciotomy in patients with chronic plantar fasciitis: A systematic review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00191-1. [PMID: 37730117 DOI: 10.1016/j.recot.2023.08.017] [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: 06/02/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Plantar fasciitis is the main cause of heel pain in middle-aged patients. In chronic cases, limited ankle dorsiflexion caused by isolated gastrocnemius contracture is considered the main risk factor for suffering it. Therefore, in recent years the number of patients operated on by proximal fasciotomy of the medial gastrocnemius (FPGM) has increased to treat chronic plantar fasciitis. MATERIAL AND METHODS Systematic review following the PRISMA guidelines. We have carried out a bibliographic search in Pubmed, Science Direct, Cochrane Library and Web of Science databases. One hundred and eighty-four articles were found. Data extraction was performed using the Covidence software, and a quality and risk of bias analysis of the included articles was performed based on the Cochrane risk of bias Tool 2.0. RESULTS Three articles were included in the review: two randomized clinical trials and one cohort study with a total of 138 patients. In the analyzed studies, patients after proximal fasciotomy of the medial gastrocnemius showed significant improvements in pain and in the AOFAS score with high levels of patient satisfaction. Increases in ankle dorsiflexion angle were found after 12 months of follow-up, with no loss of gastrocnemius strength. The complication rate was low and fewer occurred in the proximal fasciotomy compared to plantar fasciotomy. CONCLUSION Proximal fasciotomy of the medial gastrocnemius provides clinical benefit in patients with chronic plantar fasciitis, with a low probability of complications and high patient satisfaction.
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Affiliation(s)
| | - C Saiz Modol
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España
| | - R Llombart Blanco
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España.
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Sankey T, Shah A. Response to "Letter Regarding: PROMIS Scores for Plantar Fasciitis Before and After Gastrocnemius Recession". Foot Ankle Int 2023; 44:937-938. [PMID: 37702361 DOI: 10.1177/10711007231191511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
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Balaji G, Duddukunta VR, Jagadevan M, Thappa S, Barathi D. Clinical, Metabolic, and Radiological Risk Factors in Individuals With Plantar Heel Pain From a South Indian Population: A Cross-Sectional Observational Study. Cureus 2023; 15:e42834. [PMID: 37664376 PMCID: PMC10472084 DOI: 10.7759/cureus.42834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/05/2023] Open
Abstract
Background One of the most common conditions seen in an orthopedic outpatient clinic is plantar heel pain (PHP). Studies analyzing various risk factors and their association with the development of PHP have been performed primarily in the Caucasian population, and no study has noted any association between the magnitude of various risk factors and their correlation to the severity of PHP. Hence, we performed a prospective cross-sectional observational study in a select South Indian population presenting with PHP to a tertiary care center. Methods All adult patients presenting to the orthopedic OPD between July 2019 and July 2020 were screened for unilateral PHP and were included after meeting the eligibility criteria. Age, sex, body mass index (BMI), random blood sugar (RBS), uric acid, thyroid-stimulating hormone (TSH), and vitamin D3 were measured as demographic and metabolic parameters. Heel pad thickness, calcaneal spurs, and plantar fascial thickness were noted radiographically. Clinically, the wall-toe distance by weight bear lunge test of each foot was noted, and the severity was measured by the foot functional index (FFI). Results Among the 40 participants, the mean age was 44 (±10.9) years. The average BMI was 30.1 (27.02-32.95). No significant association was noted between the biochemical parameters and the occurrence of PHP. The plantar fascial thickness (PFT) and heel pad thickness (HPT) were thicker than the asymptomatic foot by 1.01 (0.60 - 1.30) mm and 0.79 (0.4-1.7) mm, respectively, which was statistically significant (p<0.001). The heel cord length was found to be reduced by 0.86 (0.6-1) cms, which was statistically significant (p<0.001). The average FFI score was 123.07 (±15.57), and the FFI score percentage in individuals was 53.5% (±6.77). None of the above risk factors showed any significant correlation to the intensity of clinical symptoms measured by FFI (p>0.05). Conclusion Participants had a high BMI and a higher percentage of females. There was a significant increase in PFT and HPT thickness and a significant reduction in gastrocnemius flexibility when compared to the asymptomatic foot. There was no significant association between various clinical, metabolic, and radiological risk factors and the intensity of plantar fasciitis measured by FFI.
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Affiliation(s)
- Gopisankar Balaji
- Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Vishal Reddy Duddukunta
- Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Mohanakrishnan Jagadevan
- Physiotherapy, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Suresh Thappa
- Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Deepak Barathi
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
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11
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Barreto Rabelo D, Coelho Figueira Freire AP, Colen Milagres Brandão F, Oliveira Melo S, Ocarino JM, Saldanha Dos Anjos MT, Schleip R, Souza TR, Simoneau G, Zambelli Pinto R. Myofascial stiffness of plantar fascia and Achilles tendon in individuals with plantar fasciopathy: An observational cross-sectional study. Musculoskelet Sci Pract 2023; 66:102781. [PMID: 37290347 DOI: 10.1016/j.msksp.2023.102781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Assessment of myofascial tissue stiffness have a role in identifying physical impairments in plantar fasciopathy (PF). It is still unclear which specific functional and tissue differences exist between individuals with PF. AIM To compare myofascial stiffness of plantar fascia, Achilles tendon, and triceps surae between symptomatic and asymptomatic limbs in individuals with PF and between individuals with and without PF. METHODS Thirty nine individuals diagnosed with PF and individuals with no history of PF were recruited. Myofascial stiffness of the plantar fascia, Achilles tendon, and triceps surae, range of motion, and clinical tests were performed. Mean difference (MD) and 95% confidence interval (CI) were calculated. RESULTS Individuals with PF showed lower mean stiffness in Achilles tendon insertion (MD = -1.00 N/mm; 95%CI: -1.80,-0.21) on the symptomatic limb compared to the corresponding symptomatic limb in control group, a lower mean stiffness in plantar fascia (MD = -0.16 N/mm; 95%CI: -0.30, -0.01) on the symptomatic limb compared to asymptomatic limb, and a lower mean stiffness in the region 3 cm above the Achilles tendon insertion (MD = -0.79; 95%CI: -1.59, -0.00) compared to control. Individuals with PF showed fewer repetitions in heel rise test (MD = -3.97 reps; 95%CI: -5.83, -2.12) and in the step-down test (MD = -5.23 reps; 95%CI: -7.02, -3.44) compared to control. CONCLUSIONS Individuals with PF present reduced stiffness in Achilles tendon insertion and plantar fascia. The reduced stiffness was more evident in Achilles tendon in individuals with PF compared to individuals without PF. Individuals with PF showed lower performance in clinical tests.
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Affiliation(s)
- Daniel Barreto Rabelo
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | | | | | - Sabrina Oliveira Melo
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | - Juliana M Ocarino
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | | | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Germany.
| | - Thales R Souza
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
| | - Guy Simoneau
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States.
| | - Rafael Zambelli Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil.
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12
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Thammajaree C, Theapthong M, Palee P, Pakpakorn P, Sitti T, Sakulsriprasert P, Bunprajun T, Thong-On S. Effects of radial extracorporeal shockwave therapy versus high intensity laser therapy in individuals with plantar fasciitis: A randomised clinical trial. Lasers Med Sci 2023; 38:127. [PMID: 37219650 DOI: 10.1007/s10103-023-03791-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/18/2023] [Indexed: 05/24/2023]
Abstract
This study aimed to compare the effects of radial extracorporeal shockwave therapy (rESWT) to the effects of high-intensity laser therapy (HILT) in the treatment of individuals with plantar fasciitis. Thirty-two individuals with unilateral plantar fasciitis were randomized into two groups: rESWT and HILT. In each group, the individuals underwent the intervention two sessions per week, for three weeks. Outcome measures included morning pain, resting pain, pain at 80 newtons (N) pressure, skin blood flow and temperature, plantar fascia (PF) and flexor digitorum brevis (FDB) thickness, and Foot Function Index (FFI). There was no significant difference in baseline characteristics of the individuals in both groups. All outcome measures, except skin blood flow and temperature, and FDB thickness, were significantly different (p < 0.05) over time. Skin blood flow was significantly different between groups at the end of the program. Either HILT or rESWT could alleviate pain in individuals with plantar fasciitis significantly. However, HILT was better at reducing FFI (functional limitation domain) rather than rESWT. This study was a randomized clinical trial and was approved by Mahidol University-Central Institutional Review Board (MU-CIRB) following the Declaration of Helsinki, COA no. MU_CIRB 2020/207.0412, the Thai Clinical Trials Registry (TDTR) numbered TCTR2021012500.
