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Plantar Fasciopathy

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Other Names

  • Plantar Fasciitis
  • Plantar Fasciopathy
  • Plantar Fasciosis
  • Plantar heel pain syndrome (PHPS)

Background

  • This page refers to fasciopathy of the the Plantar Fascia of the foot, most commonly referred to as 'Plantar Fasciitis' (PF)

History
Epidemiology

  • General
    • Peak age is between 45 and 65 years[1]
    • About 1 in 3 patients will have bilateral symptoms[2]
    • An estimated $284 million is spent each year on plantar fasciitis treatments (need citation)
  • Prevalence
    • Affects 1 in 10 people in their lifetime (need citation)
    • 2 million people receive treatment for this condition annually around the world[1]

Introduction

General

  • Defined by pain and structural changes at the proximal insertion of the plantar fascia on the calcaneus
  • It is the most common cause of chronic heel pain in adults (need citation)
  • Generally thought to occur due to degeneration of the plantar fascia as a result of repetitive microtears of the fascia
  • This leads to an inflammatory reaction, and is not a primary inflammatory process (as often thought to be)
  • Approximately 90-95% of cases resolve within 12 months with conservative treatment[3]

Terminology

  • Fasciitis: describes inflammation of the plantar fascia
  • Fasciosis: degenerative changes of the plantar fascia
  • Fasciopathy: describes more chronic thickening and degenerative process
  • Fasciopathy is more appropriate as the vast majority of patients have findings consistent with chronic injuries including thickening and degeneration
  • Note that patients often do not seek healthcare until their symptoms can be classified as chronic

Etiology

  • General
    • Overall, this condition is poorly understood
    • Tensile strength of the plantar fascia appears to be a key feature of pathogenesis[4]
    • Known to be associated with several limiting biomechanical risks
    • Often due to either overuse (runners, military personnel) or excessive loading (obesity, sedentary)[5]
  • Tight gastrocnemius
    • Increases Achilles tendon tension and dorsiflexion stiffness of the ankle
    • Thus increasing plantar fascia tension during weight-bearing activities
  • Histopathology[4]
    • The increased fascial load is sensed by the gap junctions between fibrocytes (mechanotransduction)
    • This mediates changes in the extracellular matrix
    • Subsequently, there is myxoid degeneration and fragmentation of the plantar fascia and perifascial structures.

Associated Conditions

Anatomy of the Plantar Fascia

  • Band of connective tissue originating at the calcaneus and inserting on the tendons of the forefoot and proximal phalanges
  • Function: support the arch of the foot, act as a shock absorber for pressure placed on the foot[6]

Risk Factors

  • Demographic
    • Increasing age[7]
    • Gender: No differences between men and women[7]
    • Obese patients have a 1.4 fold increased risk[8][9]
  • Orthopedic/ Anatomic
    • Calcaneal enthesophytes (heel spurs) do not appear to increase the risk of PF (need citation)
      • One study found neither the shape nor size of the spur has a correlation with function or pain before or after treatment[10]
    • Baxters Neuropathy may co-exist and increase risk[11]
  • Systemic/ Intrinsic
    • Spondyloarthropathy
    • Genetic
  • Sports
  • Occupational
    • Military Service[14]
    • 'Weight Bearing Tasks'
    • Long periods of standing
  • Biomechanical
    • Tight gastrocnemius muscle[15]
    • Planovalgus feet
    • Gastrocnemius contracture
    • Severe hallux valgus[16]
    • Limited ankle dorsiflexion
      • 83% of patients with recalcitrant PF have limited ankle dorsiflexion[17]
    • Pes Cavus
    • Tight intrinsic foot muscles
    • Leg length discrepancy
    • Poor fitting shoes
    • Improper gait[18]

Differential Diagnosis

Differential Diagnosis Foot Pain

Clinical Features

History

  • The diagnosis is often made clinically
  • The pain is located on the plantarmedial aspect of the heel
  • Post Static Dyskinesia: classically, perhaps pathognomonic, patients report pain upon first waking and standing up in the morning
    • This tends to improve after a walking for a while
    • It improves with activity initially, then worsens as the activity becomes prolonged
  • Pain is described as dull aching or throbbing pain

Physical Exam: Physical Exam Foot

  • Tenderness is located at the plantar aspect of the medial calcaneal tuberosity at the fascia insertion

Special Tests

Evaluation

Radiographs

  • Standard Radiographs Foot
    • Often reveal calcaneal enthesophytes (heel spurs)
      • A sign of calcification at the origin of the flexor digitorum brevis muscle, thought to be a response to chronically tight achilles tendon
      • Although here is a higher incidence of heel spurs in patients suffering from PF (75% vs 63% in asymptomatic patients)
      • There is no apparent correlation between spurs and pain[19]

