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Barr L, Richards J, Dickson C, Tawse J, Munro N, Scott H, Holland A, Chapman GJ. To scan or not to scan? Comparing the effectiveness and cost differential of insoles manufactured from foam-box casts versus direct scans in treating musculoskeletal conditions of the foot and ankle: a double-blinded, randomised controlled trial. BMC Musculoskelet Disord 2025; 26:282. [PMID: 40121418 PMCID: PMC11929285 DOI: 10.1186/s12891-025-08513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Accepted: 03/10/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Foot orthoses produced using computer-aided-design and manufacture (CAD/CAM) are commonly used to treat musculoskeletal conditions of the foot and ankle, however minimal evidence exists as to the most effective method used to capture the patients foot shape. This trial aimed to determine the effectiveness and cost of insoles manufactured from a direct scan of the foot compared with those manufactured from foam-box casts. METHODS This double blinded clinical trial randomly assigned participants with lower limb musculoskeletal pathologies into two groups and provided them with custom CAD/CAM foot orthoses manufactured either from a direct scan of the participants' feet (direct scan group) or from foam-box casts of their feet (foam-box cast group). 114 participants were recruited and asked to wear their foot orthoses for 12-weeks. The Foot Health Status Questionnaire (FHSQ) was completed at baseline, 4, 8 and 12-weeks to evaluate the primary outcome measure of pain, as well as secondary outcomes for foot function, foot health and footwear, and the Orthotic and Prosthetic User Survey Client Satisfaction with Device module (OPUS-CSD) was completed at 12-weeks. Adherence was measured using a daily wear-diary recorded over 12-weeks. The number of manual insole adaptations was also recorded, and staff time, material and transportation costs were evaluated. RESULTS 112 participants completed the trial. Despite no significant between-group differences, both groups reported significant improvements in pain, function and foot health from baseline to 4, 8 and 12-weeks, which all exceeded their respective minimum important differences. The direct scan group reported greater satisfaction at 12-weeks (p = 0.04), greater adherence (p < 0.001), and required less insole adaptations (n = 4) compared to the foam-box cast group (n = 15) (p = 0.006). Overall costs and staff time costs were higher in the foam-box cast group. CONCLUSIONS CAD/CAM insoles are effective in reducing pain, and improving foot function and foot health after 4-weeks, and sustained at 12-weeks, however the method of shape capture does not affect these responses. Over 12-weeks participant satisfaction and adherence was greater when using the direct scan approach, which also required fewer manual insole adaptations. There was a greater overall cost associated with foam-box insoles. Clinicians are therefore recommended to use direct foot scanning over foam-box casting when prescribing CAD/CAM insoles for patients with musculoskeletal foot and ankle conditions. TRIAL REGISTRATION ClinicalTrials.gov, trial number NCT05444192. Trial registration date 30th June 2022.
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Affiliation(s)
- Laura Barr
- Orthotic Service, Orthotic Department, NHS Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, Scotland, G12 0YN, UK
- Allied Health Research Unit, University of Central Lancashire, Brook Building (BB128), Preston, PR1 2HE, UK
| | - Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Brook Building (BB128), Preston, PR1 2HE, UK
| | - Colette Dickson
- Orthotic Service, Orthotic Department, NHS Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, Scotland, G12 0YN, UK
| | - Jillian Tawse
- Orthotic Service, Orthotic Department, NHS Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, Scotland, G12 0YN, UK
| | - Nikki Munro
- Orthotic Service, Orthotic Department, NHS Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, Scotland, G12 0YN, UK
| | - Hannah Scott
- Orthotic Service, Orthotic Department, NHS Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, Scotland, G12 0YN, UK
| | - Aimie Holland
- Orthotic Service, Orthotic Department, NHS Greater Glasgow and Clyde, Gartnavel General Hospital, Glasgow, Scotland, G12 0YN, UK
| | - Graham J Chapman
- Allied Health Research Unit, University of Central Lancashire, Brook Building (BB128), Preston, PR1 2HE, UK.
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Abdel-Aal NM, Amen FS, Azzam AH, Elwan MA. Effect of acetic acid shockwave phonophoresis on spur morphology, foot pain and function in patients with calcaneal spur: A randomised controlled trial. Clin Rehabil 2025; 39:187-201. [PMID: 39704113 DOI: 10.1177/02692155241306072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Abstract
OBJECTIVE To investigate the effect of acetic acid shockwave phonophoresis on spur morphology, foot pain, and function in patients with calcaneal spurs. DESIGN A double-blinded, randomised clinical trial. SETTING Outpatients physical therapy clinics. PARTICIPANTS One hundred forty-seven patients with calcaneal spurs, 18-65 years old, were randomly allocated to three equal groups. INTERVENTION The study group (A) received acetic acid shockwave phonophoresis plus conventional physical therapy. The study group (B) received shockwave therapy plus conventional physical therapy. The control group received conventional physical therapy programme only. Interventions were applied twice a week for 3 weeks. OUTCOME MEASURES Calcaneal spur width, calcaneal spur length, pain intensity level, pain pressure threshold and foot and ankle ability measure activities of daily living subscale were measured at baseline, after 3 weeks of interventions and after 4 weeks of follow-up with no intervention. RESULTS Between-group differences were observed for calcaneal spur width and length, pain intensity, pain pressure threshold and function after 3 weeks favouring Group A (p < 0.001). Mean differences (95% CI) between study groups were -1.11 mm (-1.46, -0.77) for spur width; -1.34 mm (-1.67, -1.01) for spur length; -20.71 mm (-24.66, -16.77) for pain; 1.45 kg/cm2 (1.05, 1.85) for pain pressure threshold; and 12.16 points (9.24, 15.09) for function after 3 weeks. CONCLUSIONS Acetic acid shockwave phonophoresis combined with exercise clinically and statistically improves calcaneal spur width, length, pain intensity, pain pressure threshold and foot function more than shockwave therapy alone or conventional physical therapy. This method might be considered an effective, feasible, safe, non-invasive and locally applicable treatment for heel spurs.
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Affiliation(s)
- Nabil Mahmoud Abdel-Aal
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Fatma Seddek Amen
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ahmad Hamdi Azzam
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Ali Elwan
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt
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Huang Z, Liang X, Luo Y, Fang Z, Xu M, Xu Y, Cheng S, Li L. The Effectiveness of Acupuncture on Myofascial Trigger Points Versus Traditional Chinese Medicine Acupoints for Treating Plantar Fasciitis With Low Back Pain: A Study Protocol for a Randomised Clinical Trial. J Pain Res 2025; 18:497-506. [PMID: 39895813 PMCID: PMC11786601 DOI: 10.2147/jpr.s492541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 01/21/2025] [Indexed: 02/04/2025] Open
Abstract
Background Plantar fasciitis is a common cause of heel pain, often associated with a higher rate of low back pain. This increased disability rate in low back pain may be correlated with reduced foot and ankle function. While both acupuncture and trigger point dry needling have been reported as potentially effective treatments for plantar fasciitis, the quality of evidence is currently low. Acupuncture at trigger points might be a promising treatment for plantar fasciitis, though there is a lack of evidence supporting its effectiveness. This trial aims to compare the effectiveness of acupuncture at trigger points versus Traditional Chinese Medicine (TCM) acupoints in the treatment of participants with plantar fasciitis and low back pain. Methods The trial will be a single-centre, parallel two-group, randomised controlled trial with 62 participants allocated in a 1:1 ratio to either the trigger point group or the TCM acupoint group. Patients with plantar fasciitis and low back pain will be enrolled in this trial. Eligible participants will receive acupuncture for 30 minutes per session over 8 total sessions, with a 12-week follow-up period. The primary outcome measure will be the change from baseline in the worst first-step pain intensity in the morning after treatment. Secondary outcomes include changes from baseline in foot and low back pain, foot and low back function, plantar fascia thickness, and participants' self-reported global improvement. Statistical analysis will be conducted using a two-sided test with a significance level of 0.05 and 95% confidence intervals. Clinical Trial Registration This trial has been registered at the Chinese Clinical Trial Registry. Registration number: ChiCTR2300067552. Registration date: 1 January 2023.
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Affiliation(s)
- Ziling Huang
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China
| | - Xin Liang
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China
| | - Yuheng Luo
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China
| | - Zhou Fang
- Department of Orthopedics, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China
| | - Ming Xu
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China
| | - Yinqin Xu
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China
| | - Shan Cheng
- Ultrasound Center, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China
| | - Lihong Li
- Department of Acupuncture and Moxibustion, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China
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Barr L, Munro N, Watters K, McCaig R, Richards J, Chapman GJ. The effectiveness of custom hard-shell 3D-printed foot orthoses in a cohort of patients who did not respond to treatment with custom ethylene-vinyl-acetate (EVA) foot orthoses. Foot (Edinb) 2024; 61:102142. [PMID: 39437628 DOI: 10.1016/j.foot.2024.102142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 10/04/2024] [Accepted: 10/06/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Patients who do not achieve positive outcomes with custom ethylene-vinyl-acetate (EVA) foot orthoses will often be escalated to other services for treatment, which may include surgery. OBJECTIVE This study aimed to explore the effectiveness of custom hard-shell 3D-printed foot orthoses for patients who did not respond to treatment with custom EVA foot orthoses and were being considered for treatment escalation. DESIGN An eight-week clinical evaluation and a two-year review of relevant medical records. METHOD Thirty-six consecutive patients with a range of musculoskeletal lower limb pathology who remained symptomatic after 12-weeks use of custom EVA foot orthoses were fitted with custom hard-shell 3D-printed foot orthoses. The Foot Health Status Questionnaire was used to assess patients at baseline and eight-week follow-up in conjunction with the Client Satisfaction with Device module of the Orthotics and Prosthetics User Survey. Patients were categorised as responders or non-responders based on their change in pain scores. A review of relevant medical records two years after receiving their orthoses determined if patients required further treatment for their initial condition. RESULTS Across the full cohort there were significant improvements in pain, function and foot health. At follow-up, responders reported significantly improved pain, function and foot health compared with non-responders. Twenty-six patients (12 responders, 14 non-responders) required no further treatment for their original condition after two years. CONCLUSIONS Custom hard-shell 3D-printed foot orthoses have the potential to improve pain, function, foot health, and provide satisfaction in patients with lower limb musculoskeletal conditions which do not improve with custom EVA foot orthoses.
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Affiliation(s)
- Laura Barr
- Orthotic Service, NHS Greater Glasgow and Clyde, Orthotic Department, Gartnavel General Hospital, G12 0YN, UK; Allied Health Research unit, University of Central Lancashire, United Kingdom
| | - Nikki Munro
- Orthotic Service, NHS Greater Glasgow and Clyde, Orthotic Department, Gartnavel General Hospital, G12 0YN, UK
| | - Kirsty Watters
- Orthotic Service, NHS Greater Glasgow and Clyde, Orthotic Department, Gartnavel General Hospital, G12 0YN, UK
| | - Ross McCaig
- Orthotic Service, NHS Greater Glasgow and Clyde, Orthotic Department, Gartnavel General Hospital, G12 0YN, UK
| | - Jim Richards
- Allied Health Research unit, University of Central Lancashire, United Kingdom
| | - Graham J Chapman
- Allied Health Research unit, University of Central Lancashire, United Kingdom.
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Sezaki Y, Ikeda N, Toyoshima S, Aoki A, Fukaya T, Yokoi Y, Morishita K. Analgesic effect and efficacy rate of radial extracorporeal shock wave therapy for plantar fasciitis: a retrospective study. J Phys Ther Sci 2024; 36:537-541. [PMID: 39239412 PMCID: PMC11374163 DOI: 10.1589/jpts.36.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/12/2024] [Indexed: 09/07/2024] Open
Abstract
[Purpose] This study aimed to measure the analgesic effects and efficacy of radial extracorporeal shock wave therapy, for which no consensus has been reached regarding optimal treatment parameters. [Participants and Methods] The study included 40 feet of 40 patients with plantar fasciitis. The visual analogue scale was used to determine the immediate and cumulative effects of radial extracorporeal shock wave therapy as well as the efficacy rate. Efficacy was calculated as a percentage visual analogue scale change of ≥20 mm and visual analogue scale improvement of ≥60%. [Results] Immediate and continued efficacy of radial extracorporeal shock wave therapy was observed and recorded. Efficacy rates based on a percentage visual analogue scale change of ≥20 mm and visual analogue scale improvement of ≥60% were both 57.5%. [Conclusion] Radial extracorporeal shock wave therapy has immediate and cumulative analgesic effects on plantar fasciitis. However, cumulative results of interventions with various treatment parameters are required to determine the optimal treatment parameter settings for diffuse pressure wave therapy for plantar fasciitis.