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Affiliation(s)
- Chutiporn Thammajaree
- Physical Therapy Center, Faculty of Physical Therapy, Mahidol University, Bangkok, 10700, Thailand
| | - Montartip Theapthong
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Phongsathon Palee
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Phrattaya Pakpakorn
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Tippawan Sitti
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Prasert Sakulsriprasert
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Tipwadee Bunprajun
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Suthasinee Thong-On
- Musculoskeletal Physical Therapy Research, Division of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
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13
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Prolotherapy. Phys Med Rehabil Clin N Am 2023; 34:165-180. [DOI: 10.1016/j.pmr.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Sugino Y, Yoshimura I, Hagio T, Ishimatsu T, Nagatomo M, Yamamoto T. Effect of plantar fascia-specific stretching and Achilles tendon stretching on shear wave elasticity of the plantar fascia in healthy subjects. Foot Ankle Surg 2023; 29:208-212. [PMID: 36646592 DOI: 10.1016/j.fas.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/29/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND The effect of stretching on the mechanical properties of the plantar fascia (PF) remain unclear. This study was performed to determine the effect of PF-specific stretching (PFSS) and Achilles tendon stretching (ATS) on the viscoelastic properties of the PF with shear wave elastography (SWE). METHODS We recruited 14 participants (8 men, 6 women) with no history of PF disorders or painful episodes. The mean age of the participants was 30.9 ± 4.8 (range, 25-41) years. All participants performed sustained PFSS (sPFSS) on one foot and intermittent PFSS (iPFSS) on the other foot. Two weeks later, all participants performed sustained ATS (sATS) on one foot and intermittent ATS (iATS) on the other foot. SWE measurements were performed immediately after each stretching. RESULTS The PF elasticity immediately before stretching ranged from 133.8 kPa to 144.7 kPa. The PF elasticity after stretching ranged from 158.9 kPa to 215.8 kPa. There was a significant increase in PF elasticity after sPFSS, iPFSS, sATS, and iATS (P < .01). The elasticity after sATS was greater than that after iATS (P = .03). In contrast, there were no differences in PF elasticity after stretching between sPFSS and iPFSS (P = .13), sPFSS and sATS (P = .17), or iPFSS and iATS (P = .50). CONCLUSIONS PF elasticity increased after stretching regardless of the frequency and type of PFSS and ATS. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Yuki Sugino
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Ichiro Yoshimura
- Fukuoka University Faculty of Sports and Health Science, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Tomonobu Hagio
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Masaya Nagatomo
- Department of Orthopedic Surgery, Nagasaki Prefecture Tsushima Hospital, 1168-7 Kechiotsu, Mitsushima-machi, Tsushima-shi, Nagasaki 817-0322, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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15
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Surgical treatment options for plantar fasciitis and their effectiveness: a systematic review and network meta-analysis. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04739-0. [PMID: 36596990 DOI: 10.1007/s00402-022-04739-0] [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] [Received: 07/19/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND To date, there are no systematic reviews on the utility of surgical management for plantar fasciitis to guide best practice. This review aimed to evaluate the operative options for plantar fasciitis and their effectiveness. METHODS A systematic review and network meta-analysis were carried out in accordance with PRISMA guidelines. A search strategy was conducted on the MEDLINE, EMBASE, and Cochrane databases. Quality was assessed using the ROBINS-I tool. RESULTS 17 studies involving 865 patients were included. Surgical options considered were open and endoscopic plantar fasciotomy, gastrocnemius release, radiofrequency microtenotomy and dry needling. All interventions resulted in improvement in VAS and AOFAS scores. No major complications were seen from any treatment modality. CONCLUSIONS Surgical interventions are effective in providing short- to medium-term symptomatic relief for plantar fasciitis refractory to non-operative management. Current evidence is equivocal regarding treatment choice. Further large randomised studies are required to establish long-term outcomes and a management algorithm. LEVEL OF EVIDENCE Level III.
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16
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Jiang ZZ, Shen HL, Zhang Q, Ye G, Li XC, Liu XT. Elasticity evaluation of the plantar fascia: A shear wave elastography study involving 33 early-stage plantar fasciopathy subjects. Front Physiol 2022; 13:1060728. [PMID: 36589438 PMCID: PMC9801482 DOI: 10.3389/fphys.2022.1060728] [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] [Received: 10/03/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Plantar fasciopathy, the most common foot condition seen in elderly and athletic populations, can be diagnosed and differentially diagnosed with imaging modalities such as ultrasound shear wave elastography (SWE). However, standard guidelines for ultrasound elastography of the plantar fascia are lacking. The purpose of this study was to determine the impact of the region of interest (ROI) on the evaluation of the plantar fascia elasticity and confirm the screening accuracy of SWE in the early-stage of plantar fasciopathy. Methods: This was an observational case‒control study involving 50 feet of 33 early-stage plantar fasciopathy subjects (the plantar fasciopathy group) and 96 asymptomatic feet of 48 healthy volunteers (the non-pain group). Clinical information, including age, gender, height, weight, visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Scale score (AOFAS), and the symptom duration, were recorded. All participants underwent both conventional ultrasound and SWE evaluation. The plantar fascia elastic parameters included SWEsingle-point, calculated with a single-point ROI set at the greatest thickness of the plantar fascia, and SWEmulti-point, calculated by multipoint ROIs set continuously from the origin at the calcaneus to about 2 cm from the calcaneal origin. Results: The plantar fasciopathy group presented a higher VAS score (median [IQR), 4.00 (3.00) vs. 0.00 (0.00), p < 0.001] and lower AOFAS score [median (IQR), 79.50 (3.00) vs. 100.00 (10.00), p < 0.001] than the non-pain group. The median plantar fascia thickness of the plantar fasciopathy group was significantly greater than that of the non-pain group [median (IQR), 3.95 (1.37) mm vs 2.40 (0.60) mm, p < 0.001]. Abnormal ultrasound features, including echogenicity, border irregularities, and blood flow signals, were more prominent in the plantar fasciopathy group than in the non-pain group (29% vs. 0%, p < 0.001; 26% vs. 1%, p < 0.001; 12% vs. 0%, p < 0.001, respectively). Quantitative analysis of the plantar fascia elasticity revealed that the difference between the value of SWEsingle-point and SWEmultipoint was significant [median (IQR), 65.76 (58.58) vs. 57.42 (35.52) kPa, p = 0.02). There was a moderate and significant correlation between the value of SWEsingle-point and heel pain. However, there was no correlation between the value of SWEmultipoint and heel pain. Finally, we utilized the results of SWEsingle-point as the best elastic parameter reflecting clinical heel pain and found that SWEsingle-point could provide additional value in screening early-stage plantar fasciopathy, with an increase in sensitivity from 76% to 92% over conventional ultrasound alone. Additionally, compared with conventional ultrasound and SWE, the use of both improved the accuracy of screening for plantar fasciopathy. Although there were no significant differences in the negative predictive value of conventional ultrasound, SWE, and their combination, the positive predictive value when using both (90.20%) was significantly greater than that when using conventional ultrasound (74.50%) or SWE alone (76.50%). Conclusion: The plantar fascia elastic parameter calculated with single-point ROIs set at the greatest thickness of the plantar fascia is positively correlated with fascia feel pain. Single-point analysis is sufficient for the screening of the early-stage plantar fasciopathy using SWE. SWEsingle-point may provide additional valuable information for assessing the severity of plantar fasciopathy.
