Plasma rico en plaquetas como opción terapéutica en el síndrome de la almohadilla grasa plantar / Platelet-rich plasma as a therapeutic option in heel fat pad syndrome

El síndrome de la almohadilla grasa plantar es la segunda causa de talalgia más frecuente en las consultas de Rehabilitación. Se trata de una desestructuración de la grasa plantar que conlleva la pérdida de amortiguación en la marcha y dolor plantar. Es debido a la degeneración o el traumatismo repetido que causa la alteración de la estructura de la almohadilla plantar, perdiendo su compresibilidad y función. El diagnóstico del síndrome de la grasa plantar se realiza mediante ecografía. El tratamiento se basa fundamentalmente en medidas conservadoras. Se plantea la infiltración con plasma rico en plaquetas como opción terapéutica con el objetivo de mejorar el dolor y la inflamación de la almohadilla grasa plantar. Describimos el primer caso clínico publicado de infiltración con plasma rico en plaquetas como tratamiento del síndrome de la almohadilla grasa plantar.(AU)

Heel fat pad syndrome is the second most frequent cause of heel pain at Rehabilitation services. It is a structure damage of the plantar fat that leads to loss of cushioning in gait and plantar pain. It is due to degeneration or repeated trauma that causes alteration of the structure of the foot pad losing its compressibility and function. The diagnosis of heel fat pad syndrome is made by ultrasound study. Treatment is primarily based on conservative measures. Infiltration with platelet-rich plasma is proposed as a therapeutic option with the aim of improving pain and inflammation of the plantar fat pad. We report the first published case of ultrasound-guided infiltration with platelet-rich plasma as a treatment for heel fat pad syndrome.(AU)

A Prospective Randomized Controlled Trial Comparing Physical Therapy With Independent Home Stretching for Plantar Fasciitis.

BACKGROUND: Although formal physical therapy (PT) is effective in treating plantar fasciitis (PF), it is unclear how this compares with home-based plantar fascia stretching (HS). METHODS: Fifty-seven patients with PF were enrolled in a prospective randomized trial comparing PT with HS. Visual analog scale (VAS), Foot and Ankle Ability Measure (FAAM), and Short Form (36) Health Survey (SF-36) scores were analyzed at 6 weeks, 3 months, 6 months, and 1 year. RESULTS: At 6 months, VAS improved in both HS (35% decrease; P < 0.001) and PT (26% decrease; P = 0.002) relative to baseline. FAAM Activities of Daily Living scores improved 13.0% (P = 0.005) in HS and 21.3% (P < 0.001) in PT at 6 months relative to baseline. The SF-36 Physical Component Summary Scores demonstrated improvement at all time points in both groups. There were no notable intergroup differences in VAS, FAAM, or SF-36 at any time point. DICUSSION: The clinical outcomes of a home stretching protocol and PT did not markedly differ for the treatment of PF. LEVEL OF EVIDENCE: Therapeutic Level I.

Superior pedal function recovery of newly designed three spike insole over total contact insole in refractory plantar fasciitis: A randomized, double-blinded, non-inferiority study.

INTRODUCTION: Plantar fasciitis is one of the common foot complaints that is chronic and can induce dysfunction. Total contact insole (TCI) is simple but effective in treating plantar fasciitis. Despite its effect, the cost and long duration for production have been the major flaws. Therefore, we developed a newly designed three-spike insole (TSI) that can be commercially productive and compared its clinical outcomes to TCI. METHODS: Patients with plantar fasciitis refractory to conservative treatment for more than 6 weeks were candidates. We produced insoles with hardness of 58 ± 5 Shore-A. Twenty-eight patients were randomized with equal allocation to either TSI or TCI. The following assessment tools were used: visual analog scale (VAS), American Orthopaedic Foot and Ankle score, Foot and Ankle Outcome Score, Karlsson-Peterson (KP) score, Short Form-36 for quality of life, and Foot Function Index. Non-inferiority was declared if VAS was within the statistical variability of minimal important difference. A blinded assessor evaluated the groups at baseline and after 6, 12, and 24 weeks. RESULTS: The groups were homogenous for majority of variables at baseline. Overall patient-reported satisfaction showed improvement from mean 5.2 (range, 1-12) weeks of wearing and all clinical outcome scores showed significant improvements in both groups over time on Friedman test (p ≤.032). TSI showed non-inferiority to TCI at each time point. Post hoc analysis revealed that many scales showed significant superiority of TSI at 3 month (p ≤.008) and KP score at 6 month (p < .001). CONCLUSION: We reaffirmed that semi-rigid insole is effective in refractory plantar fasciitis and showed TSI restores pedal function more rapidly than TCI. TSI can be not only effective in deriving better clinical outcomes but also be manufactured for popularization to lower the price and producing time of orthosis.

Effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis.

OBJECTIVES: This study aimed to investigate the effect of a home-based stretching exercise on multi-segmental foot motion and clinical outcomes in patients with plantar fasciitis (PF). METHODS: A single group pre- and post-test design was conducted for this study in 20 patients with PF. They had the self home-based stretching program of calf muscle for 3 weeks. They were assessed for the multi-segmental foot motion (degree) and clinical outcomes which included the plantar fascia pain/disability scale (PFPS) (score), muscle length (degree) of gastrocnemius and soleus, and muscle strength (kg) of ankle dorsiflexors, plantarflexors, invertors, evertors, great toe flexors, and lesser toe flexors. RESULTS: There were no significant differences (p>0.05) in multi-segmental foot motion and muscle length after exercise. Significant improvements (p<0.05) were found in PFPS and muscle strength of ankle plantarflexors, invertors, evertors, great toe flexors, and lesser toe flexors after exercise. CONCLUSIONS: A home-based stretching exercise was an effective program for reducing pain, enhancing muscle strength for both extrinsic and intrinsic foot muscles in patients with PF.

Corticosteroid injection plus exercise versus exercise, beyond advice and a heel cup for patients with plantar fasciopathy: protocol for a randomised clinical superiority trial (the FIX-Heel trial).

BACKGROUND: Plantar fasciopathy has a lifetime prevalence of 10%. Patients experience sharp pain under the heel, often for several months or years. Multiple treatments are available, but no single treatment appears superior to the others. A corticosteroid injection offers short-term pain relief but is no better than placebo in the longer term (> 8 weeks). Heavy-slow resistance training has shown potentially positive effects on long-term outcomes (> 3 months), and combining exercises with an injection may prove to be superior to exercises alone. However, the effect of heavy-slow resistance training compared with a simpler approach of patient advice (e.g., load management) and insoles is currently unknown. This trial compares the efficacy of patient advice with patient advice plus heavy-slow resistance training and with patient advice plus heavy-slow resistance training plus a corticosteroid injection in improving the Foot Health Status Questionnaire pain score after 12 weeks in patients with plantar fasciopathy. METHODS: In this randomised superiority trial, we will recruit 180 patients with ultrasound-confirmed plantar fasciopathy and randomly allocate them to one of three groups: (1) patient advice and an insole (n = 60); (2) patient advice, an insole, and self-dosed heavy-slow resistance training consisting of heel raises (n = 60); or (3) patient advice, an insole, heavy-slow resistance training, and an ultrasound-guided corticosteroid injection (n = 60). All participants will be followed for 1 year, with the 12-week follow-up considered the primary endpoint. The primary outcome is the Foot Health Status questionnaire pain domain score. Secondary outcomes include the remaining three domains of the Foot Health Status Questionnaire, a 7-point Global Rating of Change, the Pain Self-Efficacy Questionnaire, physical activity level, health-related quality of life measured by the EQ-5D-5L, and Patient Acceptable Symptom State, which is the point at which participants feel no further need for treatment. Additionally, a health economic evaluation of the treatments will be carried out. DISCUSSION: This trial will test if adding heavy-slow resistance training to fundamental patient advice and an insole improves outcomes and if a corticosteroid injection adds even further to that effect in patients with plantar fasciopathy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03804008. Prospectively registered on January 15, 2019.

Outpatient vs Home Management Protocol Results for Plantar Fasciitis.