Ultrasound

  • Can be considered to exclude other soft tissue pathology
  • Potential Findings
    • Plantar fascia is softer using sonoelastrography in patients with typical clinical manifestations of plantar fasciitis[20]
    • Thickness tends to be greater than 4 mm on diagnostic ultrasound[21]
    • A plantar fascia thickness >4.5 mm and the presence of hypoechoic areas are specific for PF[22]
    • Subcalcaneal bone spurs (24%), peritendinous edema (5%), subcalcaneal bone erosion (4%), intratendinous calcification (3%), and retrocalcaneal bursitis are associated with PF but are not specific[23][22]

MRI

  • Can be considered to exclude other soft tissue pathology
  • Findings
    • Increased signal intensity and proximal plantar fascia thickening[24]
    • Thickening of the plantar fascia, although there does not appear to be a correlation between thickness and pain[25]

Classification

  • Not applicable

Management

General

  • Indications
    • All cases
  • Explanation to patients
    • Explain to patients that pain will likely settle over time and manage expectations
  • Ice Therapy
    • Many clinicians recommend 'rolling' the arch with a frozen water bottle
  • Heat Therapy
    • Was superior to sham therapy for plantar fascia pain[26]
  • NSAIDS
  • Physical Therapy
    • First line choice and primary treatment modality
    • Calf-stretching exercises with eccentric loading may be the most important treatment[27]
    • Benefits from strengthening extrinsic and intrinsic foot muscles, strengthening abductor and lateral rotator hip muscles, and stretching[28]
    • Plantar fascia specific therapy is superior to EWST[29]
  • Foot Orthotic
    • Goals: decrease pronation, off-load the proximal insertion of the fascia
    • RCT comparing over-the-counter shoe inserts with customized shoe inserts found no difference in pain relief 12-month follow-up[30]
    • Can also consider Heel Cup
    • More effective when combined with night splint[31]
    • When compared to extra corporeal shock wave therapy, both groups improved with no differences between groups[32]
  • Nocturnal Splint (Tension Night Splint)
    • Goal: stretch the fascia to prevent morning stiffness and pain[33]
    • Multiple studies show benefit, but patients do not tolerate well and compliance can be problematic[34][35][36]

Therapeutic Modalities

  • Dry Cupping
    • Dry cupping on calf muscle myofascial trigger points combined with stretching was superior to stretching only[37]
    • No difference between dry cupping and electrical stimulation after 4 weeks of treatment[38]
  • Dry Needling (DN)
    • DN plus stretching was superior to stretching alone up to 6 weeks[39]
    • DN improved pain and plantar fascia thickness but had no effect on range of motion[40]
    • Adding electrical DN manual therapy, exercise and ultrasound was more effective manual therapy, exercise and ultrasound at 3 months[41]
    • DN was similar to corticosteroids early, but superior at 6 and 12 months[42]
    • Trigger point DN improved heel pain but not range of motion compared to controls[43]
    • Compared to sham injections, trigger point DN provided a non statistically significant improvement in symptoms with more adverse effects[44]
  • Extracorporeal Shock Wave Therapy (ESWT)
    • Meta-analysis suggests focused shock wave (FSW) can relieve pain but no firm conclusions of general ECSWT and radial shock wave (RSW)[45]
    • In an open label study, ESWT was superior to botulinum toxin in the control of pain in patients with PF.[46]
    • Patients improved with ESWT, however there was no difference between low, medium, or high levels of ESWT in terms of pain, foot functions, fascia thickness[47]
    • Similar improvements in symptoms between the control and ESWT groups[48]
    • High energy ESWT for high number of sessions is more effective than Low energy ESWT for low number of sessions on pain, quality of life, physical function, fatigue, and disability in patients with PF[49]
    • No difference when adding ESWT to usual care (exercise and orthotic support) when compared to usual care alone[50]
    • ESWT combined with dry needling was superior to ESWT alone at 1 month[51]
    • ESWT provided similar but longer lasting relief compared to corticosteroid injection[52]
    • When compared to custom foot orthotics, both groups improved with no differences between groups[32]
    • ESWT superior to corticosteroids for plantar fascia thickness, symptoms at 12 weeks[53]
    • ESWT combined with topical corticosteroids was superior to ESWT alone[54]
    • Compared to controls, ESWT was effective up to 2 years for chronic PF[55]
    • Using ultrasound did not improve outcomes with ESWT[56]
    • ESWT was superior to corticosteroid injections at 2 months, although both groups demonstrated improvement[57]
    • ESWT combined with orthopedic insole was superior to EWST alone[58]
    • ESWT was inferior to manual plantar fascia specific stretching[29]
  • Acupuncture
    • Patients who received electroacupuncture plus warm needling (EAWN) had improved VAS scores up to 8 weeks compared to controls[59]
    • Electroacupuncture (EA) and manual acupuncture (MA) both appear to provide relief with no differences up to 28 weeks[60]
    • Electro-acupuncture plus conventional treatments provided a success rate of 80%, which was more effective than conventional treatments alone[61]
    • Standard therapy + acupuncture was superior to standard therapy alone[62]
    • Patients improved with acupuncture to acupoint PC 7[63]
    • Acupuncture + Chinese herbs pyrogenic dressing was superior to acupuncture alone[64]
  • Low Dye Taping
  • Low Level Laser Therapy
  • Neuromuscular Electrical Stimulation
  • Radiofrequency Radiation/ Therapy
  • Therapeutic Ultrasound (TUS)
    • TUS was superior to extracorporeal shock wave therapy for improvement in foot function index[65]
  • Radiation Therapy
    • Thought to have anti-inflammatory effects that reduce inflammatory mediators and pain
    • Small risk of carcinogenesis
    • Superior to corticosteroid injections for pain relief at 3 and 6 months[66]
  • Iontophoresis
    • Iontophoresis with 5% acetic acid was superior to dexamethasone or saline when combined with LowDye taping and home exercises[67]
  • Mini Scalpel Needle
    • Was similar to corticosteroid injection at 1 month and superior at 6 and 12 months[68]