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Affiliation(s)
- Zhen-Zhen Jiang
- Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Hua-Liang Shen
- Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Qi Zhang
- Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Gang Ye
- Pain Management, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Xiu-Cheng Li
- Department of Orthopedics, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China
| | - Xia-Tian Liu
- Department of Ultrasound, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China,*Correspondence: Xia-Tian Liu,
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17
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Wheeler PC, Dudson C, Calver R. Radial Extracorporeal Shockwave Therapy (rESWT) is not superior to "minimal-dose" rESWT for patients with chronic plantar fasciopathy; a double-blinded randomised controlled trial. Foot Ankle Surg 2022; 28:1356-1365. [PMID: 35817643 DOI: 10.1016/j.fas.2022.06.016] [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] [Received: 03/11/2022] [Revised: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Investigating outcomes following radial-extra-corporeal-shockwave-therapy (rESWT) in patients with chronic plantar fasciopathy METHODS: This double-blinded RCT in a single NHS Sports medicine clinic recruited 117 patients with chronic plantar fasciopathy randomised equally to either 3 sessions of rESWT or "minimal-dose" respectively. Mean age 51.7 ± 9.6 years, 66 % female, symptom duration: 32.6 ± 30.8 months. RESULTS "Average pain" improved by 50 % at 6-months, (>1/3 at interim time-points). Statistically significant within-group improvements were identified in pain, local function, and "ability" PROMs in both groups. Fewer benefits in activity levels or mood. No between-group differences were seen at the interim or final time-points. CONCLUSION 3 sessions of "recommended-dose" rESWT is non-superior to "minimal-dose" rESWT in patients with chronic plantar fasciopathy. rESWT may be ineffective in the treatment of patients with chronic plantar fasciopathy, "minimal-dose" rESWT may be sufficient for a therapeutic effect, or a greater number of treatment sessions may be required for benefit. LEVEL OF EVIDENCE Level I - Randomised controlled trial.
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Affiliation(s)
- Patrick C Wheeler
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, UK; School of Sport, Exercise and Health Sciences, Loughborough University, UK; National Centre of Sport and Exercise Medicine, Loughborough, UK.
| | - Chloe Dudson
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Rachel Calver
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, UK
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18
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Impact of plantar fasciitis on postural control and walking in young middle-aged adults. Foot (Edinb) 2022; 53:101951. [PMID: 36463613 DOI: 10.1016/j.foot.2022.101951] [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] [Received: 12/23/2021] [Revised: 07/11/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To assess if plantar fasciitis has an impact on postural control and walking pattern from gait analysis across different experimental conditions. METHODS Thirty participants (n = 15 with plantar fasciitis) performed 5 different balance tasks on a force platform, and the center of pressure (COP) was computed for postural control analysis. Participants were also asked to walk at 3 different speeds on a gait analysis system to compute the spatial-temporal parameters. Clinical foot measurements (pain, mobility) were also collected through all participants. RESULTS Clinical foot measurements showed no significant difference between the two groups; except for pain palpation in plantar fasciitis group. Significant differences were observed between the two groups for COP area displacement sway (p < 0.01; d = 0.08) and velocity (p = 0.022; d = 0.04), where the fasciitis group reported poorer postural control than control mainly during more challenging balance tasks (semi-tandem, unipodal). Plantar fasciitis group reported a decrease of gait velocity (p < 0.01; d = 0.12), step length (p < 0.01; d = 0.16) and step width (p < 0.01; d = 0.18) when compared to the healthy group across walking speed tests. CONCLUSIONS Individuals with plantar fasciitis report poor postural control and changes in walking pattern across three speeds performance.
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19
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Peña-Martínez VM, Acosta-Olivo C, Tamez-Mata Y, Simental-Mendía LE, Blázquez-Saldaña J, Vilchez-Cavazos F, Simental-Mendía M. Normal saline injection produces a therapeutic effect in patients with plantar fasciitis: A systematic review and meta-analysis of randomized controlled trials. Foot Ankle Surg 2022; 28:1129-1138. [PMID: 35637108 DOI: 10.1016/j.fas.2022.04.005] [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] [Received: 01/27/2022] [Revised: 03/15/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Injectable therapies have been increasingly investigated to treat plantar fasciitis in randomized controlled trials (RCT) where normal saline injections are frequently used as placebo. The purpose was to quantify the effect of saline injections and compared against available minimal clinically important difference (MCID) criteria specific for plantar fasciitis to assess if changes were clinically meaningful. METHODS RCT including a placebo group (normal saline) and reporting changes in pain and functional outcomes in plantar fasciitis were identified through a search in MEDLINE, Embase, Web of Science, and Scopus to February 2022. PRISMA guidelines and a registered protocol (PROSPERO: CRD42020214035) were followed to conduct the study. RESULTS Pooled analysis of 13 RCT (379 subjects) included for analysis revealed a significant improvement on pain (P < .00001) and functional scores (P < .00001) after normal saline injections. These changes exceeded the established MCID criteria. CONCLUSIONS Normal saline injections in plantar fasciitis showed a therapeutic effect with statistically and clinically meaningful improvement when administered in the setting of an RCT for up to 12 months. The control of potential confounders influencing the effect of saline injections is required for future research.
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Affiliation(s)
- Víctor Manuel Peña-Martínez
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Carlos Acosta-Olivo
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Yadira Tamez-Mata
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Luis E Simental-Mendía
- Instituto Mexicano del Seguro Social, Biomedical Research Unit, Delegación Durango, Durango, Mexico
| | - Jaime Blázquez-Saldaña
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Félix Vilchez-Cavazos
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Mario Simental-Mendía
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico.
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20
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Matthews M, Betrus CJ, Klein EE, Joshi A, Hamer SW, Sorensen MD, Weil L, Fleischer AE. Comparison of Regenerative Injection Therapy and Conventional Therapy for Proximal Plantar Fasciitis. J Foot Ankle Surg 2022; 62:469-471. [PMID: 36529579 DOI: 10.1053/j.jfas.2022.11.010] [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] [Received: 08/10/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 11/24/2022]
Abstract
Treatment of subacute and chronic heel pain often presents a unique challenge to the physician. Regenerative therapies, such as injectable amnion and connective tissue matrix, may represent a promising new approach in these patients, and have become increasingly popular in the United States. However, little literature exists evaluating these injections compared to conventional nonoperative means. As such, we designed a retrospective comparative study evaluating patients in our practice who received a standardized plantar fascial treatment protocol only (standard therapy), and those who received regenerative plantar fascial injections in addition to standard therapy. A total of 54 patients were followed over a 3-month observation period (91.7 ± 73.9 days), with numeric pain rating (NPR) serving as the primary outcome. Both groups saw an improvement in NPR at the end of the observation period, but patients in the regenerative therapy group demonstrated lower pain scores than those receiving standard therapy alone (mean NPR 2.1 ± 2.3 vs 4.4 ± 2.8, p = .004). Additionally, those in the standard therapy group were significantly more likely to proceed onto surgical intervention compared to the regenerative therapy group (unadjusted odds ratio 15.6, 95% CI 3.0-27.9). The use of regenerative injections for subacute and chronic plantar fasciitis showed promise in our study, and may help mitigate against the need for invasive surgical intervention.
