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High long-term stress on the plantar fascia (PF) is the main cause of plantar fasciitis. Changes in the midsole hardness (MH) of running shoes are an important factor leading to the alteration of the PF. This study aims to establish a finite-element (FE) model of the foot–shoe, and investigates the effects of midsole hardness on PF stress and strain. The FE foot–shoe model was built in ANSYS using computed-tomography imaging data. Static structural analysis was used to simulate the moment of running push and stretch. Plantar stress and strain under different MH levels were quantitatively analyzed. A complete and valid 3D FE model was established. With an increase in MH from 10 to 50 Shore A, the overall stress and strain of the PF were decreased by approximately 1.62%, and the metatarsophalangeal (MTP) joint flexion angle was decreased by approximately 26.2%. The height of the arch descent decreased by approximately 24.7%, but the peak pressure of the outsole increased by approximately 26.6%. The established model in this study was effective. For running shoes, increasing the MH reduces the stress and strain of PF, but also imposes a higher load on the foot.

Purpose To assess the efficacy of shear-wave elastography (SWE) of the plantar fascia (PF) in identifying plantar fasciitis. Methods A literature search was conducted on the PubMed and Medline databases for articles published up to August 2022. The Newcastle–Ottawa scale was used to assess the risk of bias. We included original research studies in English dealing with the evaluation of patients with plantar fasciitis by means of SWE and including shear modulus (KPa) and/or shear-wave velocity (m/s). We compared healthy and pathologic PF stiffness using the standardised mean difference (SMD) in a random-effects model (95% CI). Results Five studies were included with a total of 158 pathologic PFs and 134 healthy PFs. No significant publication bias was detected. Studies were highly heterogeneous (p I2 = 97%). Pathologic PFs showed significantly lower stiffness, with an SMD of − 3.00 m/s (95% confidence interval: − 4.95 to − 1.06, p = 0.002), compared to healthy PF. Conclusion Pathologic PFs present significantly lower stiffness than healthy PFs. However, the analysed studies are highly heterogeneous.

The purpose of this study was to identify association between magnetic resonance imaging (MRI) features and clinical data at baseline and six months following platelet-rich plasma (PRP) or corticosteroid (CS; cortivazol) injection in patients with plantar fasciitis, and to identify initial MRI criteria associated with a favorable clinical response to treatment.The study was registered on ClinicalTrials.gov (NCT03857334). MRI examinations of 36 patients with plantar fasciitis lasting more than 3 months who were randomly assigned to receive ultrasound-guided PRP (PRP group, 20 patients) or CS (CS group, 18 patients) injection were quantitatively and qualitatively analyzed with respect to plantar fascia thickness, plantar fascia hyperintensity on T2-weighted STIR (HSTIR) images, calcaneal bone marrow and surrounding soft tissues. Clinical evaluation including visual analytic scale (VAS) assessment and MRI examinations were obtained before and 6 months after treatment. Good clinical response was defined as pain VAS decrease50% at 6 months. ROC curves with AUC measurements were used to determine cut-off points.In the whole study population, an association was found between MRI features (deep soft tissue and calcaneal bone marrow HSTIR) and pain VAS scores for the first steps of the day (P = 0.028 and P = 0.007, respectively). No significant radioclinical associations on post-treatment MRI examinations were found in either group. Initial coronal thickness of plantar fascia was associated with a good clinical response in the CS group (P0.01). ROC curve analysis found that 7-mm or thicker plantar aponeurosis at initial MRI was predictive of good clinical response in patients with CS treatment (Youden index = 0.6). PRP infiltrations were effective regardless of fascia thickness (73% of patients with ≤ 7 mm aponeurosis and 67% for thicker ones).Initial facia thickness (7 mm) is predictive of good clinical response six months after CS injection, whereas PRP injection shows effectiveness regardless of fascia thickness.

