Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination

Abstract

Background:Plantar fasciitis (PF) affects 7% to 10% of the population. The long-term prognosis is unknown.Purpose:Our study had 4 aims: (1) to assess the long-term prognosis of PF, (2) to evaluate whether baseline characteristics (sex, body mass index, age, smoking status, physical work, exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad.Study Design:Cohort study; Level of evidence, 3.Methods:From 2001 to 2011 (baseline), 269 patients were diagnosed with PF based on symptoms and US. At follow-up (2016), all patients were invited to an interview regarding their medical history and for clinical and US re-examinations. Kaplan-Meier survival estimates were used to estimate the long-term prognosis, and a multiple Cox regression analysis was used for the prediction model.Results:In all, 174 patients (91 women, 83 men) participated in the study. All were interviewed, and 137 underwent a US examination. The mean follow-up was 9.7 years from the onset of symptoms and 8.9 years from baseline. At follow-up, 54% of patients were asymptomatic (mean duration of symptoms, 725 days), and 46% still had symptoms. The risk of having PF was 80.5% after 1 year, 50.0% after 5 years, 45.6% after 10 years, and 44.0% after 15 years from the onset of symptoms. The risk was significantly greater for women (P < .01) and patients with bilateral pain (P < .01). Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups (P < .01) from 6.9 mm and 6.7 mm, respectively, to 4.3 mm in both groups. Fascia thickness (P = .49) and presence of a heel spur (P = .88) at baseline had no impact on prognosis. At follow-up, fascia thickness and echogenicity had normalized in only 24% of the asymptomatic group. The mean fat pad thickness was 9.0 mm in patients who had received a US-guided corticosteroid injection and 9.4 mm in those who had not been given an injection (P = .66).Conclusion:The risk of having PF in this study was 45.6% at a mean 10 years after the onset of symptoms. The asymptomatic patients had PF for a mean 725 days. The prognosis was significantly worse for women and patients with bilateral pain. Fascia thickness decreased over time regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us to determine the efficacy of different treatment strategies.

Adaptation of Tendon Structure and Function in Tendinopathy With Exercise and Its Relationship to Clinical Outcome

“…It is noteworthy that some tendons may increase collagen content and size, but reduce water content after an exercise intervention so overall their thickness does not change and in this case adaptation may only be detected by assessing mechanical properties. A recent study 43 investigating the long-term prognosis (5-15 y follow-up) in plantar fascia-related pain found a greater decrease than studies included in this review (in asymptomatic and symptomatic groups from 6.9 and 6.7 mm, respectively, to 4.3 mm in both groups). However, at follow-up, fascia thickness and echogenicity had normalized in only 24% of the patients in the asymptomatic group and fascia thickness decreased over time regardless of symptoms and had no impact on prognosis.…”

Online questionnaire, clinical and biomechanical measurements for outcome prediction of plantar heel pain: feasibility for a cohort study

“…Heel pad thickness, echogenicity, bony erosions, heel spurs, ossi cation, and signs of fascia rupture or broma were sought as reduced fascia thickness and other US ndings could also be a sign of PHP recovery. 22 Neovascularization was graded using a modi ed Ohberg grading scale from 0-5. 46…”

“…The course of the disease has long been regarded as self-limiting but this is now known not to be the case. 36 Various treatment strategies are proposed for PwPHP, but results are not satisfactory, with no accepted treatment of choice 22 and no clear prognostic indicators. Recovery rates from the many tested interventions vary between 50-80% at 6 months.…”

“…12 However, the prognostic evidence of these factors is neither complete nor causal. 22 Prospective research for PwPHP has typically considered single or limited numbers of outcome predictors with analysis limited by relatively small sample sizes. 22,23 Although numerous studies using crosssectional or matched case-control designs have been conducted, 29,17 at best single variable prediction models have been created.…”

“…22 Prospective research for PwPHP has typically considered single or limited numbers of outcome predictors with analysis limited by relatively small sample sizes. 22,23 Although numerous studies using crosssectional or matched case-control designs have been conducted, 29,17 at best single variable prediction models have been created. 35 In order to increase treatment success of more complex situations, enabling prognosis determination could be helpful by taking multi factors into consideration as in other pathologies.…”