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Affiliation(s)
| | | | - Erin E Klein
- Weil Foot and Ankle Research Institute, Mount Prospect, IL
| | - Alisha Joshi
- Weil Foot and Ankle Research Institute, Mount Prospect, IL
| | | | | | - Lowell Weil
- Weil Foot and Ankle Research Institute, Mount Prospect, IL
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21
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Nakagawa H, Sung K, Ashkani-Esfahani S, Waryasz G, May T, Sussman WI. Plantar fasciitis: a comparison of ultrasound-guided fasciotomy with or without amniotic membrane allograft injection. Regen Med 2022; 17:931-940. [PMID: 36222008 DOI: 10.2217/rme-2022-0094] [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: 11/21/2022] Open
Abstract
Aim: The purpose of this study was to evaluate the clinical response to augmenting an ultrasound-guided percutaneous plantar fasciotomy (UGPF) with an amniotic membrane (AM) allograft injection. Design: Retrospective, single-center, matched, case-controlled study. Methods: Patients underwent either an UGPF (n = 15) or a combined UGPF and AM injection (n = 16). Results: The UGPF plus AM group demonstrated a significant reduction in pain (p = 0.02) from baseline at the short-term follow-up, but there was no significant difference in pain or patient satisfaction between groups at the 52-week follow-up. Conclusion: Both groups demonstrated a significant reduction in pain and high level of patient satisfaction, but the combination of UGPF with an AM injection may provide a greater reduction in pain earlier in the post-operative period.
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Affiliation(s)
- Hirotaka Nakagawa
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Kyungje Sung
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Soheil Ashkani-Esfahani
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.,Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Gregory Waryasz
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.,Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Tabitha May
- Department of Radiation Oncology, UMass Chan Medical School, 55 N Lake Ave, Worcester, MA 01655, USA
| | - Walter I Sussman
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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22
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Mazzotti A, Zielli SO, Artioli E, Facchini G, Miceli M, Faldini C. Iatrogenic Lesion of the Lateral Plantar Artery following Plantar Fasciotomy for Cavus Foot Correction - A Case Report. J Orthop Case Rep 2022; 12:10-13. [PMID: 36874890 PMCID: PMC9983385 DOI: 10.13107/jocr.2022.v12.i10.3344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/23/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction The aim of this study was to report a patient with a iatrogenic lesion of the lateral plantar artery following plantar fasciotomy (PF) for cavus foot correction, an extremely rare complication. Case Report A 13-year-old male patient with bilateral cavus foot was surgically treated at the right foot. At 36 days follow-up, after plaster cast removal, a massive soft plantar bulge was located on the medial aspect of the foot. Once suture stiches removal was performed, a huge blood collection was evacuated, and active bleeding observed. Contrast-enhanced angio-CT revealed a lesion of the lateral plantar artery. A vascular suture was performed. At 5 months follow-up, the patient was pain-free in his foot. Conclusion Despite a iatrogenic lesion of the plantar vascular structures following PF is extremely rare, it is a potential complication to consider. Meticulous attention to surgical technique and careful inspection of the foot the day after surgery, before patient discharge, are recommended.
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Affiliation(s)
- Antonio Mazzotti
- Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simone Ottavio Zielli
- Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Artioli
- Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Koh DTS, Yeo W, Koo KOT, Singh IR, Yeo NEM. Radiofrequency Plantar Fascia Coblation With and Without Gastrocnemius Recession in the Management of Recalcitrant Plantar Fasciitis. Foot Ankle Int 2022; 43:1167-1173. [PMID: 35652744 DOI: 10.1177/10711007221091807] [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: 02/01/2023]
Abstract
BACKGROUND Plantar fasciitis is the most common cause of plantar heel pain. Although most are self-limiting, recalcitrant conditions can be debilitating, significantly reducing patient's quality of life. A myriad of surgical procedures are available for the treatment of recalcitrant plantar fasciitis (RPF) with little consensus on best practice. This purpose of this study was to assess the efficacy of radiofrequency coblation with and without gastrocnemius release on the surgical management of RPF. METHODS Between June 2013 and June 2019, a total of 128 patients with RPF and tight gastrocnemius were treated surgically. Presence of tight gastrocnemius was assessed clinically by a positive Silfverskiold test. Group A (n = 73) consisted of patients who underwent radiofrequency coblation alone; group B (n = 55) consisted of patients who underwent radiofrequency coblation and endoscopic gastrocnemius recession. The primary outcome measure was visual analog scale (VAS) score. Secondary outcome measures included (1) American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score; (2) physical (PCS) and mental component summaries (MCS) of the 36-Item Short Form Health Survey; (3) overall assessment of improvement, expectation fulfilment, and satisfaction; and (4) complication rates. RESULTS Both groups reported significant improvement in VAS, AOFAS, and PCS scores postoperatively at 6 and 24 months. Group B (radiofrequency coblation with gastrocnemius recession) was associated with better VAS at both 6 months (3.0 ± 2.9 vs 1.7 ± 2.6, P < .05) and 24 months postoperatively (1.9 ± 3.1 vs 0.8 ± 2.0, P < .05) compared with group A (radiofrequency coblation without gastrocnemius recession). At 24 months postoperatively, no differences were found in AOFAS, PCS, MCS scores, expectation fulfilment, or overall satisfaction. No wound complications were reported in either group. One patient (group B) has persistent symptoms consistent with tarsal tunnel syndrome. CONCLUSION In this retrospective cohort comparative study, treatment of RPF with radiofrequency coblation alone was associated with slightly inferior results than radiofrequency coblation combined with endoscopic gastrocnemius recession in terms of pain relief without an increase in complication rates. However, at 2 years, we did not find a significant difference in other measures of outcome. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kevin Oon Thien Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,The Bone and Joint Centre, Mount Elizabeth Hospital, Singapore
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Wheeler PC, Dudson C, Gregory KM, Singh H, Boyd KT. Autologous Blood Injection With Dry-Needling vs Dry-Needling Alone Treatment for Chronic Plantar Fasciitis: A Randomized Controlled Trial. Foot Ankle Int 2022; 43:646-657. [PMID: 35068224 DOI: 10.1177/10711007211061365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Autologous blood injection (ABI) for patients with chronic plantar fasciitis has been promoted as an approach to improve outcomes over standard dry-needling approaches. The purpose of this trial was to investigate if there are improved outcomes following an ultrasonography-guided ABI compared to dry needling alone for patients with chronic plantar fasciitis. METHODS A double-blinded (participant-blinded and observer-blinded) RCT within a single clinic enrolled 90 patients with symptoms of plantar fasciitis that had failed to improve with a minimum of 3 months of rehabilitation. The mean age was 49.5±8.9 years, 67% were female, and the mean symptom duration was 40.0±28.2 months (range: 8 months-10 years). Participants were randomized to receive ABI or an identical dry-needle fenestration-procedure without coadministration of autologous blood. All participants received identical structured rehabilitation and were followed up at 2, 6, 12, and 26 weeks. Outcome measures included local foot pain, validated foot patient-reported outcome measures (Foot Function Index-revised, Manchester-Oxford Foot Questionnaire, Foot and Ankle Ability Measure), measures of general function and "ability" (EuroQol [EQ]-5D-5L, Oswestry Disability Index), specific measures of activity (International Physical Activity Questionnaire), sleep (Pittsburgh Sleep Quality Index), and mood (Hospital Anxiety and Depression Scale). RESULTS There were no significant between-group differences seen at any time-point studied. There were a number of statistically significant within-group improvements for local foot pain and function in both groups comparing baseline/follow-up data. Overall, levels of pain improved by 25% by 6 weeks and by 50% at 6 months. There were improvements in some generalized function markers. Activity rates did not change, demonstrating that improvements in pain did not necessarily influence physical activity. CONCLUSION Coadministration of 3 mL of autologous blood had no additional effect compared to a dry-needling procedure alone for patients with chronic plantar fasciitis. LEVEL OF EVIDENCE Level I, double-blinded randomized controlled trial.
