Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis

Abstract

We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.

Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial

“…[ 82 ] The FFI is the most widely used foot-specific self-reporting measure[ 83 ] and is a commonly used outcome measure in patients with PF. [ 22 , 32 , 41 ] The FFI has been shown to be valid, reliable and sensitive to change in various populations with a variety of foot and ankle disorders. [ 83 , 84 ] Subscale scores range from 0% to 100%, with higher scores indicating lower levels of function and poorer foot health-related quality of life.…”

“…For cases of persistent PF, physicians often recommend corticosteroid injections;[ 8 , 31 ] however, while corticosteroid injections may be useful for managing PF symptoms at short-term, long-term outcomes appear to be lacking. [ 23 , 32 , 33 ] Moreover, steroid injections have been linked with plantar fat pad atrophy, calcaneal osteomyelitis, plantar fascia weakening and rupture. [ 34 – 36 ] Platelet rich plasma treatment has also been found to be effective for PF;[ 37 ] nevertheless, platelet rich plasma injections are considered controversial, expensive and are not normally covered by insurance plans.…”

Platelet-rich plasma in orthopaedic sports medicine: state of the art

“…Three reviews without meta-analysis reported superiority of PRP treatment. [64][65][66] On the opposite, two recent meta-analysis of nine RCTs failed to confirm those data. 67 68 Tsikopoulos et al 67 showed that corticosteroid injections are more effective in pain relief in the short term, whereas Yang et al 68 ► Most common term referred to a cluster of products including: autologous conditioned plasma, platelet-enriched plasma, platelet-rich concentrate, autogenous platelet gel, platelet releasate, platelet rich in growth factors and others.…”

“…However, around 10% of patients seemed not to respond positively. 64 Therefore, PRP injections into the plantar fascia, with or without ultrasound guidance, have been recently introduced as an alternative therapy. Recent systematic reviews, comparing corticosteroid versus PRP injections, reported controversial results.…”

Short-term efficacy of kinesiotaping versus extracorporeal shockwave therapy for plantar fasciitis: A randomized study

“…[ 3 ] It has been estimated that about 90% of patients with PF get relief through conservative management alone. [ 4 ] Although there are many treatment modalities, there is no consensus for a definitive nonsurgical method for symptom relief in individuals with PF. [ 5 ]…”