Effectiveness of Corticosteroid Injections in the Treatment of Plantar Fasciitis.

CLINICAL SCENARIO: For active individuals, plantar fasciitis (PF) is one of the most clinically diagnosed causes of heel pain. When conservative treatment fails, one of the next most commonly used treatments includes corticosteroid injections. Although PF has been identified as a degenerative condition, rather than inflammatory, corticosteroid injection is still commonly prescribed. However, the literature has not been examined to determine the effect of corticosteroid injection on PF. Focused Clinical Question: Are corticosteroid injections more effective than other interventions (placebo, platelet-rich plasma, and tenoxicam injections) in the short- and long-term treatment of PF? Summary of Key Findings: Corticosteroid injections are not more effective in the long-term treatment of PF pain than other treatments (platelet-rich plasma, tenoxicam). Clinical Bottom Line: The level 2 and 3 evidence shows that corticosteroids are more effective than placebo injections but are no more effective than tenoxicam injections and perhaps less effective than platelet-rich plasma treatment. STRENGTH OF RECOMMENDATION: Level 2 and 3 evidence suggests that corticosteroid injections are not more effective in the long-term treatment of PF than platelet-rich plasma or tenoxicam.

Identifying Meaningful Patient Outcomes After Lower Extremity Injury, Part 1: Patient Experiences During Recovery.

CONTEXT: Determining meaningful aspects of health is crucial for outcome assessment; however, limited literature exists on the aspects of health that are deemed meaningful by the athletic patient population. OBJECTIVE: To identify experiences and meaningful outcomes after lower extremity (LE) musculoskeletal injury among collegiate athletes. DESIGN: Qualitative study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A purposive sample of 20 athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury. DATA COLLECTION AND ANALYSIS: Semistructured face-to-face interviews and inductive data analysis were conducted. Trustworthiness of the data was established using member checks and peer debriefing. RESULTS: Four themes emerged from the data, revealing that physical changes, psychological changes, personal and lifestyle changes, and support were the most meaningful outcomes among athletes with an LE injury. The 4 themes were associated with 21 subthemes, indicating the complexity with which LE injury affects individuals. CONCLUSIONS: Our findings demonstrate the importance of caring for the whole person. Athletic trainers must broaden their focus to provide the best patient care and consider the person's activities and life demands outside of athletic participation. The themes identified in this study provide a basis for selecting appropriate health markers and outcome measures.

Identifying Meaningful Patient Outcomes After Lower Extremity Injury, Part 2: Linking Outcomes to the International Classification of Functioning, Disability and Health.

CONTEXT: The International Classification of Functioning, Disability and Health (ICF) provides a framework and common language for describing and understanding health that incorporates function and disability, as well as contextual factors. However, whether the meaningful patient outcomes reported by collegiate athletes who have sustained a lower extremity (LE) injury correspond to the ICF model is uncertain. OBJECTIVES: To determine if the patient outcomes reported by collegiate athletes after LE injury corresponded with the ICF classification and to identify the most relevant ICF categories and domains. DESIGN: Themes and subthemes from the qualitative analysis were linked to the ICF using established linking rules. The frequencies of the linked ICF categories were identified. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty collegiate athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury. DATA COLLECTION AND ANALYSIS: Semistructured face-to-face interviews and ICF linking process. RESULTS: The data from the qualitative interviews were successfully linked to 63 ICF second-level domains (eg, moving around, d455) across all 4 ICF categories: body functions (b), body structures (s), activities and participation (d), and environmental factors (e). The 63 second-level domains corresponded with 20 first-level domains (eg, mobility, d4). CONCLUSIONS: The ICF provided a common language for describing health and disability, as all outcomes reported by our collegiate athletes after LE injury were linked with the ICF classification. Athletic trainers should use the results of this study for assessing and monitoring collegiate athletes' health and function after an LE injury.

Differences in lower extremity kinematics between a bilateral drop-vertical jump and a single-leg step-down.

STUDY DESIGN: Mixed-model, repeated-measures design in a laboratory setting. OBJECTIVES: To examine the differences in hip, knee, and ankle kinematics between a bilateral drop-vertical jump and single-leg step-down. A secondary purpose was to examine gender differences in kinematics of the tasks. BACKGROUND: Both a drop-vertical jump and step-down task have been used to evaluate lower extremity movement and injury risk. The differences in joint angles between these tasks have not been reported. METHODS AND MEASURES: Three-dimensional joint angles of the hip, knee, and ankle of 19 females and 18 males were evaluated with a high-speed camera system while the subjects performed a bilateral drop-vertical jump and a single-leg step-down. Maximum joint angles were compared between tasks and genders using ANOVA models. eversion (12 degrees compared to 8 degrees) (P<.0005) and hip adduction (16 degrees compared to 1 degrees) (P= .03) than the drop-vertical jump. Females had greater hip internal rotation in the step-down than in the drop-vertical jump (5 degrees compared to 2 degrees) (P = .02). When averaged across both tasks, females had greater knee abduction than males in both tasks (4 degrees compared to 0 degrees) (P<.0005). CONCLUSIONS: The unilateral step-down task produced greater motion in the frontal and transverse planes at the ankle and hip, and would be appropriate in evaluating control of the hip. The bilateral drop-vertical jump produced greater knee abduction in both genders and may be appropriate for evaluating excessive knee abduction as a risk factor for noncontact anterior cruciate ligament injury, for example. The 2 tasks appear to challenge the neuromuscular system in different manners, and both should continue to be used in the investigation of injury risk.

