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1.
Zhonghua Wai Ke Za Zhi ; 57(11): 829-833, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694131

RESUMO

Objective: To examine the clinical effect of all-inside endoscopic treatment of recalcitrant plantar fasciitis through two medial portals. Methods: The recalcitrant plantar fasciitis data of 67 cases (79 feet) that underwent two medial portals all-inside endoscopic treatment at Department of Hand and Foot Microsurgery, Xuzhou Central Hospital from October 2016 to June 2018 were retrospectively analyzed.There were 24 males (30 feet) and 43 females (49 feet) aged 44.3 years old(range:24-76 years).The mean disease duration from the specialist doctor intervention to operation was (23.7±11.0) months (range: 12-60 months). All the patients were treated with the two medial portals all-inside endoscopic procedure when the 6 months conservative treatment had failed.The endoscopic procedure including debridement and partial plantar fasciotomy.The clinical results,including pain,activity,gait and foot health quality,were scored using visual analogue pain scale (VAS),American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale (AOFAS) and SF-36. Results: All the patients were followed up for (15.2±6.7) months (range: 12-24 months). All cases achieved primarily healing of the wound without postoperative complications of nerve,vessel and tendon.At the last follow-up,the VAS decreased from (5.3±2.0) preoperative to 0 prooperative (t=21.60, P=0.000), AOFAS increased from (72.6±9.4) to (97.3±4.6)(t=19.43,P=0.000),SF-36 increased from (93.6±8.4) to (119.1±7.3) (t=18.78, P=0.000), non-recurrent calcaneal spur, normal foot and ankle activity was recorded. Conclusion: The two medial portals all-inside endoscopic procedure is effective for the treatment of recalcitrant plantar fasciitis.


Assuntos
Endoscopia/métodos , Fasciíte Plantar/cirurgia , Fasciotomia/métodos , Adulto , Idoso , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
BMC Musculoskelet Disord ; 20(1): 378, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421688

RESUMO

BACKGROUND: Corticosteroid injection is frequently used for plantar heel pain (plantar fasciitis), although there is limited high-quality evidence to support this treatment. Therefore, this study reviewed randomised trials to estimate the effectiveness of corticosteroid injection for plantar heel pain. METHODS: A systematic review and meta-analysis of randomised trials that compared corticosteroid injection to any comparator. Primary outcomes were pain and function, categorised as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks). RESULTS: A total of 47 trials (2989 participants) were included. For reducing pain in the short term, corticosteroid injection was more effective than autologous blood injection (SMD -0.56; 95% CI, - 0.86 to - 0.26) and foot orthoses (SMD -0.91; 95% CI, - 1.69 to - 0.13). There were no significant findings in the medium term. In the longer term, corticosteroid injection was less effective than dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) and platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06). Notably, corticosteroid injection was found to have similar effectiveness to placebo injection for reducing pain in the short (SMD -0.98; 95% CI, - 2.06, 0.11) and medium terms (SMD -0.86; 95% CI, - 1.90 to 0.19). For improving function, corticosteroid injection was more effective than physical therapy in the short term (SMD -0.69; 95% CI, - 1.31 to - 0.07). When trials considered to have high risk of bias were excluded, there were no significant findings. CONCLUSIONS: Based on the findings of this review, corticosteroid injection is more effective than some comparators for the reduction of pain and the improvement of function in people with plantar heel pain. However, corticosteroid injection is not more effective than placebo injection for reducing pain or improving function. Further trials that are of low risk of bias will strengthen this evidence. REGISTRATION: PROSPERO registration number CRD42016053216 .