Injections

  • Corticosteroid Injection
    • Cochrane review shows low quality evidence of benefits for 1 month, but none after[69]
    • Risks: heel pad atrophy, plantar fascia rupture
    • Consider alternative treatment options
    • Strongly consider use of ultrasound to avoid risks
    • 20 mg of methylprednisolone was similar 40 mg at 3 weeks following injection[70]
    • Use of ultrasound guided injection improves outcomes compared to palpation guided injections[71]
    • There was no benefit to corticosteroid injections when added to standard management compared to standard management alone[72]
    • A single dose of dexamethasone provided pain relief up to 4 weeks, but not any longer past that[73]
    • Steroid injection, with or without ultrasound, showed benefit at 6 and 12 weeks[74]
  • Dextrose Prolotherapy (DXP)
    • Inferior to corticosteroid injection early, no differences between groups at 12 weeks[75]
    • Similar benefits when compared to extracorporeal shockwave therapy at 3 months[76]
    • Compared to control group, the DXP group did significant better at 7 and 15 weeks[77]
    • Adding 5% DXP to standard corticosteroid injection decreased VAS symptoms[78]
    • Platelet Rich Plasma was superior at 2 weeks however there was no difference at 2 and 6 months follow up[79]
  • NSAID Injections
    • Both Tenoxicam and corticosteroids provided relief at 6 and 12 months with no difference between groups[80]
  • Ozone Injection
  • Autologous Blood Injection
    • One small prospective study of 35 patients showed some benefit[81]
  • Botulinum Toxin
    • A small RCT showed statistically significant changes in the treatment group[82]
    • Study by Ahadi et al showed similar outcomes when compared to CSI, however the botulinum toxin group had longer lasting relief[83]
    • Another study comparing Botulinum Toxin A, Corticosteroid, and Anesthetic Injection for Plantar Fasciitis found relief up to 6 months with no difference between groups[84]
    • Injection into the medial gastroc provided relief for PF up to 1 year[85]
    • Compared to saline control, patients who received botulinum toxin had better relief up to 6 months[86]
    • Botulin toxin plus stretching was superior to corticosteroids plus stretching[87]
    • A small study found botulinum toxin superior to corticosteroids up to 6 months[88]
    • Compared to placebo, ultrasound guided botulinum toxin injections were superior up to 3 months[89]
    • A small RCT found botulinum toxin was superior to placebo up to 8 weeks[90]
  • Platelet Rich Plasma
    • A systematic review and meta-analysis found benefit at 3 months compared to placebo[91]
  • Allogeneic Growth Factors
    • A small study showed superiority to control saline injections at 3 months follow up[92]
    • Platelet Rich Plasma was superior at 2 weeks however there was no difference at 2 and 6 months follow up[79]
  • Cryopreserved Human Amniotic Membrane (c-hAM)
    • A very small study showed similar outcomes compared to corticosteroid, limited by a small N[93]
    • Improved outcomes compared to placebo injection at 3 months follow up[94]
    • Improved compared to placebo, no difference between 0.5 cc and 1.25 cc dose[95]
  • Hyaluronic Acid (HA)
    • Although HA showed early benefit, it was inferior to corticosteroids at 6 weeks with no difference between groups at 24 weeks[96]
    • High Molecular weight HA was superior to low molecular weight HA[97]
  • Tibial Nerve Block
    • Inferior to corticosteroid for symptom relief, may provide benefit in combination[98]
  • Polydeoxyribonucleotide Injection (PDRN)
    • Corticosteroid injection was superior at 2 and 6 weeks however this was no difference between groups at 6 months[99]
    • Compared to placebo, PDRN was superior at 12 weeks for VAS and MOXFQ scores[100]