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Affiliation(s)
- Yui Sezaki
- Department of Rehabilitation Science, Graduate School of
Health Sciences, Josai International University: 1 Gumyo, Togane, Chiba 283-8555,
Japan
- Department of Rehabilitation, Shiraishi Clinic Orthopedics
& Internal Medicine & Gastrointestinal Medicine, Japan
| | - Naoto Ikeda
- Department of Rehabilitation Science, Graduate School of
Health Sciences, Josai International University: 1 Gumyo, Togane, Chiba 283-8555,
Japan
- Department of Rehabilitation, Shiraishi Clinic Orthopedics
& Internal Medicine & Gastrointestinal Medicine, Japan
| | - Sho Toyoshima
- Department of Rehabilitation, Shiraishi Clinic Orthopedics
& Internal Medicine & Gastrointestinal Medicine, Japan
- Department of Rehabilitation, Rakusai Shimizu Hospital,
Japan
| | - Atsushi Aoki
- Department of Rehabilitation Science, Graduate School of
Health Sciences, Josai International University: 1 Gumyo, Togane, Chiba 283-8555,
Japan
| | - Taizan Fukaya
- Department of Physical Therapy, Faculty of Social Work
Studies, Josai International University, Japan
| | - Yuka Yokoi
- Department of Rehabilitation, Shiraishi Clinic Orthopedics
& Internal Medicine & Gastrointestinal Medicine, Japan
- Department of Physical Therapy, Faculty of Social Work
Studies, Josai International University, Japan
| | - Katsuyuki Morishita
- Department of Rehabilitation, Shiraishi Clinic Orthopedics
& Internal Medicine & Gastrointestinal Medicine, Japan
- Department of Rehabilitation, Rakusai Shimizu Hospital,
Japan
- Department of Physical Therapy, Faculty of Social Work
Studies, Josai International University, Japan
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Simental-Mendía M, Simental-Mendía LE, Sánchez-García A, Sahebkar A, Jamialahmadi T, Vilchez-Cavazos F, Peña-Martínez VM, Acosta-Olivo C. Effect of extracorporeal shockwave therapy on plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2024; 144:3503-3516. [PMID: 39023569 DOI: 10.1007/s00402-024-05464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Extracorporeal shockwave therapy (ESWT) has been used as a therapeutic option for plantar fasciitis. The objective was to investigate the effect of ESWT over the plantar fascia thickness. METHODS MEDLINE, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials evaluating the effect of ESWT in patients with plantar fasciitis, comparing ESWT with another treatment. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. Meta-regression and subgroup analyses were also carried out. RESULTS A total of 14 studies (867 participants) were included. ESWT significantly decreased plantar fascia thickness (weighted mean difference [WMD], -0.21 mm [95% CI -0.39, -0.02]; p = 0.03). No significant improvement in pain was observed (WMD, -0.51 cm [95% CI -1.04, 0.01]; p = 0.06) compared with non-surgical interventions. CONCLUSIONS Our results suggest that plantar fascia thickness is significantly decreased after ESWT intervention in patients with plantar fasciitis. However, pain relief was not significantly improved compared to other non-surgical interventions.
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Affiliation(s)
- Mario Simental-Mendía
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico
| | - Luis E Simental-Mendía
- Biomedical Research Unit, Delegación Durango, Instituto Mexicano del Seguro Social, Durango, Mexico
| | - Adriana Sánchez-García
- Endocrinology Division, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Monterrey, Mexico
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tannaz Jamialahmadi
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Félix Vilchez-Cavazos
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico
| | - Víctor M Peña-Martínez
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico
| | - Carlos Acosta-Olivo
- Orthopedic Trauma Service, School of Medicine, Universidad Autonoma de Nuevo Leon, University Hospital "Dr. José Eleuterio González", Ave. Francisco I. Madero and Ave. Dr. José Eleuterio González, 64460, Monterrey, Nuevo León, Mexico.
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Heide M, Røe C, Mørk M, Myhre K, Brunborg C, Brox JI, Hoksrud AF. Is radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses more effective than advice plus customised foot orthoses alone in the treatment of plantar fasciopathy? A double-blind, randomised, sham-controlled trial. Br J Sports Med 2024; 58:910-918. [PMID: 38904119 PMCID: PMC11347971 DOI: 10.1136/bjsports-2024-108139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES To assess whether radial extracorporeal shock wave therapy (rESWT), sham-rESWT or a standardised exercise programme in combination with advice plus customised foot orthoses is more effective than advice plus customised foot orthoses alone in alleviating heel pain in patients with plantar fasciopathy. METHODS 200 patients with plantar fasciopathy were included in a four-arm, parallel-group, sham-controlled, observer-blinded, partly patient-blinded trial. At baseline, before randomisation, all patients received advice plus customised foot orthoses. Patients were randomised to rESWT (n=50), sham-rESWT (n=50), exercise (n=50) or advice plus customised foot orthoses alone (n=50). Patients in the rESWT and sham-rESWT groups received three treatments. The exercise programme comprised two exercises performed three times a week for 12 weeks, including eight supervised sessions with a physiotherapist. Patients allocated to advice plus customised foot orthoses did not receive additional treatment. The primary outcome was change in heel pain during activity in the previous week per Numeric Rating Scale (0-10) from baseline to 6-month follow-up. The outcome was collected at baseline, and 3, 6 and 12 months. RESULTS The primary analysis showed no statistically significant between-group differences in mean change in heel pain during activity for rESWT versus advice plus customised foot orthoses (-0.02, 95% CI -1.01 to 0.96), sham-rESWT versus advice plus customised foot orthoses (0.52, 95% CI -0.49 to 1.53) and exercise versus advice plus customised foot orthoses (-0.11, 95% CI -1.11 to 0.89) at 6 months. CONCLUSION In patients with plantar fasciopathy, there was no additional benefit of rESWT, sham-rESWT or a standardised exercise programme over advice plus customised foot orthoses in alleviating heel pain. TRIAL REGISTRATION NUMBER NCT03472989.
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Affiliation(s)
- Marte Heide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cecilie Røe
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marianne Mørk
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Kjersti Myhre
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Jens Ivar Brox
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Aasne Fenne Hoksrud
- Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
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Daher M, Covarrubias O, Herber A, Oh I, Gianakos AL. Platelet-Rich Plasma vs Extracorporeal Shock Wave Therapy in the Treatment of Plantar Fasciitis at 3-6 Months: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Foot Ankle Int 2024; 45:796-803. [PMID: 38419209 DOI: 10.1177/10711007241231959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Plantar fasciitis (PF) is a common foot disorder with variability in treatment strategy. Two effective management techniques include platelet-rich plasma (PRP) injections and extracorporeal shock wave therapy (ESWT). The purpose of this meta-analysis is to compare the effectiveness of PRP vs ESWT in the management of PF. METHODS A systematic search was performed of PubMed, Cochrane, and Google Scholar for randomized controlled trials comparing PRP to ESWT. Studies met inclusion criteria if mean and SDs for visual analog scale (VAS) pain scores and plantar fascia thickness (PFT) were reported. Mean differences were used to compare VAS pain score and PFT between PRP and ESWT. RESULTS Six randomized controlled trials, comparing a total of 214 subjects in the PRP group and 218 subjects in the ESWT group, were analyzed. A significantly greater statistical improvement was seen in the PRP group in VAS pain (mean difference = -0.67 [95% CI -1.16, -0.18], P = .007) and plantar fascia thickness (PFT) (mean difference = -0.56 [95% CI -0.77, -0.35], P < .001). CONCLUSION PRP had a statistically higher pain reduction than ESWT, but the difference does not reach clinical significance in this meta-analysis.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Oscar Covarrubias
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Agustin Herber
- School of Osteopathic medicine, Midwestern University, Chicago, IL, USA
| | - Irvin Oh
- Department of Foot and Ankle Surgery, Yale University, New Haven, CT, USA
| | - Arianna L Gianakos
- Department of Foot and Ankle Surgery, Yale University, New Haven, CT, USA
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Harnroongroj T, Arunakul M, Reingrittha P, Chuckpaiwong B, Angthong C, Tharmviboonsri T, Lertwattanachai P. Outcomes of Tibiotalocalcaneal Arthrodesis vs Talar Body Prosthesis as Treatment of Collapsed Avascular Necrosis of the Talus: A 10- to 13-Year-Follow-up Retrospective Comparative Study. Foot Ankle Int 2024; 45:435-443. [PMID: 38501708 DOI: 10.1177/10711007241231966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Joint salvage surgeries such as tibiotalocalcaneal arthrodesis and talar prosthesis are commonly used in the surgical treatment of collapsed avascular necrosis of the talus (AVNT). However, differences in outcomes of these 2 surgical treatments are still inconclusive. This study compared the 10- to 13-year outcomes and 10-year survivorship rates of tibiotalocalcaneal arthrodesis and talar body prosthesis in the surgical treatment of collapsed AVNT. METHODS A retrospective comparative study was conducted of patients who underwent either tibiotalocalcaneal arthrodesis or talar body prosthesis implantation between 2005 and 2012. The demographic matching process resulted in 24 patients per treatment group. Clinical outcomes were evaluated using a numeric rating scale (NRS) of 2 hours of activities of daily living (ADL) and Foot and Ankle Ability Measure (FAAM) for ADL. Radiographic assessments included the incidence of nonunion, adjacent joint arthritis, and prosthesis loosening. The 10-year survivorship of both surgical treatments was calculated. A P value of less than .05 was considered statistically significant. RESULTS The median NRS of 2 hours of ADL and FAAM score for ADL were statistically significantly better in the talar body prosthesis group, with P values of .001 and <.001, respectively. The statistically significant differences in FAAM score for ADL exceeded the minimum clinically important difference. In the tibiotalocalcaneal arthrodesis group, nonunion was observed in 7 of 24 patients (29.2%). No prosthesis loosening was reported in the talar body prosthesis group. The 10-year survivorship was statistically significantly higher in talar body prosthesis than tibiotalocalcaneal arthrodesis (95.8% vs 70.8%), P = .023. CONCLUSION Talar body prosthesis implantation in selected eligible patients demonstrated statistically significantly better 10- to 13-year clinical outcomes and higher 10-year survivorship compared with tibiotalocalcaneal arthrodesis in the surgical treatment of collapsed AVNT. LEVEL OF EVIDENCE Level III, retrospective cohort comparative study.
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Affiliation(s)
- Thos Harnroongroj
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand
| | - Marut Arunakul
- Department of Orthopedic Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pissanu Reingrittha
- Department of Orthopedic Surgery, Buddhachinaraj Phitsanulok Hospital, Phitsanulok, Thailand
| | - Bavornrit Chuckpaiwong
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand
| | - Chayanin Angthong
- Department of Orthopedic Surgery, Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Thailand
| | - Theerawoot Tharmviboonsri
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand
| | - Penpun Lertwattanachai
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand
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Barr L, Richards J, Chapman GJ. Comparing the effectiveness of computer-aided design/computer-aided manufacturing (CAD/CAM) of insoles manufactured from foam box cast versus direct scans on patient-reported outcome measures: a protocol for a double-blinded, randomised controlled trial. BMJ Open 2024; 14:e078240. [PMID: 38569685 PMCID: PMC10989167 DOI: 10.1136/bmjopen-2023-078240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/23/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Custom insoles are a routine treatment for many foot pathologies, and the use of computer-aided design and computer-aided manufacturing (CAD/CAM) is well established within clinical practice in the UK. The method of foot shape capture used to produce insoles varies throughout orthotic services. This trial aims to investigate the effectiveness of two common shape-capture techniques on patient-reported outcomes in people who require insoles for a foot or ankle pathology. METHODS AND ANALYSIS This double-blinded randomised controlled trial will involve two intervention groups recruited from a National Health Service orthotic service. Participants will be randomly assigned to receive a pair of custom CAD/CAM insoles, manufactured either from a direct digital scan or a foam box cast of their feet and asked to wear the insoles for 12 weeks. The primary outcome measure will be the Foot Health Status Questionnaire (FHSQ) pain subdomain, recorded at baseline (immediately after receiving the intervention), 4, 8 and 12 weeks post intervention. Secondary outcome measures will include FHSQ foot function and foot health subdomains recorded at baseline, 4, 8 and 12 weeks. The Orthotic and Prosthetic User Survey Satisfaction with Device will be recorded at 12 weeks. The transit times associated with each arm will be measured as the number of days for each insole to be delivered after foot shape capture. Tertiary outcome measures will include participant recruitment and dropout rates, and intervention adherence measured as the daily usage of the insoles over 12 weeks. The change in FHSQ scores for the subdomains and insole usage will be compared between the groups and time points, and between group differences in time in transit, cost-time analysis and environmental impact will be compared. ETHICS AND DISSEMINATION Ethical approval was obtained from the Health Research Authority, London Stanmore Research Ethics Committee (22/LO/0579). Study findings will be submitted for publication in peer-reviewed journals, conference presentations and webinars. TRIAL REGISTRATION NUMBER NCT05444192.
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Affiliation(s)
- Laura Barr
- Orthotic Department, Gartnavel General Hospital, Glasgow, UK
- Allied Health Research unit, University of Central Lancashire, Preston, UK
| | - Jim Richards
- Allied Health Research unit, University of Central Lancashire, Preston, UK
| | - Graham J Chapman
- Allied Health Research unit, University of Central Lancashire, Preston, UK
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11
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Fleischer AE, Albright RH. Prospective Surgical Cohort Analysis. Clin Podiatr Med Surg 2024; 41:281-290. [PMID: 38388125 DOI: 10.1016/j.cpm.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
A well-conducted prospective cohort study has the potential to change the way in which surgeons practice. However, not all are equal. In this article, we provide many of the tools needed to critically appraise this powerful study design. We advocate for using a 3-step approach that centers on understanding the study's generalizability, results, and validity. We illustrate how this process is applied into practice regularly at our hospital section's journal club sessions.
