Sports Therapy
Plantar Faciitis

Plantar Faciitis

Hello there since the running season is starting up I wanted to bring up some common injuries that are starting to come into the clinic these days.  I am starting to get a lot of people showing up at our Westboro physiotherapy and Orleans physiotherapy clinics.

Plantar Faciitis

There are many options for treatment of plantar faciitis and below are a few

Orthotics, i.e., foot supports, are the only non-surgical therapy to have been supported by studies rated by the Center for Evidence-Based Medicine as being of high quality.[3]Landorf et al.[6] performed a single-blind experiment in which patients were randomly assigned to receive off-the-shelf orthotics, personally customized orthotics, or sham orthotics made of a soft, thin foam. Patients receiving real orthotics showed statistically significant short-term improvements in functionality compared to those receiving the sham treatment. There was no statistically significant reduction in pain, and there was no long-term effect when the patients were re-evaluated after 12 months. Off-the-shelf orthotics were found to be as effective as customized ones for acute (short term) plantar fasciitis. There is some evidence that taping may supply short-term relief, but the evidence is weaker than the evidence suporting orthotics.[3]

Some evidence shows that stretching of the calf and plantar fascia may provide up to 2–4 months of benefit.[3] One study has shown improvement over a four-month period with stretching.[7] In cases of chronic plantar fasciitis,the ultrasound therapy with 3 MHz for 10-15minutes/day is beneficial.One study has shown high success rates with a stretch of the plantar fascia,[8] but has been criticized[3] because it was not blinded, and contained a bias because the analysis did not use the intention to treat method. Because it is impractical to do double-blind experiments involving stretching, such studies are vulnerable to placebo effects. The Center for Evidence-Based Medicine has not rated any study of stretching as being of high quality.[9]

Pain with the first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease pain on waking. These have many different designs. The type of splint has not been shown to affect outcomes.

To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.[10]. Dexamethasone 0.4 %or acetic acid 5% delivered by ionophoresis combined with low dye strapping and calfstretching has been shown to provide short term pain relief and increased function.[11]

Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle.[12] Recurrence rates may be lower if injection is performed under ultrasound guidance.[13] Repeated steroid injections may result in rupture of the plantar fascia. While this may actually improve pain initially, it has deleterious long-term consequences.

There is mixed evidence regarding the effectiveness of extracorporeal shockwave therapy.[14][15] A non-controlled study by Norris et al. showed positive effects. A controlled study by Buchbinder et al. showed no benefit for shockwave therapy compared to a placebo. Proponents of shockwave therapy argue that the doses used by Buchbinder were too low.

In refractory cases, surgery is sometimes indicated.

  1. ^ Plantar Fasciitis A Degenerative Process (Fasciosis) Without Inflammation
  2. ^ Risk factors for Plantar fasciitis: a matched case-control study. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. J Bone Joint Surg Am. 2003;85-A:872-877.
  3. ^ abcde Heel Pain – Plantar Fasciitis. J Orthop Sports Phys Ther. 2008:38(4)
  4. ^ Buchbinder R. Clinical practice. Plantar fasciitis. N Engl J Med. 2004;350:2159-2166.
  5. ^ Plantar fasciitis: evidence-based review of diagnosis and therapy. Cole C, Seto C, Gazewood J. Am Fam Physician. 2005;72:2237-2242
  6. ^ Landorf et al., Arch Intern Med 2006:166:1305
  7. ^ Porter et al., Foot Ankle Int 1999:20:214
  8. ^ Digiovanni, Benedict F.; Deborah A. Nawoczenski, Daniel P. Malay, Petra A. Graci, Taryn T. Williams, Gregory E. Wilding, and Judith F. Baumhauer (2006). “Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up”. The Journal of bone and joint surgery (American)88 (8): 1775–81. doi:10.2106/JBJS.E.01281. PMID16882901.
  9. ^ J Orthop Sports Phys Ther. 2008;38(4):A1-A18. doi:10.2519/jospt.2008.0302
  10. ^ Lynch, D.; Goforth, W., Martin, J., Odom, R., Preece, C., & Kottor M. (1998). “Conservative treatment of plantar fasciitis. A prospective study”. Journal of the American Podiatric Medical Association88 (8): 375–380. PMID9735623.
  11. ^ Treatment of plantar fasciitis by Low Dye taping and iontophoresis: short term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid. Osborne HR, Allison GT. Br J Sports Med. 2006;40:545-549; discussion 549.
  12. ^ Genc, Hakan; Meryem Saracoglu, Bans Nacir, Hatice Rana Erdem and Mahmut Kacar (2005). “Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection”. Joint Bone Spine72 (1): 61–5. doi:10.1016/j.jbspin.2004.03.006. PMID15681250.
  13. ^ Tsai, Wen-Chung; Chih-Chin Hsu, Carl P. C. Chen, Max J. L. Chen, Tung-Yang Yu, Ying-Jen Chen (2006). “Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance”. Journal of Clinical Ultrasound34 (1): 12–16. doi:10.1002/jcu.20177. PMID16353228.
  14. ^ Norris, Donald M.; Kimberly M. Eickmeier and Bruce R. Werber (2005). “Effectiveness of Extracorporeal Shockwave Treatment in 353 Patients with Chronic Plantar Fasciitis”. Journal of the American Podiatric Medical Association95 (6): 517–524. PMID16291842.
  15. ^ Buchbinder, R, et al. (2002). “Extracorporeal Shock Wave Therapy for Plantar Fasciitis:A Randomized Controlled Trial.”. Journal of the American Medical Association228: 1364–1372. doi:10.1001/jama.288.11.1364.
  16. ^ Kauffman, Jeffrey (2006-09-21). “Plantar fasciitis”. MedlinePlus Medical Encyclopedia. National Institutes of Health.

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