Operative

  • Indications
    • Failure of at least 12 months of conservative therapy
  • Technique
    • Medial open release of approximately the medial third of the fascia (fasciotomy)
    • Release of the first branch of the lateral plantar nerve (nerve decompression)
    • Isolated proximal medial gastrocnemius release
    • Ultrasound guided EPF release
    • Endoscopic plantar fascial release
    • Open plantar fascial release

Rehab and Return to Play

Rehabilitation

  • Typical postoperative course
    • 3 weeks of immobilization
    • Followed by 3 weeks of partial weight bearing

Return to Play/Work

  • General
    • Typically gradual with emphasis on avoiding training through pain
    • Often cross training with non-impact activities

Complications & Prognosis

Prognosis

  • Nonoperative management
    • Approximately 95% of patients will be pain free at 12 months without surgery[101]
  • Comparing surgical technique
    • Monteagudo et al found more patients improved with complete gastrocnemius release (95%) than those who had partial plantar fasciotomy (60%)[102]

Complications

  • Surgical
    • Infection
    • Nerve injury
    • Plantar fascia rupture

See Also

Internal

External

References

  1. ↑ 1.0 1.1 Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int 2004;25:303–310.
  2. ↑ Neufeld, SK, Cerrato, R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg 2008;16(6):338–346.
  3. ↑ Crawford F, Thompson CE. Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2003;3:CD000416.
  4. ↑ 4.0 4.1 Zhang, J, Nie, D, Rocha, JL, Hogan, MV, Wang, JH-C. Characterization of the structure, cells, and cellular mechanobiological response of human plantar fascia. J Tissue Eng. 2018;9:2041731418801103.
  5. ↑ Riddle, DL, Pulisic, M, Pidcoe, P, Johnson, RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85(5):872–877.
  6. ↑ Tong KB, Furia J. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop (Belle Mead NJ). 2010;39(5):227–231.
  7. ↑ 7.0 7.1 Beeson P. Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg 2014;20:160–165
  8. ↑ Frey C, Zamora J. The effects of obesity on orthopaedic foot and ankle pathology. Foot Ankle Int 2007;28:996–999.
  9. ↑ Van Leeuwen KD, Rogers J, Winzenberg T, van Middelkoop M. Higher body mass index is associated with plantar fasciopathy/‘plantar fasciitis’: systematic review and meta-analysis of various clinical and imaging risk factors. Br J Sports Med 2016;50:972–981.
  10. ↑ Ahmad J, Karim A, Daniel JN. Relationship and classification of plantar heel spurs in patients with plantar fasciitis. Foot Ankle Int 2016;37:994–1000.
  11. ↑ Ferkel E, Davis WH, Ellington JK. Entrapment neurophaties of the foot and ankle. Clin Sports Med 2015;34:791–801.
  12. ↑ Sobhani S, Dekker R, Postema K, Dijkstra PU. Epidemiology of ankle and foot overuse injuries in sports: a systematic review. Scand J Med Sci Sports 2013;23:669–686
  13. ↑ Noon M, Hoch AZ, McNamara L, Schimke J. Injury patterns in female Irish dancers. PM R 2010;2:1030–1034.
  14. ↑ Scher DL, Belmont PJ, Jr, Bear R, et al. The incidence of plantar fasciitis in the United States military. J Bone Joint Surg Am 2009;91:2867–2872
  15. ↑ Amis J. The gastrocnemius: a new paradigm for the human foot and ankle. Foot Ankle Clin N Am 2014;19:637–647.
  16. ↑ Kitaoka HB, Luo ZP, An KN. Mechanical ulticent of the foot and ankle after plantar fascia release in the unstable foot. Foot Ankle Int 1997;18:1–15.
  17. ↑ Patel A, DiGiovanni B. Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot Ankle Int 2011;32:5–8.
  18. ↑ Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 suppl):S1–S19.
  19. ↑ Solan MC, Carne A, Davies MS. Gastrocnemius shortening and heel pain. Foot Ankle Clin 2014;19:719–738.
  20. ↑ Wu CH, Chen WS, Wang TG. Plantar fascia softening in plantar fasciitis with normal B-mode sonography. Skeletal Radiol. 2015 Nov;44(11):1603-7. doi: 10.1007/s00256-015-2215-4. Epub 2015 Jul 16. PMID: 26173419.
  21. ↑ Draghi F, Gitto S, Bortolotto C, et al. Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights Imaging. 2017;8(1):69–78.
