Current therapeutic approaches for plantar fasciitis

Abstract

Almost 1 million Americans are affected by plantar fasciitis (PF), which is the commonest cause of chronic heel pain. This condition is often managed conservatively, and many rehabilitation protocols, some with the aid of orthoses, have been adopted, with goodto-excellent clinical results. Although most cases of chronic PF can be successfully managed with a conservative approach, alternative treatments, including high-energy shock wave therapy and corticosteroid injections, are commonly accepted as second-line treatment when traditional conservative therapy fails. However, surgery is still an important mode of treatment. Recently, new minimally invasive surgical techniques that offer numerous advantages (faster recovery time, early weight-bearing, lower postoperative pain) over standard surgical approaches have been proposed, with good results and low complication rates. The purpose of this review is to report new conservative and surgical techniques for the treatment of PF. A literature search for articles about plantar fasciitis was conducted on the PubMed database in order to identify publications addressing the treatments of PF. The literature suggests that, initially, traditional conservative treatments consisting of rest, oral nonsteroidal anti-inflammatory drugs, foot orthotics, and stretching exercises can be tried for several weeks. In patients with chronic recalcitrant PF, extracorporeal shock wave therapy or corticosteroid injection can be considered. Surgery (minimally invasive techniques) should be considered only after failure of the conservative treatments.

Corticosteroid versus placebo injection for plantar fasciitis: A meta-analysis of randomized controlled trials

“…The etiology of plantar fasciitis is not fully understood and may be multifactorial (2,4,13). Evidence has suggested that gender, age and weight contribute to the disease process (13).…”

“…This was not mentioned in two other studies (7,9). Plantar fasciitis is generally a self-limiting disease, and the majority of patients report spontaneous heel pain relief within one year, even without treatment (2,23); however, ~10% of patients seek care from the physician due to unrelieved pain and disabled daily activities (2). Corticosteroid injection is considered to be one of the first-line treatments and has been found to produce satisfactory short-term results by blockading the inflammatory response and improving local edema, swelling, pain and foot function.…”

“…It has been estimated to affect overweight individuals who spend long periods standing (1) and ~10% of runners (2). The patients feel initial pain on the first step out of bed in the morning.…”

“…Corticosteroid injection is usually one of the first-line treatments for plantar fasciitis. Owing to its anti-inflammatory effect, this treatment may relieve both acute and chronic pain of the heel (4); however, histological examination has shown that plantar fasciitis is not an inflammatory response but a degenerative process with microtears of the fascia and collagen necrosis, and a number of investigators have recommended that plantar fasciitis should be more exactly termed plantar fibrosis (2,5). As a result, the efficacy of corticosteroid injection has been brought into question.…”

Valor del Test de Silfverskiöld para el diagnóstico de la fascitis plantar

“…12 Se ha mostrado en cadáveres que existe una continuidad de la fascia plantar con el paratendón del tendón de Aquiles, proporcionando una correlación positiva entre la carga del tendón de Aquiles y la tensión de la fascia plantar. 13 Esta ampliamente aceptado que la disminución de la dorsiflexión de tobillo es uno de los principales factores de riesgo para desarrollar tanto fascitis [14][15][16][17][18] como otras patologías del miembro inferior (tendinopatía Aquílea [19][20][21] , esguince de tobillo, atrapamiento nervioso en el dorso del pie y metatarsalgia 22-23 , lesiones del ligamento cruzado anterior 24 , tendinopatía rotuliana 25 , síndrome de dolor patelofemoral 21,23,26 y Morbus Osgood Schlatter 27 ).…”