Assuntos
Fasciíte Plantar/terapia , Glucocorticoides/administração & dosagem , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Transfusão de Sangue Autóloga , Fasciíte Plantar/complicações , Fasciíte Plantar/fisiopatologia , Órtoses do Pé , Calcanhar/fisiopatologia , Humanos , Injeções Intralesionais , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Placebos/administração & dosagem , Plasma Rico em Plaquetas , Recuperação de Função Fisiológica , Resultado do Tratamento
3.
BMC Med Imaging ; 19(1): 62, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31390990

RESUMO

BACKGROUND: Imaging methods for the plantar fascia have included radiography, ultrasound and magnetic resonance imaging (MRI), all of which have provided valuable information. This study assessed the reliability of ultrasonography examinations of the plantar fascia using a comparative study. METHODS: Fifty healthy adult volunteers (25 males and 25 females, mean age 31.6 ± 3.5 years) were included in this study. Images of the plantar fascia from 100 ft were acquired with ultrasonography, CT and MRI. Ultrasound was used to measure the thickness of the plantar fascia. Imaging data from CT and MRI in a DICOM format were transformed into the Materialise Mimics Innovation Suite 16.0 software for digital analysis. SPSS software (SPSS, USA) was used for statistical analysis. The reliability was established by a t-test. Moreover, 42 patients with unilateral plantar fasciitis were examined by ultrasonography. RESULTS: There were no significant differences between the three imaging modalities for patients of the same sex (P > 0.05). There were no statistically significant differences between the left and right sides for patients of the same sex (P > 0.05), but the difference between males and females was statistically significant (P < 0.01). There were no significant differences between US, CT and MRI in the normal group, but there were significant differences in the plantar fasciitis group evaluated with ultrasound. The plantar fascii of normal male subjects are significantly thicker than those of the normal female. CONCLUSION: Ultrasonography can be a relatively simple and reliable method for the measurement of plantar fascia thickness.


Assuntos
Fasciíte Plantar/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Caracteres Sexuais , Software , Adulto Jovem
4.
Med Sci Monit ; 25: 4916-4922, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31266932

RESUMO

BACKGROUND There are many methods of dynamic analysis of foot loading, however, we still need a simple, easily applicable system for foot plantar pressure analysis. In this study we asked the question: "Can a new system for foot evaluation, the ITE System, provide a good quantitative dynamic foot pressure analysis? Can it be used in clinical practice?". MATERIAL AND METHODS Twenty healthy volunteers, 8 females and 12 males, aged 20 to 25 years old took part in this study. Normal static foot loading was tested using a typical pedobarographic platform, followed by a dynamic analysis using the foot-pressure ITE System. A new algorithm for data analysis (from 8 sensors) was proposed. RESULTS The sum of all maximal values from sensors was 11.71 N mean, with relatively low standard deviation (SD) of 1.81. Loading of sensor 1 (heel) was the highest - on average 29.84%. Sensor 2 (medial midfoot) received the lowest loading - normal range for this segment would be 0-4%. The manner of loading heel/toes, dynamics of changes in loading during gait was quite diverse; when analyzing courses of changes on sensors, 4 gait patterns were observed. CONCLUSIONS Use of the ITE System creates a new possibility for dynamic foot evaluation, drawing from pedobarography and methods of gait analysis. The proposed data analysis algorithm is simple and can be applied in all cases. Normally, 30% of the sum of all pressures during stance phase falls on the rearfoot; 39% falls on forefoot.


Assuntos
Fasciíte Plantar/fisiopatologia , Análise da Marcha/métodos , Caminhada/fisiologia , Adulto , Algoritmos , Fenômenos Biomecânicos , Feminino , , Marcha , Análise da Marcha/instrumentação , Calcanhar , Humanos , Masculino , Pressão , Suporte de Carga
5.
Medicine (Baltimore) ; 98(26): e16258, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261593