  22. ↑ 22.0 22.1 Mahowald, S, Legge, BS, Grady, JF. The correlation between plantar fascia thickness and symptoms of plantar fasciitis. J Am Podiatr Med Assoc. 2011;101(5):385–389.
  23. ↑ Kane, D, Greaney, T, Shanahan, M, et al. The role of ultrasonography in the diagnosis and management of idiopathic plantar fasciitis. Rheumatology (Oxford). 2001;40(9):1002–1008.
  24. ↑ amba, C, Sala-Pujals, A, Perez-Prieto, D, et al. Relationship of plantar fascia thickness and preoperative pain, function, and quality of life in recalcitrant plantar fasciitis. Foot Ankle Int. 2018;39(8):930–934.
  25. ↑ Toomey EP. Plantar heel pain. Foot Ankle Clin 2009;14:229–245.
  26. ↑ Petrofsky, Jerrold, Michael Laymon, and Haneul Lee. "Local heating of trigger points reduces neck and plantar fascia pain." Journal of back and musculoskeletal rehabilitation 33.1 (2020): 21-28.
  27. ↑ . DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain: a prospective, randomized study. J Bone Joint Surg Am 2003;85:1270–1277.
  28. ↑ Cheung RT, Sze LK, Mok MW, Ng GY. Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis. J Sci Med Sport 2016;19:713–715.
  29. ↑ 29.0 29.1 Rompe, Jan D., et al. "Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy." JBJS 92.15 (2010): 2514-2522.
  30. ↑ Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med 2006;166:1305–1310.
  31. ↑ Lee WC, Wong WY, Kung E, Leung AK. Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis. J Rehabil Res Dev. 2012;49(10):1557–1564.
  32. ↑ 32.0 32.1 Okur, Sibel Çağlar, and Abdulkadir Aydın. "Comparison of extracorporeal shock wave therapy with custom foot orthotics in plantar fasciitis treatment: A prospective randomized one-year follow-up study." Journal of Musculoskeletal & Neuronal Interactions 19.2 (2019): 178.
  33. ↑ Roos E, Engstrom M, Soderberg B. Foot orthoses for the treatment of plantar fasciitis. Foot Ankle Int 2006;27:606–611.
  34. ↑ Batt ME, Tanji SL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin J Sport Med 1996;6:158–162.
  35. ↑ Powell M, Post WR, Keener J, et al. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot Ankle Int 1998;19:10–18.
  36. ↑ Probe RA, Baca M, Adams R, Preece C. Night splint treatment for plantar fasciitis: a prospective randomized study. Clin Orthop Relat Res 1999;368:190–195.
  37. ↑ AlKhadhrawi, Nazar, and Ali Alshami. "Effects of myofascial trigger point dry cupping on pain and function in patients with plantar heel pain: A randomized controlled trial." Journal of bodywork and movement therapies 23.3 (2019): 532-538.
  38. ↑ Ge, Weiqing, Chelsea Leson, and Corey Vukovic. "Dry cupping for plantar fasciitis: a randomized controlled trial." Journal of physical therapy science 29.5 (2017): 859-862.
  39. ↑ Salehi, Saman, et al. "Effects of dry needling and stretching exercise versus stretching exercise only on pain intensity, function, and sonographic characteristics of plantar fascia in the subjects with plantar fasciitis: a parallel single-blinded randomized controlled trial." Physiotherapy Theory and Practice (2022): 1-14.
  40. ↑ Saein, Afsaneh Moosaei, et al. "The effect of dry needling on pain, range of motion of ankle joint, and ultrasonographic changes of plantar fascia in patients with plantar fasciitis." Journal of Sport Rehabilitation 31.3 (2021): 299-304.
  41. ↑ Dunning, James, et al. "Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial." PLoS One 13.10 (2018): e0205405.
  42. ↑ Rastegar, Shirvan, et al. "Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: a single-blind randomized clinical trial." International orthopaedics 42 (2018): 109-116.
  43. ↑ Eftekharsadat, Bina, Arash Babaei-Ghazani, and Vahideh Zeinolabedinzadeh. "Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial." Medical journal of the Islamic Republic of Iran 30 (2016): 401.
  44. ↑ Cotchett, Matthew P., Shannon E. Munteanu, and Karl B. Landorf. "Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial." Physical therapy 94.8 (2014): 1083-1094.
  45. ↑ Sun, Jiale, et al. "Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: A meta-analysis of RCTs." Medicine 96.15 (2017).
