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OBJECTIVE: To evaluate the use of custom-made insoles adapted to flip-flops on pain intensity, foot function, and functional walking ability in individuals with persistent plantar heel pain in the short and medium term. DESIGN: Randomised controlled trial. SETTING: Flip-flop sandals in patients with persistent plantar heel pain. MAIN MEASURES: Participants (n = 80) were assessed at baseline, six and 12 weeks after the intervention, and 4 weeks post-intervention. RESULTS: For the primary outcomes, after 6 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.4 (95% confidence intervals = -1.5 to 0.8). Similarly, after 12 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.7 (95% confidence intervals = -1.9 to 0.6). Finally, at 4 weeks after the end of the intervention, there was no between-group difference in morning pain or pain on walking, mean difference = 0.01 (95% confidence intervals = -1.4 to 1.4). All differences and confidence intervals were smaller than the minimum clinically important difference for pain (2 points). There were no differences between the groups for the secondary outcomes. In addition, the mean differences were smaller than the minimum clinically important differences for pain intensity, foot function and functional walking ability. CONCLUSION: Custom-made insoles fitted to flip-flops did not differ from flip-flops with sham insoles in improving pain intensity, foot function and functional walking ability in people with persistent heel pain.Trial registration: ClinicalTrials.gov (Identifier: NCT04784598). Data of registration: 2023-01-20.

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OBJECTIVE: Extracorporeal shockwave therapy (ESWT) has been used as a therapeutic option for plantar fasciitis. The objective was to investigate the effect of ESWT over the plantar fascia thickness. METHODS: MEDLINE, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials evaluating the effect of ESWT in patients with plantar fasciitis, comparing ESWT with another treatment. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. Meta-regression and subgroup analyses were also carried out. RESULTS: A total of 14 studies (867 participants) were included. ESWT significantly decreased plantar fascia thickness (weighted mean difference [WMD], -0.21 mm [95% CI -0.39, -0.02]; p = 0.03). No significant improvement in pain was observed (WMD, -0.51 cm [95% CI -1.04, 0.01]; p = 0.06) compared with non-surgical interventions. CONCLUSIONS: Our results suggest that plantar fascia thickness is significantly decreased after ESWT intervention in patients with plantar fasciitis. However, pain relief was not significantly improved compared to other non-surgical interventions.

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Background and Objectives: Plantar fasciitis (PF) is a prevalent musculoskeletal disease, with inflammation at the origin of the plantar fascia, that affects sedentary people, particularly middle-aged women. Foot pain and functional limitations lead patients to seek treatment. Investigate the therapeutic effect of conservative treatment combining a custom insole with minimalist flexible shoes and the shoes alone in a gait-training protocol, in the short and long term, in women with PF. Materials and Methods: Design: A randomized, controlled, and single-blind trial. SETTING: Biomechanics laboratory. PARTICIPANTS: 36 women, 26 with acute PF and 10 controls. INTERVENTION: Gait-training protocol wearing the minimalist shoes alone (SG, n = 12, age: 46.4 ± 9.6, height: 1.60 ± 0.2, BMI: 28.8 ± 4.2), with a custom insole in the shoes (CIG, n = 14, age: 48.9 ± 9.8, height: 1.60 ± 0.1, BMI: 26.7 ± 5.6), and control (CG, n = 10, age: 46.1 ± 10.7, height: 1.61 ± 0.2, BMI: 26.4 ± 4.8). Evaluations were performed at baseline (T0) and after three (T3) and six (T6) months. The intervention had a duration of six months (six hours a day, seven days a week). Primary outcomes were rearfoot pain (visual analogue scale), the Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br), and 6 min walk test (6MWT). The secondary outcomes were plantar pressure distribution during gait, measured by the pressure platform, and foot posture. Results: The CIG was effective for reducing pain and improving the FPI after T6 compared to CG. The FPI, FHSQ-Br and 6MWT demonstrated improvements after T6 in both the CIG and SG, compared to the CG. After T6, contact area (rearfoot) and maximum force (forefoot) reduced with CIG. Maximum force (midfoot and rearfoot) reduced with CIG and SG, as did peak pressure (forefoot and midfoot) in relation to CG. Conclusions: A customized insole associated with minimalist flexible shoes during a gait-training protocol can be recommended as a more effective treatment than minimalist flexible shoes alone over the short and long term, for reduction in calcaneus pain, increased function and foot health, and improved walking through reduced plantar load in women with PF.

