Plantar fascia release for chronic plantar fasciitis in runners

Plantar fascia release has been suggested to be of benefit for patients with symptoms of chronic unresponsive plantar fasciitis. However, results of this procedure have not been published. We performed 11 releases in 9 long-distance runners whose symptoms had been present for an average of 20 months and had not responded to nonsurgical treatment. The results of these operations were excellent in 10 feet and good in 1 foot at an average follow-up time of 25 months. Eight out of nine patients returned to desired full training at an average time of 4.5 months. Histologic examination of surgical biopsy specimens from these patients showed collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, and matrix calcification. Plantar fascia release was an effective procedure for these patients.     

Plantar fasciitis. Mechanics and pathomechanics of treatment

An excessive amount and/or a prolonged duration of pronation is the most common mechanical cause of structural strain resulting in plantar fasciitis. Temporary relief of pain can be achieved by customary antiinflammatory drugs or therapy; long-term relief is achieved by adequate remedy of the aggravating pronation factors. A semirigid, custom-molded orthosis reduces excessive plantar fascial strain by supporting the first metatarsal bone and by controlling calcaneal position when in conjunction with a firm posterior counter shoe. A clinical environment with physician and orthotist together allows ideal evaluation and treatment of patients.     

Predicting plantar fasciitis in runners

Ninety-one runners were studied to determine whether specific variables were indicative of runners who had suffered with plantar fasciitis either presently or formerly vs runners who had never suffered with plantar fasciitis. Each runner was asked to complete a running history, was subjected to several anatomical measurements, and was asked to run on a treadmill in both a barefoot and shoe condition at a speed of 3.35 mps (8 min mile pace). Factor coefficients were used in a discriminant function analysis which revealed that, when group membership was predicted, 63% of the runners could be correctly assigned to their group. Considering that 76% of the control group was correctly predicted, it was concluded that the predictor variables were able to correctly predict membership of the control group, but not able to correctly predict the presently or formerly injured sufferers of plantar fasciitis.     

Plantar fasciitis: MR imaging

The clinical presentation of plantar fasciitis may be mimicked by a number of other painful heel conditions. Thus, magnetic resonance (MR) imaging was used to develop objective morphologic criteria to establish a diagnosis of plantar fasciitis in eight patients. Sagittal T1-weighted and coronal intermediate and T2-weighted images of symptomatic and asymptomatic feet were obtained; additional sequences were used for symptomatic feet. Maximum thickness of the plantar fascia was significantly increased (P less than .0001) in patients with plantar fasciitis (sagittal, 7.40 mm +/- 1.17, and coronal, 7.56 mm +/- 1.01) compared with age- and sex-matched volunteers (sagittal, 3.22 mm +/- 0.44, and coronal, 3.44 mm +/- 0.53) and young male controls (sagittal, 3.00 mm +/- 0.8, and coronal, 3.00 mm +/- 0.0). Furthermore, nine of 10 feet with plantar fasciitis had areas of moderately increased signal intensity in the substance of the fascia. MR imaging may provide an objective assessment of the morphologic changes associated with plantar fasciitis, as well as assist in excluding other causes of heel pain.     

Dynamic stability in runners with and without plantar fasciitis

BackgroundPlantar fasciitis (PF) is a common overuse injury experienced by runners. PF may decrease the ability of the plantar fascia to create tension and reduce stability of the foot. Stability of the foot is necessary for whole-body dynamic stability during running which consists of cyclical periods of single leg stance. Given that a major risk factor for running-related injury is previous injury, evaluating dynamic stability in runners with PF, runners with resolved PF, and healthy runners may elucidate differences between these individuals and clarify risk for secondary injury in these groups.Research questionIs dynamic stability reduced in runners with PF and runners with resolved PF compared to healthy runners?MethodsThirty runners were recruited for this retrospective comparative study based on mileage and injury status: current PF (PF), resolved PF (RPF), or healthy (CON). Kinematic and kinetic data were collected during running and dynamic stability was determined by time-to-contact (TtC) analysis for early, mid, and late stance to the anterior, posterior, medial, and lateral boundary of the foot. Dynamic stability was compared between groups one-way ANOVAs (α = 0.05) and Tukey post-hoc tests conducted when appropriate. Cohen’s d effect sizes (d) were reported for all TtC comparisons (small = 0.20, medium = 0.50, large = 0.80).ResultsTtC values were shorter in PF compared to the other groups to all boundaries during mid-stance. TtC was significantly greater in PF compared to RPF to the anterior boundary during late stance.SignificanceShorter TtC observed in PF compared to the other groups during midstance may indicate reduced dynamic stability during the most stable portion of running which may lead to increased injury risk.     

