RESUMO
OBJECTIVE: To evaluate the effects of insoles adapted into flip-flop sandals on pain and function in individuals with plantar fasciopathy (PF). DESIGN: Randomized, double-blind controlled study. SETTING: Physiotherapy clinic of the Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil. SUBJECTS: Sixty-six patients of both genders with PF were randomized into two groups: sandal insole group (SI; n = 34), which received a pair of custom flip-flop sandals with insoles covered with smooth synthetic leather; and plain sandal group (PS; n = 32), which received an identical pair of flip-flop sandals, but without the insoles. INTERVENTIONS: Patients were instructed to wear the flip-flops for 12 weeks for at least 4 hours/day. MAIN MEASURES: Pain (visual analogue scale-VAS) in the morning and at the end of the day were considered primary outcomes. Function (Foot Function Index-FFI and Foot and Ankle Ability Measure-FAAM) and functional capacity (6-minute walk test-6MWT) were considered secondary outcomes. The outcomes were evaluated at baseline and immediately after the intervention by a blind assessor. RESULTS: Between-group differences were observed in terms of morning pain (mean difference (MD) = -1.82 cm; 95% confidence interval (CI) = -3.3 to -0.3; P = 0.016) and function (MD = -0.10; 95% CI = -0.19 to -0.01; P = 0.023) after the interventions with the SI group showing superior improvements in comparison to the PS group. CONCLUSION: The use of insoles adapted in flip-flop sandals for 12 weeks was effective at improving pain and function in individuals with PF. LEVEL OF EVIDENCE: 1b.
Assuntos
Fasciíte Plantar/terapia , Órtoses do Pé , Dor/prevenção & controle , Sapatos , Adulto , Brasil , Método Duplo-Cego , Fasciíte Plantar/complicações , Fasciíte Plantar/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Medição da DorRESUMO
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.
Assuntos
Doenças da Medula Óssea/cirurgia , Fosfatos de Cálcio/uso terapêutico , Fasciíte Plantar/cirurgia , Fasciotomia , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/diagnóstico por imagem , Fasciíte Plantar/complicações , Fasciíte Plantar/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel.
Assuntos
Pé/inervação , Nervo Tibial/anatomia & histologia , Cadáver , Estudos Transversais , Suscetibilidade a Doenças , Fasciíte Plantar/complicações , Pé/irrigação sanguínea , Variação Genética , Humanos , Síndrome do Túnel do Tarso/etiologia , Síndrome do Túnel do Tarso/cirurgiaRESUMO
BACKGROUND: Plantar fasciitis is the third most frequent injury in runners. Despite its high prevalence, its pathogenesis remains inconclusive. The literature reports overload as the basic mechanism for its development. However, the way that these plantar loads are distributed on the foot surface of runners with plantar fasciitis and the effects of pain on this mechanical factor has not yet been investigated. Therefore, the aim of this study was to evaluate and compare the plantar pressure distributions during running in runners with symptom or history of plantar fasciitis and runners without the disease. METHODS: Forty-five recreational runners with plantar fasciitis (30 symptomatic and 15 with previous history of the disease) and 60 runners without plantar fasciitis (control group) were evaluated. Pain was assessed by a visual analogue scale. All runners were evaluated by means of the Pedar system insoles during running forty meters at a speed of 12(5%) km/h, using standard sport footwear. Two-way ANOVAS were employed to investigate the main and interaction effects between groups and plantar areas. FINDINGS: No interaction effects were found for any of the investigated variables: peak pressure (P = 0.61), contact area (P = 0.38), contact time (P = 0.91), and the pressure-time integral (P = 0.50). INTERPRETATION: These findings indicated that the patterns of plantar pressure distribution were not affected in recreational runners with plantar fasciitis when compared to control runners. Pain also did not interfere with the dynamic patterns of the plantar pressure distributions.