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Resumen: Introducción: la fascitis o fasciosis plantar es una causa de dolor en el pie, en la cual frecuentemente se encuentran casos resistentes al tratamiento conservador. La cirugía queda reservada para los pacientes que no han respondido a tratamientos conservadores, ondas de choque o infiltraciones con corticosteroides. El objetivo de este trabajo es realizar una revisión sistemática de la literatura disponible y describir una técnica para el tratamiento de la fascitis o fasciosis plantar consistente en el rasgado longitudinal de la aponeurosis plantar asistido con ecografía. Material y métodos: se realizó una búsqueda sistemática de publicaciones previas sobre la tenotomía longitudinal en el tratamiento de la fascitis plantar. Se incluyeron los encabezados de temas médicos o MeSH (Medical subjects headings por sus siglas en inglés), en inglés: Curettage, Tenotomy y Plantar Fasciitis. La búsqueda electrónica incluyó las bases de datos de PubMed, Embase, Cochrane central register of controlled trials, Trip database y National Institute for Health and Care Excellence (NICE por sus siglas en inglés). Se realizó una descripción detallada de la técnica con la intención de que pueda ser reproducida. Conclusión: la tenotomía longitudinal representa una alternativa para el tratamiento de la fascitis plantar. Se basa en la extrapolación del conocimiento en el territorio Aquíleo con una base fisiopatológica de respaldo. Se trata de una técnica no invasiva que se puede realizar de forma ambulatoria y que permitiría la rápida incorporación del paciente a sus actividades. La tenotomía longitudinal podría evitar al paciente someterse a cirugías de mayor envergadura.

Abstract: Introduction: plantar fasciitis or fasciosis is a cause of foot pain with cases resistant to conservative treatment. Surgery is reserved for patients who have not responded to conservative treatment, shock waves, or corticosteroid injections. The aim of this publications is to carry out a systematic review of the available literature and to describe a specific technique for the treatment of plantar fasciosis consisting of the longitudinal tearing of the plantar aponeurosis assisted with ultrasound. Material and methods: a systematic search was carried out for previous publications on longitudinal tenotomy in the treatment of plantar fasciitis. The Medical Subject Headings (MeSH) terms «Curettage¼, «Tenotomy¼ and «Plantar Fasciitis¼ were included. The electronic search included PubMed, Embase, Cochrane central register of controlled trials, Trip database, and National Institute for Health and Care Excellence (NICE) databases. A detailed description of the technique was included with the intention that it can be reproduced. Conclusion: longitudinal tenotomy represents an alternative for the treatment of plantar fasciitis. It is based on the extrapolation of knowledge in the Achilles tendon territory with a supporting pathophysiological basis. It is a non-invasive technique that can be performed on an outpatient basis and that would allow the rapid incorporation of the patient to their activities. Longitudinal tenotomy would prevent the patient from undergoing major surgeries.

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BACKGROUND: Injectable therapies have been increasingly investigated to treat plantar fasciitis in randomized controlled trials (RCT) where normal saline injections are frequently used as placebo. The purpose was to quantify the effect of saline injections and compared against available minimal clinically important difference (MCID) criteria specific for plantar fasciitis to assess if changes were clinically meaningful. METHODS: RCT including a placebo group (normal saline) and reporting changes in pain and functional outcomes in plantar fasciitis were identified through a search in MEDLINE, Embase, Web of Science, and Scopus to February 2022. PRISMA guidelines and a registered protocol (PROSPERO: CRD42020214035) were followed to conduct the study. RESULTS: Pooled analysis of 13 RCT (379 subjects) included for analysis revealed a significant improvement on pain (P < .00001) and functional scores (P < .00001) after normal saline injections. These changes exceeded the established MCID criteria. CONCLUSIONS: Normal saline injections in plantar fasciitis showed a therapeutic effect with statistically and clinically meaningful improvement when administered in the setting of an RCT for up to 12 months. The control of potential confounders influencing the effect of saline injections is required for future research.

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Resumen La fascitis plantar (FP) es una patología frecuente e invalidante que puede tratarse con ondas de choque focalizadas. El objetivo principal del estudio fue valorar la eficacia del tratamiento con ondas de choque focalizadas en la FP según la densidad de energía utilizada. Se incluyeron 82 pacientes con diagnóstico clínico de FP que fueron asignados mediante muestreo aleatorio simple a dos grupos de tratamiento: densidad de energía media- alta (0,59mJ/mm2) y densidad de energía media-baja (0,27mJ/mm2). Se evaluaron el dolor y la funcionalidad, mediante las escalas EVA (Escala Visual Analógica) y AOFAS (American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale) respectivamente, al inicio del estudio (consulta base), y al primer, tercer y sexto mes tras el tratamiento. Por último, se evaluó el grado de satisfacción de los pacientes mediante la escala de Roles y Maudsley. Se compararon los resultados de las escalas en las revisiones posteriores al tratamiento, obteniéndose significación estadística para las variables principales del estudio (dolor y funcionalidad) en cada grupo de intervención. Aunque los niveles de dolor y la funcionalidad mejoraron en ambos grupos de estudio, se obtuvo una respuesta analgésica y funcional mayor y más precoz en el grupo tratado con densidad de energía media-alta.