BACKGROUND: We compared the effectiveness of stretching and strengthening exercises combined with myofascial releasing and mobilization techniques to a stretching and strengthening only home program in plantar fasciitis (PF) management. METHOD: The study included 53 feet of 47 patients with plantar fasciitis (35 women / 12 men; mean age 48.9±11.2 years). Pain, disability, and activity restrictions were assessed by Foot Function Index (FFI), and first step pain was graded by visual analog scale (VAS). Ankle range of motion (ROM), gastrocnemius-soleus flexibility, proprioception, dynamic balance, and foot sensation were also considered. The patients were randomly divided into outpatient clinic treatment (Outpatient, n = 27 feet) and home rehabilitation groups (Home, n = 26 feet). Patient education was routine for all at the beginning of the management programs. In the Outpatient group, the foot-ankle-hip exercise program, myofascial releasing, and joint and soft tissue mobilization techniques were "hands on" at a clinic (twice a week for 8 weeks), whereas the Home group completed their home rehabilitation program on their own (8 weeks' duration with follow-ups every week). RESULTS: VAS, FFI, ROM, balance, proprioception, foot sense, and flexibility improved at the eighth week in both groups according to intragroup comparison (P < .05). When the 2 groups were compared, the results of plantar flexion range, balance, proprioception, foot sensation, flexibility, FFI, and VAS showed significant improvements in the Outpatient vs the Home group (P < .05). Also, the FFI and VAS scores at the sixth month were superior in the Outpatient group (P < .05). CONCLUSION: A combined supervised management protocol had superior clinical results in plantar fasciitis management. LEVEL OF EVIDENCE: Level II, comparative study.

Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial.

QUESTION: For people with plantar fasciopathy, is a 12-week self-dosed heavy-slow resistance training program more beneficial than a 12-week pre-determined heavy-slow resistance training program? DESIGN: A randomised trial with concealed allocation, partial blinding, and intention-to-treat analysis. PARTICIPANTS: Seventy people with plantar fasciopathy confirmed on ultrasonography. INTERVENTION: Both groups performed a repeated heel raise exercise in standing for 12 weeks. Participants in the experimental group were self-dosed (ie, they performed as many sets as possible with as heavy a load as possible, but no heavier than 8 repetition maximum). The exercise regimen for the control group was pre-determined (ie, it followed a standardised progressive protocol). OUTCOME MEASURES: The primary outcome was the Foot Health Status Questionnaire pain domain. Secondary outcomes included: a 7-point Likert scale of Global Rating of Change dichotomised to 'improved' or 'not improved'; Patient Acceptable Symptom State defined as when participants felt no further need for treatment; and number of training sessions performed. RESULTS: There was no significant between-group difference in the improvement of Foot Health Status Questionnaire pain after 12 weeks (adjusted MD -6.9 points, 95% CI -15.5 to 1.7). According to the Global Rating of Change, 24 of 33 in the experimental group and 20 of 32 in the control group were improved (RR = 1.16, 95% CI 0.83 to 1.64). Only four participants achieved Patient Acceptable Symptom State: three of 35 in the experimental group and one of 35 in the control group. No significant between-group difference was found in the number of training sessions that were performed (MD -2 sessions, 95% CI -8 to 3). CONCLUSION: Self-dosed and pre-determined heavy-slow resistance exercise programs are associated with similar effects on plantar fasciopathy pain and other outcomes over 12 weeks. Advising people with plantar fasciopathy to self-dose their slow-heavy resistance training regimen did not substantially increase the achieved dose compared with a pre-determined regimen. These regimens are not sufficient to achieve acceptable symptom state in the majority of people with plantar fasciopathy. REGISTRATION: ClinicalTrials.govNCT03304353.

Extracorporeal Shockwave Therapy Plus Rehabilitation for Patients With Chronic Plantar Fasciitis Might Reduce Pain and Improve Function but Still Not Lead to Increased Activity: A Case-Series Study With Multiple Outcome Measures.