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Affiliation(s)
- Adam E Fleischer
- Podiatric Medicine & Surgery Residency Program, Advocate Illinois Masonic Medical Center/RFUMS, Chicago, IL, USA; Weil Foot & Ankle Institute, Chicago, IL, USA; Department of Podiatric Medicine & Surgery, Rosalind Franklin University of Medicine & Science (RFUMS), 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Rachel H Albright
- Foot & Ankle Surgery, Department of Surgery, Stamford Health Medical Group, Stamford, CT, USA
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12
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Reinstein M, Weisman A, Masharawi Y. Barefoot walking is beneficial for individuals with persistent plantar heel pain: A single-blind randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101786. [PMID: 38118297 DOI: 10.1016/j.rehab.2023.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND A lack of data exist about the effectiveness of active treatments for persistent plantar heel pain (PPHP). OBJECTIVES To compare short-term functional and clinical effects of a 4-week barefoot or shod treadmill walking program for people with PPHP. METHODS A single-blinded clinical trial randomized 52 participants with PPHP into either a barefoot walking group (BWG), or a shod walking group (SWG). All participants received therapeutic ultrasound. Outcomes were measured at baseline (t0), following 4 weeks of treatment (t1), and at 1-month follow-up (t2). The SF-36 functional questionnaire score was the main outcome. Secondary outcomes were self-reported and clinically-assessed pain provocation levels, pressure pain thresholds and pain tolerance. Treadmill walking time and speed were measured at t0 and t1; people also recorded the time spent walking each day in a diary. RESULTS The BWG exhibited significant improvements in all SF-36 items (except "emotional well-being") (P < 0.05), whereas the SWG exhibited improvements only in "pain" and "health change" items (P = 0.0001; effect size 0.13-0.94). Greater improvements were observed in the BWG than the SWG for "physical function" (P = 0.019) and "role limitations due to physical health" items (P = 0.035). Both groups demonstrated significant improvements in pain, with greater improvements in the BWG (P = 0.0001; effect size 0.89). Only the BWG showed significant improvements in pain pressure thresholds (P < 0.05; effect size 0.70) and pain tolerance (P < 0.001; effect size 0.67). Both groups significantly increased their speed and time spent walking on the treadmill (BWG Δ=19.7 min and Δ=1.7 km/h; SWG Δ=16.7 min and Δ=1.1 km/h) and time outdoors (SWG ∆=38.2 min/week; BWG mean ∆=48.5 min/week) (P < 0.001). All clinical tests of pain were significantly less positive in the BWG at all time points (P < 0.05). CONCLUSIONS Both walking programs benefited people with PPHP by alleviating pain and improving function and quality of life. Greater improvements were observed in the BWG than the SWG overall.
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Affiliation(s)
- Miriam Reinstein
- Mevaseret Zion and Bruchim Outpatient Clinics, Jerusalem District, Meuhedet Health Services, Jerusalem, Israel; Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Israel
| | - Asaf Weisman
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel Aviv University, Israel.
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13
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García-Gomariz C, Hernández-Guillén D, Nieto-Gil P, Blasco-García C, Alcahuz-Griñán M, Blasco JM. Effects of Kinesiotape versus Low-Dye Tape on Pain and Comfort Measures in Patients with Plantar Fasciitis: A Randomized Clinical Trial. Life (Basel) 2024; 14:249. [PMID: 38398758 PMCID: PMC10890258 DOI: 10.3390/life14020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Bandages are commonly used to relieve pain in patients with plantar fasciitis. The goal was to compare the effects of using kinesiotape versus low-dye tape in the acute phase of plantar fasciitis on pain and comfort measures. METHODS Forty individuals with plantar fasciitis were allocated to the kinesiotape or low-dye tape interventions. The patients were assessed at baseline and every 24 h until the fifth day. The primary measure was a visual analog scale of pain. The other measures were comfort, mobility, durability, personal hygiene, sweating, and allergies. The effects were compared with an ANOVA test, 95% CI. RESULTS Kinesiotape was more effective in reducing pain; the greater effect occurred during the first day, with a between-group difference of 2.0 (95% CI: 1.8 to 2.2). The pain differences between the treatments progressively reduced each day from the second day. Kinesiotape offered significantly higher performance than low-dye tape in mobility, comfort, and comfort in hygiene, sweating, and durability, with a large effect size d > 0.8. CONCLUSIONS Kinesiotape could be more effective than low-dye tape in relieving pain in patients with plantar fasciitis, with a significant clinical impact on the first day of treatment. Kinesiotape can also provide higher performance in terms of comfort.
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Affiliation(s)
- Carmen García-Gomariz
- Department of Nursing, University of Valencia, Menéndez y Pelayo Av S/N, 46010 Valencia, Spain; (C.G.-G.); (P.N.-G.); (C.B.-G.); (M.A.-G.)
- Group of Physiotherapy in the Ageing Process: Social and Health Care Strategies, Department of Physiotherapy, University of Valencia, Gascó Oliag 5, 46010 Valencia, Spain;
| | - David Hernández-Guillén
- Group of Physiotherapy in the Ageing Process: Social and Health Care Strategies, Department of Physiotherapy, University of Valencia, Gascó Oliag 5, 46010 Valencia, Spain;
- Department of Physiotherapy, University of Valencia, Dr. Moliner 50 Av., 46100 Burjassot, Spain
| | - Pilar Nieto-Gil
- Department of Nursing, University of Valencia, Menéndez y Pelayo Av S/N, 46010 Valencia, Spain; (C.G.-G.); (P.N.-G.); (C.B.-G.); (M.A.-G.)
| | - Carlos Blasco-García
- Department of Nursing, University of Valencia, Menéndez y Pelayo Av S/N, 46010 Valencia, Spain; (C.G.-G.); (P.N.-G.); (C.B.-G.); (M.A.-G.)
| | - Montse Alcahuz-Griñán
- Department of Nursing, University of Valencia, Menéndez y Pelayo Av S/N, 46010 Valencia, Spain; (C.G.-G.); (P.N.-G.); (C.B.-G.); (M.A.-G.)
| | - José-María Blasco
- Group of Physiotherapy in the Ageing Process: Social and Health Care Strategies, Department of Physiotherapy, University of Valencia, Gascó Oliag 5, 46010 Valencia, Spain;
- Department of Physiotherapy, University of Valencia, Dr. Moliner 50 Av., 46100 Burjassot, Spain
- IRIMED Joint Research Unit (IIS-LaFe—UV), Dr. Moliner 50 Av., 46100 Burjassot, Spain
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Riiser MO, Husebye EE, Hellesnes J, Molund M. Outcomes After Proximal Medial Gastrocnemius Recession and Stretching vs Stretching as Treatment of Chronic Plantar Fasciitis at 6-Year Follow-up. Foot Ankle Int 2024; 45:1-9. [PMID: 37902240 PMCID: PMC10822063 DOI: 10.1177/10711007231205559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Evidence from prospective short-term studies suggest that proximal medial gastrocnemius recession is a safe and efficient procedure to treat chronic plantar fasciitis resistant to nonoperative treatment. The aim of this study was to evaluate the long-term clinical outcomes of proximal medial gastrocnemius recession and stretching compared to a stretching exercise protocol for patients with chronic plantar fasciitis and an isolated gastrocnemius contracture (IGC). METHODS Forty patients with plantar fasciitis lasting more than 1 year were prospectively randomized to a home stretching exercise program only, or to proximal medial gastrocnemius recession in addition to the stretching program. Clinical and functional data in this study were obtained at baseline and 6-year follow-up. The main outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Secondary outcomes were the visual analog scale (VAS) for pain, the Manchester Oxford Foot Questionnaire (MOxFQ), ankle dorsiflexion, and Achilles complex performance. RESULTS Thirty-three of 40 patients completed the 6-year follow-up. Seven patients had crossed over from nonoperative treatment to operative treatment. At 6 years, the operative group demonstrated significantly better outcomes with AOFAS (88.9 vs 78.6, P = .012), for pain measured by VAS (2.5 vs 5.5, P < .001) and with the MOxFQ total score (24.4 vs 45.9, P = .05) (per protocol analysis excluding crossovers). No between-group differences were observed for ankle dorsiflexion or Achilles complex performance at 6 years. CONCLUSION This study demonstrates that the improved function and reduced level of pain by proximal medial gastrocnemius recession and stretching is better compared to stretching alone after 6 years of follow-up for patients with chronic plantar fasciitis and a concomitant isolated gastrocnemius contracture. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Martin Okelsrud Riiser
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Elisabeth Ellingsen Husebye
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Jan Hellesnes
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Marius Molund
- Department of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Østfold Hospital, Grålum, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
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Abstract
Importance Morton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to nonoperative treatment. Observations Morton neuroma, consisting of interdigital neuronal thickening and fibrosis, is characterized by burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes (commonly the third and fourth toes). First-line nonoperative therapy consists of reducing activities that cause pain, orthotics, and interdigital corticosteroid injection; however, approximately 30% of patients may not respond to conservative treatment. Plantar fasciitis accounts for more than 1 million patient visits per year in the US and typically presents with plantar heel pain. Fifteen years after diagnosis, approximately 44% of patients continue to have pain. First-line nonoperative therapy includes stretching of the plantar fascia and foot orthotics, followed by extracorporeal shockwave therapy, corticosteroid injection, or platelet-rich plasma injection. Midportion Achilles tendinopathy presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel. The primary nonoperative treatment involves eccentric strengthening exercises, but extracorporeal shockwave therapy may be used. Conclusions and Relevance Morton neuroma, plantar fasciitis, and Achilles tendinopathy are painful foot and ankle conditions. First-line therapies are activity restriction, orthotics, and corticosteroid injection for Morton neuroma; stretching and foot orthotics for plantar fasciitis; and eccentric strengthening exercises for Achilles tendinopathy.
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Lourenço BM, Campos MGM, Maia L, Castro B, Trede RG, Oliveira VC. Efficacy of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis: a systematic review and meta-analysis. Br J Sports Med 2023; 57:1516-1521. [PMID: 37620126 DOI: 10.1136/bjsports-2022-106403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To investigate the effects of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis. DESIGN Systematic review of randomised controlled trials (RCTs). DATA SOURCES AMED, MEDLINE, PEDro, Cochrane, SPORTDiscus, CINAHL, EMBASE and PsycINFO without language or date restrictions up to 3 February 2023. ELIGIBILITY CRITERIA RCTs that evaluated the efficacy of any pharmacological and non-pharmacological therapies compared with control (placebo, sham, waiting list or no intervention) on pain intensity and disability in people with plantar fasciitis. Two reviewers independently screened eligible trials, extracted data, assessed the methodological quality of included trials and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. Mean differences (MDs) with 95% CIs were reported. RESULTS Seventeen different therapies investigated in 28 trials were included in the quantitative analysis. For non-pharmacological therapies, moderate certainty evidence showed short-term effects of customised orthoses on pain intensity when compared with control (MD of -12.0 points (95% CI -17.1 to -7.0) on a 0-100 scale). Low certainty evidence showed short-term effects of taping on pain intensity (-21.3 (95% CI -38.6 to -4.0)). Long-term effects and effects on disability are still uncertain. For pharmacological therapies, low to very low quality evidence from few trials with small samples was inconclusive and supports that high-quality trials are needed. CONCLUSIONS Moderate-quality and low-quality evidence demonstrates customised orthoses and taping, respectively, reduce pain intensity in the short term in patients with plantar fasciitis. PROSPERO REGISTRATION NUMBER CRD42021224416.
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Affiliation(s)
- Bianca Martins Lourenço
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Mariana Gabrich Moraes Campos
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Laísa Maia
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Brenda Castro
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Renato Guilherme Trede
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Vinícius Cunha Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
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17
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Fong HPY, Zhu MT, Rabago DP, Reeves KD, Chung VCH, Sit RWS. Effectiveness of Hypertonic Dextrose Injection (Prolotherapy) in Plantar Fasciopathy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2023; 104:1941-1953.e9. [PMID: 37098357 DOI: 10.1016/j.apmr.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/21/2023] [Accepted: 03/14/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To systematically review the effectiveness of hypertonic dextrose prolotherapy (DPT) in plantar fasciopathy (PF) compared with other non-surgical treatments. DATA SOURCES PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Allied and Complementary Medicine Database, Global Health, Ovid Nursing Database, Dimensions, and WHO ICTRP were searched from inception to April 30th, 2022. STUDY SELECTION Two independent reviewers selected randomized controlled trials (RCTs) that evaluated the effectiveness of DPT in PF compared with non-surgical treatments. Outcomes included pain intensity, foot and ankle function, and plantar fascia thickness. DATA EXTRACTION Two independent reviewers conducted data extraction. Risk of bias (RoB) assessment was conducted using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was assessed with Grading of Recommendation Assessment, Development, and Evaluation (GRADE). DATA SYNTHESIS Eight RCTs (n=469) met the inclusion criteria. Pooled results favored the use of DPT versus normal saline (NS) injections in reducing pain (weighted mean difference [WMD] -41.72; 95% confidence interval [CI] -62.36 to -21.08; P<.01; low certainty evidence) and improving function [WMD -39.04; 95% CI -55.24 to -22.85; P<.01; low certainty evidence] in the medium term. Pooled results also showed corticosteroid (CS) injections was superior to DPT in reducing pain in the short term [standardized mean difference 0.77; 95% CI 0.40 to 1.14; P<.01; moderate certainty evidence]. Overall RoB varied from "some concerns" to "high". The overall certainty of evidence presented ranges from very low to moderate based on the assessment with the GRADE approach. CONCLUSION Low certainty evidence demonstrated that DPT was superior to NS injections in reducing pain and improving function in the medium term, but moderate certainty evidence showed that it was inferior to CS in reducing pain in the short term. Further high-quality RCTs with standard protocol, longer-term follow-up, and adequate sample size are needed to confirm its role in clinical practice.
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Affiliation(s)
- Hugo P Y Fong
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Meng-Ting Zhu
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - David P Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA
| | | | - Vincent C H Chung
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Regina W S Sit
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China.
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Alshammari S, Alshwieer MAM, Dammas SS, Alrasheed AM, Alasmari MA, Alahmari MMA, Alazmi AK. Arabic translation, cross cultural adaptation, and validation of Foot Health Status Questionnaire among Saudi individuals with plantar fasciitis. J Orthop Surg Res 2023; 18:754. [PMID: 37794498 PMCID: PMC10552317 DOI: 10.1186/s13018-023-04202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Measuring quality of life (QoL) plays an essential role in enabling meaningful cross-cultural comparisons. The Foot Health Status Questionnaire (FHSQ) is a valid tool for assessing both foot-specific and general health-related quality of life (HrQoL), making it suitable for evaluating Plantar Fasciitis (PF) patients. METHODOLOGY The aim of this study is to translate the FHSQ into Arabic following methodological assessments of the translation procedure. The translation was done using forward and back translation. A pre-test questionnaire was distributed among 50 patients, resulting in the final FHSQ-Ar version, which then underwent various psychometric evaluations among 87 persons with PF, including internal consistency, dimensionality, reliability, interpretability, and construct validity against the 100-mm Visual Analogue Scale (VAS). RESULTS Internal consistency was adequate, ranging from 0.70 to 0.92. Reliability values ranged from 0.69 to 0.80, with a poor standard error of measurement (individual) but an acceptable standard error of measurement (group). Two domains exhibited floor effects, while one domain showed a ceiling effect. Regarding validity, three out of four hypothesized correlations with VAS scores were confirmed. Factor analysis revealed four dimensions, and confirmatory factor analysis demonstrated good fit (comparative fit index = 0.98, standardized root mean square = 0.06). CONCLUSION The psychometric properties of the FHSQ-Ar were satisfactory. Further validation for other diseases may be warranted.