Plantar fasciitis: a retrospective analysis of 267 cases

Objectives: To gain a better understanding of the anthropometric, biomechanical and treatment statistics for a diversified population affected with plantar fasciitis. Design: A retrospective case review. Setting: The Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, Canada. Subjects: Referral patients seen by attending physicians from 1998–2000. Age 43·1 years (±3·81), weight 72·2 kg (±14·7), height 1·61 m (±0·9), BMI 24·7 kg/m² (±5·16), number of years active 10·6 (±10·42), weekly activity 5·6 h (±8·6). Results: Over half (54·7%) of patients with plantar fasciitis were reported as having excessive pronation. The frequencies for other biomechanical variables include: genu valgum (20·2%), genu varum (16·9%), pes cavus arch (10·1%), and leg length inequality (6·7%). A prior history of injury to the ankle/foot area was reported in 21·7% of patients and training errors were felt to be the cause in 17·2% of cases. A majority of patients were prescribed stretching and strengthening exercises (76·8%), and orthotics and NSAIDs were given to 49·1% and 41·6% respectively. Of the 78 patients for whom follow-up data was available, 17·9% claimed to have complete resolution of symptoms, and 39·7% reported having 75% improvement or better.     

Conservative Treatment of Plantar Fascial Strain

Athletes in almost every sport are vulnerable to this painful and often frustratingly disabling disorder. A basic understanding of the anatomy, biomechanics, and pathophysiology is critical to effective conservative treatment.     

Exercise metabolism in runners.

The purpose of this study was to re-examine the commonly accepted association between high maximum oxygen uptake (VO2 max) values and the characteristics of metabolic adaptation to endurance training. The metabolic responses of 9 active males and 8 endurance trained females were observed during one hour of treadmill running at two speeds. One speed was common to both groups (3.58 m s-1. Test 1) whereas the second speed represented approximately 62% VO2 max for each individual (Test 2). The VO2 max values of the males were significantly (p less than 0.01) higher than those of the females but observations of the respiratory exchange ratio and of the changes in the concentrations of metabolites were indicative of greater fat metabolism in the well-trained female group in both Tests. Thus the results of this study suggest that the benefits of endurance training are independent of the absolute values of VO2 max.     

Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot

Objective To determine the association of atrophy of the abductor digiti minimi muscle (ADMA), an MRI manifestation of chronic compression of the inferior calcaneal nerve suggesting the clinical diagnosis of Baxter’s neuropathy, with MRI markers of potential etiologies, including calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and posterior tibial tendon dysfunction (PTTD). Materials and methods Prevalence of calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and PTTD was assessed retrospectively on 100 MRI studies with ADMA and 100 MRI studies without ADMA. Patients ranged in age from 10–92 years. Pearson chi-square analyses and Fisher’s exact test were used to compare prevalence of the above findings in patients with and without ADMA. Logistic regression was used to determine which variables were significantly associated with ADMA. Results Among patients with ADMA, there was significantly greater age (57.2 years vs 40.8 years, p < 0.001), presence of Achilles tendinosis (22.0% vs 3.0%, P < 0.001), calcaneal edema (15.0% vs 3.0%, P = 0.005), calcaneal spur (48.0% vs 7.0%, P < 0.001), plantar fasciitis (52.5% vs 11.0%, P < 0.001), and PTTD (32.0% vs 11.0%, P < 0.001). After multivariate logistic regression analysis, only age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.03, 1.09], calcaneal spur (OR 3.60, 95% CI 1.28, 10.17), and plantar fasciitis (OR 3.35, 95% CI 1.31, 8.56) remained significant. Conclusion Advancing age, calcaneal spur, and plantar fasciitis are significantly associated with ADMA. Their high odds ratios support the notion of a possible etiologic role for calcaneal spur and plantar fasciitis in the progression to Baxter’s neuropathy.     

Lipids and platelet function in runners.

The effect of distance running on the fatty acid composition of platelet and erythrocyte membranes has been investigated, together with platelet aggregation and levels of high density lipoprotein-cholesterol (HDLc), low density lipoprotein cholesterol (LDLc), total cholesterol and triglycerides in runners (n = 11) and healthy age-matched non-running controls (n = 12). Platelet aggregation and fatty acid composition of membrane lipids in both platelets and erythrocytes are similar in both groups with the following exceptions: in platelets docosahexaenoic acid (C22:6 omega 3) is significantly higher in runners; in erythrocytes the fatty acids C20:3 omega 6/C22:1 omega 9 and C22:5 omega 3 are significantly higher in runners. There were no significant differences between the levels of HDLc, LDLc and total cholesterol in runners and controls although triglycerides were significantly lower in runners. Possible beneficial effects of running are probably mediated through effects on serum lipid and lipoprotein concentrations, and probably not due to any antithrombotic effect of platelets.     

Treatment of eosinophilic fasciitis with cimetidine]

A case of a female patient with clinical and histological manifestation of eosinophilic fascitis has been reported. After five months cimetidine therapy a significant improvement was achieved. During the therapy some adverse effects occurred and cimetidine therapy had to be ceased.