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Affiliation(s)
- Patrick C Wheeler
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom
| | - Chloe Dudson
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Kim M Gregory
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom
| | - Harjinder Singh
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom
| | - Kevin T Boyd
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
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Abstract
BACKGROUND This systematic review aims to summarize the outcomes of gastrocnemius recession in the treatment of plantar fasciitis. METHODS A systematic review was performed according to PRISMA guidelines using the PubMed, Embase, Emcare, Web of Science, Scopus, and CINAHL databases. A 2-stage title/abstract and full text screening process was performed independently by 2 reviewers. Randomized controlled trials, cohort, and case-control studies reporting the results of gastrocnemius recession in patients with plantar fasciitis were included. The MINORS and Joanna Briggs Institute Criteria were used to assess study quality and risk of bias. RESULTS A total of 285 articles were identified, with 6 of these studies comprising 118 patients being ultimately included. Significant postoperative improvement in American Orthopaedic Foot & Ankle Society, visual analog scale, 36-Item Short Form Health Survey, Foot Forum Index, and Foot and Ankle Ability Measure scores were reported. Included studies also described an increase in ankle dorsiflexion range of motion and plantarflexion power. An overall pooled complication rate of 8.5% was seen, with persistent postoperative pain accounting for the most common reported complication. Gastrocnemius recession is associated with greater postoperative improvement than plantar fasciotomy and conservative stretching exercises. CONCLUSION The current evidence demonstrates that gastrocnemius recession is effective in the management of plantar fasciitis, specifically in patients with gastrocnemius contracture who do not respond to conservative treatment. LEVEL OF EVIDENCE Level III, Systematic review of level I-III studies.
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Affiliation(s)
- Zaki Arshad
- School of Clinical Medicine, University
of Cambridge, Cambridge, UK
- Zaki Arshad, BA, School of Clinical
Medicine, University of Cambridge, Downing College, Box 111 Cambridge Biomedical
Campus, Regent Street, Cambridge, CB2 1DQ, UK.
| | - Aiman Aslam
- School of Clinical Medicine, University
of Cambridge, Cambridge, UK
| | | | - Maneesh Bhatia
- Department of Trauma and Orthopaedic
Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Pickin CC, Elmajee M, Aljawadi A, Fathalla I, Pillai A. Gastrocnemius Recession in Recalcitrant Plantar Fasciitis: A Systematic Review. J Foot Ankle Surg 2022; 61:396-400. [PMID: 34838458 DOI: 10.1053/j.jfas.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 02/03/2023]
Abstract
Plantar fasciitis is a common cause of heel pain. Recalcitrant plantar fasciitis can be difficult to manage. Medial gastrocnemius recession is increasingly being used to treat recalcitrant plantar fasciitis, with advocates describing fewer complications and quicker recovery time than other surgical options. This systematic review aimed to determine the effectiveness of gastrocnemius recession for the treatment of patients with recalcitrant plantar fasciitis. Multiple databases were searched using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The level of evidence of each study was assessed according to the American Academy of Orthopaedic Surgeons Levels of Evidence. The level of bias for each study was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Seven studies were retrieved: 3 retrospective case series, 1 retrospective study that compared gastrocnemius recession to open plantar fasciotomy, 1 prospective cohort study (pre-post study with no control group), and 2 randomized controlled trials. All 6 studies that assessed pre- and postoperative pain using the Visual Analogue Scale showed a large reduction in pain postoperatively. Four studies that assessed pain at 12 months postoperatively showed a weighted mean of 76.06 ± 10.65% reduction in pain. No major complications were reported. Minor complications included sural neuritis. This review found a consistent reduction in pain following gastrocnemius release in patients with recalcitrant plantar fasciitis, suggesting it is a very promising treatment. However, the included studies are limited by low quality study designs and inherent biases, limiting the strength of recommendation. Further definitive, well-designed trials are required.
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Affiliation(s)
| | - Mohammed Elmajee
- The Royal Orthopaedic Hospital, Northfield, Birmingham, United Kingdom
| | - Ahmed Aljawadi
- Wythenshawe Hospital, Wythenshawe, Manchester, United Kingdom
| | | | - Anand Pillai
- Wythenshawe Hospital, Wythenshawe, Manchester, United Kingdom
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Similar Benefits Seen After Radial Extracorporeal Shockwave Therapy or Autologous Blood Injection in Patients With Chronic Plantar Fasciitis-A Retrospective Cohort Study. Clin J Sport Med 2022; 32:e107-e115. [PMID: 34267064 DOI: 10.1097/jsm.0000000000000930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the outcomes for patients with chronic plantar fasciitis after extracorporeal shockwave therapy (ESWT) or autologous blood injection (ABI). DESIGN Cohort study-retrospective analysis of prospectively collected data. SETTING Hospital-based Sports Medicine Outpatient Clinic. PATIENTS One hundred two consecutive patients with chronic plantar fasciitis, treated with either radial-ESWT (rESWT) (n = 54) or ABI (n = 48), with minimum 3-month follow-up and 96% (98/102) having 6-month follow-up. Mean age 49.5 years and mean duration of symptoms 37.5 months before treatment. INTERVENTIONS Patients received either 3 sessions of radial ESWT (one session per week for 3 weeks), or a single ultrasound-guided dry needling and ABI (3 mL whole autologous blood). All patients received standardized after-care, including progressive structured home exercise program of flexibility, strengthening, and proprioception exercises. MAIN OUTCOME MEASURES 0 to 10 numerical rating scale (NRS) for self-reported "average pain" and "average stiffness" values. Secondary outcome measures included assessments of local foot function [including Manchester-Oxford Foot Questionnaire (MOXFQ), revised-Foot Function Index] as well as markers of mental health functioning (HAD), global health (EQ-5D-5L), and physical activity (International Physical Activity Questionnaire). RESULTS This study demonstrated statistically significant improvements in self-reported measures of pain and local foot function after either procedure at 6 weeks, 3 months, and 6 months, but no statistically significant differences were seen between groups at any time-period studied. At 6 months, the average pain using a 0 to 10 NRS was improved from 6.8 ± 1.8 to 4.0 ± 2.7 (P < 0.001) after ESWT and from 7.1 ± 1.6 to 3.8 ± 2.7 (P < 0.001) after ABI. At 6 months, significant improvements were seen following either group using a number of different validated patient-rated outcome measures assessing local foot pain and function, eg, the total score for MOXFQ improved from 56.1 ± 12.8 to 42.5 ± 16.6 (P < 0.001) after ESWT and from 58.8 ± 13.2 to 44.2 ± 19.2 (P < 0.001) after ABI. However, measures of physical activity or wider aspects of patient functioning did not consistently improve from baseline values to follow-up periods. CONCLUSIONS Patients with chronic plantar fasciitis improved to statistically significant extent after either rESWT or ABI procedures, with no significant differences seen between groups. The lack of randomization in this pragmatic study is noted, which may have influenced the outcome seen. Potentially larger and more robust studies are required to investigate this treatment comparison further.
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Arif MA, Hafeez S. Effectiveness of Gastrocnemius-Soleus Stretching Program as a Therapeutic Treatment of Plantar Fasciitis. Cureus 2022; 14:e22532. [PMID: 35345689 PMCID: PMC8956500 DOI: 10.7759/cureus.22532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Plantar fasciitis is a painful ailment that causes frustration to both the patient and physician. Stretching exercises targeting the plantar fascia are an excellent therapy option for plantar fasciitis. Objective: To compare the outcome of a gastrocnemius-soleus stretching program versus tendo Achilles stretching exercises for the management of chronic plantar fasciitis. Methods: Patients aged 30-70 years of either gender with chronic plantar fasciitis were included and randomly divided into two groups. In group A, the gastrocnemius-soleus stretching program was applied, whereas in group B, the tendo Achilles stretching exercises were adopted. The pain score was determined at baseline and after eight weeks, and the change in pain score was calculated. All information was noted in the proforma and then entered and analyzed in the Statistical Package for the Social Sciences (SPSS) software version 21 (International Business Machines (IBM), New York, United States). An independent-samples t-test was conducted to compare the mean change in pain score in both groups. A P value of <0.05 was considered significant. Results: The mean age of the patients in the gastrocnemius-soleus stretching group was 48.70 ± 9.80 years, whereas that in the tendo Achilles stretching exercises group was 48.63 ± 8.43 years. Group A included 16 (53.3%) men and 14 (46.7%) women, whereas in group B, there were 15 (50%) men and 15 (50%) women. The mean change in pain score in group A was 2.57 ± 1.01, whereas that in group B was 1.77 ± 0.57. The difference in both groups was significant (P < 0.05). Conclusion: Gastrocnemius-soleus stretching exercises are more effective for reducing the symptoms of plantar fasciitis in the adult population.
