Fascitis plantar: análisis de opciones terapéuticas / Plantar fasciitis. Analysis of therapeutic options

El objetivo de este artículo es analizar las distintas opciones de tratamiento. Se realizó una encuesta virtual a diferentes traumatólogos especialistas en pierna y pie, sobre el tratamiento de la fascitis plantar. Los resultados fueron variados, lo que demuestra que no hay una respuesta concreta ante el tratamiento crónico. Conclusiones: La fascitis plantar es un cuadro doloroso frecuente. Su origen es desconocido, pero está relacionada con múltiples factores. Se han recomendado muchas modalidades terapéuticas, como fármacos, fisioterapia, ortesis y cirugía, pero no existe un estudio que analice la eficacia de cada una de ellas por separado ni que confirme categóricamente su utilidad. Nivel de Evidencia: V

This report aims to review the different treatment options for plantar fasciitis. We conducted a virtual survey of foot and ankle specialists in our country where we asked for their opinion on the treatment of plantar fasciitis. The results varied, which shows that there is no single response to chronic treatment. Conclusion: Plantar fasciitis is a frequent, painful condition. The origin is unknown, but the association with multiple factors is known. Many treatment modalities have been recommended, including drugs, physiotherapy, orthotic devices, and surgery, but no report analyzes the effectiveness of each of them separately or categorically confirms its benefits. Level of evidence: V

Um teste clínico randomizado comparando o fortalecimento de abdutores do quadril e terapia manual em pacientes com fascite plantar: um protocolo de estudo / A randomized clinical trial comparing hip abductors strengthening and manual therapy in patients with plantar fasciitis: a study protocol

| 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)

Modifiable Risk Factors of Plantar Fasciitis in Non-Athletic Patients and Proposal of a New Objective Assessment System - RKISP / Fatores de risco modificáveis para fasciíte plantar em pacientes não atletas e proposta de um novo sistema de avaliação objetiva - RKISP

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.

Correlação entre o tempo de aceleração plantar, o índice tornozelo braquial e os escores SVS-WIfI em pacientes com isquemia crônica ameaçadora do membro / Plantar acceleration time correlates with WIfI stages in both non-diabetic and diabetic patients with chronic limb threatening ischemia

RESUMO Introdução: A avaliação hemodinâmica dos membros pelo índice tornozelo-braquial (ITB) em pacientes diabéticos com isquemia crônica ameaçadora dos membros pode estar falsamente elevada devido à calcinose da camada média das artérias. Alternativas como medidas de pressão do dedo do pé, pressão transcutânea de oxigênio (TCPO2) ou pletismografia não estão disponíveis na maioria das unidades vasculares no mundo. Uma nova abordagem diagnóstica por meio da análise espectral do fluxo ao Doppler na artéria plantar lateral do pé mostrou correlação com o grau de isquemia do membro e os estágios de risco de amputação do sistema de classificação (SVS-WIfI). Objetivo: Determinar a acurácia do Tempo de Aceleração Plantar (TAP) em relação ao Índice Tornozelo-Braquial (ITB) e os estágios de risco de amputação do sistema de classificação SVS-WIfI em pacientes com isquemia crônica ameaçadora do membro (Chronic Limb Threatening Ischemia-CLTI). Métodos: Estudo transversal realizado na Unidade de Cirurgia Vascular do Hospital Universitário Risoleta Tolentino Neves, Brasil, entre junho de 2019 e março de 2020, incluindo pacientes maiores de 18 anos, portadores de CLTI. Os dados coletados nos prontuários foram: dados demográficos, comorbidades, ITB e mensuração do TAP. Os indivíduos foram categorizados em três graus com base no ITB (ITB <0,8; ITB <0,6; ITB <0,4) e dois graus com base no risco de amputação (1-muito baixo e baixo; 2- moderado e alto), de acordo com a Classificação SVS-WIfI. A correlação do ITB e do risco de amputação com o TAP foi feita por meio da correlação de Spearman. Sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia também foram calculados através das curvas ROC (Receiver Operator CharacCurves) Resultados: Cento e oitenta e quatro pacientes consecutivos (265 membros inferiores) foram encaminhados para exame de ultrassonografia vascular com Doppler do membro inferior. 141 pacientes (74 diabéticos e 67 não diabéticos), 198 membros inferiores (104 diabéticos e 94 não diabéticos) atenderam aos critérios e foram incluídos para análise. O TAP correlacionou-se significativamente com o ITB e o risco de amputação (P <0,001) em ambos os grupos. A acurácia do TAP para detectar ITB<0,8 foi de até 91% no grupo diabético e 85% no grupo não diabético. Da mesma forma, para o diagnóstico de ITB<0,6 em pacientes diabéticos, observamos uma acurácia de 79% e em não diabéticos essa acurácia foi de 85%. Para detectar um ITB inferior a 0,4, a acurácia atingiu 88% em pacientes diabéticos e 87% em não diabéticos. No grupo diabético e não diabético, a acurácia do PAT para detectar SVS de risco moderado e alto de amputação atingiu 77%. O TAP se correlacionou com precisão com o ITB e os escores SVS-WifI. Conclusões: O tempo de aceleração plantar demonstrou alta correlação com o ITB e os estágios de classificação de isquemia e risco de amputação do sistema de classificação SVS-WIfI com alta sensibilidade, especificidade e acurácia em pacientes com isquemia crônica com risco de membro.

