The British Journal of Medicine published two interesting articles this month. The first is an education review on the overdiagnosis and medicalization of athletes (and the public at large)(1). The authors cite several factors supporting this trend in sports medicine, including: The belief that more intervention improves outcomes. Making the definition of disease more inclusive.... MORE
Treating plantar fasciitis with modalities
Although frequently seen in athletes, plantar fasciitis affects nearly 10% of the US population no matter what age, gender, or activity level. This condition manifests as heel pain sometimes radiating to the arch of the foot. Despite the common occurrence, effective treatment for plantar fasciitis remains elusive. Some of the methods currently used to treat this condition include, manual therapy, stretching, night splint, orthotics, shockwave therapy, steroid injections, and taping. The research to determine the most successful treatment strategy remains inconclusive. Much of the research contains faulty methods, small populations, and inconsistent treatment parameters. Therefore, it is difficult to compare studies.
Therapeutic ultrasound, thought to increase the temperature and metabolism within tissues, stimulate blood flow and promote healing, remains part of the treatment repertoire for plantar fasciitis. Theoretically, the use of therapeutic ultrasound should improve the condition. However, the research in this area was inconclusive. Israeli researchers sought to answer this question once and for all. In a well-designed prospective, double blind, randomized controlled study, the researchers compared the use of ultrasound as an additive treatment to a therapeutic stretching program.
Fifty patients were assigned to either the study group, which received a stretching protocol accompanied by therapeutic ultrasound, or a control group, which participated in the same stretching program but received a sham ultrasound. At the conclusion of the study, both groups showed significant improvement. However, the improvement between the groups was nearly the same. That is to say that, the ultrasound group did not show any statistically significant difference in the levels of improvement.
While this study did not include a control group that received no treatment, the authors concluded that ultrasound provided no additional benefit when it accompanied a therapeutic stretching program. However, it appears that stretching and exercise continue to be an effective treatment approach for plantar fasciitis (see figure 1).
Figure 1: Towel Scrunches
Begin in sitting and scrunch a towel with both feet. Progress to standing scrunches with both feet, then standing on one foot.
What about other modalities?
Chinese scientists recently reviewed the literature on the subject of treatment modalities used for plantar fasciitis. They found radial extracorporeal shock wave therapy (ESWT) to be the most effective treatment when compared to laser, ultrasound, ultrasound guided pulsed radiofrequency treatment, intracorporeal pneumatic shockwave therapy, and noninvasive interactive neurostimulation(2). Another group of Chinese researchers performed a meta-analysis on the literature on the topic and came to the same conclusion. They found that patients treated with ESWT showed significantly better outcomes than those with other treatment approaches(3).
Further investigation in China compared the effectiveness of ESWT to corticosteroid injection. Though only six studies met the inclusion criteria, they showed a significant difference in the resulting visual analog scale for pain between those patients who received ESWT and those with steroid injection(4). Therefore, while ultrasound doesn’t improve the outcomes of plantar fasciitis, ESWT appears to be a safe and effective choice for treatment.
- 2018 Nov;48(11):847-54
- Medicine (Baltimore). 2018 Oct;97(43)
- Foot Ankle Surg. 2018 Nov 13;[Epub ahead of print]
- Arch Orthop Trauma Surg. 2018 Nov 13 [Epub ahead of print]