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Affiliation(s)
- Sulaiman Alshammari
- Department of Family and Community Medicine, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
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Viglione V, Boffa A, Previtali D, Vannini F, Faldini C, Filardo G. The 'placebo effect' in the conservative treatment of plantar fasciitis: a systematic review and meta-analyses. EFORT Open Rev 2023; 8:719-730. [PMID: 37787480 PMCID: PMC10562949 DOI: 10.1530/eor-23-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Purpose The study of the placebo effect is key to elucidate the 'real effect' of conservative interventions for plantar fasciitis. The aim of this meta-analysis was to quantify the impact of placebo in the different conservative treatments of plantar fasciitis. Methods A systematic literature review was performed on double-blind placebo-controlled trials (RCTs) according to PRISMA guidelines on PubMed, Embase, and Web of Science. The meta-analysis primary outcome was the 0-10 pain variation after placebo treatments analyzed at 1 week, 1, 3, 6, and 12 months. The risk of bias was assessed using the RoB 2.0 tool, while the overall quality of evidence was graded according to the GRADE guidelines. Results The placebo effect for conservative treatments was studied in 42 double-blind RCTs on 1724 patients. The meta-analysis of VAS pain showed a statistically significant improvement after placebo administration of 2.13/10 points (P < 0.001), being highest at 12 months with 2.79/10 points (P < 0.001). The improvement of the placebo groups was higher in the extracorporeal shock wave therapy studies compared to the injection studies (2.59 vs 1.78; P = 0.05). Eight studies had a low risk of bias, 23 studies had 'some concerns,' and 4 studies had a high risk of bias. The GRADE evaluation showed an overall high quality of evidence. Conclusion This systematic review and meta-analysis demonstrated that the placebo effect represents an important component of all conservative approaches to treat plantar fasciitis. This effect is statistically and clinically significant, increases over time, and depends on the type of conservative treatment applied to address plantar fasciitis.
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Affiliation(s)
- Valentina Viglione
- Clinica Ortopedica e Traumatologica 1 IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Angelo Boffa
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Previtali
- Department of Surgery, EOC, Service of Orthopaedics and Traumatology, Lugano, Switzerland
| | - Francesca Vannini
- Clinica Ortopedica e Traumatologica 1 IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Clinica Ortopedica e Traumatologica 1 IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Surgery, EOC, Service of Orthopaedics and Traumatology, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Amoako-Tawiah P, Love H, Chacko Madathilethu J, LaCourse J, Fortune AE, Sims JMG, Ampat G. Use of orthotics with orthotic sandals versus the sole use of orthotics for plantar fasciitis: Randomised controlled trial. World J Orthop 2023; 14:707-719. [PMID: 37744719 PMCID: PMC10514714 DOI: 10.5312/wjo.v14.i9.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Plantar fasciitis (PF) affects around 10% of the population. Prefabricated orthotics with arch support has been shown to provide symptom relief in PF by decreasing the repetitive stress sustained by the plantar fascia. However, prefabricated orthotics are only effective when shoes are worn, meaning the foot may be left unsupported when it is impractical to wear shoes. Using orthotic sandals in conjunction with prefabricated orthotics may increase PF symptom relief, as they can be worn inside the home, extending the period in which the foot is supported. AIM To compare the combined use of prefabricated orthotics and orthotic sandals vs the sole use of prefabricated orthotics in the treatment of PF. METHODS 98 participants with PF were randomised into two groups. The intervention group received the Aetrex L420 Compete orthotics and the Aetrex L3000 Maui Flips (orthotic sandals), whilst the control group received the Aetrex L420 Compete orthotics only. Foot pain was assessed both by the numerical rating scale (NRS) and the pain sub-scale of the foot health status questionnaire (FHSQ). Foot functionality was measured using the function sub-scale of the FHSQ. Symptom change was measured using the global rating of change scale (GROC). RESULTS Foot pain scores measured both by NRS and FHSQ pain sub-scale showed statistically significant reductions in foot pain in both groups (P < 0.05) at six months. Both groups also reported statistically significant improvements (P < 0.05) in function as measured by the FHSQ function subscale and improvement of symptoms as measured by the GROC scale. Between-group analysis showed that the intervention group with the combined use of orthotics and orthotic sandals scored better on all four outcome measures as compared to the control group with the sole use of orthotics. However, the between-group analysis only reached statistical significance on the NRS pain score (P < 0.05). CONCLUSION Combined use of prefabricated orthotics and orthotic sandals provides a greater decrease in foot pain and improvement in foot function in PF compared to using prefabricated orthotics alone.
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Affiliation(s)
- Portia Amoako-Tawiah
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
| | - Holly Love
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
| | | | - Jessica LaCourse
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
| | - Alice E Fortune
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
| | - Jonathan M G Sims
- Research Unit, Talita Cumi Ltd., Merseyside, Southport PR8 3NS, United Kingdom
| | - George Ampat
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
- Research Unit, Talita Cumi Ltd., Merseyside, Southport PR8 3NS, United Kingdom
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21
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Riel H, Vicenzino B, Olesen JL, Bach Jensen M, Ehlers LH, Rathleff MS. Does a corticosteroid injection plus exercise or exercise alone add to the effect of patient advice and a heel cup for patients with plantar fasciopathy? A randomised clinical trial. Br J Sports Med 2023; 57:1180-1186. [PMID: 37414460 PMCID: PMC10579183 DOI: 10.1136/bjsports-2023-106948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To compare the effectiveness of patient advice plus heel cup alone (PA) versus PA and lower limb exercise (PAX) versus PAX plus corticosteroid injection (PAXI) to improve self-reported pain in patients with plantar fasciopathy. METHODS We recruited 180 adults with plantar fasciopathy confirmed by ultrasonography for this prospectively registered three-armed, randomised, single-blinded superiority trial. Patients were randomly allocated to PA (n=62), PA plus self-dosed lower limb heavy-slow resistance training consisting of heel raises (PAX) (n=59), or PAX plus an ultrasound-guided injection of 1 mL triamcinolone 20 mg/mL (PAXI) (n=59). The primary outcome was changed in the pain domain of the Foot Health Status Questionnaire (ranging from 0 'worst' to 100 'best') from baseline to the 12-week follow-up. The minimal important difference in the pain domain is 14.1 points. The outcome was collected at baseline and at 4, 12, 26, and 52 weeks. RESULTS The primary analysis found a statistically significant difference between PA and PAXI after 12 weeks favouring PAXI (adjusted mean difference: -9.1 (95% CI -16.8 to -1.3; p=0.023)) and over 52 weeks (adjusted mean difference: -5.2 (95% CI -10.4 to -0.1; p=0.045)). At no follow-up did the mean difference between groups exceed the pre-specified minimal important difference. No statistically significant difference was found between PAX and PAXI or between PA and PAX at any time. CONCLUSION No clinically relevant between-group differences were found after 12 weeks. The results indicate that combining a corticosteroid injection with exercise is not superior to exercise or no exercise. TRIAL REGISTRATION NUMBER NCT03804008.
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Affiliation(s)
- Henrik Riel
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | - Bill Vicenzino
- The University of Queensland School of Health and Rehabilitation Sciences: Physiotherapy: Sports Injury Rehabilitation and Prevention for Health, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Martin Bach Jensen
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
| | | | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
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22
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Chutumstid T, Susantitaphong P, Koonalinthip N. Effectiveness of dextrose prolotherapy for the treatment of chronic plantar fasciitis: A systematic review and meta-analysis of randomized controlled trials. PM R 2023; 15:380-391. [PMID: 35338597 DOI: 10.1002/pmrj.12807] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/30/2021] [Accepted: 03/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To systematically investigate the efficacy and safety of dextrose prolotherapy for treating chronic plantar fasciitis. LITERATURE SURVEY EMBASE, PubMed, Scopus, and Google Scholar (from inception to December 9, 2021). METHODOLOGY Comprehensive review of randomized controlled trials investigating dextrose prolotherapy for chronic plantar fasciitis was done. Two investigators independently screened the titles, abstracts, and full texts and extracted data from eligible studies. The changes in visual analog scale (VAS) pain score, foot function index (FFI), American Orthopaedic Foot and Ankle Society (AOFAS) score, and plantar fascia thickness were analyzed. Reports of complications of the procedure were collected. SYNTHESIS Eight randomized controlled trials (RCTs) were included in the meta-analysis, analyzing 444 patients in total. The subgroup analysis showed that at short-term follow-up (<6 months) dextrose prolotherapy was more effective in reducing VAS pain score compared to the non-active treatment control group including exercise and normal saline solution (NSS) injection. However, there was no difference in the change of VAS pain score between dextrose prolotherapy and active treatment control group, which included extracorporeal shock wave therapy (ESWT), steroid injection, and platelet-rich plasma (PRP) injection. Dextrose prolotherapy was more effective in reducing FFI, increasing AOFAS score, and reducing plantar fascia thickness at short-term (<6 months) follow-up compared to other comparators. For long-term (≥6 months) follow-up, there was no significant difference in the change in VAS pain score and FFI between the dextrose prolotherapy group and other comparators. No serious complication was reported. CONCLUSIONS Dextrose prolotherapy is an effective treatment of chronic plantar fasciitis to reduce pain, improve foot functional score, and decrease plantar fascia thickness at short-term follow-up. Further studies in larger populations are needed to identify the optimal treatment regimen including dextrose concentration, volume, injection site, injection technique, and the number of injections required. The long-term effects of these treatments also require further examination.
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Affiliation(s)
- Tunchanok Chutumstid
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Nantawan Koonalinthip
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Masiello F, Pati I, Veropalumbo E, Pupella S, Cruciani M, De Angelis V. Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2023; 21:119-136. [PMID: 36346880 PMCID: PMC10072988 DOI: 10.2450/2022.0087-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/10/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND In this systematic review and meta-analysis, we evaluated ultrasound (US)-guided injections of platelet-rich plasma (PRP) as conservative treatment of tendinopathies. MATERIALS AND METHODS We searched MEDLINE, EMBASE, SCOPUS, OVID, and the Cochrane Library to identify randomized controlled trials (RCT) on the use of US-guided PRP for tendinopathies. RESULTS We found 33 RCT (2,025 subjects) that met our inclusion criteria: 8 in lateral epicondylitis, 5 in plantar fasciitis, 5 in Achilles tendinopathy, 7 in rotator cuff tendinopathy, 3 in patellar tendinopathy and 5 in carpal tunnel syndrome. PRP, given as a single injection (20 trials) or multiple injections (13 trials), was compared to US-guided injection of steroids, saline, autologous whole blood, local anesthetic, dry needling, prolotherapy, bone marrow mesenchymal stem cells, or with non-injective interventions. The outcomes more commonly reported included pain and functional measures, subgrouped as in the short-term (<3 months from the intervention), medium-term (3 to 6 months) or long-term (≥12 months). No clear between-group differences in these outcomes were observed in patients with lateral epicondylitis, plantar fasciitis, or Achilles, rotator cuff or patellar tendinopathy. In patients with carpal tunnel syndrome, visual analog scale scores for pain at 3 and 6 months and Boston Carpal Tunnel Questionnaire severity scores at 1, 3 and 6 months were significantly lower in PRP recipients than in controls. The certainty of evidence of all these comparisons was graded as low or very low due to risk of bias, imprecision and/or inconsistency. Pain at the injection site was more common among PRP recipients than among controls receiving other US-guided injections. DISCUSSION In patients with tendinopathies, a trend towards pain reduction and functional improvement from baseline was observed after US-guided PRP injection, but in the majority of the comparisons, the effect size was comparable to that observed in control groups.
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Affiliation(s)
- Francesca Masiello
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Ilaria Pati
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Eva Veropalumbo
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Simonetta Pupella
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Mario Cruciani
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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Empfehlung für Fragebögen zur Untersuchung der Fuß- und Sprunggelenkfunktion vom Research-Komitee der AGA. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-023-00594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ZusammenfassungDas standardisierte Erheben von Behandlungsergebnissen findet immer mehr Einzug in die moderne Medizin. Hierbei ist vor allem das subjektive Ergebnis aus Patientensicht und die damit häufig einhergehende Zufriedenheit mit der medizinischen Behandlung in den Fokus gerückt. Dies hat in den letzten Jahren nicht nur in der akademischen Landschaft, sondern auch auf gesundheitspolitischer Ebene deutlich an Bedeutung gewonnen. Dies bedeutet, dass das Behandlungsergebnis immer mehr Einfluss auf die Vergütung der Leistungserbringer erhält, auch „value-based healthcare“ genannt. Insbesondere in der Orthopädie und Traumatologie gibt es dabei zahlreiche gelenkspezifische Messinstrumente (Fragebögen, Scores oder „patient-reported outcome measures“ [PROMs]), wobei in der Fuß- und Sprunggelenkchirurgie hierfür eine Vielzahl an Fragebögen verfügbar ist, die sich jedoch häufig sehr heterogen und selten pathologiespezifisch darstellen. In Anbetracht der derzeitigen Mannigfaltigkeit an PROMs in der aktuellen Literatur ist es deshalb von Interesse, die wissenschaftliche Qualität zu prüfen und gleichzeitig die Forschungskommunikation zu vereinheitlichen, indem etablierte und gemäß akademischen Gütekriterien ausgewählte Fragebögen zum Einsatz kommen. Ziel ist es, valide, verlässliche und möglichst repräsentative Daten zu gewinnen, um eine akkurate Darstellung der tatsächlichen Ergebnisse zu erreichen. Dies bedingt neben qualitativen Kriterien auch immer kompakte und leicht verständliche Fragenkataloge, um so eine möglichst hohe Rücklaufquote zu generieren. Schließlich sollte auch immer eine Einschätzung der klinischen Relevanz der erhaltenen Ergebnisse stattfinden. Hierfür hat sich der kleinste vom Patienten als klinische Veränderung wahrgenommene Wert des jeweiligen PROM („minimal clinically important difference“, MCID) durchgesetzt. Für den Fuß- und Sprunggelenkbereich werden dabei vom Research Komitee der AGA unter Berücksichtigung dieser Kriterien folgende Messinstrumente empfohlen: FAOS (Foot and Ankle Outcome Score) zur Beurteilung der allgemeinen Schmerzsymptomatik und Funktion sowie der EQ-5D-Fragebogen zur Beurteilung der Lebensqualität. Zwar kann aufgrund fehlender Datenlage keine pathologiespezifische Empfehlung abgegeben werden, jedoch ist der FAOS für eine Vielzahl von Fuß- und Sprunggelenkpathologien validiert und liegt zudem in deutscher Sprache vor.