ABSTRACT Introduction: Limb hemodynamic evaluation through ankle-brachial index (ABI) in diabetic patients with chronic limb threatening ischemia may be falsely elevated due to the calcinosis of the arteries media layer. Alternatives as toe pressure measurements, transcutaneous oxygen pressure (TCPO2) or plethysmography are not readily available in most of the vascular units in the world. A new diagnostic approach through Spectral Doppler analysis of the flow in the lateral plantar artery of the foot has shown correlation with the grade of the limb ischemia and amputation risk stages of the Wound, Ischemia, and foot Infection (WIfI) classification system and ABI. Objective: to determine the accuracy of Plantar Acceleration Time (TAP) compared to the Ankle-Brachial Index (ABI) and the amputation risk stages of the SVS-WIfI classification system in patients with chronic limb threatening ischemia (CLTI). Methods: a cross-sectional study at the Vascular Surgery Unit at the university Hospital Risoleta Tolentino Neves, in Brazil, between June 2019 and March 2020, included patients >18 years, with CLTI. Data collected from medical records were demographics, comorbidities, ABI and measurement of TAP. Individuals were categorized in three degrees based on their ABI (ABI < 0,8; ABI < 06; ABI <0,4) and two degrees based on their amputation risk (1-very low and low; 2- moderate and high), according to SVS-WIfI classification. The correlation of ABI and amputation risk with TAP was made through Spearman's correlation. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were also calculated using receiver operator characteristic (ROC) curves Results: A hundred eighty-four consecutive patients (265 lower limbs) were referred to the vascular imaging unit for an arterial lower limb vascular ultrasound examination. 141 patients (74 diabetic and 67 non-diabetic), 198 lower limbs (104 diabetic and 94 non-diabetic) met the criteria and were included for analysis. Plantar Acceleration Time correlated significantly with ABI and amputation risk (P < 0.001) in both groups. The accuracy of PAT to detect ABI<0.8 was up to 91% in diabetic group and 85% in non-diabetic group. Likewise, for diagnosing ABI <0.6 in diabetic patients, we observed an accuracy of 79% and in non-diabetics this accuracy was 85%. To detect an ABI lower than 0.4, the accuracy reached 88% in diabetic patients and 87% in non-diabetics. In the diabetic and non-diabetic group, the accuracy of PAT to detect moderate and high amputation risk WIfI SVS reached 77%. PAT accurately correlates with ABI and WIfI-SVS scores. Conclusions: Measurement of the Plantar Acceleration Time demonstrates high correlation with ABI and the Ischemia grading and amputation risk stages of the SVS-WIfI classification system with high sensitivity, specificity and accuracy in patients with chronic limb threatening ischemia.