Plantar fasciitis is a common cause of plantar-aspect heel pain. Although many patients will improve, a proportion will have ongoing and sometimes debilitating symptoms. Evidence from randomized controlled trials has shown that extracorporeal shockwave therapy (ESWT) results in benefits in treating pain. However, uncertainties remain whether these benefits translate to improvements in overall function. The present prospective case series examined the results from 35 patients with chronic plantar fasciitis who had undergone a course of ESWT in addition to a graded rehabilitation program. Of the 35 subjects, 34% were male, and the median age was 50.9 years. The duration of symptoms before ESWT was 24 months. The results of the present case series demonstrated statistically significant improvements in measures of self-reported "average pain" from a median of 7.0 of 10 at baseline to 5.0 of 10 at 3 months (p < .001) and of "worst pain" from 9.0 of 10 at baseline to 7.0 of 10 at 3 months (p < .001). In addition, significant improvements were found in several validated patient-rated outcome measures of local foot/ankle function but not in overall markers of health, anxiety/depression scores, or activity levels, despite the improvements in pain. No statistically significant correlations were found between gender, age, or chronicity of symptoms and the improvements seen. No significant side effects occurred in the present study. The results of our series support the use of ESWT for patients with chronic plantar fasciitis for local pain symptoms; however, uncertainties remain regarding global benefits to health.

Síndrome de Baxter, a propósito de un caso / Baxter syndrome: a case report

El síndrome de Baxter consiste en una neuropatía por atrapamiento de la primera rama del nervio plantar lateral o calcáneo inferior que cursa con dolor, imposibilidad para la abducción del 5.° dedo y, en algunos casos, parestesias. Se presenta el caso de una paciente de 44 años diagnosticada de fascitis plantar, tratada quirúrgicamente con fasciectomía tras el fracaso del tratamiento conservador. Durante el postoperatorio presentó pérdida de la movilidad del 5.° dedo, parestesias difusas y dolor moderado con dificultad para la deambulación. Tras la realización de resonancia magnética y electromiograma es diagnosticada de síndrome de Baxter. Inició tratamiento de rehabilitación obteniendo mejoría de la alodinia a nivel de la cicatriz y adquirió marcha sin ayudas técnicas, con menor dificultad para puntillas y talones. Sin embargo mantuvo parestesias ocasionales y ausencia de movilidad del 5º dedo (AU)

Baxter syndrome is an entrapment neuropathy of the first branch of the lateral plantar nerve or inferior calcaneal nerve that causes pain, inability to abduct the fifth toe and, in some cases, paraesthesia. We report the case of a 44-year-old woman with a diagnosis of plantar fasciitis, treated surgically with fasciectomy after failure of conservative treatment. During the postoperative period, the patient showed loss of mobility of the fifth toe, moderate diffuse pain, numbness, and difficulty walking. After the performance of magnetic resonance imaging and electromyography, the patient was diagnosed with Baxter syndrome. She began rehabilitation, which improved allodynia of the scar and allowed her to walk without technical aids and with less difficulty in heel toe walking. However, there was persistence of occasional numbness and lack of mobility of the fifth toe (AU)

New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis.

OBJECTIVE: To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis. DESIGN: Randomized, controlled, prospective study. SETTING: Outpatient of local medical center settings. PARTICIPANTS: Patients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278). INTERVENTIONS: ESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4d). In the low-, moderate-, and high-intensity groups, 2400 impulses total of ESWT with an energy flux density of 0.2, 0.4, and 0.6mJ/mm2, respectively (a rate of 8 impulses per second), were applied. MAIN OUTCOME MEASURES: The independent variables were patient age, sex, body mass index, affected side, duration of symptoms, Roles and Maudsley score, visual analog scale (VAS) score when taking first steps in the morning, edema, bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS score was considered as minimum clinically successful therapy. The correlations between the achievement of minimum clinically successful therapy and independent variables were analyzed. The statistically significant factors identified were further analyzed by multivariate logistic regression, and the predictive model was established. RESULTS: The success rate of ESWT was 66.9%. Univariate analysis found that VAS score when taking first steps in the morning, edema, and the presence of heel spur in radiograph significantly affected the outcome of the treatment. Logistic regression drew the equation: minimum clinically successful therapy=(1+e[.011+42.807×heel spur+.109×edema+5.395×VASscore])-1.The sensitivity of the predictive factors was 96.77%, 87.63%, and 86.02%, respectively. The specificity of the predictive factors was 45.65%, 42.39%, and 85.87%, respectively. The area under the curve of the predictive factors was .751, .650, and .859, respectively. The Youden index was .4243, .3003, and .7189, respectively. The Hosmer-Lemeshow test showed a good fitting of the predictive model, with an overall accuracy of 89.6%. CONCLUSIONS: This study establishes a new and accurate predictive model for the efficacy of ESWT in managing patients with chronic plantar fasciitis. The use of these parameters, in the form of a predictive model for ESWT efficacy, has the potential to improve decision-making in the application of ESWT.