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Podiatric assessment in children and adults with epidermolysis bullosa: are foot and ankle patient-reported outcome measures (PROMs) able to measure the severity of podiatric involvement among EB patients? Int J Womens Dermatol 2023; 9:e046. [PMID: 36700162 PMCID: PMC9851710 DOI: 10.1097/jw9.0000000000000046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/25/2022] [Indexed: 01/27/2023] Open
Abstract
Epidermolysis bullosa (EB) represents a group of rare genetic skin fragility disorders characterized by (muco) cutaneous blistering upon minimal mechanical trauma. Ninety percent of EB patients experience podiatric symptoms which may affect physical functioning and emotional well-being. To date, an EB-specific podiatric assessment has not been outlined to guide clinicians in the assessment of EB podiatric involvement. This review describes the podiatric involvement of patients with EB and assesses the relevance of validated foot and ankle patient-reported outcome measures (PROMs) in measuring podiatric severity among EB patients. A literature review was conducted to identify systematic reviews and clinical studies investigating foot health and podiatric manifestations using validated foot health PROMs across foot and ankle conditions. Limited studies have documented the significance of podiatric involvement among EB patients. Existing EB-specific PROMs are not region-specific for assessing podiatric involvement. Among the foot and ankle PROMs, the Foot Health Status Questionnaire, Foot Function Index, and Manchester Oxford Foot Questionnaire were identified as potentially appropriate for assessing podiatric severity among EB patients, each with its strengths and limitations in assessment. However, they have not been widely validated for assessing dermatology-related diseases. An evaluation of the relevance of each identified PROM to EB podiatric assessment would enable future development of an appropriate EB-specific podiatric assessment tool that would guide management.
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Surgical treatment options for plantar fasciitis and their effectiveness: a systematic review and network meta-analysis. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04739-0. [PMID: 36596990 DOI: 10.1007/s00402-022-04739-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND To date, there are no systematic reviews on the utility of surgical management for plantar fasciitis to guide best practice. This review aimed to evaluate the operative options for plantar fasciitis and their effectiveness. METHODS A systematic review and network meta-analysis were carried out in accordance with PRISMA guidelines. A search strategy was conducted on the MEDLINE, EMBASE, and Cochrane databases. Quality was assessed using the ROBINS-I tool. RESULTS 17 studies involving 865 patients were included. Surgical options considered were open and endoscopic plantar fasciotomy, gastrocnemius release, radiofrequency microtenotomy and dry needling. All interventions resulted in improvement in VAS and AOFAS scores. No major complications were seen from any treatment modality. CONCLUSIONS Surgical interventions are effective in providing short- to medium-term symptomatic relief for plantar fasciitis refractory to non-operative management. Current evidence is equivocal regarding treatment choice. Further large randomised studies are required to establish long-term outcomes and a management algorithm. LEVEL OF EVIDENCE Level III.
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Gomoll AH, Mandelbaum BR, Farr J, Archambault WT, Sherman SL, Tabet SK, Kimmerling KA, Mowry KC. An Initial Injection and a Crossover Injection of Amniotic Suspension Allograft Following Failed Treatment with Hyaluronic Acid or Saline Are Equally Effective in the Treatment of Moderate Symptomatic Knee Osteoarthritis Over 12 Months. Arthroscopy 2023; 39:66-78. [PMID: 35840067 DOI: 10.1016/j.arthro.2022.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this crossover study was to determine the efficacy of amniotic suspension allograft (ASA) for moderate symptomatic knee osteoarthritis following failed treatment with hyaluronic acid (HA) or saline through 12 months' postcrossover injection using patient-reported and safety outcomes. METHODS In this multicenter study, 95 patients from a 200-patient single-blind randomized controlled trial were eligible to crossover and receive a single injection of ASA 3 months after failed treatment with HA or saline. Patient-reported outcomes, including Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analog scale (VAS), were collected out to 12 months postcrossover to determine pain and function. Radiographs and blood were collected for assessment of changes. Statistical analyses were performed using mixed effects model for repeated measures. RESULTS Treatment with ASA following failed treatment with HA or saline resulted in significant improvements in KOOS and VAS scores compared with crossover baseline. There were no differences in radiographic measures or anti-human leukocyte antigen serum levels compared with baseline and no severe adverse events reported. In addition, more than 55% of patients were responders at months 3, 6, and 12 as measured by the Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International simplified responder criteria. There were no significant differences between the original ASA randomized group and crossover cohorts at any of the time points evaluated, suggesting that prior failed treatment with HA or saline did not significantly impact outcomes following treatment with ASA. CONCLUSIONS This study showed that patients who previously failed treatment with HA or saline had statistically significant improvements in pain and function scores following a crossover injection of ASA that was sustained for 12 months, as measured by KOOS and VAS. There were no serious adverse events reported, and the injection was safe. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Andreas H Gomoll
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
| | | | - Jack Farr
- Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California
| | - Samuel K Tabet
- New Mexico Orthopaedic Associates, Albuquerque, New Mexico
| | - Kelly A Kimmerling
- Department of Research and Development, Organogenesis, Birmingham, Alabama, U.S.A
| | - Katie C Mowry
- Department of Research and Development, Organogenesis, Birmingham, Alabama, U.S.A
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Naterstad IF, Joensen J, Bjordal JM, Couppé C, Lopes-Martins RAB, Stausholm MB. Efficacy of low-level laser therapy in patients with lower extremity tendinopathy or plantar fasciitis: systematic review and meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e059479. [PMID: 36171024 PMCID: PMC9528593 DOI: 10.1136/bmjopen-2021-059479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We investigated the effectiveness of low-level laser therapy (LLLT) in lower extremity tendinopathy and plantar fasciitis on patient-reported pain and disability. DESIGN Systematic review and meta-analysis. DATA SOURCES Eligible articles in any language were identified through PubMed, Embase and Physiotherapy Evidence Database (PEDro) on the 20 August 2020, references, citations and experts. ELIGIBILITY CRITERIA FOR SELECTION OF STUDIES Only randomised controlled trials involving participants with lower extremity tendinopathy or plantar fasciitis treated with LLLT were included. DATA EXTRACTION AND SYNTHESIS Random effects meta-analyses with dose subgroups based on the World Association for Laser Therapy treatment recommendations were conducted. Risk of bias was assessed with the PEDro scale. RESULTS LLLT was compared with placebo (10 trials), other interventions (5 trials) and as an add-on intervention (3 trials). The study quality was moderate to high.Overall, pain was significantly reduced by LLLT at completed therapy (13.15 mm Visual Analogue Scale (VAS; 95% CI 7.82 to 18.48)) and 4-12 weeks later (12.56 mm VAS (95% CI 5.69 to 19.42)). Overall, disability was significantly reduced by LLLT at completed therapy (Standardised Mean Difference (SMD)=0.39 (95% CI 0.09 to 0.7) and 4-9 weeks later (SMD=0.32 (95% CI 0.05 to 0.59)). Compared with placebo control, the recommended doses significantly reduced pain at completed therapy (14.98 mm VAS (95% CI 3.74 to 26.22)) and 4-8 weeks later (14.00 mm VAS (95% CI 2.81 to 25.19)). The recommended doses significantly reduced pain as an add-on to exercise therapy versus exercise therapy alone at completed therapy (18.15 mm VAS (95% CI 10.55 to 25.76)) and 4-9 weeks later (15.90 mm VAS (95% CI 2.3 to 29.51)). No adverse events were reported. CONCLUSION LLLT significantly reduces pain and disability in lower extremity tendinopathy and plantar fasciitis in the short and medium term. Long-term data were not available. Some uncertainty about the effect size remains due to wide CIs and lack of large trials. PROSPERO REGISTRATION NUMBER CRD42017077511.
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Affiliation(s)
- Ingvill Fjell Naterstad
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Hordaland, Norway
| | - Jon Joensen
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Hordaland, Norway
| | - Jan Magnus Bjordal
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Hordaland, Norway
| | - Christian Couppé
- Department of Physical Therapy, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Martin Bjørn Stausholm
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Hordaland, Norway
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Health-related quality of life is substantially worse in individuals with plantar heel pain. Sci Rep 2022; 12:15652. [PMID: 36123358 PMCID: PMC9485111 DOI: 10.1038/s41598-022-19588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 08/31/2022] [Indexed: 12/01/2022] Open
Abstract
This study aimed to compare health-related quality of life (HRQoL) in people with and without plantar heel pain (PHP). This was a cross-sectional observational study that compared 50 adult participants with PHP to 25 participants without PHP who were matched for age, sex and body mass index (BMI). HRQoL measures included a generic measure, the Short Form 36 version 2 (SF-36v2), and foot-specific measures, including 100 mm visual analogue scales (VASs) for pain, the Foot Health Status Questionnaire (FHSQ), and the Foot Function Index-Revised (FFI-R). Comparisons in HRQoL between the two groups were conducted using linear regression, with additional adjustment for the comorbidity, osteoarthritis, which was found to be substantially different between the two groups. For generic HRQoL, participants with PHP scored worse in the SF-36v2 physical component summary score (p < 0.001, large effect size), but there was no difference in the mental component summary score (p = 0.690, very small effect size). Specifically, physical function (p < 0.001, very large effect size), role physical (p < 0.001, large effect size) and bodily pain (p < 0.001, large effect size) in the physical component section were worse in those with PHP. For foot-specific HRQoL, participants with PHP also scored worse in the VASs, the FHSQ and the FFI-R (p ≤ 0.005, huge effect sizes for all domains, except FHSQ footwear, which was large effect size, and FFR-R stiffness, activity limitation, and social issues, which were very large effect sizes). After accounting for age, sex, BMI and osteoarthritis, adults with PHP have poorer generic and foot-specific HRQoL.
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Palomo-Toucedo IC, Domínguez-Maldonado G, Reina-Bueno M, Vázquez-Bautista MDC, Castillo-López JM, Ramos-Ortega J, Munuera-Martínez PV. Effectiveness of custom-made functional foot orthoses versus flat cushioning insoles on pain in patients with systemic lupus erythematosus. Clin Rehabil 2022; 37:86-97. [PMID: 35786028 DOI: 10.1177/02692155221111927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the effect of foot orthoses on pain, disability and foot functionality in patients with Systemic Lupus Erythematosus. DESIGN Randomized clinical trial. SETTING University Podiatric Clinical Area. SUBJECTS Patients with systemic lupus erythematosus. INTERVENTIONS Patients were randomly assigned to either group A, which received custom-made functional foot orthoses, or group B, which received flat cushioning insoles, for three months. MAIN MEASURES The primary outcome was foot pain, measured by 11-point numeric pain rating scale. Foot functionality and foot-related disability were evaluated using the foot function index, the Manchester foot pain and disability, at the beginning and at days 90. RESULTS Sixty-six participants (age 47.3 ± 11.9 years) suffering from foot pain, received either the custom-made foot orthoses (N = 33) or the flat cushioning insoles (N = 33). For the analysis of the data, only participants who had finished the follow-up period (90 days) were included. None statistically significant difference between groups were found. In group A, all variables showed statistically significant differences when comparing the initial and final measurements. Pain showed 6.8 ± 1.6 and 4.2 ± 2.9 in group A, at baseline and at 90 days, respectively, group B showed 6.5 ± 1.5 and 4.7 ± 3.0 at baseline and at 90 days, respectively. CONCLUSION Both groups showed a reduction in foot pain. This study suggests that not only controlling the foot function, but providing cushioning to the foot, may have positive effects to manage foot pain in patients with systemic lupus erythematosus.
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Rasenberg N, Dijkgraaf LJM, Bindels PJ, Bierma-Zeinstra SM, van Middelkoop M. Can we predict which patients with plantar heel pain are more likely to benefit from insoles? A secondary exploratory analysis of a randomized controlled trial. J Foot Ankle Res 2022; 15:14. [PMID: 35144668 PMCID: PMC8830116 DOI: 10.1186/s13047-022-00516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Plantar heel pain (PHP) is a common cause of foot complaints, for which treatment with custom-made insoles is frequently applied. So far few studies have investigated patient characteristics that predict response to these treatments. The aim of this secondary exploratory analysis was twofold; firstly, to identify patient characteristics that predict prognosis in patients with PHP treated with insoles, and secondly to identify characteristics that might interact with treatment with insoles. Methods Data from a randomized trial in which participants received either custom insoles (N = 70) or sham insoles (N = 69) were used. At baseline, information was collected on demographics, foot symptoms, foot and ankle range of motion, navicular drop, presence of neuropathic pain, physical activity and other illnesses in the last 12 months. The primary outcome of this study was the Foot Function Index score (FFI) at 26 weeks. Multivariable linear regression models were generated to identify patients characteristics that predict the outcome for each type of intervention (i.e. insoles and GP-led usual care). Results We found two variables associated with a better function score at 26 weeks in patients treated with insoles, female sex (β − 9.59 95%CI -17.87; − 1.31) and a lower FFI score at baseline (β 0.56 95%CI 0.30; 0.82). Explorative analyses in patients treated with insoles showed no significant interaction effects between the type of insole (custom-made versus sham) and any of the potential predictive factors. Conclusion When communicating about the effect of insoles for PHP clinicians should take sex and the amount of pain and disability at first presentation into account. Women and people with better foot function scores at baseline (according to FFI) might respond better to treatment with insoles in terms of foot function. Trial registration Trial registration: NTR5346.