RESUMO

RATIONALE: Plantar fasciitis is a common cause of foot pain presenting with morning stiffness and plantar area pain. This case study is to optimize the management in patient with plantar fasciitis accompanied by apparent high-arch foot. PATIENT CONCERNS: A 55-year-old women presented with plantar fasciitis accompanied by apparent high-arch foot. The pain presents for the heel and pelvic areas with long-distance walking. DIAGNOSES: She was diagnosed with plantar fasciitis accompanied by apparent high-arch foot for physical examination and plain radiographs. In muscle performance and dynamic postural stability tests, indicated the muscle weakness and postural instability. INTERVENTIONS: The patient was treated with manual therapy such as joint and soft tissue mobilization interventions including plantar fascia and gastrocnemius stretching, but the heel and pelvic pain were aggravated during long-distance walking. After hip strengthening exercises, the heel and pelvic pain significantly improved. OUTCOMES: The 3-month follow-up revealed that the heel and pelvic pain did not occur in the long-distance walking, and there was no pain and discomfort at one year follow-up. LESSONS: To optimize the management in patient with plantar fasciitis accompanied by apparent high-arch deformity, clinicians should try to identify the hip abductor muscles weakness, and therapists should consider incorporating hip strengthening exercises.


Assuntos
Terapia por Exercício , Fasciíte Plantar/terapia , Treinamento de Resistência , Terapia por Exercício/métodos , Feminino , Quadril , Humanos , Pessoa de Meia-Idade
6.
J Physiother ; 65(3): 144-151, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31204294

RESUMO

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.


Assuntos
Terapia por Exercício , Fasciíte Plantar/reabilitação , Treinamento de Resistência/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Inquéritos e Questionários
7.
J Am Podiatr Med Assoc ; 109(2): 108-112, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31135197

RESUMO

BACKGROUND: Plantar fasciitis is one of the most common clinical presentations seen by podiatric clinicians today. With corticosteroid injection being a classic treatment modality and extracorporeal pulse-activated therapy (EPAT) technology improving, the purpose of this study was to retrospectively compare pain and functional outcomes of patients with plantar fasciitis treated with either injection or EPAT. METHODS: Between November 1, 2014, and April 30, 2016, 60 patients who met the inclusion criteria were treated with either corticosteroid injection or EPAT. Patients were evaluated with both the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society Hindfoot Score at each visit. RESULTS: The EPAT was found to reduce pain on the VAS by a mean of 1.98 points, whereas corticosteroid injection reduced pain by a mean of 0.94 points. This was a significant reduction in the VAS score for EPAT compared with corticosteroid injection (P = .035). CONCLUSIONS: Extracorporeal pulse-activated therapy is as effective as corticosteroid injection, if not more so, for the treatment of recalcitrant plantar fasciitis and should be considered earlier in the treatment course of plantar fasciitis.


Assuntos
Dexametasona/uso terapêutico , Tratamento por Ondas de Choque Extracorpóreas , Fasciíte Plantar/terapia , Glucocorticoides/uso terapêutico , Triancinolona Acetonida/uso terapêutico , Feminino , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento
8.
Recurso educacional aberto em Português | CVSP - Brasil | ID: cfc-382784

RESUMO

Esta edição do Ligado em Saúde fala sobre fascite plantar, explica por que ela ocorre, quais os fatores que contribuem para seu aparecimento, diz qual o tratamento indicado e orienta exercícios que podem aliviar e prevenir a dor. Para falar sobre o assunto, a apresentadora Marcela Morato recebe o ortopedista, especialista em pé e tornozelo, do Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Vítor Miranda.


Assuntos
Fasciíte Plantar , Doenças do Pé
9.
Br J Hosp Med (Lond) ; 80(4): 196-200, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30951414

RESUMO

Heel pain presents frequently to primary care, commonly affecting athletic and elderly patients. Its presentation can be a common source of confusion for clinicians given the wide variety of differential diagnoses and the similarities in presenting symptoms and signs. This review classifies heel pain according to site of pain and explores the common pathologies clinicians may encounter. A brief summary of common imaging modalities used is provided. The literature is reviewed to guide evidence-based practice and to provide a framework to help clinicians investigate and manage heel pain before onward referral for specialist intervention. A linked article detailing the imaging of heel pain is included in this issue ( https://doi.org/10.12968/hmed.2019.80.4.192 ).


