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Plantar Fasciitis Research


Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study.

In this study, plantar fascia specific stretching was evaluated in 101 patients with chronic plantar fasciitis. The patients studied had diagnosed plantar fasciitis for at least 10 months. The patients were divided into two groups. The first group was given a plantar fascia tissue-stretching program and the second group was given an Achilles tendon-stretching program. All patients were educated by a video on plantar fasciitis, were given specific insoles and an anti-inflammatory medication for 3 weeks.

At 8 weeks, 82 patients had completed the therapy regimen and were reevaluated. The patients with the plantar fascia specific stretching program showed statistically significant improvement compared with the Achilles tendon stretching program.

Conclusion: A plantar fascia specific stretching program provides more benefit than an Achilles tendon stretching program, for those with plantar fasciitis.

J Bone Joint Surg Am. 2003 Jul;85-A(7):1270-7

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Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis: A Prospective Clinical Trial with Two-Year Follow-Up

This is the follow-up study on the plantar fascia-stretching study mentioned above. This study evaluates the long term outcomes of the plantar fascia specific stretching regimen. After the 8 weeks and success was noted with the specific stretching routine, the patients originally using the Achilles tendon-stretching program were encouraged to use the plantar fascia specific stretching program for 8 weeks.

At 2 years, 82 patients were mailed a questionnaire to address their pain, function and satisfaction with treatment. Sixty six of the 82 patients responded. Ninty-two percent of those who responded reported total satisfaction or satisfaction with some minor reservations regarding their treatment. Sixteen of the 66 who responded said they did seek further treatment by a clinician.

Conclusion: A plantar fascia specific stretching program can provide long term benefits for those with plantar fasciitis.

J Bone Joint Surg Am. 2006 Aug;88(8):1775-81

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Extracorporeal shock wave for chronic proximal plantar fasciitis: 225 patients with results and outcome predictors.

This was a retrospective study evaluating 225 patients with plantar fasciitis for 6 months or more and who had failed at least 5 conservative therapies. Each patient underwent extracorporeal shockwave therapy (ESWT) treatment by a single physician between the years 2002 and 2004.

A health questionnaire was used to survey the patients after the procedure and success rates were 70.7% at 3 months and 77.2% at 12 months. The patient’s weight, history of steroid injections, duration of symptoms and the plantar fascia thickness did not influence the outcome of the treatment. Older adults and individuals with diabetes or psychological issues had worse outcomes than those who did not.

Conclusion: Extracorporeal shockwave therapy is an effective treatment for chronic fasciitis, but success rates may not be as high as previously reported.

J Foot Ankle Surg. 2009 Mar-Apr;48(2):148-55.

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Novel Procedure for Heel Pain

Forty-four patients with plantar fasciitis who were unresponsive to therapy had a local anesthetic at the heel area and then application of dry needling. Dry needling is a technique involving repeated needle punctures without the injection of any medication. The needle insertion is guided by ultrasound. The goal is to cause injury to a localized area to stimulate the healing response. An ultrasound guided steroid injection was then given after the treatment and patients were also given orthotics. They were followed for a period of six months. After 3 weeks, 95% of the patients had complete resolution of their symptoms and remained pain-free after 6 months.

Conclusion: The dry needling technique followed by steroid injection and orthotics may prove to be an effective treatment for plantar fasciitis, but more research is needed to evaluate safety and effectiveness.

RSNA 2008: 94th Scientific Assembly and Annual Meeting of the Radiological Society of North America: Scientific Session A10-07. Presented November 30, 2008.

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Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study.

This study included 80 individuals with chronic heel pain and 80 without chronic heel pain. Body Mass Index, foot posture (foot position while standing), ankle range of motion, lower limb stress and calf endurance were measured in each group and questions on activites and time spent were asked. The group with chronic heel pain had a significantly greater body mass index, a more pronated foot position and greater ankle dorsiflexion (foot movement up at the ankle) range of motion. There was no difference between the groups for calf endurance or on reported time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting.

Conclusion: Obesity and pronation are associated with chronic heel pain but there is not association with limitation of ankle joint dorsiflexion and chronic heel pain.

BMC Musculoskelet Disord. 2007 May 17;8(1):41

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Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis.

This study evaluated 236 patients with plantar fasciitis who were divided into five treatment groups and followed for 8 weeks. One group performed stretching only, three groups were given different types of over-the-counter/prefabricated inserts and the fifth group was given custom made orthotics. After 8 weeks, all groups showed improvement ranging from 68% with the custom made foot orthoses to 95% with the silicone inserts. All groups using prefabricated inserts and insoles had greater improvements than those using the custom made orthoses.

Conclusion: When stretching is combined with a prefabricated insert, the short term improvements in plantar fasciitis are greater than with those using a custom made foot orthoses.

Foot Ankle Int. 1999 Apr;20(4):214-21.

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Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis.

Forty-three patients with plantar fasciitis were divided into three treatment groups; treatment with orthotics, orthotics and night splints or night splints alone. After one year, 88 % of the patients returned for follow up evaluation and all treatment groups had significant improvement compared to their initial evaluation. At one year, the two groups using orthotics had a reduction in pain of 62% compared to a reduction of 48% with the group using only night splints.

Conclusion: Patients with plantar fasciitis were more likely to continue to use orthotics than the night splint at one year. Note: night splints are generally used for a few months of treatment.

Foot Ankle Int. 2006 Aug;27(8):606-11.
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last updated 5/22/15

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