Factores asociados con dolor severo en pacientes con fascitis plantar: Un análisis de relaciones / Factors associated with severe pain in patients with plantar fasciitis: An association analysis

Objetivo: Describir los factores asociados con niveles de dolor mas severo en una cohorte de pacientes con fascitis plantar. El objetivo secundario fue analizar cuales de estos factores estaban asociados con niveles mas altos de mejoria clinica luego del tratamiento conservador. Materiales y Métodos: Se evaluo a una cohorte prospectiva de pacientes con diagnostico de fascitis plantar. Cada participante completo una escala ordinal visual de dolor (del 1 al 10) para dolor del primer paso y dolor al final del dia y encuestas FFI-R (Foot Function Index-Revised). Tambien se realizo una evaluacion demografica. La dorsiflexion de la articulacion del tobillo, el rango de movilidad de la primera articulacion metatarsofalangica, la rigidez del gastrocnemio y el angulo popliteo tambien se evaluaron de manera estandar. Resultados: Se incluyo a 214 pacientes. El 64% eran hombres (118 pacientes), la media de la edad era de 49.67 anos (DE 13.16) y el indice de masa corporal promedio, de 28,53 (DE 5,18). En el analisis multivariado, se observo que el riesgo de un puntaje ≥8 en la escala de dolor aumento cuando el paciente refirio estar de pie por mas de 6 h (OR 1,17; p = 0,03; IC95% 1,02-1,35). El riesgo de un puntaje >8 fue mayor cuando el grado de dorsiflexion del tobillo fue <0° (OR 1,20; p = 0,03; IC95% 1,02-1,41). Conclusión: Nuestros hallazgos apoyan indirectamente la hipotesis de que la dorsiflexion limitada del tobillo juega un papel como factor de riesgo asociado a un puntaje ≥8 en la escala de dolor, en los casos de fascitis plantar. Nivel de Evidencia: IV

Objective: The main purpose of our study was to describe the factors associated with more severe pain levels in a cohort of patients with plantar fasciitis (PF). The secondary purpose of this study was to determine which of these factors were associated with higher levels of clinical improvement after conservative therapy. Materials and Methods: We conducted a prospective study in a cohort of patients with PF. Each participant completed an ordinal pain scale (1-10) for first-step pain and end-of-day pain, and Foot Function Index-Revised (FFI-R) surveys at enrollment. Also, patient demographics were evaluated. The ankle joint dorsiflexion, the range of motion (ROM) for the first metatarsophalangeal joint (MTPJ), the gastrocnemius tightness, and the popliteal angle were evaluated through standard tests. Results: Our study included 214 participants, of which 64% (118 patients) were males, the average age was 49.67 years (SD 13.16) and the average BMI was 28.53 (SD 5.18). The multivariate analysis showed that the risk of having a Visual Analog Scale (VAS) score ≥8 increased when the patient reported standing for more than 6 hours (OR=1.17; P=0.03; CI95%: 1.02-1.359). The risk of a >8-VAS score was higher when the level of ankle dorsiflexion was <0 (OR=1.20; P=0.03; CI95%: 1.02-1.41). Conclusion: Our findings indirectly support the hypothesis that limited ankle dorsiflexion ROM plays a role as a risk factor associated with VAS scores ≥8 in PF patients. Level of Evidence: IV

Fascitis plantar: Estudio comparativo entre tres esquemas terapéuticos / Comparison of three treatment regimens for plantar fasciitis