Assuntos
Analgésicos/uso terapêutico , Órtoses do Pé , Calcanhar , Dor Musculoesquelética/terapia , Modalidades de Fisioterapia , Tendão do Calcâneo , Corticosteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Bursite/terapia , Calcâneo/lesões , Tratamento Conservador , Gerenciamento Clínico , Fasciíte Plantar/terapia , Doenças do Pé/terapia , Fraturas de Estresse/terapia , Humanos , Injeções , Ortopedia , Osteoartrite/terapia , Encaminhamento e Consulta , Sapatos , Articulação Talocalcânea , Síndrome do Túnel do Tarso/terapia , Tendinopatia/terapia
10.
Br J Hosp Med (Lond) ; 80(4): 192-195, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30951433

RESUMO

Heel pain is a common presentation in primary care and affects a wide range of the population but predominantly elderly, obese and athletic patients. History and clinical assessment are paramount in the management of this condition but the presentation can confound clinicians, necessitating the use of imaging to confirm or clarify the diagnosis when there is clinical uncertainty. This article illustrates the various conditions producing heel pain to help clinicians determine the appropriate imaging modality to image the common causes of heel pain. A linked article detailing the management of heel pain is included in this issue ( https://doi.org/10.12968/hmed.2019.80.4.196 ).


Assuntos
Calcanhar/diagnóstico por imagem , Dor Musculoesquelética/diagnóstico por imagem , Tendão do Calcâneo/diagnóstico por imagem , Bursite/diagnóstico por imagem , Calcâneo/diagnóstico por imagem , Calcâneo/lesões , Fasciíte Plantar/diagnóstico por imagem , Doenças do Pé/diagnóstico por imagem , Fraturas de Estresse/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Osteoartrite/diagnóstico por imagem , Radiografia , Articulação Talocalcânea/diagnóstico por imagem , Síndrome do Túnel do Tarso/diagnóstico por imagem , Tendinopatia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia
11.
J Foot Ankle Surg ; 58(3): 519-527, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30910490

RESUMO

Intense therapeutic ultrasound for chronic plantar fasciitis musculoskeletal tissue pain reduction was evaluated in a pivotal clinical trial examining effectiveness, safety, and patient tolerance. In this single-blinded study, 33 patients received 2 treatments that were 4 weeks apart on plantar fascia tissue along with conservative standard of care. Patients were followed for up to 6 months after the first treatment, receiving a physical examination and diagnostic ultrasound at each follow-up visit and completing patient-/subject-reported outcome measure and Foot Function Index surveys. The goal was to reduce overall pain by ≥25% on average and >25% individually. Hypoechoic area changes on diagnostic ultrasound and adverse events were measured. The percentage meeting pain reduction criteria at weeks 4, 8, 12, and 26 were 72%, 81%, 86%, and 79%, respectively. Mean pain scores at each visit were significantly different from baseline (p < .001) at -39%, -49%, -51%, and -44%. Hypoechoic lesions were found in all patients and decreased in size significantly (p < .05) at weeks 8 and 12 (-56% and -67%). Foot Function Index scores declined favorably from baseline (p < .001) at all time points (-32%, -46%, -49%, and -32%). The percentages of patients meeting satisfaction criteria were 72%, 85%, 90%, and 83%. The mean pain score during treatment 1 was 3.4, and during treatment 2, 2.9. Attrition of only 1 patient owing to pain occurred, after treatment 1. No adverse events occurred. Intense therapeutic ultrasound for chronic plantar fasciitis is shown to be effective, safe, and well tolerated in this pivotal clinical trial.


Assuntos
Fasciíte Plantar/terapia , Terapia por Ultrassom , Adulto , Idoso , Aponeurose/diagnóstico por imagem , Terapia Combinada , Fasciíte Plantar/diagnóstico por imagem , Feminino , Órtoses do Pé , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Exame Físico , Modalidades de Fisioterapia , Método Simples-Cego , Ultrassonografia , Escala Visual Analógica
12.
J Am Podiatr Med Assoc ; 109(3): 193-200, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30916579