  46. ↑ Roca, Bernardino, María A. Mendoza, and Manuel Roca. "Comparison of extracorporeal shock wave therapy with botulinum toxin type A in the treatment of plantar fasciitis." Disability and rehabilitation 38.21 (2016): 2114-2121.
  47. ↑ Güzel, Şükran, et al. "Comparison of plantar pressure distribution, ultrasonographic and clinical features following the application of different energy levels of extracorporeal shock wave therapy in patients with plantar fasciitis: A randomized, prospective, double-blind clinical trial." Journal of the American Podiatric Medical Association 1.aop (2022): 1-26.
  48. ↑ Tognolo, Lucrezia, et al. "Myofascial points treatment with focused extracorporeal shock wave therapy (f-ESWT) for plantar fasciitis: an open label randomized clinical trial." Eur J Phys Rehabil Med 58.1 (2022): 85-93.
  49. ↑ Gezginaslan, Ömer, and Gökhan Başar. "Comparison of effectiveness of density and number of sessions of extracorporeal shock wave therapy in plantar fasciitis patients: A double-blind, randomized-controlled study." The Journal of Foot and Ankle Surgery 60.2 (2021): 262-268.
  50. ↑ Cinar, Eda, et al. "Extracorporeal shockwave therapy in the management of plantar fasciitis: A randomized controlled trial." The Foot 44 (2020): 101679.
  51. ↑ Bagcier, Fatih, and Nurdan Yilmaz. "The impact of extracorporeal shock wave therapy and dry needling combination on pain and functionality in the patients diagnosed with plantar fasciitis." The Journal of Foot and Ankle Surgery 59.4 (2020): 689-693.
  52. ↑ Xu, Dingli, et al. "Comparison between extracorporeal shock wave therapy and local corticosteroid injection for plantar fasciitis." Foot & ankle international 41.2 (2020): 200-205.
  53. ↑ Lai, Ta-Wei, et al. "Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial." Journal of musculoskeletal & neuronal interactions 18.1 (2018): 47.
  54. ↑ Vahdatpour, Babak, et al. "Enhancement of the effectiveness of extracorporeal shock wave therapy with topical corticosteroid in treatment of chronic plantar fasciitis: a randomized control clinical trial." Advanced biomedical research 7 (2018).
  55. ↑ Ibrahim, Mahmoud I., et al. "Long‐term results of radial extracorporeal shock wave treatment for chronic plantar fasciopathy: A prospective, randomized, placebo‐controlled trial with two years follow‐up." Journal of Orthopaedic Research 35.7 (2017): 1532-1538.
  56. ↑ Njawaya, Masiiwa M., et al. "Ultrasound guidance does not improve the results of shock wave for plantar fasciitis or calcific achilles tendinopathy: a randomized control trial." Clinical Journal of Sport Medicine 28.1 (2018): 21-27.
  57. ↑ Eslamian, Fariba, et al. "Extra corporeal shock wave therapy versus local corticosteroid injection in the treatment of chronic plantar fasciitis, a single blinded randomized clinical trial." Pain Medicine 17.9 (2016): 1722-1731.
  58. ↑ Yan, Wenguang, Shaodan Sun, and Xuhong Li. "Therapeutic effect of extracorporeal shock wave combined with orthopaedic insole on plantar fasciitis." Zhong nan da xue xue bao. Yi xue ban= Journal of Central South University. Medical Sciences 39.12 (2014): 1326-1330.
  59. ↑ Ho, Lai Fun, et al. "Efficacy of electroacupuncture plus warm needling therapy for plantar heel pain: a randomised waitlist-controlled trial." Acupuncture in Medicine 39.4 (2021): 283-291.
  60. ↑ Wang, Weiming, et al. "Comparison of electroacupuncture and manual acupuncture for patients with plantar heel pain syndrome: a randomized controlled trial." Acupuncture in Medicine 39.4 (2021): 272-282.
  61. ↑ Kumnerddee, Wipoo, and Nitsara Pattapong. "Efficacy of electro-acupuncture in chronic plantar fasciitis: a randomized controlled trial." The American Journal of Chinese Medicine 40.06 (2012): 1167-1176.
  62. ↑ Karagounis, Panagiotis, et al. "Treatment of plantar fasciitis in recreational athletes: two different therapeutic protocols." Foot & ankle specialist 4.4 (2011): 226-234.
  63. ↑ Zhang, Shi Ping, Tsui-Pik Yip, and Qiu-Shi Li. "Acupuncture treatment for plantar fasciitis: a randomized controlled trial with six months follow-up." Evidence-Based Complementary and Alternative Medicine 2011 (2011).
