Treatment of plantar fasciitis

Plantar fasciitis is a common cause of heel pain in adults. The disorder classically presents with pain that is particularly severe with the first few steps taken in the morning. In general, plantar fasciitis is a self-limited condition. However, symptoms usually resolve more quickly when the interval between the onset of symptoms and the onset of treatment is shorter. Many treatment options exist, including rest, stretching, strengthening, change of shoes, arch supports, orthotics, night splints, anti-inflammatory agents and surgery. Usually, plantar fasciitis can be treated successfully by tailoring treatment to an individual's risk factors and preferences.     

Thiosinaminum in the treatment of plantar fasciitis with calcaneal spurs

43 patients with plantar fasciitis and calcaneal spurs were studied. Rhus tox. has been recommended for this condition but gave disappointing results. Most patients with relatively recent symptoms responded to Thiosinaminum 3x. Patients with longer standing symptoms responded to Thiosinaminum 3x combined with Mercurius corrosivus 30c or Mercurius biniodatus 6c. After resolution of symptoms patients were treated with placebo and followed up for at least 8 months.     

体外冲击波治疗慢性足底筋膜炎

学术背景:已经证实应用体外冲击波治疗慢性足底筋膜炎的疗效是确定的,关于其作用机制有不同的解释,尚未完全明确.目的:介绍体外冲击波治疗慢性足底筋膜炎的作用机制及临床应用方面的研究进展.检索策略:由第一、二作者应用计算机检索PUBMED、HighWire、Springer数据库公开的截止到2007-08的相关文献,检索词为"chronic plantar fasciitis extracorporeal shock wave application",限定语言种类为"English".纳入标准:内容与体外冲击波治疗慢性足底筋膜炎的作用机制和临床应用有关.排除标准:较陈旧和重复研究.文献评价:共收集到65篇相关文献,25篇文献符合标准,其中4篇是综述和述评类文献,其余均为关于作用机制、临床应用的研究的文章.资料综合:①作用机制:有人认为高能量冲击波选择性地破坏了无髓鞘的感觉神经纤维;而低能量冲击波则可使如降钙素基因相关肽等肽类物质的释放,在局部产生神经源性炎症反应,进而抑制了感觉神经末梢的传导.并可引起大脑局部血流的改变,调整疼痛记忆,使对局部疼痛刺激反应的减少,从而起到了长期镇痛作用.②临床应用:有许多关于近期、远期疗效、不同能量等级的疗效以及使用局麻药物、跖筋膜的厚度、治疗位置的选择等对疗效的影响的报告.结论:应用体外冲击波治疗慢性足底筋膜炎有确定的疗效的,不同的临床应用方法可影响临床疗效.     

高能体外冲击波治疗慢性足底筋膜炎

目的:观察高能体外冲击波对慢性足底筋膜炎的临床治疗效果。方法:选择2004-12/2005-12在深圳市第六人民医院疼痛科门诊就诊的足底筋膜炎患者167例,均自愿参加观察。按奇偶序列随机分为2组,治疗组84例,对照组83例。①治疗组采用HKSW-O冲击波治疗机进行标准治疗,工作电压7～10V,冲击波频率60次/min,治疗时间15min。②对照组除机器探头未与治疗部位充分有效接触外,定位及治疗参数设置同治疗组。两组患者均治疗3次,间隔5d治疗1次。①治疗前及治疗结束3个月后对两组患者进行简式McGill疼痛问卷测评:包括感觉类评分(0～33分)、情感类评分(0～12分)、疼痛总分(0～45分)、目测类比疼痛评分(0～10分)及现有疼痛强度评分(0～5分),以上各项分值越高,表示疼痛强度越大。②治疗后3个月对两组患者进行疗效评估:显效为疼痛明显减轻;好转为疼痛略减轻;无效为症状较治疗前无改变或加重。③患者治疗后第3天复诊时进行副作用观察,包括皮肤发红、疼痛、肿胀及其他(如恶心、眩晕、异感等)。结果:167例足底筋膜炎患者全部进入结果分析,无脱落。①两组患者治疗前及治疗3个月后简式McGill疼痛问卷评分比较:治疗3个月后,治疗组感觉类、情感类、疼痛总分、目测类比疼痛评分及现有疼痛强度评分均显著低于治疗前(t=2.639～3.416,P<0.01)。除现有疼痛强度评分外,治疗3个月后治疗组患者的感觉类、情感类、疼痛总分及目测类比疼痛评分均显著低于对照组(t=2.467～3.487,P<0.01)。②治疗3个月后两组患者的临床疗效比较:治疗组患者的显效率显著高于对照组(χ2=112.33,P<0.01)。③治疗后第3天复诊时治疗组患者的副作用发生情况:治疗组患者有少部分病例会出现皮肤发红和局部疼痛,而肿胀和其他副作用几乎不出现。结论:高能体外冲击波对慢性足底筋膜炎的临床治疗效果确切,具有安全、有效、简易和快速等特点。     

