Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment

Abstract

ObjectiveThe aim of this study was to define a quantitative parameter to indicate which cases of plantar fasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of two different treatment modalities.MethodsSeventy patients (mean age: 49.10; range: 41–58) with chronic plantar fasciitis unresponsive to conservative treatment for 3 months were treated with either betamethasone injection or extracorporeal shock wave therapy (ESWT). Correlation between AOFAS scores, fascia thickness, duration of symptoms, age and calcaneal spur length were assessed.ResultsDegree of fascial thickening (mean 4.6 mm for all patients) did not influence baseline AOFAS scores (r = −0.054). Plantar fascia thickness significantly decreased in both groups after treatment (1.2 mm for steroid, 1.2 mm for ESWT) (p < 0.01 for both groups). Percentage of change in AOFAS scores (68% for steroid and 79% for ESWT, p = 0.069) and fascial thickness (24% for steroid and 26% for ESWT, p = 0.344) were similar between two groups. Functional recovery was not correlated with baseline fascial thickness (r = 0.047) or degree of fascial thinning after treatment (r = −0.099). Percentage of change in AOFAS scores was correlated only with baseline AOFAS scores (r = −0.943).ConclusionsPlantar fascia thickness increases significantly in plantar fasciitis and responds to treatment. Both ESWT and betamethasone injection are effective in alleviating symptoms and reducing plantar fascia thickness in chronic plantar fasciitis. However, the only predictive factor for functional recovery in terms of AOFAS scores is patients' functional status prior to treatment. Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis.Level of evidenceLevel III, Therapeutic study.

Comparison of Botulinum Toxin A, Corticosteroid, and Anesthetic Injection for Plantar Fasciitis

“…In spite of these results, the patients showed a good clinical evolution. Similar results were reported by Ermutlu et al, 13 where the functional recovery of the patients was not associated with a normal degree of fascia thinning after treatment.…”

The Diagnostic Significance of Ultrasonographic Measurement of the Achilles Tendon Thickness for the Insertional Achilles Tendinopathy in Patients with Heel Pain

“…A previous study in the Korean population suggested that a thickness of greater than 3.8 mm was a clinically meaningful US finding of plantar fasciitis [ 8 ]. In the present study, the thickness of the plantar fascia in patients with plantar fasciitis was significantly thicker than in normal controls, but the mean thickness of the plantar fascia in patients with plantar fasciitis ( n = 109 feet) was 3.74 mm, which appears to be less thick than previously reported cases with a mean maximal thickness of 2.9 to 6.9 mm [ 6 , 7 , 33 , 34 , 35 ]. Our finding that the thickness of the plantar fascia in patients with plantar fasciitis was less than that in prior research can be attributed to the following causes.…”

Demographic and Clinical Factors Predict Focused Shockwave Therapy Results on Patients With Plantar Fasciitis. A Multilevel Analysis

“…ESWT has been widely used as a treatment option for plantar fasciitis due to its non-invasive feature, fast recovery time and convenience for daily life of patients (10). In literature, demographic, clinical and ultrasound factors have been investigated as predictors of a better response to ESWT, with conflicting results (11)(12)(13)(14)(15)(16)(17). The aim of this study was to conduct a retrospective analysis to create models for a pre-treatment evaluation in people with plantar fasciitis, and to assess whether demographic and clinical features could be used to predict medium-term outcomes six months after focused ESWT.…”