  64. ↑ Liu, M. Y., et al. "Observation on therapeutic effect of acupuncture at Xuanzhong (GB 39) combined with Chinese herbs pyrogenic dressing therapy for treatment of calcaneus spur." Zhongguo Zhen jiu= Chinese Acupuncture & Moxibustion 30.3 (2010): 189-191.
  65. ↑ Akinoğlu, Bihter, et al. "Comparison of the acute effect of radial shock wave therapy and ultrasound therapy in the treatment of plantar fasciitis: a randomized controlled study." Pain Medicine 18.12 (2017): 2443-2452.
  66. ↑ Canyilmaz E, Canyilmaz F, Aynaci O, et al. Prospective randomized comparison of the effectiveness of radiation therapy and local steroid injection for the treatment of plantar fasciitis. Int J Radiat Oncol Biol Phys. 2015;92(3):659–666.
  67. ↑ Osborne, Hamish R., and Garry T. Allison. "Treatment of plantar fasciitis by LowDye taping and iontophoresis: short term results of a double blinded, randomised, placebo controlled clinical trial of dexamethasone and acetic acid." British journal of sports medicine 40.6 (2006): 545-549.
  68. ↑ Li, Shuming, et al. "Miniscalpel-needle versus steroid injection for plantar fasciitis: a randomized controlled trial with a 12-month follow-up." Evidence-Based Complementary and Alternative Medicine 2014 (2014).
  69. ↑ David JA, Sankarapandian V, Christopher PR, Chatterjee A, Macaden AS. Injected corticosteroids for treating plantar heel pain in adults. Cochrane Database Syst Rev 2017;11:CD009348
  70. ↑ Ahmadzadeh Heshmati, Afshin, and Shahab Ilka. "Effect of dose of the corticosteroid injected locally on inflammatory diseases." Current Orthopaedic Practice 30.2 (2019): 160-163.
  71. ↑ Chen, Chien-Min, et al. "Effectiveness of device-assisted ultrasound-guided steroid injection for treating plantar fasciitis." American Journal of Physical Medicine & Rehabilitation 92.7 (2013): 597-605.
  72. ↑ Abdihakin, Mohamed, et al. "A randomised controlled trial of steroid injection in the management of plantar fasciitis." SA Orthopaedic Journal 11.4 (2012): 33-38.
  73. ↑ McMillan, Andrew M., et al. "Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial." BMj 344 (2012).
  74. ↑ Ball, Elisabeth MA, et al. "Steroid injection for inferior heel pain: a randomised controlled trial." Annals of the rheumatic diseases 72.6 (2013): 996-1002.
  75. ↑ Raissi, Gholamreza, et al. "Ultrasound-guided injection of dextrose versus corticosteroid in chronic plantar fasciitis management: a randomized, double-blind clinical trial." Foot & Ankle Specialist (2021): 1938640020980924.
  76. ↑ Asheghan, Mahsa, et al. "Dextrose prolotherapy versus radial extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: A randomized, controlled clinical trial." Foot and Ankle Surgery 27.6 (2021): 643-649.
  77. ↑ Mansiz-Kaplan, Basak, et al. "Effect of dextrose prolotherapy on pain intensity, disability, and plantar fascia thickness in unilateral plantar fasciitis: a randomized, controlled, double-blind study." American Journal of Physical Medicine & Rehabilitation 99.4 (2020): 318-324.
  78. ↑ Moshrif, A., and M. Elwan. "The Effect of Addition of Buffered Dextrose 5% Solution on Pain Occurring During Local Steroid Injection for Treatment of Plantar Fasciitis: A Randomized Controlled Trial." Muscles, Ligaments & Tendons Journal (MLTJ) 9.4 (2019).
  79. ↑ 79.0 79.1 Kim, Eunkuk, and Jong Ha Lee. "Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis." Pm&r 6.2 (2014): 152-158.
  80. ↑ Guner S, Onder H, Guner SI, et al. Effectiveness of local tenoxicam versus corticosteroid injection for plantar fasciitis treatment. Orthopedics 2013; 36: e1322–e1326.
  81. ↑ Wheeler, Patrick. "Autologous blood injections for chronic plantar fasciitis–a pilot case-series study shows promising results." International Musculoskeletal Medicine 35.1 (2013): 3-7.
  82. ↑ Babcock MS, Foster L, Pasquina P, Jabbari B. Treatment of pain attributed to plantar fasciitis with botulinum toxin A: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil 2005;84:649–654