Patient-Reported Outcomes Measurement Information System Physical Function Item Bank, Version 1.0: Physical Function Assessment for Athletic Patient Populations.

CONTEXT: The Patient-Reported Outcomes Measurement Information System (PROMIS) item banks have been validated for general populations, but their application to high-functioning patient populations remains speculative. OBJECTIVE: To examine the measurement properties of the PROMIS physical function item bank, version 1.0, when applied to individuals representing high levels of physical ability. DESIGN: Cross-sectional study. SETTING: National Collegiate Athletic Association Division I and III collegiate athletic training rooms and intramural events. PATIENTS OR OTHER PARTICIPANTS: A heterogeneous sample of 215 adults from Division I or Division III collegiate or recreational sports volunteered for this study. Participants were divided into 4 groups depending on sport activity and injury status: healthy collegiate (HC; 33 men, 37 women; age = 19.7 ± 1.1 years), injured and currently active in sport (IP; 21 men, 29 women; age = 19.9 ± 1.2 years), injured and currently not active in sport (INP; 12 men, 18 women; age = 19.7 ± 1.3 years), and healthy recreational (HR; 47 men, 18 women; age = 20.1 ± 1.4 years). MAIN OUTCOME MEASURE(S): Participants completed 2 assessments: (1) an injury-history questionnaire and (2) the PROMIS physical function item bank, version 1.0, in computer-adaptive form. Mean PROMIS physical function scores were determined for each group. RESULTS: The PROMIS physical function score for the HC group (61.7 ± 6.0) was higher than for the IP (54.9 ± 7.5) and INP (44.1 ± 8.2) groups (P < .001). The IP group had a higher score than the INP group (P < .001). Mean PROMIS scores were not different between the HC and HR participants (mean difference = 1.9, P = .10). CONCLUSIONS: The computer-adaptive PROMIS physical function item bank, version 1.0, accurately distinguished injury status in elite-level athletes on a physical function latent trait continuum. Although it was unable to distinguish HC athletes from HR athletes, exposing a possible ceiling effect, it offers potential for use as an outcome instrument for athletic trainers and other sports medicine clinicians.

Developing a framework for ankle function: a delphi study.

CONTEXT: Addressing clinical outcomes is paramount to providing effective health care, yet there is no consensus regarding the appropriate outcomes to address after ankle injuries. Compounding the problem is the repetitive nature of lateral ankle sprains, referred to as functional (FAI) or chronic (CAI) ankle instability. Although they are commonly used terms in practice and research, FAI and CAI are inconsistently defined and assessed. OBJECTIVE: To establish definitions of a healthy/normal/noninjured ankle, FAI, and CAI, as well as their characteristics and assessment techniques. DESIGN: Delphi study. SETTING: Telephone interviews and electronic surveys. PATIENTS OR OTHER PARTICIPANTS: Sixteen experts representing the fields of ankle function and treatment, ankle research, and outcomes assessment and research were selected as panelists. DATA COLLECTION AND ANALYSIS: A telephone interview produced feedback regarding the definition of, functional characteristics of, and assessment techniques for a healthy/normal/noninjured ankle, an unhealthy/acutely injured ankle, and FAI/CAI. Those data were compiled, reduced, and returned through electronic surveys and were either included by reaching consensus (80% agreement) or excluded. RESULTS: The definitions of a healthy/normal/noninjured ankle and FAI reached consensus. Experts did not agree on a definition of CAI. Eleven functional characteristics of a healthy/normal/noninjured ankle, 32 functional characteristics of an unhealthy/acutely injured ankle, and 13 characteristics of FAI were agreed upon. CONCLUSIONS: Although a consensus was reached regarding the definitions and functional characteristics of a healthy/normal/noninjured ankle and FAI, the experts could only agree on 1 characteristic to include in the FAI definition. Several experts did, however, provide additional comments that reinforced the differences in the interpretation of those concepts. Although the experts could not agree on the definition of CAI, its characteristics, or the preferred use of the terms FAI and CAI, our findings provide progress toward establishing consistency in those concepts.

Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running.

BACKGROUND: Movement and muscle activity of the hip have been shown to affect movement of the lower extremity, and been related to injury. The purpose of this study was to determine if increased hip strength affects lower extremity mechanics during running. METHODS: Within subject, repeated measures design. Fifteen healthy women volunteered. Hip abduction and external rotation strength were measured using a hand-held dynamometer. Three-dimensional biomechanical data of the lower extremity were collected during running using a high-speed motion capture system. Measurements were made before, at the mid-point, and after a 6-week strengthening program using closed-chain hip rotation exercises. Joint range of motion (rearfoot eversion, knee abduction, hip adduction, and internal rotation), eversion velocity, eversion angle at heel strike, and peak joint moments (rearfoot inversion, knee abduction, hip abduction, and external rotation) were analyzed using repeated measures analysis of variance (P