Abstract Plantar fasciitis (FP) is a frequent and disabling condition that can be treated with focused extracorporeal shock waves. The main objective of this study was to assess the effectiveness of focused extracorporeal shockwave treatment in FP according to the energy density used. Eighty-two patients with a clinical diagnosis of FP were included and assigned, by simple random sampling, to two treatment groups: medium-high energy density (0.59mJ/mm2) and low-medium energy density (0.27mJ/mm2). Pain and functionality were assessed using the VAS (Visual Analogical Scale) and AOFAS (American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale) scales, respectively, at the start of the study (baseline consultation), and at the first, third and sixth month post-treatment. Finally, the degree of patient satisfaction was evaluated using the Roles and Maudsley score. The results of the scales in the post-treatment reviews were compared, and statistical significance was obtained for the main study variables (pain and functionality) in each intervention group. Although pain levels and functionality improved in both study groups after treatment, a greater and earlier analgesic and functional response was obtained for the medium-high energy density group.

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INTRODUCTION: plantar fasciitis or fasciosis is a cause of foot pain with cases resistant to conservative treatment. Surgery is reserved for patients who have not responded to conservative treatment, shock waves, or corticosteroid injections. The aim of this publications is to carry out a systematic review of the available literature and to describe a specific technique for the treatment of plantar fasciosis consisting of the longitudinal tearing of the plantar aponeurosis assisted with ultrasound. MATERIAL AND METHODS: a systematic search was carried out for previous publications on longitudinal tenotomy in the treatment of plantar fasciitis. The Medical Subject Headings (MeSH) terms "Curettage", "Tenotomy" and "Plantar Fasciitis" were included. The electronic search included PubMed, Embase, Cochrane central register of controlled trials, Trip database, and National Institute for Health and Care Excellence (NICE) databases. A detailed description of the technique was included with the intention that it can be reproduced. CONCLUSION: longitudinal tenotomy represents an alternative for the treatment of plantar fasciitis. It is based on the extrapolation of knowledge in the Achilles tendon territory with a supporting pathophysiological basis. It is a non-invasive technique that can be performed on an outpatient basis and that would allow the rapid incorporation of the patient to their activities. Longitudinal tenotomy would prevent the patient from undergoing major surgeries.

INTRODUCCIÓN: la fascitis o fasciosis plantar es una causa de dolor en el pie, en la cual frecuentemente se encuentran casos resistentes al tratamiento conservador. La cirugía queda reservada para los pacientes que no han respondido a tratamientos conservadores, ondas de choque o infiltraciones con corticosteroides. El objetivo de este trabajo es realizar una revisión sistemática de la literatura disponible y describir una técnica para el tratamiento de la fascitis o fasciosis plantar consistente en el rasgado longitudinal de la aponeurosis plantar asistido con ecografía. MATERIAL Y MÉTODOS: se realizó una búsqueda sistemática de publicaciones previas sobre la tenotomía longitudinal en el tratamiento de la fascitis plantar. Se incluyeron los encabezados de temas médicos o MeSH (Medical subjects headings por sus siglas en inglés), en inglés: Curettage, Tenotomy y Plantar Fasciitis. La búsqueda electrónica incluyó las bases de datos de PubMed, Embase, Cochrane central register of controlled trials, Trip database y National Institute for Health and Care Excellence (NICE por sus siglas en inglés). Se realizó una descripción detallada de la técnica con la intención de que pueda ser reproducida. CONCLUSIÓN: la tenotomía longitudinal representa una alternativa para el tratamiento de la fascitis plantar. Se basa en la extrapolación del conocimiento en el territorio Aquíleo con una base fisiopatológica de respaldo. Se trata de una técnica no invasiva que se puede realizar de forma ambulatoria y que permitiría la rápida incorporación del paciente a sus actividades. La tenotomía longitudinal podría evitar al paciente someterse a cirugías de mayor envergadura.