RESUMO

BACKGROUND: The purpose of this study was to determine feasibility of further investigation of treatment with instrument-assisted soft-tissue mobilization (IASTM), using the Graston technique, compared with conservative care for treatment of chronic plantar heel pain (CPHP). METHODS: Eleven participants with plantar heel pain lasting 6 weeks to 1 year were randomly assigned to one of two groups, with each group receiving up to eight physical therapy visits. Both groups received the same stretching, exercise, and home program, but the experimental group also received IASTM using the Graston technique. Outcome measures of pain and function were recorded at baseline, after final treatment, and 90 days later. Feasibility of a larger study was determined considering recruitment and retention rates, compliance, successful application of the protocol and estimates of the treatment effect. RESULTS: Both groups demonstrated improvements in current pain (pain at time of survey), pain with the first step in the morning, and function after final treatment and at 90-day follow up. Medium-to-large effect sizes between groups were noted, and sample size estimates demonstrated a need for at least 42 participants to realize a group difference. A larger-scale study was determined to be feasible with modifications including a larger sample size and higher recruitment rate. CONCLUSIONS: This pilot study demonstrates that inclusion of IASTM using the Graston technique for CPHP lasting longer than 6 weeks is a feasible intervention warranting further study. Clinically important changes in the IASTM group and moderate-to-large between-group effect sizes suggest that further research is warranted to determine whether these trends are meaningful.


Assuntos
Fasciíte Plantar/terapia , Manipulações Musculoesqueléticas/instrumentação , Modalidades de Fisioterapia/instrumentação , Adulto , Terapia Combinada , Fasciíte Plantar/complicações , Feminino , Calcanhar , Humanos , Masculino , Pessoa de Meia-Idade , Exercícios de Alongamento Muscular , Manipulações Musculoesqueléticas/métodos , Dor/etiologia , Dor/reabilitação , Medição da Dor , Projetos Piloto , Resultado do Tratamento
13.
Dtsch Arztebl Int ; 116(6): 83-88, 2019 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-30892183

RESUMO

BACKGROUND: Plantar fasciitis (PF) is characterized by pain on weight-bearing in the medial plantar area of the heel, metatarsalgia (MTG) by pain on the plantar surface of the forefoot radiating into the toes. Reliable figures on lifetime prevalence in Germany are lacking. METHODS: This review is based on pertinent publications retrieved from a selective search in PubMed, on guidelines from Germany and abroad, and on the authors' clinical experience. RESULTS: Plantar fasciitis is generally diagnosed from the history and physical examination, without any ancillary studies. In 90-95% of cases, conservative treatment (e.g., stretching exercises, fascia training, ultrasound therapy, glucocorticoid injections, radiotherapy, shoe inserts, and shock-wave therapy) brings about total, or at least adequate, relief of pain within one year. Intractable pain is an indication for surgical treatment by plantar fasciotomy and/or calf muscle release. In metatarsalgia, a directed diagnostic work-up to find the cause is mandatory, including a search for excessive mechanical stress due to abnormal foot posture, neuropathic pain, rheumatoid arthritis, aseptic bony necrosis, or malignant disease; imaging studies and pedobarography are needed. For causally oriented treatment, a wide range of conservative and surgical measures can be considered. CONCLUSION: The reported results of treatments for plantar fasciitis and metatarsalgia are heterogeneous. The efficacy of the individual measures should be studied in randomized controlled trials.


Assuntos
Fasciíte Plantar , Alemanha , Calcanhar , Humanos , Dor , Exame Físico
14.
Acta Chir Orthop Traumatol Cech ; 86(1): 65-71, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-30843516