Medial calcaneal neuropathy: A rare cause of prolonged heel pain.

Pain heel constitutes 15% of foot pain. Pain may be caused by plantar fasciitis, calcaneal fractures, calcaneal apophysitis, heel pad atrophy, inflammatory diseases or related with nerve involvement. Tibial, plantar and/or medial nerve entrapment are the neural causes of pain. Most of the heel soft tissue sensation is provided by medial calcaneal nerve. Diagnosis of heel pain due to neural causes depends on history and a careful examination. Surgery should not be undertaken before excluding other causes of heel pain. Diagnosis should be reconsidered following conservative therapy.

Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis.

OBJECTIVE: To evaluate the therapeutic benefit of ultrasound-guided pulsed radiofrequency (PRF) stimulation at the posterior tibial nerve (PTN) in patients with recalcitrant plantar fasciitis (PF). DESIGN: A prospective, randomized, double-blinded, placebo-controlled trial (12-wk follow-up). SETTING: Outpatient local medical center settings. PARTICIPANTS: Patients (N=36) with recalcitrant PF underwent randomization, and all were included in the final data analysis. INTERVENTIONS: Patients in the PRF group were treated with 1 dose of ultrasound-guided PRF stimulation at the PTN, and those in the control group received 1 dose of 2% lidocaine, 0.5mL, injected at the PTN under ultrasound guidance. MAIN OUTCOME MEASURES: The visual analog scale (first-step and overall pain), American Orthopedic Foot-Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasonographic thickness of the plantar fascia were evaluated at 1, 4, 8, and 12 weeks after treatment. RESULTS: Thirty-six patients (20 feet per group) completed the study. The PRF group had a significantly larger improvement in first-step pain, overall pain, and AOFAS score (all P<.001), as well as plantar fascia thickness (P<.05), compared with those of the control group at all observed time points. CONCLUSIONS: This study shows that ultrasound-guided PRF stimulation at the PTN is effective for treating recalcitrant PF. This simple, reproducible method could be a novel strategy for managing recalcitrant PF.

Physiotherapy for plantar fasciitis: a UK-wide survey of current practice.

OBJECTIVES: To identify how United Kingdom (UK) physiotherapists currently diagnose, assess and manage plantar fasciitis in routine practice. DESIGN: Online questionnaire survey. PARTICIPANTS: Practising physiotherapists across the UK who treat patients with plantar fasciitis. METHODS: Physiotherapists were approached via 'interactive Chartered Society of Physiotherapy (CSP)' online networks and an email database of clinical educators in South West England. An online questionnaire was developed by reviewing similar existing physiotherapy surveys and consultation with experienced musculoskeletal researchers/clinicians. Descriptive statistics were used to analyse the data. RESULTS: 285 physiotherapists responded, with 257 complete survey responses. Pain on palpation and early morning pain were the most common diagnostic criteria, with some physiotherapists using no formal test criteria. Advice (237/257, 92%), plantar fasciitis pathology education (207/257, 81%) and general stretching exercises (189/257, 74%) were most routinely used. Prefabricated orthotics, custom made orthotics and night splints were seldom always used. For the manual therapy approach, the most frequently used modalities were massage, myofascial release, specific soft tissue mobilisations and myofascial trigger point therapy. Commonly used outcome measures were pain assessment, functional tests and range of movement. CONCLUSIONS: Physiotherapists appeared to follow most of the established diagnostic criteria for PF, but have not followed established outcome measure guidelines. Advice as well as education with an emphasis on self-management including calf/hamstring stretching was the most commonly reported treatment approach. There was uncertainty whether this approach accurately reflected clinical practice used throughout the UK, owing to potential response bias/unknown response rate and the low number of patients with PF treated by the respondents.