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OBJECTIVE: We performed a systematic review to investigate the effects of low-level laser therapy (LLLT) on pain and disability in patients with plantar fasciitis (PF). METHODS: We searched Pubmed, PEDro database, Scielo, and Cochrane Central for randomized controlled trials that evaluated the effects of LLLT for patients with PF. The methodological aspects of the studies included were scored using the PEDro scale. Three comparisons were made: LLLT compared with placebo, LLLT combined with conventional rehabilitation (CR) compared with CR and LLLT compared with extracorporeal shock wave therapy. RESULTS: Fourteen studies (817 patients) met the study criteria. Compared to the placebo group, LLLT improved pain (MD, -2.3; 95% CI: 2.6 to -2, I2 = 0%; 4 studies, N = 234: moderate-quality evidence) in the short term (0-6 weeks). No significant difference in short-term disability was found for participants in the LLLT group compared to the placebo group. Compared to the CR group, LLLT combined with CR improved pain (MD, -2.0; 95% CI: 2.9 to -1.1, I2 = 0%; 2 studies, N = 90: moderate-quality evidence) in the short term (0-6 weeks). Compared to extracorporeal shock wave therapy, LLLT did not significantly reduce pain intensity in the short term (MD, 0.5; 95% CI: 2.0 to 2.9, I2 = 96%; 4 studies, N = 175: low-quality evidence). CONCLUSIONS: LLLT may improve pain in the short term and can be considered as a component of care of patients with PF. However, this superiority disappeared compared to extracorporeal shock wave therapy. LEVEL OF EVIDENCE: Therapeutic level I.

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| INTRODUÇÃO: A fascite plantar (FP) é uma causa comum de dor no calcanhar e deformidade da articulação do tornozelo. Mais de 11% -15% da população com sintomas nos pés precisa de cuidados de longo prazo. Foi comprovado que várias intervenções de fisioterapia com terapia convencional, que inclui terapia manual, ajudam nessa condição. OBJETIVO: Avaliar o efeito do fortalecimento do abdutor do quadril e da terapia manual (MT) em paciente com fascite plantar (FP). MÉTODOS: O desenho do estudo será um ensaio de controle randomizado de dois grupos, pré-teste e pós-teste. Um total de 30 participantes do sexo masculino e feminino com idade acima de 18-60 anos com dores provocadas pelos primeiros passos da manhã, dor na região plantar do calcanhar, serão alocados aleatoriamente em dois grupos - o Grupo A receberá terapia manual (TM) com fisioterapia convencional enquanto o Grupo B receberá fortalecimento dos abdutores do quadril com fisioterapia convencional. Ambos os grupos receberão 16 sessões de tratamento por 4 dias em cada semana durante 4 semanas. "Foot Function Index", "Podia scan", "Teste de queda do navicular" serão usados como medida de desfecho e serão avaliados na 1ª semana e na 4ª semana de tratamento em ambos os grupos. CONCLUSÃO: Os pacientes que recebem a intervenção de fortalecimento do abdutor do quadril podem ter resultados positivos quando comparados à intervenção de MT entre pacientes com FP. Este será o primeiro estudo a comparar o efeito do fortalecimento dos abdutores do quadril e da terapia manual. REGISTRO DE ENSAIO: Registro de Ensaios Clínicos - Índia. (CTRI / 2020/04/024541)

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain and deformity of the ankle joint. More than 11%- 15% of the population with foot symptoms need long-term care. Various physical therapy intervention with conventional therapy, including manual therapy, has been proven to help this condition. OBJECTIVE: To evaluate the effect of Hip abductor strengthening and Manual therapy (MT) in a patient with Plantar Fasciitis (PF). METHODS: The design of the study will be A Two Group PretestPosttest randomized control trial. A total of 30 male and female participants aging above 18-60 years experiencing pain provoked by taking the first few steps in the morning, pain in the plantar heel region, will be allocated randomly into two groups- Group A will receive Manual therapy (MT) with conventional physiotherapy while Group B will receive hip abductors strengthening with conventional physiotherapy. Both groups will receive 16 sessions of treatment for 4 days each week for 4 weeks. "Foot function index," "Podiascan," "Navicular drop test" will be used as outcome measures and will be evaluated at the first week and fourth week of treatment in both the groups. CONCLUSION: The patients who receive Hip Abductor Strengthening intervention may have positive results compared to the MT intervention among patients with PF. This will be the first study to compare the effect of hip abductors strengthening and manual therapy. TRIAL REGISTRATION: Clinical Trial Registry- India. (CTRI/2020/04/024541)

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Abstract Objective To determine the modifiable risk factors associated with severity of plantar fasciitis and to formulate an objective scoring system for indexing plantar fasciitis in the non-athletic population. Methods This was a prospective observational study. The main outcome measure was the association of a modifiable risk factor, which was measured with the Pearson coefficient (R-value) and the level of significance, which was kept as p < 0.05. Result In a sample size of 50 patients, the body mass index (BMI) and ill-cushioned shoes were found to be significantly associated with pain in plantar fasciitis. All the other risk factors were either non-modifiable or had no significant association. Conclusion Based on available data and further interpretation, an index was be formulated, named as Ranjeet-Kunal Index for Scoring Plantar fasciitis (RKISP), which can be successfully used for not only grading plantar fasciitis but also prognosticating the conservative management of the same, thus deciding the modality of treatment.