Introducción: La fascitis plantar, descrita, por primera vez, por Plettner, es la causa más común de dolor en el talón. Su etiología continúa en estudio, participan factores anatómicos, como el acortamiento de la flexión plantar, y relacionados con el aumento de peso. Si bien no se ha publicado cuál es el mejor tratamiento para este cuadro, se recomienda el tratamiento conservador temprano. El objetivo de este estudio fue comparar tres métodos de tratamiento de la fascitis plantar. Materiales y Métodos: Entre marzo de 2016 y marzo de 2017, se trató a 90 pacientes con fascitis plantar, quienes fueron divididos en tres grupos, según el tratamiento recibido: grupo A o de control, ejercicios de elongación de la fascia plantar; grupo B, infiltración corticoanestésica y ejercicios de elongación de la fascia plantar, y grupo C, infiltración con solución salina y ejercicios de elongación de la fascia plantar. Resultados: Se mencionan los resultados comparativos sobre la base de la edad, el lado afectado, las enfermedades previas, la forma del pie, las cirugías previas del pie, el dolor posinfiltración, la escala analógica visual: grupo A: 0,73; grupo B: 1,03, grupo C: 2,7 y el tiempo hasta el retorno a la actividad previa: grupo A: 19.1 días, grupo B: 12.63 días, grupo C: 15.12 días. Conclusiones: Nuestro estudio demuestra que los tres tratamientos para la fascitis plantar son eficaces. La recuperación fue más rápida en los pacientes tratados con infiltración corticoanestésica, con un bajo número de complicaciones, pero sin diferencias a largo plazo. Nivel de Evidencia: IV

Objective: Plantar fasciitis, first described by Plettner, is the most common cause of heel pain. The pathophysiology of this condition is still being studied, but it involves both anatomical factors-such as shortening of plantar flexion-and factors related to weight gain. Although literature is not conclusive on the best treatment strategy, early conservative management is recommended. The objective of this study was to compare three treatment regimens for plantar fasciitis. Materials and Methods: Ninety patients with plantar fasciitis were treated between March 2016 and March 2017. They were divided into 3 groups based on the treatment received. Group A (the control group) was managed with plantar fasciitis stretches; Group B was managed with steroid injections and plantar fasciitis stretches; and Group C was managed with saline injections and plantar fasciitis stretches. Results: Results of the comparative study were as follows (reported based on age, affected side, underlying conditions, foot shape, previous foot surgeries, post-injection pain, and visual analog scale scoring): Group A - 0.73, Group B - 1.03, Group C - 2.7. Regarding the time elapsed until patients were able to resume previous activities, results were as follows: Group A - 19.1 days, Group B - 12.63 days, Group C - 15.12 days. Conclusions: Our study showed the effectiveness of the three treatment regimens used. A shorter time to recovery and a lower complication rate were observed in patients treated with steroid injections, but no long-term differences were detected. Level of Evidence: IV

Fascitis plantar. Criterios y experiencias sobre la infiltración con anestésicos locales y corticoesteroides / Plantar fasciitis Criteria and experiences on infiltration with local anesthetics and corticosteroids

Introducción: Dentro del grupo de las enfermedades del sistema osteomioarticular la fascitis plantar (FP) es una de las causas más frecuente de dolor crónico del pie. Objetivo: aportar criterios sobre el empleo de la infiltración de anestésicos locales y corticoesteroides para el tratamiento de la fascitis plantar. Desarrollo: se seleccionaron las infiltraciones de corticoesteroides y de anestésicos locales que se realizan con mayor frecuencia en la práctica clínica, se analizó su efectividad según la evidencia en la literatura internacional y a partir de ahí se contrastaron los resultados encontrados con los criterios y experiencias de los autores de este trabajo. Conclusiones: Las consideraciones realizadas en este estudio apuntan a que el uso de los corticoides mediante infiltraciones en patologías ortopédicas es un medio valioso para mejorar la inflamación de los tejidos y para el alivio de los dolores, tanto cuando se emplea en las articulaciones como en las partes blandas(AU)

Introduction: within the group of diseases of the osteomioarticular system, plantar fasciitis (FP) is one of the most frequent causes of chronic foot pain. Objective: to provide criteria on the use of infiltration of local anesthetics and corticosteroids for the treatment of plantar fasciitis. Development: the infiltrations of corticosteroids and local anesthetics that are performed more frequently in clinical practice were selected, their effectiveness was analyzed according to the evidence in the international literature and from there the results were contrasted with the criteria and experiences of the patients authors of this work. Conclusions: the considerations made in this study suggest that the use of corticosteroids through infiltrations in orthopedic pathologies is a valuable means to improve inflammation of the tissues and for the relief of pain, both when used in the joints and in the joints and soft parts(AU)

Terapia de ondas de choque frente a infiltración corticosteroidea en el tratamiento de la fascitis plantar crónica / Extracorporeal shockwave therapy versus corticosteroid injection in chronic plantar fasciitis

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.