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De Prado M, Cuervas-Mons M, De Prado V, Dalmau-Pastor M. Percutaneous plantar fasciotomy: An anatomical study about its safety and efficacy. Foot Ankle Surg 2022; 28:14-19. [PMID: 33468404 DOI: 10.1016/j.fas.2021.01.002] [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] [Received: 09/12/2019] [Revised: 12/16/2020] [Accepted: 01/01/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous plantar fasciotomy is one of the available options for recalcitrant cases of plantar fasciopathy, but there is a mismatch in the clinical results between different author's experience, possibly due to variability when choosing the exact cutaneous entry point. The purpose of this study is to validate the plantar approach in the surgical treatment of plantar fasciopathy, describing a safe path and cutaneous entry point to perform a percutaneous plantar fasciotomy with a 2 mm incision testing the procedure on cadavers. METHODS a unicentric cross-sectional analytical study was conducted in 12 cadaveric feet to verify the accuracy of the percutaneous fasciotomy entry point. Independent variables analysed were: extent of fasciotomy, entry point location, spur resection, and soft tissues injuries. A double evaluation was performed: an indirect evaluation under fluoroscopic vision, and a direct evaluation after anatomical dissection. RESULTS No cases of plantar cortical lesion on the calcaneus was observed. Satisfactory fasciotomy was performed in 91.7% of the cases. An optimal entry point was noticed in all cases with a mean distance to the tip of tibial malleolus of 22.5 mm (±6.9; 35.1-12.1) and a mean distance to foot midline of 7.8 mm (±1.7; 11.8-5.1). No neurological nor vascular lesions were found. In all the feet, a laceration of the plantar part of flexor digitorum brevis muscle was noted. CONCLUSION the plantar approach for percutaneous total plantar fasciotomy is a safe procedure. The current study provides an intraoperative guideline for minimising the possible risks.
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Affiliation(s)
- Mariano De Prado
- Department of Orthopaedics and Trauma Surgery, Quirónsalud Murcia Hospital, Calle Miguel Hernandez, 12. 30011 Murcia, Spain
| | - Manuel Cuervas-Mons
- Department of Orthopaedics and Trauma Surgery, 'Gregorio Marañón' University Hospital, Calle Dr Esquerdo, 46. 28007 Madrid, Spain.
| | - Virginia De Prado
- Department of Podiatry Quirónsalud Murcia Hospital, Calle Miguel Hernandez, 12. 30011 Murcia, Spain
| | - Miki Dalmau-Pastor
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain; GRECMIP - MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied - Minimally Invasive Foot and Ankle Society), Merignac, France; Vilamèdic Medical Center, Santa Coloma de Gramanet, Barcelona, Spain
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Gamba C, Álvarez Gomez C, Martínez Zaragoza J, Leal Alexandre C, Bianco Adames D, Ginés-Cespedosa A. Proximal Medial Gastrocnemius Release. JBJS Essent Surg Tech 2022; 12:ST-D-20-00039. [DOI: 10.2106/jbjs.st.20.00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Leggit J, Mark R, Hulsopple C, Carey PM, Alisangco JB. Disorders of the Lower Extremity. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Paris A, Beccati F, Pepe M. Plantar fasciitis in 19 endurance horses: Diagnosis, treatment and follow‐up. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Paris
- Private Practitioner Sigillo (PG)Italy
| | - F. Beccati
- Department of Veterinary Medicine Veterinary Teaching Hospital of the University of Perugia PerugiaItaly
- Sport Horse Research Centre Department of Veterinary Medicine University of Perugia Perugia Italy
| | - M. Pepe
- Department of Veterinary Medicine Veterinary Teaching Hospital of the University of Perugia PerugiaItaly
- Sport Horse Research Centre Department of Veterinary Medicine University of Perugia Perugia Italy
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Singh T, Kumar P. Plantar fasciopathy—looking beyond the obvious? A case report. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The biggest challenge in treating this diagnosis is the lack of literature focusing on regional interdependence. The current literature suggests a narrow and localized approach targeting plantar fascia and ankle/foot complex. The literature available on conservative treatment focused on utilizing various inflammatory modalities such as injections and extracorporeal shockwave therapy. The surgical approach targets Baxter’s nerve decompression techniques and releases techniques to the gastrocnemius and plantar fascia. The article focuses on utilizing manual therapy techniques to the lumbosacral spine and plantar fascia. In addition, the neurodynamic flossing targeted lateral plantar nerve mobility.
Case presentation
The patient is a 54-year-old African American female seen for right heel pain at Texas’s outpatient orthopedic physical therapy clinic. The patient had the diagnosis of plantar fasciopathy with negative Windlass testing. The patient was provided manual therapy interventions to the lumbosacral spine and plantar fascia to improve weight-bearing patterns and overall functional outcomes.
Conclusion
The manual therapy interventions to the lumbosacral spine and plantar fascia and flossing techniques to the lateral plantar nerve improved symptoms of heel pain. The patient showed improved outcomes with this approach.
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Burton I. Combined extracorporeal shockwave therapy and exercise for the treatment of tendinopathy: A narrative review. SPORTS MEDICINE AND HEALTH SCIENCE 2021; 4:8-17. [PMID: 35782779 PMCID: PMC9219268 DOI: 10.1016/j.smhs.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
Tendinopathy is a chronic degenerative musculoskeletal disorder that is common in both athletes and the general population. Exercise and extracorporeal shockwave therapy (ESWT) is among the most common treatments used to mediate tendon healing and regeneration. The review presents the current understanding of mechanisms of action of ESWT and exercise in isolation and briefly synthesises evidence of their effectiveness for various tendinopathies. The central purpose of the review is to synthesize research findings investigating the combination of ESWT and exercise for five common tendinopathies (plantar heel pain, rotator cuff, lateral elbow, Achilles, and patellar tendinopathy) and provide recommendations on clinical applicability. Collectively, the available evidence indicates that ESWT combined with exercise in the form of eccentric training, tissue-specific stretching, or heavy slow resistance training are effective for specific tendinopathies and can therefore be recommended in treatment. Whilst there are at present a limited number of studies investigating combined EWST and exercise approaches, there is evidence to suggest that the combination improves outcomes in the treatment of plantar heel pain, Achilles, lateral elbow, and rotator cuff tendinopathy. However, despite overall positive outcomes in patellar tendinopathy, the combined treatment has not been shown at present to offer additional benefit over eccentric exercise alone.
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Acosta-Olivo C, Simental-Mendía LE, Vilchez-Cavazos F, Peña-Martínez VM, Elizondo-Rodíguez J, Simental-Mendía M. Clinical Efficacy of Botulinum Toxin in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2021; 103:364-371.e2. [PMID: 34688605 DOI: 10.1016/j.apmr.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the efficacy of botulinum toxin A (BTX-A) for the treatment of plantar fasciitis through a meta-analysis of randomized controlled trials (RCTs) focusing on pain and functional outcomes since current literature has supported a potential benefit of BTX-A. DATA SOURCES The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched until December 2020 for RCTs reporting the effects of BTX-A injections on plantar fasciitis. The complementary literature search included Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and greylit.org. STUDY SELECTION Only RCTs assessing the effect of BTX-A injections on pain, functional improvement, or plantar fascia thickness in patients with plantar fasciitis were included. Multiple researchers carried out the screening process of the 413 records. DATA EXTRACTION Data were extracted independently and in duplicate using a standardized data extraction format. Information was contrasted by a third observer. DATA SYNTHESIS BTX-A injections resulted in significant pain relief (mean difference, -2.07 [95% CI, -3.21 to -0.93]; P=.0004; I2=97%) and functional improvement (standardized mean difference, 1.15 [95% CI, 0.39-1.91]; P=.003; I2=87%). A subanalysis indicated that pain relief was sustained at 12 months while functional improvement remained significant after 0-6 months. The results were not affected by a single study after sensitivity analysis. The site of injection and the use or not of ultrasound-guided injections may account for potential sources of interstudy heterogeneity. CONCLUSIONS This meta-analysis suggests both a statistically significant and a clinically meaningful improvement on plantar fasciitis symptoms after BTX-A treatment.