Resumo Objetivo Determinar os fatores de risco modificáveis associados à gravidade da fasciíte plantar e formular um sistema objetivo de pontuação para indexação da doença na população não atlética. Métodos Estudo observacional prospectivo. A principal medida de desfecho foi a associação de um fator de risco modificável, mensurada pelo valor de R (coeficiente de Pearson) e pelo nível de significância de p < 0,05. Resultados Em uma amostra de 50 pacientes, o índice de massa corporal (IMC) e calçados com amortecimento inadequado foram associados de maneira significativa à dor na fasciíte plantar. Todos os demais fatores de risco eram não modificáveis ou não apresentaram associação significativa. Conclusão Com base nos dados à disposição e sua interpretação, um índice, denominado Índice de Ranjeet-Kunal de Pontuação da Fasciíte Plantar (RKISP, em inglês) , foi formulado e utilizado com sucesso não apenas na classificação da fasciíte plantar, mas também na determinação do prognóstico de seu tratamento conservativo, auxiliando a escolha da modalidade terapêutica.

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RESUMEN Introducción: La causa común de dolor en la región subcalcánea es la fascitis plantar. Por su efecto analgésico y antiinflamatorio, el empleo de la radiación electromagnética en su tratamiento constituye una opción terapéutica. Objetivos: Evaluar la utilidad de la radiación electromagnética en pacientes que presentaban síndrome doloroso en la región subcalcánea y relacionar la mejoría clínica con los grupos de edades y sexos. Métodos: Se realizó un estudio descriptivo de corte transversal a dos grupos de pacientes con dolor en la región subcalcánea. Para el análisis estadístico, al final del tratamiento se utilizó la prueba de homogeneidad λ2 con un nivel de significación de ά 0,05. Resultados: A las 20 sesiones de tratamiento, el 93,33 por ciento de los pacientes tratados con la radiación electromagnética no presentaron dolor, el 94,44 por ciento de ellos pertenecían al grupo de edades de 25-59 años y el 90,90 por ciento eran del sexo femenino. Conclusiones: Se evalúa de positiva la utilidad de la radiación electromagnética en el tratamiento del dolor en la región subcalcánea, con una diferencia significativa en relación con el tratamiento médico convencional. El mayor número de pacientes correspondió al grupo de edades entre 25 y 59 años, con predominio del sexo femenino(AU)

ABSTRACT Introduction: The common cause of pain in the subcalcaneal region is plantar fasciitis. The electromagnetic radiation in its treatment constitutes a therapeutic option due to its analgesic and anti-inflammatory effect. Objectives: To assess the value electromagnetic radiation in patients who suffered pain syndrome in the subcalcaneal region and to relate the clinical improvement with age and gender groups. Methods: A descriptive cross-sectional study was conducted in two groups of patients with pain in the subcalcaneal region. For the statistical analysis, the λ2 homogeneity test was used at the end of the treatment with a significance level of ά 0.05. Results: After a treatment of 20 electromagnetic radiation sessions, 93.33 percent did not had pain, 94.44 percent were in the 25-to-59-year-olds group and 90.90 percent were women. Conclusions: The value of electromagnetic radiation in the treatment of pain in the subcalcaneal region is positively assessed, showing significant difference in relation to conventional medical treatment. The largest number of patients corresponded to the 25-to-59-year-olds group, with a predominance of women(AU)

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Objective: This systematic review and meta-analysis updated the effects of photobiomodulation therapy (PBMT) on pain, the Foot Function Index (FFI), and the effects on fascial thickness in adults with acute or chronic plantar fasciitis (PF). Methods: A systematic literature search was conducted in the PubMed (Public/Publisher MEDLINE), EMBASE (Excerpta Medica Database), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Two researchers independently screened titles and abstracts of the retrieved studies for eligibility. A random-effects model was used for this meta-analysis. Subgroup meta-analyses were conducted to evaluate the influence of PBMT in pain and foot function under investigation and the study design on the overall weighted mean effect size. Results: From a total of 3865 studies, 7 randomized controlled trials were selected after final review and 4 were selected for meta-analysis. There was a significant difference between PBMT and control for Visual Analog Scale (Chi2 = 29.30; p < 0.00001) with an I2 value of 90% in favor of PBMT versus the control. The overall effect of PBMT was statistically significant (p < 0.02) with PBMT favoring for thickness of the plantar fascia reduction. FFI between PBMT and control group [Chi2 -83.46, df = 1 (p < 0.00001)]; I2 = 99% in favor of the PBMT. Conclusions: This meta-analysis presents evidence that PBMT is an effective treatment modality to reduce pain and improvement of foot function in patients with chronic PF, however, a broad discrepancy was found in the PBMT dosimetry. The ideal treatment parameters for PF need to be elucidated.