Terapia de ondas de choque en patología músculo-esquelética / Pathology shock wave therapy muscle-skeletal

Extracorporeal shock waves are unique sound waves that generate a rapid increase in pressure in the tissues in which they are applied. They were first used on the management of urolithiasis and later spread to other pathologies such as musculoskeletal. A series of studies have been carried out to support the usefulness of shock waves in patients with plantar fasciitis, Achilles tendinopathy, epicondylitis, rotator cuff injury with or without calcification, patellar tendinopathy and peritrochanteric pathology that has lasted more than three months and have not responded to the initial handling. There is no consensus regarding the specific protocols to be used. In these conditions, shock waves are only a part of a comprehensive treatment, and should always be associated with other conventional therapies. (AU)

Translation and cultural adaptation of the revised foot function index for the Portuguese language: FFI-R Brazil

ABSTRACT BACKGROUND: The revised foot function index (FFI-R) is used to evaluate the functionality of patients with conditions that affect the feet. The objective here was to produce the Brazilian Portuguese version of this index. DESIGN AND SETTING: Translation and validation study conducted at the Federal University of São Paulo, Brazil. METHODS: The translation and cultural adaptation process involved translation by two independent translators, analysis by an expert committee, back translation into the original language, analysis by the expert committee again and a pretest. The Portuguese-language version was administered to 35 individuals with plantar fasciitis and metatarsalgia to determine their level of understanding of the assessment tool. RESULTS: Changes were made to the terms and expressions of some original items to achieve cultural equivalence. Terms not understood by more than 10% of the sample were altered based on the suggestions of the patients themselves. CONCLUSION: The translation and cultural adaptation of the FFI-R for the Portuguese language were completed and the Brazilian version was obtained.

Terapia por Ondas de Choque Extracorpórea e Laser na redução da dor de indivíduos com fasciíte plantar: revisão sistemática / Extracorporeal Shock Wave Therapy and Laser in pain reduction of individuals with plantar fasciitis: a systematic review

Objetivo: Avaliar a efetividade da Terapia por Ondas de Choque Extracorpórea (ESWT) e do Laser na redução da dor de indivíduos com fasciíte plantar. Métodos: Foram feitas buscas de ensaios clínicos randomizados nas bases de dados MEDLINE, LILACS e Cochrane até novembro de 2016, nos idiomas inglês e português. Foram incluídos estudos que tinham como forma de tratamento as ESWT ou Laser, comparados com outros métodos, e que avaliaram a dor com a escala visual analógica. Foi utilizada a escala de PEDro para avaliação da qualidade metodológica dos estudos. Resultados: Foram encontrados 131 artigos. Destes, 106 foram excluídos após a leitura de seus títulos e resumos e 15 após sua leitura na íntegra, restando oito que tiveram como forma de tratamento as ESWT e dois o Laser. Conclusão: Dos dez artigos encontrados seis apresentaram resposta estatisticamente significativa em relação à dor, sendo dois sobre Laser e quatro sobre ESWT.

Purpose: To evaluate the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) and Laser in pain reduction of individuals with plantar fasciitis. Methods: Searches were made of randomized trials in MEDLINE, LILACS and Cochrane until November 2016, in English and Portuguese. They included studies that had as a treatment ESWT or the Laser, compared with other methods, and assessed pain with a visual analogue scale. It used the PEDro scale to assess the methodological quality of the studies. Results: We found 131 articles. Of these, 106 were excluded after reading their titles and abstracts and 15 after reading in full, leaving eighy who had as a treatment the ESWT and two the Laser. Conclusion: Of the 10 articles found six showed statistically significant response in relation to pain, two on Laser and six on ESWT.

Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

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.

Eficacia de las ondas de choque en el tratamiento de la fascitis plantar: una revisión sistemática de revisiones sistemáticas / Efficacy of shock wave therapy for treating plantar fasciitis: a systematic review of systematic reviews

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.