RESUMO

PURPOSE OF THE STUDY The prospective study evaluates the short-term outcomes of endoscopic treatment of calcar calcanei in patients who underwent unsuccessfully more than 6 months of conservative therapy. MATERIAL AND METHODS Our study included 34 patients with refractory plantar fasciitis, in whom endoscopic treatment of inferior calcar calcanei with partial plantar fasciotomy was performed in the period from 01. 01. 2009 to 31. 07. 2015. The assessed parameters were the following: level of function, pain relief and patient satisfaction on the FAAM (Foot and Ankle Ability Measure) score and VAS (Visual Analog Scale) score with the minimum follow-up of 1 year. RESULTS A marked increase in the FAAM score from 39.2 preoperatively to 94.0 one year after the surgery and also a major pain relief on the VAS score from the initial 8 to the median 0 were observed. In total, 79.4% of patients were symptom-free one year after the surgery. The recurrence of calcar calcanei or ossification was seen on the radiograph taken one year after the surgery in 8 patients (23.5 %). DISCUSSION In our opinion, the most important outcome of our study is the considerable reduction in pain postoperatively (the median VAS score declined from 8 to 0 one year after the surgery) and concurrently a notable increase in the FAAM score (from 39.2 preoperatively to 94.0 one year after the surgery). Similar results of endoscopic partial fasciotomy were achieved also by some other authors. Therefore, this method can be considered validated. It has also been proven that the correlation between the calcar calcanei recurrence, or a higher BMI and recurrence of symptoms postoperatively is insignificant. CONCLUSIONS The endoscopic treatment of inferior calcar calcanei and plantar fasciotomy with denervation of fascial attachment is a fast, minimally invasive and safe method which brings very satisfactory results in the treatment of refractory plantar fasciitis. It is evidenced by subjective patient satisfaction, great function improvement, considerable pain relief after the surgery together with a minimum incidence of complications. Kew words:hindfoot, plantar heel pain, plantar fasciitis, arthroscopic treatment, short-term results.


Assuntos
Endoscopia , Fasciíte Plantar , Fasciíte Plantar/terapia , Seguimentos , Humanos , Estudos Prospectivos , Resultado do Tratamento
15.
J Foot Ankle Surg ; 58(2): 301-305, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30850099

RESUMO

Plantar fasciopathy (PF) is a common disorder for which there is no consensus regarding an optimal treatment strategy. We hypothesized that dry needling would be as effective as the use of corticosteroid injections for treating PF while avoiding the potential adverse effects of corticosteroids. After approval was received from the institutional review board, patients diagnosed with PF were prescribed a 3-week nonoperative treatment regimen. In addition to using oral and topical antiinflammatory drugs, patients engaged in plantar fascia and gastrocnemius stretching exercises. A study population of 98 patients was planned. An appointment was made in the third week of first-line treatment. Patients whose pain did not abate and who required further treatment were included in the study. One week later, we randomly divided patients into 2 groups using an online random number generator. Group 1 underwent dry needling, and group 2 underwent corticosteroid injection. All dry needling was performed by a single physiotherapist, and all corticosteroid injections were performed by the second author. Patients were assessed in the third week and sixth month by a single investigator using the foot function index. In terms of foot function index scores, dry needling caused significant decrease in the third week and also in the sixth month. However, although corticosteroid use led to a significant decrease at the third week, it lost efficacy in the sixth month (p < .001). In conclusion, dry needling seems to be a reliable procedure for treating PF, with better outcomes than corticosteroid injection.


Assuntos
Terapia por Acupuntura/métodos , Corticosteroides/uso terapêutico , Terapia por Exercício/métodos , Fasciíte Plantar/terapia , Medição da Dor , Administração Tópica , Adulto , Terapia Combinada , Fasciíte Plantar/diagnóstico , Feminino , Seguimentos , Hospitais Universitários , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do Tratamento , Turquia
16.
Orthopade ; 48(3): 261-280, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30747270

RESUMO

"Heel pain" describes a very common reason for foot orthopedic consultation and the further differential diagnostic investigation is crucial for the choice of correct treatment. In the treatment of frequent underlying diseases, such as plantar fasciitis or insertional tendinopathy of the Achilles tendon, a variety of modern strategies are available. Rarer diseases, such as tumors or nerve entrapment syndromes must be delineated and correctly classified. This article provides the current state of the diagnostics and treatment of the most common entities of heel pathologies.