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Plantar fasciitis is one of the most common chief complaints seen in the foot and ankle clinic. With a relatively benign course, most cases are self-limiting or amendable to conservative therapy; ~90% of all plantar fasciitis cases will respond to these methods. When conservative treatment and time fail, surgical intervention can be necessary to improve outcomes. We present a novel method using Subchondroplasty® (SCP®; Zimmer Holdings, Inc.; Warsaw, IN) and revision fasciotomy in a case in which initial fasciotomy had failed. After the patient had failed to improve, a worsening underlying bone marrow lesion was identified at the origin of the plantar fascia; thus, SCP® was used with repeat fasciotomy. SCP® involves injecting calcium phosphate into bone marrow lesions to stimulate long-term bone repair. At 10 months after SCP®, the patient remained pain free and had returned to running at the final follow-up examination. This surgical treatment should be considered as an adjunctive procedure for those patients with plantar fasciitis, identifiable bone marrow lesions on magnetic resonance imaging, and continued pain when other treatment modalities have failed.

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Introducción La fascitis plantar crónica (FPC) es una afección dolorosa, en la cual el objetivo principal del tratamiento es aliviar el dolor y restaurar la función. La terapia de ondas de choque (TOCH) ha demostrado eficacia en el tratamiento de la fascitis plantar con pocos efectos secundarios en comparación con otros métodos conservadores. El objetivo del estudio es comparar la respuesta al tratamiento de TOCH frente a la infiltración con corticosteroides en el tratamiento de la fascitis plantar crónica. Materiales y métodos Sesenta pacientes con FPC fueron distribuidos de forma aleatoria para recibir TOCH (grupo A, n=36) o infiltración con corticosteroides (grupo B, n=24) a través de un programa de generación aleatorizada. Fueron evaluados con EVA y AOFAS para el retropié antes del tratamiento, inmediatamente después del tratamiento, a los 3, 6 y 12 meses posteriores al tratamiento. Resultados Los dos grupos fueron similares en características demográficas. Ambos grupos mejoraron durante el tratamiento y el período de seguimiento. La media de EVA disminuyó de 8 a 1,68 (p <0,001) en el grupo A y de 6,75 a 1,31 (p <0,001) en el grupo B. En el AOFAS presentó un incremento medio de 50,3 a 67,8 (p <0,001) en el grupo A y de 51,3 a 66 (p <0,001) en el grupo B a los 12 meses de seguimiento. A los 3 meses, el grupo B presentó una puntuación media de EVA más baja que en el grupo A (1,12 frente a 1,96; p=0,035), pero al final del seguimiento se observó mejoría en ambos grupos. Discusión Las infiltraciones con corticosteroideas y TOCH son efectivas en la reducción de síntomas y el incremento de la funcionalidad de los pacientes diagnosticados de FPC. Nivel de evidencia clínica Nivel II.

Background Chronic plantar fasciitis (CPF) is a painful condition where the primary goal of treatment is relieve the pain and restore function. Extracorporeal shockwaves therapy (ESWT) has shown efficacy in the treatment of plantar fasciitis with reported few side effects compared to other conservative methods. The purpose of the study is to compare the response to treatment of ESWT against corticosteroid infiltration for PF using VAS (Visual Analogue Scale) and AOFAS (American Orthopedic Foot and Ankle Society's) hind foot scales. Materials & methods Sixty patients with PF were randomized to receive ESWT (group A, n=36) or corticosteroid infiltration (group B, n=24) through a program of random number generation. They were evaluated with VAS and AOFAS hind foot scales before treatment, immediately after treatment and at 3, 6 and 12 months post treatment. Results The two groups were similar in demographic characteristics. Both groups improved during treatment and follow-up period. The mean VAS decreased from 8 to 1.68 (p <0.001) in group A and 6.75 to 1.31 (p <0.001) in group B and presented a mean increase in AOFAS scale from 50.3 to 67.8 (p <0.001) in group A and 51.3 to 66 (p <0.001) in group B at 12 months follow up. At 3 months, the B group presented a lower average score in VAS when compared with patients in group A (1.12 vs 1.96; p=0.035). Finally, follow-up improvement was seen in both groups with no significant differences. Discussion ESWT and corticosteroid injections are both effective in reducing symptoms and increased functionality when applied to patients diagnosed with CPF. Evidence level II.