  83. ↑ Ahadi, Tannaz, et al. "Comparison of the effect of ultrasound-guided injection of Botulinum toxin type A and corticosteroid in the treatment of chronic plantar fasciitis: A randomized controlled trial." American Journal of Physical Medicine & Rehabilitation 101.8 (2022): 733-737.
  84. ↑ Elizondo-Rodríguez, Jorge, et al. "Comparison of botulinum toxin A, corticosteroid, and anesthetic injection for plantar fasciitis." Foot & Ankle International 42.3 (2021): 305-313.
  85. ↑ Abbasian, Mohammadreza, et al. "Outcomes of ultrasound-guided gastrocnemius injection with botulinum toxin for chronic plantar fasciitis." Foot & ankle international 41.1 (2020): 63-68.
  86. ↑ Ahmad, Jamal, Stacy H. Ahmad, and Kennis Jones. "Treatment of plantar fasciitis with botulinum toxin: a randomized, controlled study." Foot & Ankle International 38.1 (2017): 1-7.
  87. ↑ Elizondo-Rodriguez, Jorge, et al. "A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study." Foot & ankle international 34.1 (2013): 8-14.
  88. ↑ Díaz-Llopis, Ismael V., et al. "Randomized controlled study of the efficacy of the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months." Clinical rehabilitation 26.7 (2012): 594-606.
  89. ↑ Huang, Yung-Cheng, et al. "Ultrasonographic guided botulinum toxin type A treatment for plantar fasciitis: an outcome-based investigation for treating pain and gait changes." Journal of rehabilitation medicine 42.2 (2010): 136-140.
  90. ↑ Babcock, Mary S., et al. "Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study." American journal of physical medicine & rehabilitation 84.9 (2005): 649-654.
  91. ↑ Singh, Prashant, et al. "A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy." International orthopaedics 41.6 (2017): 1169-1181.
  92. ↑ Kandil, Mahmoud Ibrahim, Eslam Abdelshafi Tabl, and Adel Samy Elhammady. "Prospective randomized evaluation of local injection of allogeneic growth factors in plantar fasciitis." Foot & Ankle International 41.11 (2020): 1335-1341.
  93. ↑ Hanselman, Andrew E., John E. Tidwell, and Robert D. Santrock. "Cryopreserved human amniotic membrane injection for plantar fasciitis: a randomized, controlled, double-blind pilot study." Foot & ankle international 36.2 (2015): 151-158.
  94. ↑ Cazzell, Shawn, et al. "Randomized controlled trial of micronized dehydrated human amnion/chorion membrane (dHACM) injection compared to placebo for the treatment of plantar fasciitis." Foot & Ankle International 39.10 (2018): 1151-1161.
  95. ↑ Zelen, Charles M., Attila Poka, and James Andrews. "Prospective, randomized, blinded, comparative study of injectable micronized dehydrated amniotic/chorionic membrane allograft for plantar fasciitis—a feasibility study." Foot & ankle international 34.10 (2013): 1332-1339.
  96. ↑ Raeissadat, Seyed Ahmad, et al. "Ultrasound-guided injection of high molecular weight hyaluronic acid versus corticosteroid in management of plantar fasciitis: A 24-week randomized clinical trial." Journal of Pain Research (2020): 109-121.
  97. ↑ Kumai, Tsukasa, et al. "Short-term efficacy and safety of hyaluronic acid injection for plantar fasciopathy." Knee Surgery, Sports Traumatology, Arthroscopy 26 (2018): 903-911.
  98. ↑ Mulherin, D., and M. Price. "Efficacy of tibial nerve block, local steroid injection or both in the treatment of plantar heel pain syndrome." The Foot 19.2 (2009): 98-100.
  99. ↑ Lee, Dong-Oh, et al. "Comparing effectiveness of polydeoxyribonucleotide injection and corticosteroid injection in plantar fasciitis treatment: A prospective randomized clinical study." Foot and Ankle Surgery 26.6 (2020): 657-661.
  100. ↑ Kim, Jae Kwang, and Jae Yoon Chung. "Effectiveness of polydeoxyribonucleotide injection versus normal saline injection for treatment of chronic plantar fasciitis: a prospective randomised clinical trial." International Orthopaedics 39 (2015): 1329-1334.
  101. ↑ Davies MS, Weiss GA, Saxby TS. Plantar fasciitis: how successful is surgical intervention? Foot Ankle Int 1999;20:803–807
  102. ↑ Monteagudo M, Maceira E, Garcia-Virto V, Canosa R. Chronic plantar fasciitis: plantar fasciotomy versus gastrocnemius recession. Int Orthop. 2013;37(9):1845–1850.
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