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Affiliation(s)
- Carlos Acosta-Olivo
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Luis E Simental-Mendía
- Instituto Mexicano del Seguro Social, Unidad de Investigación Biomédica, Delegación Durango, Durango, México
| | - Félix Vilchez-Cavazos
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Víctor M Peña-Martínez
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Jorge Elizondo-Rodíguez
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Mario Simental-Mendía
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México.
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Poenaru D, Badoiu SC, Ionescu AM. Therapeutic considerations for patients with chronic plantar fasciitis (Review). MEDICINE INTERNATIONAL 2021; 1:9. [PMID: 38939365 PMCID: PMC11208983 DOI: 10.3892/mi.2021.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/14/2021] [Indexed: 06/29/2024]
Abstract
Heel pain is a common complaint in the population, leading to a limitation in daily activities and a poor quality of life. Chronic plantar fasciitis is the most common cause of heal pain. Despite its name, which suggests inflammation, the underlying process is rather a degenerative one. The clinical course is often chronic or relapsing, as a challenge to physicians to find the most effective therapeutically approach. First-line treatment consists of rest, shoe modification, orthosis and physiotherapy. Physical exercise is an important tool which can be combined with other therapeutic options. Medication is usually administered in acute cases, in the form of simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) or opioids, in different regimens. For chronic evolution, the use of NSAIDs is controversial. Second-line treatment includes extracorporeal shock wave therapy and corticosteroid local injection. New therapies have emerged, as autologous blood derivatives and prolotherapy, with growing evidence, to be included in clinical practice. The present review article discusses the therapeutic options for patients with chronic plantar fasciitis, to with an aim to shed light on the treatment strategies for this condition.
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Affiliation(s)
- Daniela Poenaru
- Department of Rehabilitation Medicine, ‘Carol Davila’ University of Medicine, Bucharest 020021, Romania
| | - Silviu Constantin Badoiu
- Department of Morphological Sciences, ‘Carol Davila’ University of Medicine, Bucharest 020021, Romania
| | - Anca Mirela Ionescu
- Department of Rehabilitation Medicine, ‘Carol Davila’ University of Medicine, Bucharest 020021, Romania
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Extracorporeal Shockwave Therapy for the Treatment of Tendinopathies: Current Evidence on Effectiveness, Mechanisms, Limitations and Future Directions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ginés-Cespedosa A, Ugarte IW, Ares-Vidal J, Solano-Lopez A, Adames DB, Gamba C. Clinical And Plantar Fascial Morphologic Changes After Proximal Medial Gastrocnemius Release Treatment of Recalcitrant Plantar Fasciitis. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211027323. [PMID: 35097465 PMCID: PMC8702947 DOI: 10.1177/24730114211027323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) has been used as a diagnostic and prognostic instrument to evaluate the results of conservative treatment for plantar fasciitis. However, there are scarce data available relative to changes in the plantar fascia after operative treatment. The primary objective of this study is to evaluate the imaging changes in patients with recalcitrant plantar fasciitis treated operatively by means of proximal medial gastrocnemius release. METHODS Thirteen patients with recalcitrant plantar fasciitis were studied with MRI preoperatively and 1 year after operative treatment. Quantitative (plantar fascia thickness) and qualitative variables (hyperintensity in the plantar fascia, insertional calcaneus bone edema, a plantar fascia tear, and the presence of perifascial collections) were assessed by 2 musculoskeletal radiologists. Clinical results were also measured with American Orthopaedic Ankle & Society (AOFAS), visual analog scale (VAS) pain, and 36-Item Short Form Health Survey (SF-36) scales. RESULTS The mean plantar fascia thickness was 6.59 mm preoperatively and 6.37 mm postoperatively (P = .972). No statistically significant differences were found in any of the qualitative variables on comparing the pre- and postoperative periods. Patients reported clinical improvements in pain VAS, AOFAS measurement, and the physical subdomains of the SF-36 scale. CONCLUSION Quantitative and qualitative variables assessed for the plantar fascia on MRI did not show any significant change after medial gastrocnemius release despite clear clinical improvement. LEVEL OF EVIDENCE Level II, perspective cohort study.
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Affiliation(s)
- Alberto Ginés-Cespedosa
- Orthopaedics Department, Hospital del Mar, UAB–Universitat Autonoma Barcelona, Barcelona, Spain
| | | | - Jesus Ares-Vidal
- Department of Radiology and Radiodiagnostic, Hospital del Mar, Barcelona, Spain
| | | | - Daniel Bianco Adames
- Orthopaedic Department, Hospital del Mar, Universitat Autonoma Barcelona (UAB), Barcelona, Spain
| | - Carlo Gamba
- Orthopaedic Department, Hospital de la Santa Creu I Sant Pau, Universitat Autonoma Barcelona, Barcelona, Spain
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Burton I. Autoregulated heavy slow resistance training combined with radial shockwave therapy for plantar heel pain: Protocol for a mixed-methods pilot randomised controlled trial. Musculoskeletal Care 2021; 19:319-330. [PMID: 33629803 DOI: 10.1002/msc.1542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Plantar heel pain (PHP) is considered a tendinopathy and it affects up to 10% of the population. Both heavy slow resistance training (HSRT) and extracorporeal shockwave therapy (ESWT) have shown effectiveness for treating PHP in isolation. However, more comprehensive exercise protocols and progression methods are needed due to poor long-term outcomes, and better standardisation of ESWT protocols are required. Autoregulation of resistance training involves self-selecting exercise dosage based on individual factors. Although autoregulation has proven effective for strength gains in athletes, it has not been investigated in tendinopathy. Recent studies recommend that PHP should not be treated by one treatment intervention in isolation. However, there is a dearth of research investigating the feasibility and effectiveness of combined treatment interventions for PHP. Currently, no studies have investigated autoregulated HSRT combined with ESWT, despite their individual efficacy. The optimal treatment protocol for PHP is unknown, and there is a need to ascertain whether the addition of ESWT to autoregulated HSRT leads to better outcomes compared to either alone. METHODS A three-arm randomised controlled trial (RCT) comparing these groups would be the ideal way to investigate this question, with a pilot RCT testing trial procedures and process evaluation required prior to a definitive RCT. Patients expectations, feasibility and acceptability of combined ESWT and exercise for PHP also remain unknown. Therefore, the addition of qualitative interviews in a mixed-methods pilot RCT would help ascertain acceptability and help explain the intervention outcomes.
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Affiliation(s)
- Ian Burton
- Angus Physiotherapy Department, NHS Tayside, Arbroath Infirmary, Arbroath, DD11 2AT, UK
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Chiu YC, Yang SC, Hsieh YH, Tu YK, Kuo SM, Hwang LC. Iatrogenic Lateral Plantar Nerve Injury After Endoscopic Plantar Fascia Release: A Case Report. J Am Podiatr Med Assoc 2020; 110:449526. [PMID: 33301581 DOI: 10.7547/19-188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present a 57-year-old female patient with iatrogenic lateral plantar nerve injury caused by endoscopic surgery for plantar fasciitis. Nerve grafting surgery was recommended, but the patient refused further surgical intervention because of personal reasons. After 1-year follow-up in outpatient clinics, she achieved only slight improvement in the lateral foot symptoms and still required oral analgesics for pain control. The purpose of this case report is to remind physicians of such a rare and serious complication that can occur after endoscopic surgery for plantar fasciitis. Good knowledge of anatomy and skilled surgical technique could decrease this type of complication.