Aim of the work To assess serum level of bone morphogenetic protein-7 (BMP-7) and to study its relation to clinical and sonographic assessment of peripheral enthesitis in ankylosing spondylitis (AS) patients. Patients and methods This study involved 49 AS patients and 40 matched controls. The serum BMP-7 level was determined by enzyme linked immunosorbant assay (ELISA). Entheses were assessed by musculoskeletal ultrasound (MSUS) and scored using Madrid Sonographic Enthesitis Index (MASEI). The AS disease activity score-C-reactive protein (ASDAS-CRP), Bath AS disease activity index (BASDAI) and Bath AS Functional Index (BASFI) were assessed. Results Patients were 45 males and 4 females with a mean age of 35.57 ± 9.71 years and median disease duration of 10 (2–28) years. US lesions were frequently found at the insertions of Achilles (76.5%), quadriceps (57.1%), plantar fascia (51%) and triceps (43.8%) tendons. Serum level of BMP-7 was significantly increased in patients (41.8 ng/ml) compared to controls (38.5 ng/ml) (p = 0.031). BMP-7 serum level significantly correlated with age (p = 0.03), disease duration (p Conclusion AS patients have a significant higher level of serum BMP-7 compared to control which indicates that it may play an important pathogenetic role in AS. However, this level did not correlate with either clinical or sonographic assessment of peripheral enthesitis.

Prior studies have shown that self- and manual massage (SMM) increases flexibility in non-adjacent body areas. It is unclear whether this also influences performance in terms of force generation. Therefore, this study investigated the effect of SMM on the plantar surface on performance in the dorsal kinetic chain. Seventeen young participants took part in this within-subject non-randomized controlled study. SMM was applied on the plantar surface of the dominant leg, but not on the non-dominant leg. A functional performance test of the dorsal kinetic chain, the Bunkie Test, was conducted before and after the intervention. We measured the performance in seconds for the so-called posterior power line (PPL) and the posterior stabilizing line (PSL). The performance of the dominant leg in the Bunkie Test decreased significantly by 17.2% from (mean ± SD) 33.1 ± 9.9 s to 27.4 ± 11.1 s for the PPL and by 16.3% from 27.6 ± 9.8 s to 23.1 ± 11.7 s for the PSL. This is in contrast to the non-dominant leg where performance increased significantly by 5.1% from 29.7 ± 9.6 s to 31.1 ± 8.9 s for the PPL and by 3.1% from 25.7 ± 1.5 s to 26.5 ± 1.7 s for the PSL. SMM interventions on the plantar surface might influence the performance in the dorsal kinetic chain.

Background The use of shear wave elastography (SWE) seems to be an important imaging method in the diagnosis of plantar fasciitis (PF). Purpose To compare patients diagnosed with PF with similar and young healthy control groups in terms of B-mode ultrasound (US) and SWE results and to evaluate the elasticity of the plantar fascia. Material and Methods A total of 140 feet of 70 participants were evaluated, including 30 patients and 40 healthy individuals as the control. Clinical, B-mode US, and SWE evaluations were performed for each patient. In addition, American Orthopedic Foot and Ankle Score (AOFAS) was calculated to evaluate pain and foot function in both groups. Results Of the patients in the PF group, 40 (88%) were women and the healthy control groups had similar sex distributions ( P = 0.23). The AOFAS score was lower in feet with PF compared to the other groups ( P Conclusion In conclusion, the evaluation of the diagnosis of PF with clinical findings and regular follow-up of measurements with SWE can provide measurement results with higher sensitivity in the diagnosis of PF.

Background: Plantar fasciitis is one of the most common disorders of foot associated with pain and limitations to activities. Aim: To investigate outcomes of patients with plantar fasciitis after 12-week exercises rehabilitation program. Patients and methods: Research design: A randomized controlled trial. Sample and setting: Sixty-four patients with plantar fasciitis attended to orthopedic department and orthopedic outpatients clinic at Assiut University Hospitals. Patients were assigned randomly into 2 equal groups as odd number (intervention group) and double number (control group). This study introduced exercises rehabilitation program to intervention group. Outcomes were measured at the time of assessment in orthopedic department and orthopedic outpatients clinic and then each 4 weeks for 12-week in orthopedic outpatients clinic. Tools: assessment sheet for patient with plantar fasciitis, numeric pain rating scale, foot functional index, American orthopedic foot and ankle society scale and exercises adherence logbook. Results: Statistical significant difference (p.value