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La fascitis plantar es un síndrome degenerativo que se produce como resultado de traumas repetidos en el origen de ésta, en el calcáneo. Suele presentarse en atletas y corredores, aunque también aparece en la población general, afectando aproximadamente a un 10% en ambos casos. Aunque su etiología no es del todo clara, es probable que la causa no sea única y haya diversos factores que contribuyan a su aparición. Estos son tales como el aumento de peso, el exceso de ejercicio físico o el calzado inadecuado, entre otros. La fascitis plantar se caracteriza por dolor en la región inferior del talón, en la planta del pie, que es especialmente intenso en los primeros momentos de la mañana al andar o después de un período de inactividad física o tras una bipedestación prolongada. A lo largo del día el dolor va disminuyendo, pero volverá si se lleva a cabo la actividad de levantamiento de peso. El tiempo de recuperación o resolución de esta patología es prolongado y existen varios métodos que pueden ayudar en su tratamiento, todos ellos diríamos que convencionales. Esta revisión plantea el tratamiento de la fascitis plantar a través del entrenamiento funcional de esquí, dadas las características biomecánicas que comporta este deporte.

Plantar fasciitis is a degenerative syndrome that occurs because of repeated traumas in the fascia origin on the calcaneus. It usually occurs in athletes and runners, although it also appears in the general population, affecting approximately 10% in both cases. Although its etiology is not entirely clear, it is likely, not due to a unique cause since there are several factors that contribute to its appearance. These are: weight gain, excessive physical exercise or inadequate footwear, etc. Plantar fasciitis is characterized by pain in the lower region of the heel, in the sole of the foot, which is especially intense in the first moments of the morning when walking, after a period of physical inactivity or after prolonged standing. Throughout the day the pain diminishes, but will return if weight-lifting activity is carried out. The recovery time or resolution of this pathology is prolonged and there are several conservative methods that may help in the treatment of plantar fasciitis. Therefore, in this review we propose the treatment of plantar fasciitis through functional ski training, given the biomechanical characteristics of this sport.

RESUMO

Abstract Introduction: Plantar fasciitis (PF) is characterized by non-inflammatory degeneration and pain under the heel, and is one of the most common foot complaints. The compensations and adjustments made to decrease the discomfort caused by the disease are clinical findings and can be a factor that contributes to impaired balance and decreased functional performance. Objective: To compare functional performance as well as static and dynamic balance among subjects with and without PF. Methods: The sample consisted of 124 subjects of both sexes aged 20-60 years. Participants were divided into two groups: a bilateral PF group (PFG; n = 62) and a control group (CG, n = 62). The following outcomes were analyzed: static and dynamic balance (using functional tests) and functional performance (using a questionnaire). We used Student's t test for independent samples to compare variables between the groups. The alpha error was set at 0.05. Results: Subjects with PF showed greater impairment in their overall dynamic balance performance (p < 0.001) than the control group, except for left posteromedial movement (p = 0.19). The CG showed showed better functional performance (p < 0.001) than the PF group. There was no difference between groups for the variable static balance on stable (p = 0.160) and unstable surfaces (p = 0.085). Conclusion: Subjects with PF displayed smaller reach distances in the overall Star Excursion Balance Test (SEBT), demonstrating a deficit in dynamic balance and functional performance when compared with healthy subjects.

Resumo Introdução: A fasciíte plantar (FP) caracteriza-se por uma degeneração não inflamatória e dor na parte inferior do calcanhar, sendo uma das queixas mais comuns na região do pé. As compensações e as adaptações para diminuir o desconforto da doença é um achado clínico e atua como um fator que pode contribuir para o comprometimento no equilíbrio e no desempenho funcional. Objetivo: comparar os equilíbrios estático, dinâmico e o desempenho funcional entre indivíduos com e sem a FP. Métodos: participaram da pesquisa 124 voluntários distribuídos em dois grupos: grupo fasciíte plantar bilateral (GFP; n = 62) e grupo controle (GC; n = 62) de ambos os sexos, na faixa etária de 20 a 60 anos. Os desfechos analisados foram o equilíbrio estático, equilíbrio dinâmico por meio dos testes funcionais e o desempenho funcional por um questionário. Os resultados foram analisados utilizando o teste t de Student de amostras independentes para comparar as variáveis entre os grupos. O erro alfa considerado foi p < 0,05. Resultados: Indivíduos com FP apresentaram maior comprometimento durante o teste de equilíbrio dinâmico total (p < 0,001), exceto no movimento póstero-medial esquerdo (p = 0,19). O GC apresentou melhor desempenho funcional (p < 0,001) e não houve diferença entre os grupos para a variável equilíbrio estático nas superfícies estável (p = 0,160) e instável (p = 0,085). Conclusão: Indivíduos com FP obtiveram menores alcances no SEBT total, apresentando déficit de equilíbrio dinâmico e comprometimento no desempenho funcional quando comparados com os participantes saudáveis.