冲击波与皮质类固醇治疗慢性跖筋膜炎的疗效比较

目的比较体外发散式冲击波与局部皮质类固醇(CS)药物注射治疗慢性跖筋膜炎的临床疗效。方法选取2018年3月至2020年5月西安红会医院足踝外科门诊治疗的80例慢性跖筋膜炎患者,进行回顾性研究,以在足底区进行CS局部封闭注射治疗的40例为封闭组,以在足底区和同侧小腿三头肌进行冲击波治疗的40例为冲击波组,比较两组满意度、VAS及Maryland评分等指标。结果两组治疗1、3、6个月时VAS及Maryland评分均较治疗前改善(P<0.05);治疗1个月时封闭组VAS及Maryland评分优于冲击波组,但治疗6个月时冲击波组VAS及Maryland评分优于封闭组(P<0.05)。冲击波组治疗后各时间点的VAS及Maryland评分均较治疗前逐渐改善,除治疗后6个月与3个月比较外,其他时点间两两比较差异均有统计学意义(P<0.05);相反封闭组从治疗1个月后逐渐出现恶化趋势,且治疗6个月时VAS及Maryland评分均较1个月时出现反弹,差异有统计学意义(P<0.05)。治疗6个月时,冲击波组满意度调查优于封闭组(P<0.05)。结论两种治疗方法对于慢性跖筋膜炎...     

Power Doppler findings in plantar fasciitis

The study was performed to characterize the power Doppler ultrasonographic (PDU) findings in plantar fasciitis using a 7.5 MHz linear transducer. Both feet of 20 patients who had a clinical and ultrasound (US) diagnosis of unilateral plantar fasciitis were evaluated with PDU. The pain level was assessed with a visual analogue scale (VAS). A total of 20 healthy volunteers were evaluated as a control group. Moderate or marked hyperemia was found in PDU in the plantar fascia and the surrounding soft tissue along the first cm distally from the insertion in 8 (40%) of the 20 symptomatic heels and in 1 patient (5%) on the asymptomatic side. Moderate or marked hyperemia was associated with a history of less than 6 months and high pain levels. The difference between both groups was significant (p < 0.05). PDU improves the value of US as a noninvasive technique for the diagnosis of plantar fasciitis, providing additional information on local hyperemia.     

超声引导下针刺触发点治疗足底筋膜炎

目的 观察超声引导下针刺触发点治疗足底筋膜炎的临床效果。方法 选取48例足底筋膜炎患者，并随机分为2组，对单纯组（n=24）采用单纯非负重跖腱膜拉伸训练，联合组（n=24）采用超声引导下针刺触发点结合非负重跖腱膜拉伸训练；分别于治疗前（T₀）及治疗后1个月（T₁）、3个月（T₂）对患者进行"第1步"数字疼痛评分（NPRS）、美国矫形外科足踝协会踝-后足功能评分（AOFAS）以及36条目健康调查量表中生理（PCS）和心理（MCS）评分。结果 治疗前后2组NPRS、AOFAS、PCS和MCS评分总体差异均有统计学意义（P均<0.01），治疗后均较治疗前改善。联合组T₁和T₂的NPRS均低于单纯组（P均<0.01），T₁和T₂的AOFAS、PCS评分均高于单纯组（P均<0.05），而2组间T₁和T₂的MCS评分差异均无统计学意义（P均>0.05）。结论 超声引导下针刺触发点联合拉伸训练和单纯非负重跖腱膜拉伸训练对于足底筋膜炎均有效，前者缓解疼痛和改善足踝功能效果更佳。     