Background The biggest challenge in treating this diagnosis is the lack of literature focusing on regional interdependence. The current literature suggests a narrow and localized approach targeting plantar fascia and ankle/foot complex. The literature available on conservative treatment focused on utilizing various inflammatory modalities such as injections and extracorporeal shockwave therapy. The surgical approach targets Baxter’s nerve decompression techniques and releases techniques to the gastrocnemius and plantar fascia. The article focuses on utilizing manual therapy techniques to the lumbosacral spine and plantar fascia. In addition, the neurodynamic flossing targeted lateral plantar nerve mobility. Case presentation The patient is a 54-year-old African American female seen for right heel pain at Texas’s outpatient orthopedic physical therapy clinic. The patient had the diagnosis of plantar fasciopathy with negative Windlass testing. The patient was provided manual therapy interventions to the lumbosacral spine and plantar fascia to improve weight-bearing patterns and overall functional outcomes. Conclusion The manual therapy interventions to the lumbosacral spine and plantar fascia and flossing techniques to the lateral plantar nerve improved symptoms of heel pain. The patient showed improved outcomes with this approach.

Objective: The effectiveness of tissue specific stretching exercises and myofascial released technique on intensity of pain and Foot function was compared in chronic plantar fasciitis patients. Study Design: Randomized controlled trial study Place and Duration of Study: This study was conducted at Al-Ain Poly clinic Karachi between 2012-13. Materials and Methods: Fifty patients with chronic plantar fasciitis were enrolled through convenience sampling and were randomly assigned into Stretching Exercise and Myofascial Release Technique groups. Intensity of pain and foot function were evaluated by Visual Analouge Scale and foot function index, respectively. Ten sessions were done for both groups. T-tests and ANCOVA test were used for statistical analysis (p

The aim of the study was to compare the efficacy of ultrasound-guided injection of botulinum toxin type A with corticosteroid in patients with chronic plantar fasciitis (PF).This randomized controlled trial was conducted on 35 patients with chronic plantar fasciitis. Participants were randomly allocated into two groups: one group received methylprednisolone in to the plantar fascia ( n = 18) and the other group received botulinum toxin type A injection into the flexor digitorum brevis and quadratus plantae ( n = 17). All injections were performed under ultrasound guidance. Patients were evaluated using the Visual Analog Scale, Foot and Ankle Ability Measures, and plantar fascia thickness before the intervention, 3 wks, 12 wks, and 6 mos after the treatment.In both groups, patients' pain and function improved significantly up to 3 wks after injection. In the botulinum toxin type A group, morning Visual Analog Scale improved significantly at 12 wks after intervention and the improvement was sustained for another 3 mos. In the botulinum toxin type A group, Foot and Ankle Ability Measures-sports subscale improved in all evaluated points, whereas in the corticosteroid group, the improvement was significant only when comparing follow-ups values to baseline.Both ultrasound-guided botulinum toxin type A and corticosteroid injection were effective in the treatment of plantar fasciitis. Our study showed that the effects of botulinum toxin type A injection last longer than those of steroid injection.

