“… 9 2011 RCT 120/60/60 41.7 vs 38.4 NR <3 1 for CSI; 56 for NSAIDs CSI, 1 mL of 40 mg methylprednisolone + 2 mL of 0.5% bupivacaine NSAIDs, one oral tablet diclofenac (50 mg) twice a day for 4 weeks VAS 0, 0.25, 0.5, 1, 2 CSI vs RT Canyilmaz et al . 10 2015 RCT 124/64/60 54.7 vs 52.6 33.1 vs 34 14 vs 18.6 1 for CSI; 6 for radiation CSI, 1 mL of 40 mg methylprednisolone + 0.5 mL of 1% lidocaine Radiation, total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week VAS, FLFS, MPPS 0, 3, 6 CSI = corticosteroid injection; SW = shock wave; PT = physical therapy; NSAIDs = nonsteroidal anti-inflammatory drugs; RT = radiation therapy; RCT = randomized controlled trial; NR = not reported; BMI = body mass index; VAS = visual analogue scale; FFI = foot function index; TT = tenderness threshold; PFT = plantar fascia thickness; HTI = heel tenderness index; TRR = therapeutic response rate; FAAM = foot and ankle ability measure; FADI = foot and ankle disability index; FFAA = frequency focal anechoic areas; LFAA = length of focal anechoic area; FAOS = foot and ankle outcome score; FLFS = five-level function score; MPPS = modified von Pannewitz pain score. Figure 1 Flow diagram of the included studies.…”
Section: Resultsmentioning
confidence: 99%
“…To date, there are various treatments for plantar fasciitis. Common treatments can be divided into non-invasive treatments, such as physical therapy (PT) 4 – 6 , orthosis 7 , 8 , oral nonsteroidal anti-inflammatory drugs (NSAIDs) 9 , radiation therapy (RT) 10 and shock wave (SW) 11 and invasive treatments, such as corticosteroid injection (CSI) 12 , 13 , botulinum toxin injection 14 , platelet-rich plasma (PRP) injection 15 and surgery 16 . PT for plantar fascia comprises stretching exercises and mobilization to improve lower extremity joint mobility and flexibility of the plantar fascia 5 .…”
Section: Introductionmentioning
confidence: 99%
“…Oral NSAIDs are known to inhibit cyclooxygenase-2, thereby exerting an anti-inflammatory effect on the plantar fascia to relieve pain 9 . RT treatments expose the heel area to radiation to reduce inflammation over the treated area 10 . SW treatment applies high pulse SW energy to the insertion zone of the plantar fascia, potentially healing the degenerative tissue of the plantar fascia 11 .…”
The first choice of treatment for patients with plantar fasciitis is non-invasive treatment, rather than corticosteroid injection (CSI). However, no comprehensive study has compared the effectiveness of CSI with non-invasive treatments for plantar fasciitis. We conducted a meta-analysis comparing CSI and non-invasive treatment effects on plantar fasciitis. The primary outcome was pain reduction. Nine randomized controlled trials comparing CSI with 4 non-invasive treatment types were included. A trend favoring CSI over non-invasive treatments was indicated regarding reduction in the visual analogue scale (VAS) score at 1–1.5 (mean difference (MD), 1.70; 95% confidence interval (CI) = 0.39–3.01; P = 0.01) and 2–3 months (MD, 1.67; 95% CI = 0.58–2.76; P = 0.003). At 1.5-month follow-up, CSI was associated with improved VAS score compared with physical therapy (PT) (MD, 2.5; 95% CI = 0.1–4.9; P = 0.04). No significant differences in the VAS score reduction were observed between CSI and shock wave therapy within 3 months. In summary, CSI tends to be more effective for pain reduction than non-invasive treatments within 3 months. Moreover, CSI provides significant pain relief at 1.5 months after treatment compared with PT. This study provides important clinical information for selecting therapeutics.
