The Value of Using Local Steroid Injection Vs. Stretching Exercises in Treatment of Plantar Fasciopathy
Downloads
Objective: to evaluate two methods of treatments; stretching exercises vs. local steroid injection in treatment of plantar fasciopathy. Patients and method: a prospective randomized study of 40 patients complaining from plantar fasciopathy during the period from march 2019 to march 2021.follow up of patient extended for four months after initiation of the treatment, pain was evaluated using VAS(Visual Analogue Score) and P value; which was significant if it is < 0.05. Results: mean visual analogue scale for steroid injection group(Group S) and stretching exercises ( Group E) was 6.42 and 6.32 respectively (p value>0.05)at the initiation of the treatment .Mean VAS was 2.25 for Group S and 3.87 for Group E at 4 weeks (p value< 0.05).At 8 weeks mean VAS was 2.63 for Group S and 3.38 for Group E(p value >0.05). Mean VAS was 3.5 and 2.25 for Group S and Group E at 12 weeks after initiation of treatment( p value< 0.05).Lastly results in this study at 16 weeks showed significant value for Group E with mean VAS of 3 and mean VAS of 4.5 for Group S ( p value <0.05). Conclusion: A conservative protocol of plantar fascia and Achilles tendon stretching exercises, in conjunction with NSAID administration, constitutes a simple, effective, and non-invasive initial treatment for plantar fasciosis. This approach provides a favorable risk-benefit profile by circumventing the potential complications of local steroid injection.
[1] E. N. Schwartz and J. Su, “Plantar fasciitis: A concise review,” The Permanente Journal, vol. 18, pp. 105–107, 2014.
[2] M. Alanazi, R. Khan, A. Muqri, Z. Alnosaier, et al., “Plantar fasciitis in primary care: A review,” International Journal of Medicine in Developing Countries, vol. 6, no. 7, pp. 1002–1005, 2022.
[3] L. Luffy, J. Grosel, R. Thomas, and S. O., “Plantar fasciitis: A review of treatments,” Journal of the American Academy of Physician Assistants, vol. 31, pp. 20–24, 2018.
[4] D. L. Riddle and S. M. Schappert, “Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: A national study of medical doctors,” Foot & Ankle International, vol. 25, pp. 303–310, 2004.
[5] R. Buchbinder, “Plantar fasciitis,” The New England Journal of Medicine, vol. 350, pp. 2159–2166, 2004.
[6] D. Singh, J. Angel, G. Bentley, and S. Trevino, “Fortnightly review: Plantar fasciitis,” BMJ, vol. 315, pp. 172–175, 1997.
[7] D. L. Scher, P. J. Belmont, Jr., R. Bear, et al., “The incidence of plantar fasciitis in the United States military,” The Journal of Bone and Joint Surgery, American Volume, vol. 91, pp. 2867–2872, 2009.
[8] H. Lemont, K. Ammirati, and N. Usen, “Plantar fasciitis: A degenerative process (fasciosis) without inflammation,” Journal of the American Podiatric Medical Association, vol. 39, pp. 234–237, 2003.
[9] M. Snider, W. Clancy, and A. McBeath, “Plantar fascia release for chronic plantar fasciitis in runners,” The American Journal of Sports Medicine, vol. 11, pp. 215–219, 1983.
[10] A. A. Tountas and V. L. Fornasier, “Operative treatment of subcalcaneal pain,” Clinical Orthopaedics and Related Research, vol. 332, pp. 170–178, 1996.
[11] O. Jarde, P. Diebold, E. Havet, G. Boulu, et al., “Degenerative lesions of the plantar fascia: Surgical treatment by fasciectomy and excision of the heel spur. A report on 38 cases,” Acta Orthopaedica [publication details to be verified].
[12] G. D. Goff and R. Crawford, “Diagnosis and treatment of plantar fasciitis,” American Family Physician, vol. 84, pp. 676–682, 2011.
[13] R. L. Martin, T. E. Davenport, S. F. Reischl, T. G. McPoil, et al., “Heel pain—plantar fasciitis: Revision 2014,” Journal of Orthopaedic & Sports Physical Therapy, vol. 44, pp. A1–A33, 2014.
[14] M. Akfirat, C. Sen, and T. Gunes, “Ultrasonographic appearance of plantar fasciitis,” Clinical Imaging, vol. 27, pp. 353–357, 2003.
[15] B. Dasgupta and J. Bowles, “Scintigraphic localisation of steroid injection site in plantar fasciitis,” The Lancet, vol. 346, pp. 1400–1401, 1995.
[16] A. Evans, “Podiatric medical applications of posterior night stretch splinting,” Journal of the American Podiatric Medical Association, vol. 91, pp. 356–360, 2001.
[17] D. S. Hammer, F. Adam, A. Kreutz, et al., “Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy,” Archives of Orthopaedic and Trauma Surgery, vol. 125, pp. 6–9, 2005.
[18] Y. Z. Tatli and S. Kapasi, “The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies,” Current Reviews in Musculoskeletal Medicine, vol. 2, 2009. [Volume, issue, and page details to be verified.]
[19] J. C. Kennedy and R. B. Willis, “The effect of local steroid injections on tendons: A biomechanical and microscopic correlative study,” The American Journal of Sports Medicine, vol. 4, no. 1, pp. 11–21, 1976.
[20] M. Wolgin, C. Cook, C. Graham, and Mauldin [initials to be verified], “Conservative treatment of plantar heel pain: A long-term follow-up,” Foot & Ankle International, vol. 15, no. 3, pp. 97–102, 1994.
[21] A. A. Schepsis, R. E. Leach, and J. Gorzyca, “Plantar fasciitis: Etiology, treatment, surgical results, and review of the literature,” Clinical Orthopaedics and Related Research, vol. 266, pp. 185–196, 1991.
[22] L. H. Gill, “Plantar fasciitis: Diagnosis and conservative management,” Journal of the American Academy of Orthopaedic Surgeons, vol. 5, no. 2, pp. 109–117, 1997.
[23] B. F. DiGiovanni, D. A. Nawoczenski, D. P. Malay, et al., “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, vol. 88, p. 1775, 2006. [Page range to be verified.]
[24] D. Celik, G. Kus, and S. O. Sirma, “Joint mobilization and stretching exercise vs. steroid injection in the treatment of plantar fasciitis: A randomized controlled study,” Foot & Ankle International, vol. 37, pp. 150–156, 2016.
[25] C. Frater, V. Vud, H. Van der Wall, C. Perera, et al., “Bone scintigraphy predicts outcome of steroid injection for plantar fasciitis,” Journal of Nuclear Medicine, vol. 47, pp. 1577–1580, 2006. [Author names to be verified.]
[26] F. Crawford and C. Thomson, “Interventions for treating plantar heel pain,” Cochrane Database of Systematic Reviews, no. 3, Art. no. CD000416, 2003.
[27] H. S. Lee, Y. R. Choi, S. W. Kim, J. Y. Lee, et al., “Risk factors affecting chronic rupture of the plantar fascia,” Foot & Ankle International, vol. 35, no. 3, pp. 258–263, 2014.
[28] J. I. Acevedo and J. L. Beskin, “Complications of plantar fascia rupture associated with corticosteroid injection,” Foot & Ankle International, vol. 19, no. 2, pp. 91–97, 1998.
[29] J. R. Sellman, “Plantar fascia rupture associated with corticosteroid injection,” Foot & Ankle International, vol. 15, no. 7, pp. 376–381, 1994.