Background Musculoskeletal involvement is extremely common in patients with systemic lupus erythematosus (SLE). Musculoskeletal ultrasound (MSUS) is an important tool for evaluation of patients with inflammatory arthritis as well as early detection of subclinical inflammation at the joint, tendon and entheseal level. Aim of the work To investigate the frequency and distribution of lower limb entheseal abnormalities detected by MSUS in SLE patients and to evaluate its relation to disease activity. Patients and methods 50 adult SLE patients were studied. SLE Disease Activity Index-2000 (SLEDAI-2K) was assessed. High-resolution MSUS assessment of quadriceps, patellar and Achilles tendons, and plantar fascia entheses was performed. Glasgow Ultrasound Enthesitis Scoring System (GUESS) was assessed. Results The median age of the patients was 30 (interquartile range 23–36.3 years) and were 49 females. The median disease duration was 4 (2–8.3 years), SLEDAI-2K was 4 (2–8) and GUESS score 3 (1–5.3). Clinical enthesitis was found in 22 (44%) patients; 58% of the patients had evident MSUS features of enthesitis and 32% had minimal or isolated entheseal abnormalities. The age and SLEDAI-2K were significantly increased in those with clinical enthesitis compared to those without (p = 0.007 and p = 0.03 respectively). GUESS significantly correlated with the age (r = 0.39, p = 0.005) and SLEDAI-2K (r = 0.29, p = 0.04). Conclusion Clinical and ultrasound-proved enthesitis are prevalent in SLE patients. Quadriceps tendon insertion is the most affected enthesis. Clinical enthesitis tends to occur in older SLE patients. Enthesitis has positive correlations with; age, and SLEDAI-2K score. The presence of enthesitis may represent a potential marker for SLE disease activity.

Objective. To investigate the clinical value of high-frequency ultrasound in psoriatic arthritis (PSA). The study subjects were 32 outpatients and inpatients with PSA who were pathologically diagnosed from January 2018 to September 2020, including 11 males and 21 females, aged 25–70 years old, with an average of (49.8 ± 14.0) years old. All patients underwent ultrasound and physical examination, including the small joints of the hands and feet on both sides, nails, and the main attachment points of the lower limbs (quadriceps tendon, patellar ligament, Achilles tendon, and plantar fascia attachment). The involvement of these joints, attachment points, and nails was observed and counted, respectively, and statistically analyzed. Results. Physical examination revealed 406 (406/1792, 22.66%) joint lesions, 79 (79/320, 24.69%) attachment inflammation, and 84 (84/320, 26.25%) nail lesions. Ultrasonography revealed 492 (492/1792, 27.46%) joint lesions, 166 (166/320, 51.88%) attachment inflammation, and 203 (203/320, 63.44%) nail lesions. The positive rate of ultrasound examination was higher than that of physical examination ( P < 0.001 ). Conclusion. Ultrasonography can detect joint, attachment, and nail lesions earlier than physical examination in patients with PSA. Ultrasonography is of great value in the diagnosis of PSA.

When performing physical activity and sports, men and women are at risk of the plantar fascia that could decrease foot functions when walking, running, and jumping. Thus it requires accurate prediction results in handling it. This study aimed to determine whether clinical findings can help plantar fascia flexibility treatments and managements through ankle stretching and self-massage interventions on posture balance based on gender. This study used a quasi-experimental design with a 2x2 factorial design for male and female categories. The population of this study was 300 students, while the samples were 40 students aged 19-26 years, consisting of 20 males and 20 females. The sampling technique used stratified random sampling. Furthermore, the ankle dorsiflexion intervention was performed by stretching the ankle to overcome plantar stiffness. For self-massage, the golf ball roll relaxation gave a relaxing effect on plantar pressure. The ankle dorsiflexion and golf ball roll relaxation were performed for 45 seconds. The data collection instrument of this study was a standing stork test as a measurement reference. Data analysis used two-way ANOVA statistical test with the help of SPSS application. The results showed that the significance value of comparing ankle stretching and self-massage technique effects for plantar fascia on the posture balance based on gender was (p0.05). The significance value of posture balance in terms of gender was (p) = 0.417. Meanwhile, the difference between ankle stretching and self-massage interaction based on gender was (p) = 0.000. This study indicates that these findings can assist the treatment and management of plantar fascia flexibility through ankle stretching and self-massage interventions to balance the posture in terms of gender. Treatment for plantar fascia flexibility is more effective with ankle stretching.

