Effectiveness of ultrasound therapy versus steroid injection in plantar fasciitis patients in western region of Nepal

Abstract

Background: Plantar fasciitis is a common painful disorder affecting the heel and plantar aspect of the foot. There are various methods of treatment like steroid injection, nonsteroid anti-inflammatory medication, iontophoresis, laser, ultrasound, ESWT, orthotic support therapy and exercise therapies. The aim of this study is to compare the effects of ultrasound therapy versus steroid injection in plantar fasciitis patients. Methods: This is a prospective study done on 60 patients. 30 patients were treated with single dose of local injection steroid (Group A) and 30 patients were treated with Ultrasound Therapy (Group B), 7 minutes in one session / day for 6 days /week for 2 weeks. All patients were taught plantar fascia active and passive stretching exercises to do for 10 minutes morning and 10 minutes evening at home. VAS Scores and FFI (Foot function Index) were measured. Results: Pain Intensity was decreased in both the groups in 2 weeks and 4 weeks follow up. VAS scores were rapidly decreased to 4.17 in Group A and 4.52 in Group B in 2 weeks follow up, which is statistically significant (p value). There was statistically significant (p value< 0.05) in FFI (Foot function Index) in both the groups at 2 weeks and 4 weeks follow up. In Group A, FFI decreased to 30.03 ± 1.44 in 4 weeks interval whereas it was decreased to 36.40 ± 2.83 in Group B in same interval. Conclusion: Both Ultrasound therapy with stretching exercise and steroid injection with stretching exercise were effective methods for moderating pain and improving function of the foot in plantar fasciitis. It was seen that steroid injection was more superior to the Ultrasound therapy combined with exercise. Keywords: Plantar fasciitis, VAS Scores, FFI (Foot function Index) IntroductionPlantar fasciitis is a common painful disorder affecting the heel and plantar aspect of the foot. It is a disorder of the insertion site of tendon on the bone and is characterized by scarring, inflammation, or structural breakdown of the foot's plantar fascia. It is mostly caused due to overuse of the plantar fascia, increases in exercise, weight or age. Although plantar fasciitis was originally thought to be an inflammatory process, newer studies have demonstrated structural changes more consistent with a degenerative process [1,2] . As a result of this new observation, many in the clinical community have stated the condition should be renamed plantar fasciitis. Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain [3] . Plantar fasciitis associated with calcaneal spur is considered to be the most common cause of foot pain in adults [4] . The etiology of plantar fasciitis is not known. It affects 10-15% of the population [5] . In 70-85% of the cases, enthesopathy of plantar fascia occurs on one side and its symptoms are always more intense on the same side. It is noteworthy that approximately 50% of individuals have had calcaneal spur and associated plantar fasciitis diagnosed [4] . Still, the correlation bet...