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Burton I, Cooper K, Alexander L, Swinton PA. Effectiveness of combined shockwave therapy and plantar fascia stretching interventions in treating plantar heel pain: a systematic review and meta-analysis protocol. JBI Evid Synth 2020; 19:1186-1192. [PMID: 33074993 DOI: 10.11124/jbies-20-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to synthesize the best available evidence on the effectiveness of interventions that have used a combination of extracorporeal shockwave therapy and plantar fascia-specific stretching to treat plantar heel pain compared to any other non-surgical intervention. INTRODUCTION Recent evidence suggests combining shockwave therapy and plantar fascia stretching may be more effective than other treatments for plantar heel pain. However, no systematic reviews have been conducted on the topic and optimal treatment protocols and clinical recommendations are lacking. INCLUSION CRITERIA Randomized controlled trials assessing the effectiveness of combined shockwave therapy and plantar stretching for plantar heel pain in adults will be included. METHODS The authors will search a wide range of sources to identify both published and unpublished studies via EBSCOhost, including, but not limited to MEDLINE, SPORTDiscus, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and Allied and Complementary Medicine Database (AMED). Studies published in a language other than English will only be considered if a translation is available. The JBI systematic review methodology will be followed when conducting the review. Data synthesis will be conducted using meta-analysis or narrative synthesis, where appropriate. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020171538.
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Affiliation(s)
- Ian Burton
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK.,The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, UK.,NHS Grampian, Aberdeen, UK
| | - Lyndsay Alexander
- School of Health Sciences, Robert Gordon University, Aberdeen, UK.,The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, UK
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Yu T, Xia J, Li B, Zhou H, Yang Y, Yu G. Outcomes of platelet-rich plasma for plantar fasciopathy: a best-evidence synthesis. J Orthop Surg Res 2020; 15:432. [PMID: 32958046 PMCID: PMC7504858 DOI: 10.1186/s13018-020-01783-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 07/02/2020] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Tao Yu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Jiang Xia
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Bing Li
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
| | - Haichao Zhou
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Yunfeng Yang
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
| | - Guangrong Yu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
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Gamba C, Serrano-Chinchilla P, Ares-Vidal J, Solano-Lopez A, Gonzalez-Lucena G, Ginés-Cespedosa A. Proximal Medial Gastrocnemius Release Versus Open Plantar Fasciotomy for the Surgical Treatment in Recalcitrant Plantar Fasciitis. Foot Ankle Int 2020; 41:267-274. [PMID: 31808359 DOI: 10.1177/1071100719891979] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plantar fasciitis is a common cause of foot pain. If conservative treatment fails, there is no consensus as to the best surgical management for recalcitrant plantar fasciitis (RPF). The aim of this study was to compare the results obtained from proximal medial gastrocnemius release (PMGR) with those obtained from open plantar fasciotomy (OPF) in terms of pain, satisfaction, health-related quality of life, and American Orthopaedic Foot & Ankle Society (AOFAS) score. METHODS This is a prospective randomized trial conducted between 2012 and 2016. Patients with RPF for at least 9 months were included. Diagnosis was clinically made. The exclusion criteria were neuropathic heel pain; a history of previous foot fracture, surgery, or deformity; rheumatoid arthritis; or the need for long-term analgesic administration. After ruling out other conditions with magnetic resonance or ultrasound imaging, patients were randomized to be operated on with OPF or PMGR independently of the Silfverskjold test. Follow-up was carried out for up to 1 year. The AOFAS, visual analog scale (VAS) for pain, SF-36, and Likert scale for satisfaction were used to evaluate the results obtained. The analysis was done with 21 patients in the OPF group and 15 in the PMGR group. The demographic data (age, sex, body mass index, duration of symptoms, and positivity to the Silfverskjold test) of the groups were comparable. RESULTS No differences were found in terms of the AOFAS (P = .24), VAS (P = .14), or any item of the SF-36. Satisfaction was very good in 85.8% of the PMGR group and 89.5% of the OPF group (P = .27). Faster recovery was observed in the PMGR group. CONCLUSION OPF and PMGR provided good results for patients with RPF. Neither was superior to the other relative to pain, AOFAS score, satisfaction, or the SF-36. We recommend PMGR as the first option in RPF surgical management in order to avoid potential biomechanical complications related to OPF. LEVEL OF EVIDENCE Level I, therapeutic randomized controlled trial.
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Affiliation(s)
- Carlo Gamba
- Orthopaedic Department, Hospital del Mar, Universitat Autonoma Barcelona (UAB), Barcelona, Spain.,Orthopaedic Department, Hospital de la Santa Creu I Sant Pau, Universitat Autonoma Barcelona (UAB), Barcelona, Spain
| | | | - Jesus Ares-Vidal
- Department of Radiology and Radiodiagnostic, Hospital del Mar, Barcelona, Spain
| | | | - Gemma Gonzalez-Lucena
- Orthopaedic Department, Hospital del Mar, Universitat Autonoma Barcelona (UAB), Barcelona, Spain
| | - Alberto Ginés-Cespedosa
- Orthopaedic Department, Hospital del Mar, Universitat Autonoma Barcelona (UAB), Barcelona, Spain
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Mariani E, Pulsatelli L. Platelet Concentrates in Musculoskeletal Medicine. Int J Mol Sci 2020; 21:ijms21041328. [PMID: 32079117 PMCID: PMC7072911 DOI: 10.3390/ijms21041328] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/06/2020] [Indexed: 12/02/2022] Open
Abstract
Platelet concentrates (PCs), mostly represented by platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are autologous biological blood-derived products that may combine plasma/platelet-derived bioactive components, together with fibrin-forming protein able to create a natural three-dimensional scaffold. These types of products are safely used in clinical applications due to the autologous-derived source and the minimally invasive application procedure. In this narrative review, we focus on three main topics concerning the use of platelet concentrate for treating musculoskeletal conditions: (a) the different procedures to prepare PCs, (b) the composition of PCs that is related to the type of methodological procedure adopted and (c) the clinical application in musculoskeletal medicine, efficacy and main limits of the different studies.
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Affiliation(s)
- Erminia Mariani
- Laboratorio di Immunoreumatologia e rigenerazione tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
- Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-6366803
| | - Lia Pulsatelli
- Laboratorio di Immunoreumatologia e rigenerazione tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
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Leggit J, Mark R, Hulsopple C, Carey PM, Alisangco JB. Disorders of the Lower Extremity. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Koh D, Goh Y, Yeo N. Calcaneal osteochondroma masquerading as plantar fasciitis: An approach to plantar heel pain - A case report and literature review. World J Orthop 2019; 10:339-347. [PMID: 31572670 PMCID: PMC6766467 DOI: 10.5312/wjo.v10.i9.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/15/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heel pain is a common orthopaedic complaint, and if left untreated can be a source of chronic morbidity. Accurate diagnosis can be challenging, owing to the complex anatomy and multiple pain generators present in the foot. We aim to share our clinical experience managing an unusual case of chronic heel pain secondary to osteochondroma.
CASE SUMMARY A 41-year-old obese male who works as a porter presented with a long-standing history of left plantar heel pain. He was assessed to have point tenderness over the plantar insertion of the calcaneus as well as a positive Silfverskiöld test. He was treated for plantar fasciitis and tight gastrocnemius but failed conservative therapies as well as surgical intervention. Magnetic resonance imaging revealed the presence of a pedunculated bony protrusion over the plantar aspect of the calcaneus. The decision was made for excision of the osteochondroma, and the patient has been pain-free since.
CONCLUSION Osteochondromas are rarely symptomatic in skeletally mature patients. While most are benign with a very low risk of malignant transformation, surgical excision can yield excellent results and significant pain relief in symptomatic patients.
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Affiliation(s)
- Don Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Yvonne Goh
- NUS Yong Loo Lin School of Medicine, NUHS Tower Block, Singapore 119228, Singapore
| | - Nicholas Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
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