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Affiliation(s)
- N Rasenberg
- Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - L J M Dijkgraaf
- Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - P J Bindels
- Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - S M Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - M van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
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Guimarães JS, Arcanjo FL, Leporace G, Metsavaht LF, Sena C, Moreno MVMG, Marçal Vieira TE, Gomes Neto M. Effect of low-level laser therapy on pain and disability in patients with plantar fasciitis: A systematic review and meta-analysis. Musculoskelet Sci Pract 2022; 57:102478. [PMID: 34847470 DOI: 10.1016/j.msksp.2021.102478] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/28/2021] [Accepted: 11/13/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We performed a systematic review to investigate the effects of low-level laser therapy (LLLT) on pain and disability in patients with plantar fasciitis (PF). METHODS We searched Pubmed, PEDro database, Scielo, and Cochrane Central for randomized controlled trials that evaluated the effects of LLLT for patients with PF. The methodological aspects of the studies included were scored using the PEDro scale. Three comparisons were made: LLLT compared with placebo, LLLT combined with conventional rehabilitation (CR) compared with CR and LLLT compared with extracorporeal shock wave therapy. RESULTS Fourteen studies (817 patients) met the study criteria. Compared to the placebo group, LLLT improved pain (MD, -2.3; 95% CI: 2.6 to -2, I2 = 0%; 4 studies, N = 234: moderate-quality evidence) in the short term (0-6 weeks). No significant difference in short-term disability was found for participants in the LLLT group compared to the placebo group. Compared to the CR group, LLLT combined with CR improved pain (MD, -2.0; 95% CI: 2.9 to -1.1, I2 = 0%; 2 studies, N = 90: moderate-quality evidence) in the short term (0-6 weeks). Compared to extracorporeal shock wave therapy, LLLT did not significantly reduce pain intensity in the short term (MD, 0.5; 95% CI: 2.0 to 2.9, I2 = 96%; 4 studies, N = 175: low-quality evidence). CONCLUSIONS LLLT may improve pain in the short term and can be considered as a component of care of patients with PF. However, this superiority disappeared compared to extracorporeal shock wave therapy. LEVEL OF EVIDENCE Therapeutic level I.
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Affiliation(s)
- Janice S Guimarães
- Programa de Pós-Graduação em Medicina e Saúde - Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, CEP 40.110-100, Salvador, BA, Brazil; Division of Foot and Ankle Surgery of Hospital São Rafael, Av. São Rafael, 2152 - São Marcos, CEP: 41253-190, Salvador, Bahia, Brazil; Division of Foot and Ankle Surgery of Hospital Manoel Victorino - Praça Cons. Almeida Couto, s/n, Largo de Nazaré - CEP: 44.150-050, Salvador, Bahia, Brazil.
| | - Fabio L Arcanjo
- Programa de Pós-Graduação em Medicina e Saúde - Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, CEP 40.110-100, Salvador, BA, Brazil; Physiotherapy Research Group of Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, BA, CEP 40.110-100, Brazil
| | - Gustavo Leporace
- Physiotherapy Research Group of Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, BA, CEP 40.110-100, Brazil; IBTS - Instituto Brasil de Tecnologia da Saúde - Rua Visconde de Pirajá, 407 - 905 - Ipanema, CEP:22410-003, Rio de Janeiro, Brazil; Unifesp - Universidade Federal de São Paulo - Rua Sena Madureira, n.° 1.500 - Vila Clementino, CEP: 04021-001, São Paulo - SP, Brazil
| | - Leonardo F Metsavaht
- IBTS - Instituto Brasil de Tecnologia da Saúde - Rua Visconde de Pirajá, 407 - 905 - Ipanema, CEP:22410-003, Rio de Janeiro, Brazil; Unifesp - Universidade Federal de São Paulo - Rua Sena Madureira, n.° 1.500 - Vila Clementino, CEP: 04021-001, São Paulo - SP, Brazil
| | - Cristiano Sena
- Programa de Pós-Graduação em Medicina e Saúde - Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, CEP 40.110-100, Salvador, BA, Brazil; Physiotherapy Research Group of Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, BA, CEP 40.110-100, Brazil; Physical Therapy Department of Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, CEP 40.110-100, Salvador, Bahia, Brazil
| | - Marcus V M G Moreno
- Division of Foot and Ankle Surgery of Hospital Cardiopulmonar - Av. Garibaldi, 2199, Ondina, CEP: 40.170-130, Salvador, Bahia, Brazil
| | - Tulio E Marçal Vieira
- Division of Foot and Ankle Surgery of Hospital Cardiopulmonar - Av. Garibaldi, 2199, Ondina, CEP: 40.170-130, Salvador, Bahia, Brazil
| | - Mansueto Gomes Neto
- Programa de Pós-Graduação em Medicina e Saúde - Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, CEP 40.110-100, Salvador, BA, Brazil; Physiotherapy Research Group of Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, BA, CEP 40.110-100, Brazil; Physical Therapy Department of Universidade Federal da Bahia - UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, CEP 40.110-100, Salvador, Bahia, Brazil
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Acosta-Olivo C, Simental-Mendía LE, Vilchez-Cavazos F, Peña-Martínez VM, Elizondo-Rodíguez J, Simental-Mendía M. Clinical Efficacy of Botulinum Toxin in the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2021; 103:364-371.e2. [PMID: 34688605 DOI: 10.1016/j.apmr.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the efficacy of botulinum toxin A (BTX-A) for the treatment of plantar fasciitis through a meta-analysis of randomized controlled trials (RCTs) focusing on pain and functional outcomes since current literature has supported a potential benefit of BTX-A. DATA SOURCES The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched until December 2020 for RCTs reporting the effects of BTX-A injections on plantar fasciitis. The complementary literature search included Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, and greylit.org. STUDY SELECTION Only RCTs assessing the effect of BTX-A injections on pain, functional improvement, or plantar fascia thickness in patients with plantar fasciitis were included. Multiple researchers carried out the screening process of the 413 records. DATA EXTRACTION Data were extracted independently and in duplicate using a standardized data extraction format. Information was contrasted by a third observer. DATA SYNTHESIS BTX-A injections resulted in significant pain relief (mean difference, -2.07 [95% CI, -3.21 to -0.93]; P=.0004; I2=97%) and functional improvement (standardized mean difference, 1.15 [95% CI, 0.39-1.91]; P=.003; I2=87%). A subanalysis indicated that pain relief was sustained at 12 months while functional improvement remained significant after 0-6 months. The results were not affected by a single study after sensitivity analysis. The site of injection and the use or not of ultrasound-guided injections may account for potential sources of interstudy heterogeneity. CONCLUSIONS This meta-analysis suggests both a statistically significant and a clinically meaningful improvement on plantar fasciitis symptoms after BTX-A treatment.
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Affiliation(s)
- Carlos Acosta-Olivo
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Luis E Simental-Mendía
- Instituto Mexicano del Seguro Social, Unidad de Investigación Biomédica, Delegación Durango, Durango, México
| | - Félix Vilchez-Cavazos
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Víctor M Peña-Martínez
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Jorge Elizondo-Rodíguez
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México
| | - Mario Simental-Mendía
- Universidad Autónoma de Nuevo León, Orthopedics and Traumatology Service, Hospital Universitario "Dr José Eleuterio González," School of Medicine, Monterrey, México.
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Miettinen M, Rämö L, Lähdeoja T, Sirola T, Sandelin H, Ponkilainen V, Repo JP. Treatment of hallux rigidus (HARD trial): study protocol of a prospective, randomised, controlled trial of arthrodesis versus watchful waiting in the treatment of a painful osteoarthritic first metatarsophalangeal joint. BMJ Open 2021; 11:e049298. [PMID: 34452964 PMCID: PMC8404449 DOI: 10.1136/bmjopen-2021-049298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Hallux rigidus is a common problem of pain and stiffness of the first metatarsophalangeal joint (MTPJ) caused mainly by degenerative osteoarthritis. Several operative techniques have been introduced for the treatment of this condition without high-quality evidence comparing surgical to non-surgical care. In this trial, the most common surgical procedure, arthrodesis, will be compared with watchful waiting in the management of hallux rigidus. METHODS AND ANALYSIS Ninety patients (40 years or older) with symptomatic first MTPJ osteoarthritis will be randomised to arthrodesis or watchful waiting in a ratio of 1:1. The primary outcome will be pain during walking, assessed using the 0-10 Numerical Rating Scale (NRS) at 1 year after randomisation. The secondary outcomes will be pain at rest (NRS), physical function (Manchester-Oxford Foot Questionnaire), patient satisfaction in terms of the patient-acceptable symptom state, health-related quality of life (EQ-5D-5L), activity level (The Foot and Ankle Ability Measure Sports subscale), use of analgesics or orthoses and the rate of complications. Our null hypothesis is that there will be no difference equal to or greater than the minimal important difference of the primary outcome measure between arthrodesis and watchful waiting. Our primary analysis follows an intention-to-treat principle. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of Helsinki and Uusimaa Hospital District, Finland. Written informed consent will be obtained from all the participants. We will disseminate the findings of this study through peer-reviewed publications and conference presentations. PROTOCOL VERSION 21 June 2021 V.2.0. TRIAL REGISTRATION NUMBER NCT04590313.
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Affiliation(s)
- Mikko Miettinen
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
- Finnish Centre for Evidence-Based Orthopaedics, FICEBO, Helsinki, Finland
| | - Tuomas Lähdeoja
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
- Finnish Centre for Evidence-Based Orthopaedics, FICEBO, Helsinki, Finland
| | - Timo Sirola
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, Vaasa Central Hospital and University of Helsinki, Helsinki, Uusimaa, Finland
- Sports Hospital, Mehiläinen, Helsinki, Uusimaa, Finland
| | - Ville Ponkilainen
- Department of Orthopaedics and Traumatology, Central Finland Hospital Nova, Jyväskylä, Central Finland, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, University of Tampere and Tampere University Hospital, Tampere, Finland
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Llurda-Almuzara L, Labata-Lezaun N, Meca-Rivera T, Navarro-Santana MJ, Cleland JA, Fernández-de-Las-Peñas C, Pérez-Bellmunt A. Is Dry Needling Effective for the Management of Plantar Heel Pain or Plantar Fasciitis? An Updated Systematic Review and Meta-Analysis. PAIN MEDICINE 2021; 22:1630-1641. [PMID: 33760098 DOI: 10.1093/pm/pnab114] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Dry needling is commonly used for the management of plantar fasciitis. This meta-analysis evaluated the effects of dry needling over trigger points associated with plantar heel pain on pain intensity and related disability or function. METHODS Electronic databases were searched for randomized controlled trials in which at least one group received dry needling, not acupuncture, for trigger points associated with plantar heel pain and in which outcomes were collected on pain intensity and related disability. The risk of bias was assessed with the Cochrane Risk of Bias tool, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the level of evidence is reported according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Between-groups mean differences (MD) and standardized mean differences (SMD) were calculated. RESULTS The search identified 297 publications, with six trials eligible for inclusion. The meta-analysis found low-quality evidence that trigger point dry needling reduces pain intensity in the short term (MD -1.70 points, 95% confidence interval [CI] -2.80 to -0.60; SMD -1.28, 95% CI -2.11 to -0.44) and moderate-quality evidence that it improves pain intensity (MD -1.77 points, 95% CI -2.44 to -1.11; SMD -1.45, 95% CI -2.19 to -0.70) and related disability (SMD -1.75, 95% CI -2.22 to -1.28) in the long term, as compared with a comparison group. The risk of bias of the trials was generally low, but the heterogeneity of the results downgraded the level of evidence. DISCUSSION Moderate- to low-quality evidence suggests a positive effect of trigger point dry needling for improving pain intensity and pain-related disability in the short term and long term, respectively, in patients with plantar heel pain of musculoskeletal origin. The present results should be considered with caution because of the small number of trials.
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Affiliation(s)
| | - Noé Labata-Lezaun
- Universitat Internacional de Catalunya (UIC-Barcelona), Barcelona, Spain
| | - Toni Meca-Rivera
- Universitat Internacional de Catalunya (UIC-Barcelona), Barcelona, Spain.,Médico Quirónsalud Aribau, Barcelona, Spain
| | - Marcos J Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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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. PLoS One 2021; 16:e0255064. [PMID: 34297721 PMCID: PMC8301654 DOI: 10.1371/journal.pone.0255064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022] Open
Abstract
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.
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Clinical manifestation and perceived symptoms of walking-related performance fatigability in persons with multiple sclerosis. Int J Rehabil Res 2021; 44:118-125. [PMID: 33534273 DOI: 10.1097/mrr.0000000000000457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fatigue and walking difficulties are common impairments and activity limitations in persons with multiple sclerosis (PwMS). Walking fatigability (WF) can be measured by a Distance Walked Index and is defined as a decline in walking distance of 10% or more during the six-minute walking test (6MWT). However, the clinical manifestation and perceived symptoms related to fatigability are still not well documented. Forty-nine PwMS [Expanded Disability Status Scale (EDSS) ≤6] and 28 healthy controls (HC) performed a 6MWT. The perceived severity of 11 common symptoms was rated on a visual analogue scale of 0-10 before, immediately after, and 10, 20 and 30 minutes after the 6MWT by means of the symptom inventory. Short motor impairment screening tests at baseline together with other descriptive measures were performed. Twenty pwMS were categorized in the WF group and were more disabled (EDSS: 4.16 ± 1.41) than the non-walking fatigability group (n = 29, EDSS: 2.62 ± 1.94). PwMS showed exacerbations of several perceived symptoms in MS, where most symptoms returned to baseline within 10 minutes after the walking test. The WF group showed significantly more muscle weakness and gait impairment, together with balance problems, and experienced an increase in spasticity, pain and dizziness after 6MWT. Our findings showed that perceived severity of symptoms are higher in pwMS presenting WF, and increase temporally after the 6MWT. Future research with quantitative measurement during and after walking is recommended.
