Plantar fasciitis medical therapy: Difference between revisions
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===Ultrasonic shock waves=== | ===Ultrasonic shock waves=== | ||
[[Therapeutic ultrasound|Ultrasonic shock waves]], also called extracorporeal shock wave therapy, is a nonsurgical procedure, but must be done either under local anaesthesia either with or without intravenous sedation (twilight sedation). The basic premise behind ESWT is that in chronic pain (over six months) the brain no longer perceives the pain (even though the patient feels pain) and so no longer is sending signals to fight the pain. ESWT basically re-inflames the area and in doing so increases blood flow to the area as a means to heal the area. | [[Therapeutic ultrasound|Ultrasonic shock waves]], also called extracorporeal shock wave therapy, is a nonsurgical procedure, but must be done either under local anaesthesia either with or without intravenous sedation (twilight sedation). Ultrasonic shock waves can be classified as high power (electrohydraulic) and low-power (electromagnetic). The basic premise behind ESWT is that in chronic pain (over six months) the brain no longer perceives the pain (even though the patient feels pain) and so no longer is sending signals to fight the pain. ESWT basically re-inflames the area and in doing so increases blood flow to the area as a means to heal the area. | ||
Meta-analyses of trails have found: | Meta-analyses of trails have found: | ||
* Low intensity (energy <0.20mJ/mm2) to be significantly more successful than sham whereas high intensity (energy >0.2mJ/mm2) was not beneficial.<ref name="pmid24662810">{{cite journal| author=Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX et al.| title=Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. | journal=Arch Phys Med Rehabil | year= 2014 | volume= 95 | issue= 8 | pages= 1585-93 | pmid=24662810 | doi=10.1016/j.apmr.2014.01.033 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24662810 }} </ref> | * Low intensity ('energy <0.20mJ/mm2) to be significantly more successful than sham whereas high intensity (energy >0.2mJ/mm2) was not beneficial.<ref name="pmid24662810">{{cite journal| author=Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX et al.| title=Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. | journal=Arch Phys Med Rehabil | year= 2014 | volume= 95 | issue= 8 | pages= 1585-93 | pmid=24662810 | doi=10.1016/j.apmr.2014.01.033 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24662810 }} </ref> | ||
* Moderate (0.1 - 0.2 mJ/mm2) and high (> 0.2 mJ/mm2) may be more effective than low-energy (< 0.1 mJ/mm2) intervention.<ref name="pmid23552334">{{cite journal| author=Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED| title=Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. | journal=Am J Phys Med Rehabil | year= 2013 | volume= 92 | issue= 7 | pages= 606-20 | pmid=23552334 | doi=10.1097/PHM.0b013e31828cd42b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23552334 }} </ref> | * Moderate (0.1 - 0.2 mJ/mm2) and high (> 0.2 mJ/mm2) may be more effective than low-energy (< 0.1 mJ/mm2) intervention.<ref name="pmid23552334">{{cite journal| author=Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED| title=Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis. | journal=Am J Phys Med Rehabil | year= 2013 | volume= 92 | issue= 7 | pages= 606-20 | pmid=23552334 | doi=10.1097/PHM.0b013e31828cd42b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23552334 }} </ref> | ||
Revision as of 11:34, 15 August 2015
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Plantar fasciitis Microchapters |
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Risk calculators and risk factors for Plantar fasciitis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Many different treatments have been effective, and although it typically takes six to eighteen months to find a favorable resolution,[1] plantar fasciitis has a generally good long-term prognosis. The mainstays of treatment are stretching the Achilles tendon and plantar fascia, resting, keeping off the foot as much as possible, discontinuing aggravating activity, cold compression therapy, contrast bath therapy, weight loss, arch support and heel lifts, and taping. To relieve pain and inflammation, non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of very limited benefit.[2] One small, placebo-controlled study has shown a beneficial effect from glucosamine.
Care should be taken to wear supportive and stable shoes. Patients should avoid open-back shoes, sandals, and flip-flops.
Orthoses
Custom foot orthoses may.[3] or may not[4] be more effective than prefabricated foot orthoses. Among prefabricated orthoses, foam covered rigid self-supporting plastic orthotic may[5] be better than other orthoses.