Tradução e adaptação cultural do Foot Function Index para a língua portuguesa: FFI - Brasil / Translation and cross-cultural adaptation of FFI to Brazilian Portuguese version: FFI - Brazil

RESUMOObjetivo:Realizar a tradução e a adaptação cultural do questionário Foot Functional Index (FFI), que avalia a funcionalidade do pé, para a versão em língua portuguesa do Brasil.Métodos:A versão brasileira do FFI foi baseada no protocolo proposto por Guillemin. O processo aplicado consistiu em: (1) tradução; (2) retrotradução; (3) análise do comitê de especialistas; (4) pré-teste. A versão brasileira foi aplicada em 40 pessoas, homens e mulheres com idade superior a 18 anos, com fasciíte plantar e metatarsalgia, para verificar o nível de compreensão do instrumento. A versão final foi definida após se obter menos de 15% de “não compreensão” em cada item.Resultados:Foram alterados termos e expressões para obter equivalência cultural do FFI. As alterações feitas foram baseadas nas sugestões dos pacientes.Conclusão:Após a tradução e adaptação cultural do questionário, foi concluída a versão da língua portuguesa do Brasil do FFI.

ABSTRACTObjective:Perform the translation and cultural adaptation of the questionnaire Foot Functional Index (FFI), which assesses the functionality of the foot, to the Brazilian Portuguese version.Method:The Brazilian version development of FFI questionnaire was based on the guideline proposed by Guillemin. The applied process consisted of: (1) translation; (2) back-translation; (3) committee review; (4) pretesting. The Portuguese version was applied to 40 patients, both genders, aged over 18 years old, with plantar fasciitis and metatarsalgia to verify the level of the instrument comprehension. The final Brazilian version of the FFI was set after getting less than 15% of “not understanding” on each item.Results:Some terms and expressions were changed to obtain cultural equivalence for FFI. The terms that were incomprehensible were changed in accordance of patient suggestions.Conclusion:After the translation and cultural adaptation of the questionnaire, the final Portuguese version of FFI was concluded.

Tratamento fisioterapêutico da fasciíte plantar / Physiotherapeutic treatment of plantar fasciitis

A fasciíte plantar ou síndrome da dor do calcanhar é uma causa frequente de dor no calcanhar e no pé em adultos que acomete cerca de 2 milhões de americanos por ano e estima-se que cerca de 10% da população mundial já apresentou ou irá apresentar queixa de dor no pé em algum momento da vida. Objetivo: Realizar uma revisão da literatura a fim de verificar a efetividade das modalidades de tratamento fisioterapêutico em pacientes com fasciíte plantar. Método: Foi realizada uma busca eletrônica nas bases de dados Cochrane Library, Medline (via Pubmed), PEDro, LILACS, sem restrições de data e idioma. Foram incluídos, no presente estudo, os artigos que abordaram o tratamento fisioterapêutico na fasciíte plantar e excluídos os artigos que tiveram como foco o tratamento cirúrgico. Resultados: No total, 23 estudos cumpriram os critérios de inclusão. As modalidades encontradas foram: Alongamento de tríceps sural, terapia manual, bandagens, órteses/palmilhas e eletroterapia. Conclusão: Há evidência moderada de que os exercícios para alongamento do tríceps sural proporcionam benefícios aos pacientes com fasciite plantar. A evidência da aplicação de bandagens ainda é fraca, porém alguns estudos relatarem melhora da dor e função a curto prazo. Há evidência de qualidade que suporte que o uso de palmilhas customizadas proporciona melhora da dor e função a curto prazo em pacientes com fasciíte plantar. A utilização de talas noturnas apresenta resultados controversos, apesar de alguns estudos terem apresentado bons resultados.

