Conservative Treatment of Plantar Fasciitis and Posterior Heel Pain: A Review

Abstract

This review focuses on the various techniques of conservative treatment of plantar fasciitis and posterior heel pain. Being the optimal therapy controversial, the intent is to drive surgeons and rehabilitation specialists in the choice of the strategies. The Data sources were MEDLINE, PubMed, CINAHL, EMBASE, and Psych INFO databases using the selected key words. Studies have been selected for review using as criteria English, adults, clinical population and intervention. Among several published studies about rehabilitation and fasciitis, only a few showed bases on scientific evidence. Moreover, many studies were heterogeneous and included different outcomes and evaluations. There is consensus that a specific rehabilitation program is necessary to avoid chronicity. However, the real efficacy of every specific treatment (orthoses, stretching, radiotherapy, botulin toxin, shock waves, corticosteroid therapy, and platelet rich plasma) is still questionable, and often related to the experience of the authors. In conclusion, patients undergoing physiotherapy obtain a better and faster outcome achievement than non-treated patients; however, evidence-based treatments, protocols and clinical trials are recommended.

Prospective Randomized Trial of Electrolysis for Chronic Plantar Heel Pain

“…Ultrasound-guided PNE was effective in the short term (0-3 months) and the intermediate term (3-6 months), providing better pain relief and improvement of functional disability than placebo. The latest published reviews on CPHP treatment include evidence for the benefits of manual therapy, stretching, taping, foot orthoses, and night splints 5,7,24,28 ; furthermore, there is weak evidence for the efficacy of low-level laser therapy and phonophoresis with ketoprofen gel, and conflicting evidence for electrotherapy with 0.4% dexamethasone or 5% acetic acid delivered via iontophoresis, acupuncture, or trigger point dry needling. 5,7,24,28 The Cochrane Review concluded that there is low quality evidence for short-term pain relief following corticosteroid injection (CI) with placebo or no treatment.…”

“…The latest published reviews on CPHP treatment include evidence for the benefits of manual therapy, stretching, taping, foot orthoses, and night splints 5,7,24,28 ; furthermore, there is weak evidence for the efficacy of low-level laser therapy and phonophoresis with ketoprofen gel, and conflicting evidence for electrotherapy with 0.4% dexamethasone or 5% acetic acid delivered via iontophoresis, acupuncture, or trigger point dry needling. 5,7,24,28 The Cochrane Review concluded that there is low quality evidence for short-term pain relief following corticosteroid injection (CI) with placebo or no treatment. 12 A recent review by Tsikopoulos et al 36 reported that micronized dehydrated human amniotic/chorionic membrane (mDHACM) is the best injection option in the short term, and botulinum toxin A is the most likely to relieve pain intensity in the first 0 to 6 months after treatment.…”