Background: Shock wave therapy is one of the modern methods of treatment used to treat diseases of muscles, tendons, and entheses in orthopedics, as well as in sports medicine. The therapy is increasingly used in the treatment of plantar fasciitis—a disease that is very difficult and burdensome to treat. Where basic conservative treatment for heel spurs fails, the only alternative consists of excision of the bone outgrowth, and shock wave therapy: a modern, minimally invasive, and relatively safe method. The aim of the study was to determine the long-term effectiveness of extracorporeal shock wave therapy in the treatment of painful ailments occurring in the course of plantar fasciitis in amateur runners. Materials and methods: The study includes a group of 39 men and women, aged 34–64 (mean age 54.05 ± 8.16), suffering from chronic pain in one or both feet, occurring in the course of plantar fasciitis. The patients had to meet five criteria to qualify for the study. The group was divided into two subgroups: those who had not undergone other physiotherapeutic procedures prior to the extracorporeal shock wave therapy (ESWT-alone; 23 people), and those who had received other procedures (ESWT-plus; 16 people). The therapy was performed using extracorporeal shock wave (ESWT). No local anesthesia was used. The effectiveness of the extracorporeal shock wave therapy was evaluated using the visual analogue scale of pain (VAS), Modified Laitinen Pain Index Questionnaire, the AOFAS scale (American Orthopedic Foot and Ankle Society), and a survey questionnaire consisting of 10 questions concerning metrics and subjective assessment of the effects of therapy. The interview was conducted before ESWT, and again five years later. Results: The use of extracorporeal shock wave therapy reduced the intensity and frequency of pain, and improved daily and recreational activity. Moreover, a reduction in the level of pain sensation on the VAS scale and pain symptoms during walking was demonstrated. More favorable results were obtained in the ESWT-plus group; however, the first effects were observed later than in the ESWT-alone group. Conclusions: Extracorporeal shock wave therapy is an effective form of therapy for amateur runners. It reduces pain associated with plantar fasciitis that amateur runners may experience at rest, while walking, and during daily and recreational activity.

Altering plantar load using foot orthoses (FOs) may alter the mechanical work required of internal structures and change the size of muscle and connective tissues. Skin sensitivity might also change as a result of altering mechanoreceptor stimulation. This study investigated the effects of FOs on foot soft tissue morphology and skin sensitivity over three months of use. Forty-one healthy participants wore pre-fabricatedprefabricated FOs (n=23) or no insert (n=18) for three months. The FOs were prescribed specific to each participant, using criteria of a change in peak pressure of 8% in the medial arch (pressure increase) and medial heel (pressure decrease). Ultrasound images were recorded pre- and post-FOs use to derive cross-sectional area and thickness of: abductor hallucis, flexor hallucis brevis, flexor digitorum brevis and the Achilles tendon at the insertion and mid-portion. Plantar fascia thickness was measured at the insertion and midfoot. The minimal detectable difference was established in piloting (n=7). Skin sensitivity was measured with monofilaments at the dorsum (between the hallux and second toe), medial and lateral heel, medial and lateral arch and the 1st metatarsal head. The FOs increased peak pressure by 15% in the medial arch and reduced it by 21% in the medial heel. None of the changes in soft tissue measurements was greater than the minimal detectable difference and there were no effects of group and time. Skin sensitivity decreased over time at the 1st metatarsal head for both groups, but there was no group effect. Using FOs over three months did not change the foot tissues nor skin sensitivity. This study challenges the notion that FOs make muscles smaller.

Introduction: The calcaneal spur is also known as an enthesophyte which is a bony outgrowth from the calcaneum at the plantar fascia insertion. Treatment aspect ranges from initial conservative methods, invasive techniques to surgical excision of the spur in cases which are not responding to any other alternative methods. This article aims in evaluating the functional outcome of calcaneal spur excision coupled with a dose of autologous platelet-rich plasma injection in recalcitrant cases of the calcaneal spur. Materials and Methods: A total of 42 cases of confirmed calcaneal spur cases were recruited for the study. All participants were offered with calcaneal excision with a dose of autologous platelet-rich plasma injection. All patients were evaluated preoperatively and post-operatively with VAS and FFI scores at the end of the 1st , 3rd; and 6th months. Results: The patients who received calcaneal spur excision along with a single dose of autologous plateletrich plasma injection reported statistically significant pain relief at the end of 6 months while comparing with the pre-operative VAS score (p = 0.003) and FFI score showed a statistically significant functional outcome between both groups at the end of 6 months (p Conclusion: Surgical removal of calcaneal spur along with a dose of an autologous platelet-rich plasma injection serve the better management for calcaneal spur and improves the functional quality of life. Keywords: Calcaneal spur, Plateletrich plasma, VAS score.