跖筋膜炎病理力学概念及治疗：富含血小板血浆治疗的前景

背景：跖筋膜炎作为跟痛症的重要病因,各级医疗机构治疗方法不尽相同,治疗效果也出入较大。
　　目的：总结跖筋膜的各种治疗,结合跖筋膜炎的发病机制及病理力学,探讨各种治疗方法的效果及适应证。方法：检索PubMed数据库、中国科技期刊数据库(万方)1993年1月至2014年1月有关跖筋膜炎的相关研究。英文关键词为“Plantar fasci tis,Mechanism,Treatment”;中文关键词为“跖筋膜炎;机制;治疗”。阅读标题及进行筛查,保留其中34篇归纳总结。
　　结果与结论：跖筋膜炎的治疗需遵循无创到有创的原则,核心的理念为跖筋膜特殊牵引治疗、矫形器及夜间夹板的固定。对于急性期的患者,如果能够接受激素治疗带来的不良反应,局部注射激素可以作为一线治疗。富含血小板血浆注射治疗的前景看似美好,但现在还缺少大量的实验证据。对于反复发作的慢性顽固性跖筋膜炎,可以考虑体外震波治疗。手术治疗需严格筛选,因为它并不能缓解所有患者的疼痛,这是治疗跖筋膜炎的最后一道防线。     

The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners

Background

Plantar fasciitis is the third most frequent injury in runners. Despite its high prevalence, its pathogenesis remains inconclusive. The literature reports overload as the basic mechanism for its development. However, the way that these plantar loads are distributed on the foot surface of runners with plantar fasciitis and the effects of pain on this mechanical factor has not yet been investigated. Therefore, the aim of this study was to evaluate and compare the plantar pressure distributions during running in runners with symptom or history of plantar fasciitis and runners without the disease.

Methods

Forty-five recreational runners with plantar fasciitis (30 symptomatic and 15 with previous history of the disease) and 60 runners without plantar fasciitis (control group) were evaluated. Pain was assessed by a visual analogue scale. All runners were evaluated by means of the Pedar system insoles during running forty meters at a speed of 12(5%) km/h, using standard sport footwear. Two-way ANOVAS were employed to investigate the main and interaction effects between groups and plantar areas.

Findings

No interaction effects were found for any of the investigated variables: peak pressure (P = 0.61), contact area (P = 0.38), contact time (P = 0.91), and the pressure-time integral (P = 0.50).

Interpretation

These findings indicated that the patterns of plantar pressure distribution were not affected in recreational runners with plantar fasciitis when compared to control runners. Pain also did not interfere with the dynamic patterns of the plantar pressure distributions.     

Diagnosing and treating plantar fasciitis: a conservative approach to plantar heel pain

Plantar fasciitis is the most common cause of pain at the weight-bearing surface of the heel, and may coexist with other sources of heel pain. This has led to a confusing array of treatment strategies, including surgery. We offer a simple, effective diagnostic and treatment algorithm that emphasizes nonsurgical treatment options for this often frustrating condition.     

Calf stretching and plantar fascia-specific stretching for plantar fasciitis: A systematic review and meta-analysis

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain. A calf stretching (CS) and a plantar fascia-specific stretching (PFSS) are two stretching techniques commonly administered by health care providers.ObjectiveTo evaluate the literature on the application of these two stretching techniques in the treatment of PF and investigate their effectiveness and efficacy.MethodA search of PubMed, Web of Sciences, PEDro, CINHAL and Scopus was conducted. Studies that applied stretching as a co-intervention were excluded. The risk of bias was assessed to determine the internal validity of the included trials. The GRADE approach was adopted to determine the overall quality. Pooled analysis was performed to determine the treatment effects of CS and PFSS in terms of the mean difference in the visual analog scale pain score.ResultsEight articles were found that represented randomized controlled trial and met the inclusion criteria. There was very low-quality evidence that the combined CS and PFSS was less effective in the short term than the other therapies. Comparison between CS and PFSS revealed moderate quality evidence for a larger effect of pain score reduction for PFSS treatment over CS, while very low-quality evidence supported that combined CS and PFSS or CS alone was superior to sham stretching.ConclusionThere was moderate to very low-quality evidence of the effectiveness of stretching for PF. The treatment effect of stretching was large and comparable to other therapies. Future trials of higher quality are needed to clarify findings or to confirm findings.     