Compared to other therapies, randomized controlled trials have found:
- Orthoses are more effective than night splints. [6]
Corticosteroid injection
Local injection of corticosteroids often gives temporary[7] or permanent relief, but may be painful, if not combined with a local anesthetic and injected slowly with a small-diameter needle.[8] Recurrence rates may be lower if injection is performed under ultrasound guidance.[9]
Stretching exercises
In cases of chronic plantar fasciitis of at least 10 months duration, one recent study has shown high success rates with a stretch of the plantar fascia.[10][11]
Night splints
Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease morning pain. Pain with first steps of the day can be markedly reduced by stretching the Achilles tendon before getting out of bed. Patients should be encouraged to lessen activities which place more pressure on the balls of the feet. Over-the-counter arch support may help, and prescription orthoses are often prescribed. These can be made of many different materials, some of which may be hard and may press on the origin of the plantar fascia. Softer, custom devices, of plastizote, poron, or leather, may be more helpful. Orthoses should always be broken in slowly.
Ultrasonic shock waves
Ultrasonic shock waves, also called extracorporeal shock wave therapy, is a nonsurgical procedure, but must be done either under local anaesthesia either with or without intravenous sedation (twilight sedation). Ultrasonic shock waves can be classified as high power (electrohydraulic) and low-power (electromagnetic). The basic premise behind ESWT is that in chronic pain (over six months) the brain no longer perceives the pain (even though the patient feels pain) and so no longer is sending signals to fight the pain. ESWT basically re-inflames the area and in doing so increases blood flow to the area as a means to heal the area.
Meta-analyses of trails have found:
- Low intensity ('energy <0.20mJ/mm2) to be significantly more successful than sham whereas high intensity (energy >0.2mJ/mm2) was not beneficial.[12]
- Moderate (0.1 - 0.2 mJ/mm2) and high (> 0.2 mJ/mm2) may be more effective than low-energy (< 0.1 mJ/mm2) intervention.[13]
References
- ↑ Young, Craig C., Rutherford, Darin S. & Niedfeldt, Mark W. (2001). "Treatment of Plantar Fasciitis". American Family Physician. 63 (3): 467–74, 477–8.
- ↑ Lynch DM, Goforth WP, Martin JE, Odom RD, Preece CK, Kotter MW (1998). "Conservative treatment of plantar fasciitis. A prospective study". J Am Podiatr Med Assoc. 88 (8): 375–80. doi:10.7547/87507315-88-8-375. PMID 9735623.
- ↑ Wrobel JS, Fleischer AE, Crews RT, Jarrett B, Najafi B (2015). "A Randomized Controlled Trial of Custom Foot Orthoses for the Treatment of Plantar Heel Pain". J Am Podiatr Med Assoc. 105 (4): 281–94. doi:10.7547/13-122.1. PMID 25941995.
- ↑ Pfeffer G, Bacchetti P, Deland J, Lewis A, Anderson R, Davis W; et al. (1999). "Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis". Foot Ankle Int. 20 (4): 214–21. PMID 10229276.
- ↑ Walther M, Kratschmer B, Verschl J, Volkering C, Altenberger S, Kriegelstein S; et al. (2013). "Effect of different orthotic concepts as first line treatment of plantar fasciitis". Foot Ankle Surg. 19 (2): 103–7. doi:10.1016/j.fas.2012.12.008. PMID 23548451.
- ↑ Roos E, Engström M, Söderberg B (2006). "Foot orthoses for the treatment of plantar fasciitis". Foot Ankle Int. 27 (8): 606–11. PMID 16919213.
- ↑ McMillan AM, Landorf KB, Gilheany MF, Bird AR, Morrow AD, Menz HB (2012). "Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial". BMJ. 344: e3260. doi:10.1136/bmj.e3260. PMID 22619193.
- ↑ Genc H, Saracoglu M, Nacir B, Erdem HR, Kacar M (2005). "Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection". Joint Bone Spine. 72 (1): 61–5. PMID 15681250.
- ↑ Tsai WC, Hsu CC, Chen CP, Chen MJ, Yu TY, Chen YJ (2006). "Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance". J Clin Ultrasound. 34 (1): 12–6. PMID 16353228.
- ↑ Janet Cromley (November 13, 2006). "A foot hold that spurs healing". Los Angeles Times.
- ↑ Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF (2006). "Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up". The Journal of bone and joint surgery. American volume. 88 (8): 1775–81. PMID 16882901.
- ↑ Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX; et al. (2014). "Is extracorporeal shock wave therapy clinical efficacy for relief of chronic, recalcitrant plantar fasciitis? A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials". Arch Phys Med Rehabil. 95 (8): 1585–93. doi:10.1016/j.apmr.2014.01.033. PMID 24662810.
- ↑ Dizon JN, Gonzalez-Suarez C, Zamora MT, Gambito ED (2013). "Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis: a meta-analysis". Am J Phys Med Rehabil. 92 (7): 606–20. doi:10.1097/PHM.0b013e31828cd42b. PMID 23552334.