Background: Imaging diagnosis plays a fundamental role in the evaluation and management of injuries suffered in sports activities. Objective: To analyze the differences in the thickness of the Achilles tendon, patellar tendon, plantar fascia, and posterior tibial tendon in the following levels of physical activity: persons who run regularly, persons otherwise physically active, and persons with a sedentary lifestyle. Design: Cross-sectional and observational. Participants: The 91 volunteers recruited from students at the university and the Triathlon Club from December 2016 to June 2019. The data were obtained (age, body mass index, and visual analog scale for quality of life together with the ultrasound measurements). Results: Tendon and ligament thickness was greater in the runners group than in the sedentary and active groups with the exception of the posterior tibial tendon. The thickness of the Achilles tendon was greater in the runners than in the other groups for both limbs (P = .007 and P = .005). This was also the case for the cross-sectional area (P P = .034 and P = .026) and for patellar tendon thickness for the longitudinal measurement (P P = .040). Conclusion: The thickness of the Achilles tendon, plantar fascia, and patellar tendon is greater in runners than in persons who are otherwise active or who are sedentary.

In the recent years, prolotherapy is increasingly being used in the field of musculoskeletal medicine. However, few studies have investigated its effectiveness in plantar fasciitis (PF). The purpose of this study was to compare the effectiveness of ultrasound-guided dextrose prolotherapy with radial extracorporeal shock wave therapy (ESWT) in the treatment of chronic PF. This randomized controlled trial was conducted on 59 patients with chronic PF. Patients were randomly assigned into two groups receiving three sessions of radial ESWT (29 patients) vs. two sessions of ultrasound-guided intrafascial 2 cc dextrose 20% injection (30 patients). The following outcome measures were assessed before and then six weeks and 12 weeks after the treatments: pain intensity by visual analog scale (VAS), daily life and exercise activities by Foot and Ankle Ability Measure (FAAM), and the plantar fascia thickness by ultrasonographic imaging. The VAS and FAAM scales showed significant improvements of pain and function in both study groups 6 weeks and 12 weeks after the treatments. A significant reduction was noted for plantar fascia thickness at these intervals (all p < .05). The inter-group comparison revealed that except for the FAAM-sport subscale which favored ESWT, the interaction effects of group and time were not significant for other outcome measures. Dextrose prolotherapy has comparable efficacy to radial ESWT in reducing pain, daily-life functional limitation, and plantar fascia thickness in patients with PF. No serious adverse effects were observed in either group. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

A better understanding of soft tissue stress and its role in supporting the medial longitudinal arch in flexible flatfoot could help to guide the clinical treatment. In this study, a 3-Dimensional finite element (FE) foot model was reconstructed to measure the stress of the soft tissue, and its variation in different scenarios related to flexible flatfoot. All bones, cartilages, ligaments and related tendons around the ankle, and fat pad were included in the finite element model. The equivalent stress on the articular surface of the joints in the medial longitudinal arch and the maximum principal stress of the ligaments around the ankle were obtained. The results show that the plantar fascia (PF) is the main tissue in maintaining the medial longitudinal arch. The equivalent stress of all the joints in the medial longitudinal arch increases when the PF attenuation and the talonavicular joint increases, while other joints decreases when all the three tissue attenuation. Moreover, the maximum principal stress variation of calcaneofibular ligament is largest when the PF attenuation and the tibionavicular ligament and posterior tibiotalar ligament are largest when the posterior tibial tendon (PTT) attenuation. The maximum principal stress variation of tibionavicular ligament and posterior tibiotalar ligament are even larger when all the three tissue attenuation. These findings support that the PF is the main factor in maintaining the medial longitudinal arch. The medial longitudinal arch collapse mainly affects the talonavicular joint and the calcaneofibular ligament, the tibionavicular ligament and the posterior tibiotalar ligament. This approach could help to improve the understanding of adult-acquired flatfoot deformity (AAFD).

