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Médecine et chirurgie du pied

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What are the different medical treatment methods for plantar fasciitis? Volume 29, issue 3, Septembre 2013

Authors

Introduction

Plantar fasciitis is an inflammation of the plantar fascia that starts from the calcaneum and stretches all the way to the base of the first row of the phalanges of the foot. This condition often results in debilitating heel pain.

Aim of the study

To show the different medical treatment options available for plantar fasciitis and establish a treatment decision algorithm.

Equipment and methods

Patients included in this study had a physical medicine and rehabilitation appointment in 2012 for heel pain associated with plantar fasciitis. Patients were excluded if they presented with heel pain associated with diabetic foot, a stress fracture or an inflammatory rheumatoid condition.

Results

Thirty patients were included in this study: 25 women and 5 men. The average age was 47.95 years. Obesity was present in 11 cases. A lateral x-ray of the ankle was requested in all cases, which revealed a calcaneal spur in 28 cases. An ultrasound of the ankle was requested in a single case, which revealed indicative signs of plantar fasciitis. Excessive weight bearing to the heel was present in all cases, combined with flat feet in 19 cases; excessive weight bearing to the ball of the foot was seen in 4 cases and high arches in 3 cases. The following treatments were proposed: infiltration anaesthesia of the heel in 5 cases, mesotherapy in 1 case and shockwave therapy in 20 cases which received treatment before the appointment; however, no improvement was seen. Stretching exercises for the Achilles tendon and plantar fascia region were proposed in 26 cases. Arch support orthotics were prescribed in all cases. In 25 cases, favourable progress was seen. A second-line treatment was proposed in the remaining 5 cases; this was a second dose of shockwave treatment in 4 cases and a first dose in one case. Progress was favourable in all cases, except for two patients who were both obese and were not compatible with other means of treatment proposed.

Discussion

The symptom that is practically constant in plantar fasciitis is heel pain. It is felt most when weight bearing, in the morning or following a period of prolonged sitting. Some authors recommend plantar ultrasonography rather than standard x-ray imaging, as the presence of a calcaneal spur neither confirms nor denies the presence of plantar fasciitis. A podiatric examination is invaluable in order to correct a potential issue when standing. There are many treatment methods available, with no standard consensus on which one is best. Our study showed the range of possible treatment options available and the fact they were combined in many cases. If a therapy fails, a second-line treatment may be proposed. Progress in our series of studies was favourable in all cases.

Conclusion

Plantar fasciitis is a debilitating condition that has many treatment options available to manage it. Treatment will not be effective without the combination of losing weight if the patient is overweight, the correction of potential problems when standing, specific stretching exercises and a good lifestyle.