Assuntos
Tendão do Calcâneo , Fasciíte Plantar , Diagnóstico Diferencial , Calcanhar , Humanos , Dor
17.
Med Sci Monit ; 25: 1392-1400, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30789873

RESUMO

BACKGROUND Traditional ankle-foot orthoses (AFOs) are not effective in treating plantar fasciitis, while customized 3-dimensional (3D) printed ankle-foot orthoses are effective in treating many ankle-foot diseases. This study investigated the effects of customized 3D printed AFOs on biomechanics and comfort of the plantar foot in plantar fasciitis. MATERIAL AND METHODS Sixty patients with bilateral plantar fasciitis aged 31-60 years participated in this study. At week 0, patients were randomly assigned into 2 groups: the control group consisting of those wearing separate shoes with prefabricated AFOs; and the experimental group consisting of those wearing a separate shoe and customized 3D-printed AFO. The Footscan® system recorded maximum pressure, maximum strength, and contact area of patients' hallux, toes 2-5, first to fifth metatarsal, midfoot, lateral heel, and midfoot heel at weeks 0 and 8. Patients used visual analogue scale scores at weeks 0 and 8 to assess overall comfort of foot orthosis, to determine the credibility and comfort of both orthopedic insole conditions. RESULTS At week 0, in the experimental group, peak pressure in the hallux and first metatarsal area was significantly higher than the control group (P<0.05), while mid-heel and lateral heel peak pressures were significantly lower than the control group (P<0.05). After 8 weeks, all groups reported more comfort compared with the same group in week 0 (P<0.05). The comfort scores reported by the experimental group were significantly lower than those of the control group (P<0.05). CONCLUSIONS This study supports the efficiency of customized 3D printing AFO for reducing damage associated with plantar lesions and improving comfort in patients with plantar fasciitis compared with prefabricated AFO. Customized AFO is useful in the treatment of plantar fasciitis compared with prefabricated AFOs.


Assuntos
Fasciíte Plantar/terapia , Manejo da Dor/métodos , Adulto , Tornozelo , Desenho de Equipamento/instrumentação , Feminino , , Órtoses do Pé , Humanos , Masculino , Pessoa de Meia-Idade , Dor/reabilitação , Medição da Dor/métodos , Modelagem Computacional Específica para o Paciente , Pressão , Impressão Tridimensional/instrumentação , Sapatos
18.
J Orthop Surg Res ; 14(1): 31, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683124

RESUMO

BACKGROUND: Both manual therapy techniques and dry needling have shown to be effective treatment options for the treatment of plantar heel pain; however, in recent years, other techniques based on dry needling (DN), such as percutaneous needle electrolysis (PNE), have also emerged. Currently, PNE is being used in clinical practice to manage myofascial trigger points, despite the lack of studies comparing the effects of this technique over dry needling. Therefore, the aim of this randomized controlled study is to compare the effectiveness of DN versus PNE for improving the level of pain experienced by patients suffering from plantar heel pain provoked by myofascial trigger points. METHODS: A randomized controlled trial will be conducted with blinded participants and outcome assessors. A sample of 94 patients with a medical diagnosis of plantar heel pain will be recruited and divided into two treatment groups. Eligible participants will be randomly allocated to either (a) treatment group with DN and a self-stretching home program or (b) treatment group with PNE and a self-stretching home program. Each group will receive one treatment session per week over a period of 4 weeks. The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire. The secondary outcome measures will be a visual analogue scale for pain (average and highest level of pain experienced during the previous 48 h; level of pain immediately after the treatment session) and health-related quality of life (assessed using the EuroQoL-5 dimensions). Cost-effectiveness data will be extracted based on the EuroQoL-5 dimensions. Follow-up measurements will take place at baseline and at 4, 8, 12, 26, and 52 weeks. DISCUSSION: The justification for this trial is the need to improve current understanding regarding the effectiveness of treatments targeting the rehabilitation of plantar heel pain. This study will be the first randomized controlled trial to directly compare the effectiveness of DN and PNE combined with a specific stretching program for the treatment of plantar heel pain provoked by myofascial trigger points. TRIAL REGISTRATION: Clinical Trials NCT03236779. Registered at clinicaltrials.gov 2 August 2017.