肌内效贴辅助物理疗法治疗足底筋膜炎的短期疗效观察

目的:观察研究肌内效贴辅助物理疗法治疗足底筋膜炎的短期疗效。方法:选取42例足底筋膜炎患者随机分为治疗组与对照组,两组患者均予以体外冲击波(ESWT)及牵伸训练,治疗组在此基础上辅以肌内效贴贴扎。治疗前、治疗后1周、治疗后2周分别采用疼痛视觉模拟评分(VAS)、肌骨超声、美国矫形足踝协会(AOFAS)踝与后足功能评分表评估患者的疼痛程度、足底筋膜厚度及足的功能状态。结果:治疗前两组患者各项指标差异无显著性意义(P0.05)。治疗后1周,一天结束时的疼痛程度及AOFAS评分治疗组均较对照组显著改善,差异具有显著性意义(P0.05,P0.01),治疗后2周晨起第一步、一天结束时的疼痛程度及AOFAS评分治疗组均较对照组显著改善,治疗组足底筋膜变薄,与对照组比较差异具有显著性意义(P0.01)。除对照组治疗后1周一天结束时的疼痛程度较治疗前无显著改善(P0.05),两组患者治疗后1周和2周,晨起第一步、一天结束时的疼痛程度及AOFAS评分均较治疗前改善,差异具有显著性意义(P0.01)。治疗组治疗后2周足底筋膜厚度较治疗前差异有显著性意义(P0.01)。结论:在冲击波和牵伸训练基础上辅以肌内效贴可更好地缓解足底筋膜炎患者的疼痛,改善功能。     

超声在跖腱膜炎诊断中的价值

目的　探讨超声测量在跖腱膜炎诊断中的价值。方法　应用超声观察和测量临床诊断为跖腱膜炎并经手术治疗证实的 46例患者的双侧跖腱膜 ,并测量 2 8例正常中年人的双侧跖腱膜作为对照。结果　患者组患侧足的跖腱膜其跟骨附着部的厚度 [(5 .7± 1.0 )mm ]较其健侧的厚度 [(3 .4± 0 .4)mm ] ,明显增加 (P <0 .0 0 1) ,亦较对照组的厚度 [(2 .9± 0 .2 )mm]明显增加 (P <0 .0 0 1)。结论　超声测量对跖腱膜炎具有明确诊断价值 ,且具有无创、便捷、价格低廉的优点     

Diagnosis and treatment of eosinophilic fasciitis: Report of two cases

BACKGROUNDEosinophilic fasciitis (EF) is a rare disease characterized by inflammation of the fascia with immune system involvement. Failure to promptly diagnose and treat this disease can seriously affect the quality of life of patients. However, no clear and uniform criteria for diagnosis and treatment exist.CASE SUMMARYIn this paper, we report two cases of EF, both of which showed symmetrical limb swelling and rigidity, increased eosinophils in the peripheral blood and bone marrow, increased red blood cell sedimentation rate, increased antinuclear antibody titer, and pathological changes in the tissues such as eosinophil and lymphocyte infiltration. Both patients were treated with hormones and cyclosporine, and showed significant improvements in their conditions.CONCLUSIONEF is an autoimmune disease causing swelling and sclerosis of the fascia and eosinophilia. It is diagnosable by magnetic resonance imaging, positron emission tomography-computed tomography, blood routine tests, and bone marrow puncture. Glucocorticoids and immunosuppressants are effective treatments.     

Clinical utility of sonography in diagnosing plantar fasciitis.

OBJECTIVE: The purpose of this study was to investigate the efficacy of sonography in the detection of plantar fasciitis (PF) compared with magnetic resonance imaging (MRI) findings in subjects with inferior heel pain. METHODS: Seventy-seven patients with unilateral (n = 9) and bilateral (n = 68) heel pain were studied. Seventy-seven age- and sex-matched asymptomatic subjects served as a control group. Magnetic resonance imaging was used to establish a diagnosis of PF with sagittal T1-weighted, T2-weighted, and short tau inversion recovery sequences. The sonographic appearances of PF were compared with MRI findings. Plantar fascia and heel pad thickness were also measured on both imaging modalities. RESULTS: Compared with MRI, sonography showed 80% sensitivity and 88.5% specificity in assessing PF. A strong correlation was found between plantar fascia and fat pad thickness measurements done by sonography (P < .001; r = 0.854) and MRI (P < .001; r = 0.798). Compared with the asymptomatic volunteers, patients with PF had significant increases in plantar fascia and heel pad thicknesses, weight, and body mass index (P = .0001). Heel pad thickness was also significantly increased with pain duration (P = .021). CONCLUSIONS: Although MRI is the modality of choice in the morphologic assessment of different plantar fascia lesions, sonography can also serve as an effective tool and may substitute MRI in the diagnosis of PF.