OBJECTIVE To compare the outcomes for patients with chronic plantar fasciitis after extracorporeal shockwave therapy (ESWT) or autologous blood injection (ABI). DESIGN Cohort study-retrospective analysis of prospectively collected data. SETTING Hospital-based Sports Medicine Outpatient Clinic. PATIENTS One hundred two consecutive patients with chronic plantar fasciitis, treated with either radial-ESWT (rESWT) (n = 54) or ABI (n = 48), with minimum 3-month follow-up and 96% (98/102) having 6-month follow-up. Mean age 49.5 years and mean duration of symptoms 37.5 months before treatment. INTERVENTIONS Patients received either 3 sessions of radial ESWT (one session per week for 3 weeks), or a single ultrasound-guided dry needling and ABI (3 mL whole autologous blood). All patients received standardized after-care, including progressive structured home exercise program of flexibility, strengthening, and proprioception exercises. MAIN OUTCOME MEASURES 0 to 10 numerical rating scale (NRS) for self-reported "average pain" and "average stiffness" values. Secondary outcome measures included assessments of local foot function [including Manchester-Oxford Foot Questionnaire (MOXFQ), revised-Foot Function Index] as well as markers of mental health functioning (HAD), global health (EQ-5D-5L), and physical activity (International Physical Activity Questionnaire). RESULTS This study demonstrated statistically significant improvements in self-reported measures of pain and local foot function after either procedure at 6 weeks, 3 months, and 6 months, but no statistically significant differences were seen between groups at any time-period studied. At 6 months, the average pain using a 0 to 10 NRS was improved from 6.8 ± 1.8 to 4.0 ± 2.7 (P < 0.001) after ESWT and from 7.1 ± 1.6 to 3.8 ± 2.7 (P < 0.001) after ABI. At 6 months, significant improvements were seen following either group using a number of different validated patient-rated outcome measures assessing local foot pain and function, eg, the total score for MOXFQ improved from 56.1 ± 12.8 to 42.5 ± 16.6 (P < 0.001) after ESWT and from 58.8 ± 13.2 to 44.2 ± 19.2 (P < 0.001) after ABI. However, measures of physical activity or wider aspects of patient functioning did not consistently improve from baseline values to follow-up periods. CONCLUSIONS Patients with chronic plantar fasciitis improved to statistically significant extent after either rESWT or ABI procedures, with no significant differences seen between groups. The lack of randomization in this pragmatic study is noted, which may have influenced the outcome seen. Potentially larger and more robust studies are required to investigate this treatment comparison further.

This case report concerns a 51-year-old woman with a 6-month history of severe right heel pain diagnosed as plantar fasciitis (PF) treated with intra-arterial infusion of imipenem/cilastatin (IPM/CS) through a 24G indwelling needle directly inserted into the posterior tibial artery (PTA). Angiography of the indwelling needle immediately before the infusion of IPM/CS demonstrated an increased number of abnormal vessels at the calcaneal attachment of the plantar fascia. Two procedures were planned: The first procedure was performed, and the second was performed 1 month after the first. A week after the first treatment, her pain gradually decreased. Three months after the first treatment, she no longer had difficulties with activities of daily living. Intra-arterial infusion of IPM/CS directly through an indwelling needle into the PTA represents a minimally invasive embolic treatment option for PF.