“… 9 2011 RCT 120/60/60 41.7 vs 38.4 NR <3 1 for CSI; 56 for NSAIDs CSI, 1 mL of 40 mg methylprednisolone + 2 mL of 0.5% bupivacaine NSAIDs, one oral tablet diclofenac (50 mg) twice a day for 4 weeks VAS 0, 0.25, 0.5, 1, 2 CSI vs RT Canyilmaz et al . 10 2015 RCT 124/64/60 54.7 vs 52.6 33.1 vs 34 14 vs 18.6 1 for CSI; 6 for radiation CSI, 1 mL of 40 mg methylprednisolone + 0.5 mL of 1% lidocaine Radiation, total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week VAS, FLFS, MPPS 0, 3, 6 CSI = corticosteroid injection; SW = shock wave; PT = physical therapy; NSAIDs = nonsteroidal anti-inflammatory drugs; RT = radiation therapy; RCT = randomized controlled trial; NR = not reported; BMI = body mass index; VAS = visual analogue scale; FFI = foot function index; TT = tenderness threshold; PFT = plantar fascia thickness; HTI = heel tenderness index; TRR = therapeutic response rate; FAAM = foot and ankle ability measure; FADI = foot and ankle disability index; FFAA = frequency focal anechoic areas; LFAA = length of focal anechoic area; FAOS = foot and ankle outcome score; FLFS = five-level function score; MPPS = modified von Pannewitz pain score. Figure 1 Flow diagram of the included studies.…”
Section: Resultsmentioning
confidence: 99%
“…To date, there are various treatments for plantar fasciitis. Common treatments can be divided into non-invasive treatments, such as physical therapy (PT) 4 – 6 , orthosis 7 , 8 , oral nonsteroidal anti-inflammatory drugs (NSAIDs) 9 , radiation therapy (RT) 10 and shock wave (SW) 11 and invasive treatments, such as corticosteroid injection (CSI) 12 , 13 , botulinum toxin injection 14 , platelet-rich plasma (PRP) injection 15 and surgery 16 . PT for plantar fascia comprises stretching exercises and mobilization to improve lower extremity joint mobility and flexibility of the plantar fascia 5 .…”
Section: Introductionmentioning
confidence: 99%
“…Oral NSAIDs are known to inhibit cyclooxygenase-2, thereby exerting an anti-inflammatory effect on the plantar fascia to relieve pain 9 . RT treatments expose the heel area to radiation to reduce inflammation over the treated area 10 . SW treatment applies high pulse SW energy to the insertion zone of the plantar fascia, potentially healing the degenerative tissue of the plantar fascia 11 .…”
The first choice of treatment for patients with plantar fasciitis is non-invasive treatment, rather than corticosteroid injection (CSI). However, no comprehensive study has compared the effectiveness of CSI with non-invasive treatments for plantar fasciitis. We conducted a meta-analysis comparing CSI and non-invasive treatment effects on plantar fasciitis. The primary outcome was pain reduction. Nine randomized controlled trials comparing CSI with 4 non-invasive treatment types were included. A trend favoring CSI over non-invasive treatments was indicated regarding reduction in the visual analogue scale (VAS) score at 1–1.5 (mean difference (MD), 1.70; 95% confidence interval (CI) = 0.39–3.01; P = 0.01) and 2–3 months (MD, 1.67; 95% CI = 0.58–2.76; P = 0.003). At 1.5-month follow-up, CSI was associated with improved VAS score compared with physical therapy (PT) (MD, 2.5; 95% CI = 0.1–4.9; P = 0.04). No significant differences in the VAS score reduction were observed between CSI and shock wave therapy within 3 months. In summary, CSI tends to be more effective for pain reduction than non-invasive treatments within 3 months. Moreover, CSI provides significant pain relief at 1.5 months after treatment compared with PT. This study provides important clinical information for selecting therapeutics.
“…Since this treatment has been proposed only recently, limited studies are available and randomized placebo-controlled studies are necessary to characterize the procedures and to optimize the treatment [65,66]. Nevertheless, controversies still exist on the real efficacy of injecting PRP around tendinous tissues: a recent metanalysis underlined that there is strong evidence against the efficacy of PRP injections for chronic lateral elbow tendinopathy [67], while other studies sustained some superior analgesic effect of radiation therapy compared to mean PG steroid injection [65]. It was also observed that botulin toxin has analgesic and nociceptive effects and its efficacy in treatment of plantar fasciitis was showed by Huang et al [33].…”
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.
“…Canyilmaz et al randomized 123 patients between LD-EBRT (6 × 1 Gy, three times a week) and 1 ml injection of 40 mg methylprednisolone and 0.5 ml 60 mg 1% lidocaine under the guidance of palpation [85]. After 3 and 6 months, VAS values and CS-scores were compared between both groups.…”
Section: Comparison Of Ld-ebrt With Other Therapiesmentioning
Degenerative changes in the plantar fascia may cause the so-called "painful heel" with typical projections of tenderness. This condition is often associated with a plantar heel spur. Radiotherapy with low doses (LD-EBRT) has been well known for its anti-inflammatory potential. In the recent years, several microbiological mechanisms were elucidated to explain immunomodulation by LD-EBRT. Furthermore, a randomized study proved the clinical efficacy of this therapy in plantar fasciitis. Two other trials defined a fractionation schedule of 6 × 0.5 Gy twice weekly as the new standard therapy. Taken together, LD-EBRT is an effective and safe therapeutic option for patients over 30 years of age and after exclusion of pregnancy. In case of an insufficient response, a second course can be offered to the patient. There are still open questions concerning target volume definition and fractionation of LD-EBRT. Furthermore, studies randomizing LD-EBRT with other conservative therapeutic approaches are missing.
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