A randomized controlled trial of custom foot orthoses for the treatment of plantar heel pain.

BACKGROUND: Up to 10% of people will experience heel pain. The purpose of this prospective, double-blind, randomized clinical trial was to compare custom foot orthoses (CFO), prefabricated foot orthoses (PFO), and sham insole treatment for plantar fasciitis. METHODS: Seventy-seven patients with plantar fasciitis for less than 1 year were included. Outcome measures included first step and end of day pain, Revised Foot Function Index short form (FFI-R), 36-Item Short Form Health Survey (SF-36), activity monitoring, balance, and gait analysis. RESULTS: The CFO group had significantly improved total FFI-R scores (77.4 versus 57.2; P = .03) without group differences for FFI-R pain, SF-36, and morning or evening pain. The PFO and CFO groups reported significantly lower morning and evening pain. For activity, the CFO group demonstrated significantly longer episodes of walking over the sham (P = .019) and PFO (P = .03) groups, with a 125% increase for CFOs, 22% PFOs, and 0.2% sham. Postural transition duration (P = .02) and balance (P = .05) improved for the CFO group. There were no gait differences. The CFO group reported significantly less stretching and ice use at 3 months. CONCLUSIONS: The CFO group demonstrated 5.6-fold greater improvements in spontaneous physical activity versus the PFO and sham groups. All three groups improved in morning pain after treatment that included standardized athletic shoes, stretching, and ice. The CFO changes may have been moderated by decreased stretching and ice use after 3 months. These findings suggest that more objective measures, such as spontaneous physical activity improvement, may be more sensitive and specific for detecting improved weightbearing function than traditional clinical outcome measures, such as pain and disease-specific quality of life.

High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.

The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function.

Predictors of response to physical therapy intervention for plantar heel pain.

BACKGROUND: Age, weight, and duration of symptoms have been associated with a poor response to treatment for plantar heel pain (PHP), but no studies were identified that examined predictors of response to physical therapy intervention. The purpose of this investigation was to examine the influence of age, body mass index (BMI), and symptom duration on treatment response to physical therapy intervention. METHODS: Sixty participants received 6 visits over 4 weeks of physical therapy intervention that included manual therapy and exercise or electrophysiological agents and exercise. Outcomes were assessed using the Foot and Ankle Ability Measure (FAAM), Numeric Pain Rating Scale (NPRS), and Global Rating of Change Scale (GRC). Logistic regression (P < .05) was used to analyze age, BMI, and symptom duration as potential predictors of a successful response based on the minimal clinically important difference of the outcome measures. Sensitivity analysis was used to assess the influence of success based on minimal clinically important changes in the FAAM, NPRS, and GRC or only the FAAM and NPRS. Receiver operating curves were used to determine the cut point for the significant predictor. RESULTS: At the 6-month follow-up to physical therapy intervention, NPRS was improved by 3 points (95% CI, 2.4-3.6) and FAAM improved by 22.5 points (95% CI, 16.8-28.2). Individuals with symptoms less than 7.2 months were 4.2 (95% CI, 1.3-13.8; P = .016) and 8.5 (95% CI, 2.5-28.9; P = .001) times more likely to respond to treatment based on the NPRS/FAAM/GRC and NPRS/FAAM success criteria, respectively. Age and BMI were not significant predictors (P ≥ .455 and P ≥ .450, respectively). CONCLUSION: Age and BMI were not associated with outcomes and obese individuals did achieve a successful outcome with the physical therapy intervention used in the clinical trial. Individuals with PHP symptoms longer than 7 months require additional consideration and further investigation of effective strategies to improve treatment response. LEVEL OF EVIDENCE: Prognosis, level 2b comparative study.

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.