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Impact of quality of life related to foot problems: a case-control study. Sci Rep 2021; 11:14515. [PMID: 34267276 PMCID: PMC8282620 DOI: 10.1038/s41598-021-93902-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
Foot problems are highly prevalent conditions, being a frequent reason for medical and podiatric consultation. The aim of this study was to compare the differences of quality of life (QoL) related to foot health in people with and without the presence of foot problems. A case–control study was carried out in an outpatient centre, where a clinician recorded data related to sociodemographic and clinical characteristics. In addition, self-reported data on foot health-related quality of life were recorded using the Spanish version of the Foot Health Status Questionnaire. The sample consisted of 498 participants (249 cases and 249 controls), with a median age of 30 years and an interquartile range of 23 years. The differences between the groups were statistically significant for gender, age, footwear, general health, foot health, and physical activity. Cases showed lower scores for the domain of footwear, physical activity and vitality compared to controls. Foot pathologies have a negative impact on quality of life related to foot health, and the domains of footwear, general health and physical activity seem to be the factors that are associated with the presence of alterations and foot deformities.
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Gomoll AH, Farr J, Cole BJ, Flanigan DC, Lattermann C, Mandelbaum BR, Strickland SM, Zaslav KR, Kimmerling KA, Mowry KC. Safety and Efficacy of an Amniotic Suspension Allograft Injection Over 12 Months in a Single-Blinded, Randomized Controlled Trial for Symptomatic Osteoarthritis of the Knee. Arthroscopy 2021; 37:2246-2257. [PMID: 33716121 DOI: 10.1016/j.arthro.2021.02.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to determine the efficacy of amniotic suspension allograft (ASA) compared to hyaluronic acid (HA) and saline at up to 12 months of follow-up through the use of patient-reported outcomes, immunoglobulin levels, and anti-human leukocyte antigen (HLA) levels. METHODS Within this multicenter study, 200 patients were randomized 1:1:1 to a single intra-articular injection of saline, HA, or ASA. Patient-reported outcomes, including Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analog scale (VAS) score, were collected at multiple time points (baseline, 1 week, 6 weeks, 3 months, 6 months) out to 12 months to assess improvements in pain and function. Radiographs at baseline and 12 months were taken to determine radiographic changes, while blood was collected at baseline, 6 weeks, and 6 months to determine changes in immunoglobulins and anti-HLA levels. Statistical analyses were performed using last observation carried forward and mixed effects model for repeated measures. RESULTS Treatment with ASA resulted in significant improvements in KOOS and VAS scores that were maintained through 12 months (P < .05). Treatment with ASA resulted in a 63.2% responder rate at 12 months using the Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International simplified definition. There were no significant differences between groups for radiographic measures in the index knee, immunoglobulins, C-reactive protein, or anti-HLA serum levels (P > .05). The number and type of adverse events (AEs) reported for ASA were comparable to the HA injection group, while no treatment-emergent AEs were reported for the saline group. CONCLUSIONS This randomized controlled trial of ASA vs HA and saline for the treatment of symptomatic knee osteoarthritis demonstrated clinically meaningful improved outcomes with ASA over the controls out to 12 months postinjection. No concerning immunologic or adverse reactions to the ASA injection were identified with regards to severe AEs, immunoglobulin, or anti-HLA levels. LEVEL OF EVIDENCE Level I, randomized controlled multicenter trial.
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Affiliation(s)
- Andreas H Gomoll
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Jack Farr
- Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - David C Flanigan
- Division of Sports Medicine Cartilage Repair Center, Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Christian Lattermann
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | | | - Sabrina M Strickland
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | | | - Kelly A Kimmerling
- Department of Research and Development, Organogenesis, Birmingham, Alabama, U.S.A
| | - Katie C Mowry
- Department of Research and Development, Organogenesis, Birmingham, Alabama, U.S.A
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Munteanu SE, Landorf KB, McClelland JA, Roddy E, Cicuttini FM, Shiell A, Auhl M, Allan JJ, Buldt AK, Menz HB. Shoe-stiffening inserts for first metatarsophalangeal joint osteoarthritis: a randomised trial. Osteoarthritis Cartilage 2021; 29:480-490. [PMID: 33588086 DOI: 10.1016/j.joca.2021.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy of carbon-fibre shoe-stiffening inserts in individuals with first metatarsophalangeal joint osteoarthritis. DESIGN This was a randomised, sham-controlled, participant- and assessor-blinded trial. One hundred participants with first metatarsophalangeal joint osteoarthritis received rehabilitation therapy and were randomised to receive either carbon fibre shoe-stiffening inserts (n = 49) or sham inserts (n = 51). The primary outcome measure was the Foot Health Status Questionnaire (FHSQ) pain domain assessed at 12 weeks. RESULTS All 100 randomised participants (mean age 57.5 (SD 10.3) years; 55 (55%) women) were included in the analysis of the primary outcome. At the 12 week primary endpoint, there were 13 drop-outs (7 in the sham insert group and 6 in the shoe-stiffening insert group), giving completion rates of 86 and 88%, respectively. Both groups demonstrated improvements in the FHSQ pain domain score at each follow-up period, and there was a significant between-group difference in favour of the shoe-stiffening insert group (adjusted mean difference of 6.66 points, 95% CI 0.65 to 12.67, P = 0.030). There were no between-group differences for the secondary outcomes, although global improvement was more common in the shoe-stiffening insert group compared to the sham insert group (61 vs 34%, RR 1.73, 95% CI 1.05 to 2.88, P = 0.033; number needed to treat 4, 95% CI 2 to 16). CONCLUSION Carbon-fibre shoe-stiffening inserts were more effective at reducing foot pain than sham inserts at 12 weeks. These results support the use of shoe-stiffening inserts for the management of this condition, although due to the uncertainty around the effect on the primary outcome, some individuals may not experience a clinically worthwhile improvement.
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Affiliation(s)
- S E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - K B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - J A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - E Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, United Kingdom
| | - F M Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, 3004, Australia
| | - A Shiell
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - M Auhl
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - J J Allan
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - A K Buldt
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - H B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
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41
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Morrissey D, Cotchett M, Said J'Bari A, Prior T, Griffiths IB, Rathleff MS, Gulle H, Vicenzino B, Barton CJ. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med 2021; 55:1106-1118. [PMID: 33785535 PMCID: PMC8458083 DOI: 10.1136/bjsports-2019-101970] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 01/10/2023]
Abstract
Objective To develop a best practice guide for managing people with plantar heel pain (PHP). Methods Mixed-methods design including systematic review, expert interviews and patient survey. Data sources Medline, Embase, CINAHL, SPORTDiscus, Cochrane Central Register of Controlled Trials, trial registries, reference lists and citation tracking. Semi-structured interviews with world experts and a patient survey. Eligibility criteria Randomised controlled trials (RCTs) evaluating any intervention for people with PHP in any language were included subject to strict quality criteria. Trials with a sample size greater than n=38 were considered for proof of efficacy. International experts were interviewed using a semi-structured approach and people with PHP were surveyed online. Results Fifty-one eligible trials enrolled 4351 participants, with 9 RCTs suitable to determine proof of efficacy for 10 interventions. Forty people with PHP completed the online survey and 14 experts were interviewed resulting in 7 themes and 38 subthemes. There was good agreement between the systematic review findings and interview data about taping (SMD: 0.47, 95% CI 0.05 to 0.88) and plantar fascia stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term. Clinical reasoning advocated combining these interventions with education and footwear advice as the core self-management approach. There was good expert agreement with systematic review findings recommending stepped care management with focused shockwave for first step pain in the short-term (OR: 1.89, 95% CI 1.18 to 3.04), medium-term (SMD 1.31, 95% CI 0.61 to 2.01) and long-term (SMD 1.67, 95% CI 0.88 to 2.45) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). We found good agreement to ‘step care’ using custom foot orthoses for general pain in the short term (SMD: 0.41, 95% CI 0.07 to 0.74) and medium term (SMD: 0.55, 95% CI 0.09 to 1.02). Conclusion Best practice from a mixed-methods study synthesising systematic review with expert opinion and patient feedback suggests core treatment for people with PHP should include taping, stretching and individualised education. Patients who do not optimally improve may be offered shockwave therapy, followed by custom orthoses.
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Affiliation(s)
- Dylan Morrissey
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK .,Physiotherapy Department, Barts Health NHS Trust, London, UK
| | - Matthew Cotchett
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Ahmed Said J'Bari
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Trevor Prior
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Ian B Griffiths
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Halime Gulle
- Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Bill Vicenzino
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, St Lucia, Queensland, Australia
| | - Christian J Barton
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia.,Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Elizondo-Rodríguez J, Simental-Mendía M, Peña-Martínez V, Vilchez-Cavazos F, Tamez-Mata Y, Acosta-Olivo C. Comparison of Botulinum Toxin A, Corticosteroid, and Anesthetic Injection for Plantar Fasciitis. Foot Ankle Int 2021; 42:305-313. [PMID: 33030035 DOI: 10.1177/1071100720961093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plantar fasciitis is the most common cause of heel pain, and injection therapies are part of the treatment modalities. This study aimed to compare 2 intralesional injection therapies for plantar fasciitis: corticosteroid and botulinum toxin A, compared with a third control group using a local anesthetic. The clinical evolution, as well as changes in the thickness of the plantar fascia and ankle dorsiflexion, was evaluated. METHODS A randomized, controlled, double-blind trial design was used. Patients were divided into 3 groups: group 1, anesthetic only; group 2, corticosteroid; and group 3, botulinum toxin A (BoNT-A). We used an ultrasonographic evaluation to measure the plantar fascia thickness. The results were evaluated using the Maryland Foot Score and a 10-cm visual analog scale. Clinical scores were recorded at the beginning of the study, at 2 weeks, and at 1, 3, and 6 months. We evaluated 78 patients for study eligibility. The 3 intervention groups were homogeneous. RESULTS All patients showed better clinical outcomes compared with their initial evaluations, without differences between groups at the end of follow-up. The thickness of plantar fascia diminished at the final evaluation, and ankle dorsiflexion was better compared with the initial values without difference between treatment groups. CONCLUSION Considering all the evaluated outcomes, no significant differences between treatment groups were observed. The pain relief and functional improvement obtained with the different treatments was maintained during the 6-month follow-up. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Jorge Elizondo-Rodríguez
- Ortopedia y Traumatología, Facultad de Medicina y Hospital Universitario "Dr José E. González," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Mario Simental-Mendía
- Ortopedia y Traumatología, Facultad de Medicina y Hospital Universitario "Dr José E. González," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Victor Peña-Martínez
- Ortopedia y Traumatología, Facultad de Medicina y Hospital Universitario "Dr José E. González," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Félix Vilchez-Cavazos
- Ortopedia y Traumatología, Facultad de Medicina y Hospital Universitario "Dr José E. González," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Yadira Tamez-Mata
- Ortopedia y Traumatología, Facultad de Medicina y Hospital Universitario "Dr José E. González," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Carlos Acosta-Olivo
- Ortopedia y Traumatología, Facultad de Medicina y Hospital Universitario "Dr José E. González," Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Efficacy of a single botulinum toxin A injection for distal tarsal tunnel syndrome: A protocol for a randomized, double-blinded trial. Contemp Clin Trials Commun 2021; 21:100725. [PMID: 33553799 PMCID: PMC7844121 DOI: 10.1016/j.conctc.2021.100725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/18/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Distal tarsal tunnel syndrome (DTTS) is characterised by compression of the tibial nerve as it passes underneath the abductor hallucis muscle belly. There is no current consensus on treatment for DTTS. This study was conducted to compare and evaluate the effect of ultrasound-guided botulinum toxin A (BTX-A) versus ultrasound-guided corticosteroid injection (CSI) for the treatment of DTTS. Methods This study was a single-centre, randomized, and double-blinded trial. The study protocol was submitted to the local ethics committee board and subsequently registered in a research registry. 88 patients with DTTS were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 12 weeks. Evaluation was via the Foot Health Status Questionnaire (FHSQ). The primary outcome measures were pain and the secondary outcomes were function and the use of oral analgesics. All of the assessments were performed at baseline and at 3, 6, and 12 weeks after treatment. Results This is a randomized controlled trial evaluating the efficacy of BTX-A versus CSI in the treatment of DTTS. This study has limited inclusion and exclusion criteria and a well-controlled intervention. Conclusions The results of this trial will provide more evidence on which method can better treat DTTS. Trial registration We have registered this trial with the Australian New Zealand Clinical Trials Registry and the temporary trial number is 380,105.