Plantar fasciitis or heel pain syndrome is a common cause of heel and foot pain in adults that affects about 2 million Americans a year and it is estimated that about 10% of the world's population have presented or will present foot pain at some time in their life. Objective: To review the literature in order to verify the effectiveness of the modalities of physical therapy in patients with plantar fasciitis. Method: An electronic search was conducted in the databases of the Cochrane Library, Medline (via Pubmed), PEDro, and LILACS, with no date or language restrictions. In the present study, articles about the physical therapy for plantar fasciitis and those that have focused on the surgical treatment were included. Results: In total, 23 studies met the inclusion criteria. The procedures were: Stretching sural triceps, manual therapy, bandaging, orthotics/insoles and electrotherapy. Conclusions: There is moderate evidence that stretching exercises for the triceps surae provide benefits to patients with plantar fasciitis. The evidence of the application of bandages is still weak, but some studies have reported improvement in pain and function in the short term. There is good quality evidence supporting the use of custom insoles that can provide short-term improvement in pain and function in patients with plantar fasciitis. The use of night splints presents controversial results, although some studies have shown good results.

Elaboração de um manual de exercícios e orientações para pacientes com fasciíte plantar / Development of an exercise manual and guidelines for patients with plantar fasciitis

A fasciíte plantar é causa frequente de dor no calcanhar e no pé que afeta cerca de 2 milhõesde americanos por ano. A fisioterapia é o tratamento inicialmente prescrito, e o sucesso dotratamento depende da adesão dos pacientes. Objetivo: Elaborar um manual de orientaçõese exercícios para pacientes com fasciíte plantar, analisar a clareza, nível de compreensão e asatisfação dos pacientes leigos e fisioterapeutas acerca do manual. Método: Foram selecionados30 fisioterapeutas e 30 pacientes que não fossem analfabetos e que não apresentassem nenhumdéficit cognitivo. Foi aplicado um manual contendo 10 exercícios e orientações para pacientescom fasciíte plantar. Resultados: Todos os exercícios e orientações tiveram alto índice decompreensão (acima de 90%). O manual foi considerado excelente pelos leigos e ótimo pelosfisioterapeutas. Conclusão: O manual apresentou um nível relevante de compreensão tanto entreos fisioterapeutas como entre os leigos, além de alto índice de satisfação entre as populaçõesabordadas. Portanto, o manual pode servir de ferramenta complementar no tratamento dospacientes com fasciíte plantar.

Plantar fasciitis is a common cause of heel and foot pain. It affects approximately 2 million Americansannually. Physiotherapy is the first treatment prescribed, and its success depends on the patient?sadherence to treatment. Objective: This study aimed to develop a manual with orientations andexercises for patients with plantar fasciitis and to assess its clarity, level of understanding, andsatisfaction among patients and physiotherapists. Method: Thirty physiotherapists and thirtypatients, who were literate and showed no cognitive deficit, participated in this study. Theyanalyzed a manual that consists of 10 exercises and orientations for patients with plantar fasciitis.Results: All exercises and orientations were well understood (above 90%). The manual wasconsidered excellent by the patients and great by physiotherapists. Conclusion: Demonstrating arelevant level of understanding and satisfaction among therapists and patients, the manual provedto be a supplementary tool in the treatment of patients with plantar fasciitis.

Talalgia: plantar fasciitis / Talalgias: fascite plantar

Plantar fasciitis is a very common painful syndrome, but its exact etiology still remains obscure. The diagnosis is essentially clinical, based on history-taking and physical examination. Complementary laboratory tests and imaging examinations may be useful for differential diagnoses. The treatment is essentially conservative, with a high success rate (around 90%). The essence of the conservative treatment is the home-based program of exercises to stretch the plantar fascia. Indications for surgical treatment are only made when the symptoms persist without significant improvement, after at least six months of conservative treatment supervised directly by the doctor...

A fascite plantar é uma síndrome dolorosa muito frequente, mas sua exata etiologia ainda permanece obscura. O diagnóstico é essencialmente clínico e tem como base a história e o exame físico. Exames complementares laboratoriais e de imagem podem ser úteis no diagnóstico diferencial. O tratamento é essencialmente conservador, com elevada taxa de sucesso (ao redor de 90%). A essência do tratamento conservador é o programa domiciliar com exercícios para alongamento da fáscia plantar. A indicação do tratamento cirúrgico somente é feita quando os sintomas persistem sem melhoria significativa, após pelo menos seis meses de tratamento conservador supervisionado diretamente pelo médico...