Assuntos
Terapia por Acupuntura/métodos , Eletrólise/métodos , Fasciíte Plantar/terapia , Agulhas , Manejo da Dor/métodos , Medição da Dor/métodos , Terapia por Acupuntura/instrumentação , Adulto , Método Duplo-Cego , Eletrólise/instrumentação , Fasciíte Plantar/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
19.
J Rehabil Med ; 51(3): 201-208, 2019 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-30667512

RESUMO

OBJECTIVE: To determine whether the appearance of a radial extracorporeal shock wave device affects clinical outcomes in chronic plantar fasciitis. STUDY DESIGN: Randomized controlled parallel assessor-blinded clinical trial. MATERIAL AND METHODS: A total of 135 patients were assigned to 3 groups: group I, standard radial extracorporeal shock wave device; group II, standard radial extracorporeal shock wave device modified to give a more sophisticated appearance; group III, standard radial extracorporeal shock wave device modified to give a more austere appearance. The radial extracorporeal shock waves emitted by the 3 devices were identical. Primary outcome was foot function, measured with the Foot Function Index. Secondary outcomes were pain at different times, measured with a visual analogue scale, and plantar fascia thickness, measured with ultrasound. RESULTS: All variables decreased significantly from baseline assessment, in all 3 groups and at all time-points: 1, 2, 4 and 14 months after the last session (p < 0.001). There were no significant differences between groups for any of the variables assessed. CONCLUSION: Device appearance had no statistically significant influence on clinical outcomes in patients with chronic plantar fasciitis treated with radial extracorporeal shock wave therapy.


Assuntos
Fasciíte Plantar/terapia , Ondas de Choque de Alta Energia/uso terapêutico , Fasciíte Plantar/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
20.
J Bodyw Mov Ther ; 23(1): 122-137, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30691739

RESUMO

BACKGROUND: Minimally invasive non-surgical techniques have been widely used worldwide to treat musculoskeletal injuries. Of these techniques, injectable pharmaceutical agents are the most commonly employed treatments, with corticosteroids being the most widely used drugs. The aim of this article is to review current scientific evidence as well as the effectiveness of minimally invasive non-surgical techniques, either alone or combined, for the treatment of plantar fasciitis. METHODS: This systematic review was conducted from April 2016 until March 2017, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and was registered with PROSPERO. Randomized controlled trials (RCTs) of adult patients diagnosed with plantar fasciitis were included as well as intervention studies, with a minimal sample size of 20 subjects per study (10 per group). Assessment of study eligibility was developed by three reviewers independently in an unblinded standardized manner. The physiotherapy evidence database (PEDro) scale was used to analyse the methodological quality of studies. RESULTS: Twenty-nine full-text articles on minimally invasive techniques were reviewed. These articles focused on corticosteroid injections, platelet-rich plasma, Botox, dextrose injections, as well as comparative studies with dry needling vs sham needling. CONCLUSION: The treatment of plantar fasciitis has dramatically improved in the past decade with minimally invasive techniques becoming increasingly available. Research findings have shown that the long term effects of minimally invasive (non-surgical) treatments such as shock wave therapy, botulinum toxin type-A injections, platelet-rich plasma injections and intratissue percutaneous electrolysis dry needling show similar and sometimes better results when compared to only corticosteroid injections. The latter have been the mainstay of treatment for many years despite their associated side effects both locally and systemically. To date, there is no definitive treatment guideline for plantar fasciitis, however the findings of this literature review may help inform practitioners and clinicians who use invasive methods for the treatment of plantar fasciitis regarding the levels of evidence for the different treatment modalities available.


Assuntos
Fasciíte Plantar/terapia , Manejo da Dor/métodos , Terapia por Acupuntura/métodos , Corticosteroides/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Glucose/uso terapêutico , Humanos , Injeções Intra-Articulares , Medição da Dor , Modalidades de Fisioterapia , Plasma Rico em Plaquetas , Polidesoxirribonucleotídeos/uso terapêutico , Terapia de Tecidos Moles/métodos
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