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44
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Whittaker GA, Munteanu SE, Roddy E, Menz HB. Measures of Foot Pain, Foot Function, and General Foot Health. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:294-320. [PMID: 33091250 DOI: 10.1002/acr.24208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/02/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Glen A Whittaker
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, Chesterfield, UK, School of Primary, Community and Social Care, Keele University, Keele, UK, and Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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45
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Rasenberg N, Bierma-Zeinstra SMA, Fuit L, Rathleff MS, Dieker A, van Veldhoven P, Bindels PJE, van Middelkoop M. Custom insoles versus sham and GP-led usual care in patients with plantar heel pain: results of the STAP-study - a randomised controlled trial. Br J Sports Med 2020; 55:272-278. [PMID: 32878869 PMCID: PMC7907578 DOI: 10.1136/bjsports-2019-101409] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare custom-made insoles to sham insoles and general practice (GP)-led usual care in terms of pain at rest and during activity at 12 weeks follow-up in individuals with plantar heel pain. METHODS In this randomised clinical trial 185 patients aged 18 to 65 years, with a clinical diagnosis of plantar heel pain for at least 2 weeks, but no longer than 2 years were recruited. Patients were randomly allocated into three groups: (1) GP-led treatment, plus an information booklet with exercises (usual care; n=46), (2) referral to a podiatrist for treatment with a custom-made insole plus an information booklet with exercises (custom-made insole; n=70) and (3) referral to a podiatrist and treatment with a sham insole plus an information booklet with exercises (sham insole; n=69). As well as the primary outcome of pain severity (11-point Numerical Rating Scale) we used the Foot Function Index (0 to 100) as a secondary outcome. RESULTS Of 185 randomised participants, 176 completed the 12-week follow-up. There was no difference in pain or function between the insole and the sham groups at 12 weeks. Participants in the GP-led usual care group reported less pain during activity at 12 weeks, (mean difference (MD) 0.94, 95% CI 0.23 to 1.65), less first step pain (MD 1.48, 95% CI 0.65 to 2.31), better function (MD 7.37, 95% CI 1.27 to 13.46) and higher recovery rates (RR 0.48, 95% CI 0.24 to 0.96) compared with participants in the custom insole group. CONCLUSIONS Referral to a podiatrist for a custom-made insole does not lead to a better outcome compared to sham insoles or compared to GP-led usual care. TRIAL REGISTRATION NUMBER NTR5346.
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Affiliation(s)
- Nadine Rasenberg
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lars Fuit
- Podiatrist practice: Podotherapie Fuit en van Houten, Rijswijk, The Netherlands
| | | | - Amy Dieker
- Dutch Association of Podiatrists, Hilversum, The Netherlands
| | - Peter van Veldhoven
- Department of Sports Medicine, Haaglanden Medical Centre, Leidschendam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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46
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Ho LF, Guo Y, Ching JYL, Chan KL, Tsang PH, Wong MH, Chen M, Chen L, Ng BFL, Lin ZX. Efficacy of electroacupuncture plus warm needling therapy for plantar heel pain: a randomised waitlist-controlled trial. Acupunct Med 2020; 39:283-291. [PMID: 32815386 DOI: 10.1177/0964528420946048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the therapeutic effects of electroacupuncture plus warm needling (EAWN) therapy on pain and foot function in adults with plantar heel pain (PHP). METHODS This prospective, randomised, parallel-group, waitlist-controlled trial was conducted at a Chinese medicine centre in Hong Kong between May 2018 and February 2019. Eighty eligible community-dwelling subjects with PHP (mean age 59.7 years; 85% female) were equally randomised to receive EAWN therapy or remain on a waitlist. The treatment group received six 30-min sessions of standardised EAWN therapy over 4 weeks; the control group received no treatment. The outcome measures were the visual analogue scale (VAS) score for first-step pain, foot function index (FFI) scores and global rating of change (GRC) scale scores. Assessments were made at baseline, week 2 and week 4 (primary endpoint). The treatment group underwent additional assessments at week 8. Outcomes were evaluated by intention-to-treat analysis. RESULTS Patients who received EAWN therapy exhibited greater improvements in the mean first-step pain VAS and all FFI scores than did those in the control group at weeks 2 and 4, with significant between-group differences (all P < 0.001). Compared with baseline, there were significant decreases in mean first-step pain VAS scores at weeks 2 and 4, and FFI scores at week 4, in the treatment group but not in the control group. The improvements in the treatment group continued until week 8. GRC scores at week 4 indicated improvement in all treated patients and only 22.5% of the control group patients (P < 0.001). There were no study-related adverse events. CONCLUSION EAWN therapy could be an effective treatment for PHP in middle-aged and older adults. TRIAL REGISTRATION NUMBER ChiCTR1800014906 (Chinese Clinical Trials Registry).
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Affiliation(s)
- Lai Fun Ho
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong, China
| | - Yuanqi Guo
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong, China.,School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jessica Yuet-Ling Ching
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Institute of Integrative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kam Leung Chan
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Institute of Integrative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ping Him Tsang
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong, China
| | - Man Hin Wong
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong, China
| | - Min Chen
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong, China
| | - Liyi Chen
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong, China.,School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Zhi Xiu Lin
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Institute of Integrative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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47
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Al-Boloushi Z, Gómez-Trullén EM, Arian M, Fernández D, Herrero P, Bellosta-López P. Comparing two dry needling interventions for plantar heel pain: a randomised controlled trial. BMJ Open 2020; 10:e038033. [PMID: 32819949 PMCID: PMC7440826 DOI: 10.1136/bmjopen-2020-038033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To compare the effectiveness of dry needling (DN) versus percutaneous needle electrolysis (PNE) for improving the level of pain, function and quality of life (QoL) of patients suffering from plantar heel pain (PHP) provoked by myofascial trigger points. DESIGN A prospective, parallel-group, randomised controlled trial with blinded outcome assessment. SETTING A single treatment facility in the State of Kuwait. PARTICIPANTS 118 participants were screened for eligibility. Of these, 102 participants were enrolled (30 men (49.5±8.9 years) and 72 women (48.1±8.8 years)) and 68 of them completed the trial. INTERVENTIONS Two parallel groups, one study arm received DN and a stretching protocol whereas the other arm received percutaneous needling electrolysis with a stretching protocol. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was the Foot Pain domain of the Foot Health Status Questionnaire, with 13 questions related to foot health-related domains. Secondary outcome measures included the 0-10 numerical rating scale pain visual analogue scale (VAS) scores, performed before and after each treatment session. In addition, QoL was measured using the EuroQoL-5 dimensions. All measurements were taken at baseline, at 4, 8, 12, 26 and 52 weeks. RESULTS Foot Pain domain improved at all time points for DN group (p<0.001; 29.7 (17.8 to 41.5)) and percutaneous needling electrolysis group (p<0.001; 32.7 (18.3 to 47.0)), without significant differences between groups. Pain VAS scores decreased at all time points for both DN (p<0.001; -2.6 (-4.0 to -1.2)) and percutaneous needling electrolysis group (p<0.001; -3.0 (-4.5 to -1.6)). QoL improved at 4 weeks for both DN (p<0.01; 0.15 (0.5 to 0.25)) and percutaneous needling electrolysis group (p<0.01; 0.09 (0.01 to 0.17)) and at 8 and 52 weeks for the PNE group (p<0.01; 0.10 (0.02 to 0.18)), with significant differences between groups for the QoL at 52 weeks (p<0.05; 0.10 (0.01 to 0.18)). There were two small haematomas in the PNE group and one in the DN group. No serious adverse events were reported. CONCLUSIONS Both PNE and DN were effective for PHP management, reducing mean and maximum pain since the first treatment session, with long lasting effects (52 weeks) and significant differences between groups in the case of QoL at 52 weeks in favour of the PNE group. TRIAL REGISTRATION NUMBER NCT03236779.
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Affiliation(s)
- Zaid Al-Boloushi
- Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, Spain
- Physical Therapy, Kuwait Ministry of Health, Safat, Kuwait
| | | | - Mohammad Arian
- Physical Therapy, Kuwait Ministry of Health, Safat, Kuwait
| | - Daniel Fernández
- iPhysio Research Group, Universidad San Jorge, Facultad de Ciencias de la Salud, Villanueva de Gallego, Spain
| | - Pablo Herrero
- iPhysio Research Group, Universidad San Jorge, Facultad de Ciencias de la Salud, Villanueva de Gallego, Spain
| | - Pablo Bellosta-López
- iPhysio Research Group, Universidad San Jorge, Facultad de Ciencias de la Salud, Villanueva de Gallego, Spain
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Wang W, Liu Y, Jiao R, Liu S, Zhao J, Liu Z. Comparison of electroacupuncture and manual acupuncture for patients with plantar heel pain syndrome: a randomized controlled trial. Acupunct Med 2020; 39:272-282. [PMID: 32811186 DOI: 10.1177/0964528420947739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Plantar heel pain syndrome (PHPS), also known as plantar fasciitis, affects millions of people worldwide. Electroacupuncture (EA) and manual acupuncture (MA) are the two acupuncture modalities frequently used for PHPS in the clinical setting. However, which modality is more effective has yet to be determined. OBJECTIVE To examine whether EA is more effective than MA with regards to pain relief for patients with PHPS. METHODS Participants were randomly assigned (1:1) to receive 12 treatment sessions of EA or MA over 4 weeks with 24 weeks of follow-up. The primary outcome was the proportion of treatment responders, defined as patients with at least a 50% reduction from baseline in the worst pain intensity experienced during the first steps in the morning after a 4-week treatment, measured using a visual analogue scale (VAS, 0-100; higher scores signify worse pain). Analysis was by intention-to-treat. RESULTS Ninety-two patients with a clinical diagnosis of PHPS were enrolled from 29 July 2018 through 28 June 2019. Of the patients, 78 (85%) completed the treatment and follow-up. The primary outcome occurred in 54.8% (23/42) of the EA group compared to 50.0% (21/42) of the MA group after the 4-week treatment (difference -4.76, 95% confidence interval, -26.10 to 16.57, P = 0.662). There were no significant between-group differences for any secondary outcomes after 4 weeks of treatment and at 16 weeks and 28 weeks of follow-up. There were no serious treatment-related adverse events in either group. CONCLUSION Among patients with PHPS, EA did not have a better effect with respect to relieving pain intensity than MA at week 4, although both EA and MA appeared to have positive temporal effects, with decreased heel pain and improved plantar function. TRIAL REGISTRATION NUMBER ChiCTR1800016531 (Chinese Clinical Trial Registry).
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Affiliation(s)
- Weiming Wang
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ruimin Jiao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Sixing Liu
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Jie Zhao
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Naruseviciute D, Kubilius R. The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: randomized participant blind controlled trial. Clin Rehabil 2020; 34:1072-1082. [PMID: 32513018 PMCID: PMC7372589 DOI: 10.1177/0269215520929073] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To evaluate and compare the efficacy of high-intensity laser therapy (HILT)
and low-level laser therapy (LLLT) for plantar fasciitis. Design: A participant blind randomized controlled trial with parallel group design
and an active comparator with follow-up at four weeks. Settings: Outpatient, University hospital. Subjects: Unilateral plantar fasciitis participants (n = 102) were
randomly assigned into two groups. Recruitment period was from January 2017
to April 2019. Interventions: Interventions included eight sessions of laser therapy over three weeks and
single session of patient education. The HILT group
(n = 51) received HILT and the LLLT group
(n = 51) received LLLT. Main measures: Primary outcomes: visual analogue scale; secondary outcomes: pressure
algometry, sonography of plantar fascia thickness (time frame: baseline to
three-week and four-week follow-up) and numeric rating scale (0%–100%) for
opinion of participants on effect of treatment (time frame: three weeks).
Data presented: mean (SD) or n (%). Results: There was no statistically significant difference between the groups
according to visual analogue scale (pain in general reduction in
three weeks: 2.57(3.45) vs. 2.88(3.28) cm), pressure algometry (pain
threshold difference between healthy and affected heel reduction in
three weeks: 1.80(6.39) vs. 1.77(2.85) kg) and sonography measurements
(plantar fascia thickness difference between healthy and affected heel
reduction in three weeks: 0.19(0.56) vs. 0.30(0.57) mm). There was a
statistically significant difference between the groups in participants’
opinion in favor to HILT group (efficacy of treatment better than 50%:
26(51%) vs. 37(73%)). Conclusion: No statistically significant difference between groups was observed.
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Affiliation(s)
- Dovile Naruseviciute
- Dovile Naruseviciute, Department of
Rehabilitation, The Lithuanian University of Health Sciences, A. Mickevičiaus
st. 9, Kaunas, LT 44307, Lithuania.
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López-López D, Fernández-Espiño C, Losa-Iglesias ME, Calvo-Lobo C, Romero-Morales C, Rodríguez-Sanz D, Navarro-Flores E, Becerro-de-Bengoa-Vallejo R. Women's Foot Health-Related Quality of Life in Ballet Dancers and Nondancers. Sports Health 2020; 12:347-351. [PMID: 32511070 DOI: 10.1177/1941738120922962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Prevalence and severity of symptoms related to muscle and joint pain seem to be high in most dancers. HYPOTHESIS There will be a worse quality of life related to foot health for ballet dancers compared with nondancers. STUDY DESIGN Case-control study. LEVEL OF EVIDENCE Level 4. METHODS A sample of 156 women was recruited from a clinic of podiatric medicine and surgery. Self-reported data were measured by the Foot Health Status Questionnaire (FHSQ), which has 33 questions that assess 8 health domains of the feet and general health, namely, foot pain, foot function, general foot health, footwear, general health, physical activity, social capacity, and vigor. RESULTS Statistically significant differences (P < 0.05) were shown for foot pain, foot function, foot health, and general health, which together revealed a worse foot health-related quality of life (lower FHSQ scores) but a better general health (higher FHSQ scores) for ballet dancers compared with nondancers. The remaining domains did not show statistically significant differences (P > 0.05). According to multivariate linear regression models (P < 0.05), the practice of ballet dance (group) was the only independent variable that predicted the dependent variables, such as foot pain (R2 = 0.052;β = +8.349), foot function (R2 = 0.108; β = +11.699), foot health (R2 = 0.039; β = +10.769), and general health (R2 = 0.019; β = -6.795). CONCLUSION Ballet dancers showed a negative impact on quality of life related to foot health but better overall quality of life (general health) compared with nondancers. CLINICAL RELEVANCE Paying attention to a dancer's foot health could provide important benefits for the dancer's foot health and physical practice of dance.
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Affiliation(s)
- Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - Cristina Fernández-Espiño
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | | | - César Calvo-Lobo
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - David Rodríguez-Sanz
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Emmanuel Navarro-Flores
- Departament d'infermeria, Facultat d'infermeria i podología, Universitat de València, Valencia, Spain
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