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OBJECTIVE: The purpose of this case report is to describe the management of using a combination of hip strengthening and manipulative therapy (MT) for a patient with plantar fasciitis. CLINICAL FEATURES: A 44-year-old patient reported heel pain for approximately 1 year before treatment. The patient reported plantar heel pain and tenderness at the calcaneal tuberosity. The pain was most noticeable in the morning but was reduced after a 30-minute walk. A diagnosis of plantar fasciitis was made at the initial assessment. INTERVENTION AND OUTCOMES: Initially, a clinical evaluation was performed to measure pain intensity (Numeric Pain Rating Scale), pressure-pain threshold (algometry), and perceived exertion (OMNI Resistance Exercise Scale). The patient then underwent 10 sessions of hip strengthening and MT over a period of 3 months. After the treatment, the intensity of pain and the pressure-pain threshold was reevaluated. The patient reported an improvement in pain intensity (baseline score = 6 vs final score = 1) and an increase in the pressure-pain threshold (initial score = 2.6 vs final score = 7.1). Perceived exertion was also improved after hip muscle strength training (initial score = 10 vs final score = 8). CONCLUSION: The combination of hip strengthening and MT improved foot pain in a patient with a clinical diagnosis of plantar fasciitis.

RESUMO

BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R2=0.15 for acute phase PF; R2=0.17 for chronic PF) and maximum force (R2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R2=0.18) and chronic (R2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R2=0.19) and chronic (R2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot.

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El tratamiento de la fascitis plantar es controvertido porque ninguna de las propuestas terapéuticas arrojaresultados claramente satisfactorios. En los últimos años se ha propuesto la aplicación de ondas de choque extracorpóreas (OC), pero las evidencias sobre su eficacia y efectividad resultaron inconsistentespara ser indicadas en el tratamiento de la FP.

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Introducción: la fascitis plantar es la inflamación del tejido denso que ocupa la parte anterior del tubérculo interno del calcáneo y constituye la causa más frecuente de dolor en la planta de los pies y dificulta en gran medida el desempeño laboral del individuo. Objetivo: caracterizar la fascitis plantar en pacientes asistidos en los servicios del Hospital General Docente "Abel Santamaría Cuadrado" en Pinar del Río. Material y método: estudio descriptivo, longitudinal y aplicado en el Departamento de Medicina Física y Rehabilitación del Hospital "Abel Santamaría Cuadrado", en el periodo comprendido desde abril del 2013 hasta abril del 2014, a los pacientes con diagnóstico de fascitis plantar. El universo coincidió con la muestra (60 pacientes). Resultados: de la muestra distribuida según ocupación laboral, 53 permanecen el mayor tiempo de pie, siendo el sexo femenino más predominante que el masculino y la edad promedio más afectada es de 40 a 49 años. El 70,0% de los pacientes mostraron dolor en las categorías de moderado a severo. Conclusiones: el sobrepeso y la obesidad crean un estrés adicional. Otro de los factores a considerar, son las neuropatías, el abuso del alcohol y el factor hereditario.

Introduction: plantar fasciitis is inflammation of the thick tissue that occupies the front of the inner tubercle of the calcaneus and is the most common cause of pain in the soles of the feet and seriously hampers the individual's work performance. Objective: to characterize the plantar fasciitis in patients assisted in the services of Abel Santamaria Cuadrado General Teaching Hospital of Pinar del Río. Material and methods: descriptive, longitudinal research implemented in the Department of Physical Medicine and Rehabilitation of Abel Santamaria Cuadrado Hospital in the period from April 2013 to April 2014, patients diagnosed with plantar fasciitis. The universe coincided with the sample (60 patients). Results: the sample was distributed according to occupation, as long as 53 remain standing, the most dominant female that the male and the average age most affected is 40-49 years. 70.0% of patients showed pain of moderate to severe categories. Conclusions: overweight and obesity create additional stress. Other factors to consider are the neuropathies, alcohol abuse and heredity.