Background A prospective study was conducted to evaluate the results of endoscopic plantar fascia release (EPFR) and its safety in treating patients with chronic plantar fasciitis. Patients and methods Thirty patients who had chronic plantar fasciitis for more than 6 months participated in this study from March 2015 to June 2018. Seventeen patients were females, and thirteen were males with an average age of 46 years (ranged between 35 and 52 years). All patients had a failed history of conservative treatment. They were treated with endoscopic plantar fascia release. If a heel spur existed, it was resected by an arthroscopic burr. Pain and functional limitations were evaluated with the American Orthopedic Foot and Ankle Society Scale (AOFAS) and Roles and Maudsley score. Results At the end of follow-up, the mean AOFAS scoring changed significantly from 67 points before surgery to 93 points (P Conclusion Endoscopy offers the optimum solution for the resistant cases, but is not without complications. EPFR should be reserved only for severe cases after a trial period of conservative methods of treatment.

Background: Plantar fasciopathy is a common orthopaedic condition that affects athletes and limits their performance. Purpose: To conduct a scoping review of the literature to summarize the evidence provided so far for the management of plantar fasciopathy in elite athletes and identify potential gaps in the current knowledge. Study Design: Scoping review; Level of evidence, 5. Methods: This scoping review followed the 6-stage methodological framework of Arksey and O’Malley and was registered in the Open Science Framework. PubMed, Scopus, and Web of Science were used to identify eligible articles. After charting of data, studies were pooled into 3 categories: epidemiological/diagnostic studies, outcome research focused on plantar fasciitis or partial tears, and studies on the rupture of the plantar fascia. The modified Coleman Methodology Score was used to assess the quality of included articles. Results: Of 742 initial studies, 10 were selected (109 patients): 8 level 4 articles and 2 level 5 articles. In 4 studies (91 athletes), potential risk factors were discussed but not investigated (ie, preexistent thickening of the fascia, spike shoes, varus hindfoot/knee alignment). In 3 studies (6 athletes) focusing on plantar fasciitis, the nonsurgical treatment led to a satisfactory but poorly documented outcome. In 3 studies (12 athletes), the rupture of the fascia was treated nonoperatively with contrasting results, while surgery was performed only in 2 cases. The mean modified Coleman Methodology Score was 19 (range, 3-42), demonstrating overall poor methodology. Conclusion: The limited number of studies and their poor quality do not allow to define the gold standard treatment of plantar fasciopathy in elite athletes. Until high-quality studies are provided, clinicians have to rely on the available literature regarding the nonprofessional or nonathletic population to make the best evidence-based decision.

Plantar fasciitis is the most common cause of heel pain. It accounts for 80% of the cases and has an estimated prevalence rate of up to 7% in the general population, with bilateral involvement in 20% to 30% of those patients. This condition affects people of working age, thereby limiting and diminishing their quality of life. There are a wide range of treatment options for the management of plantar fasciitis that include both conservative and surgical treatments. Although surgical treatment based on partial or total plantar fascia release has success rates of some 70% to 90%, it is not free of complications. These complications, soft-tissue healing problems, superficial infection, or longitudinal arch collapse in cases of a greater than 40% release of the fascia. Bipolar radiofrequency appears to be a safe procedure for refractory plantar fasciitis that can provide outcomes equivalent to open plantar fascia release with less morbidity. The purpose of this article is to describe the local percutaneous radiofrequency technique for patients with chronic, recalcitrant plantar fasciitis., Technique Video Video 1 The patient is positioned supine with the ankle draped and hanging freely over the edge of the table. With the ankle in dorsiflexion, the painful heel area is tested and outlined with a sterile marker. The points where radiofrequency will be applied are also drawn inside the painful area, with a distance of 5 mm between them. The calcaneal branch of the posterior tibial nerve is blocked under local anesthesia with mepivacaine 1%, 2 cm distal to the tip of the medial malleolus (ultrasound guidance can be used). The radiofrequency skin entrance points are punctured with a 1- to 1.5-mm Kirschner wire. The TOPAZ microdebrider is connected to the console and attached to a sterile saline solution drip, set at a drip rate of 1 drop every 2 seconds (the console must be set in position 4). Two radiofrequency impulses are delivered sequentially through each previously created percutaneous microincision (ultrasound guidance can be used). Postoperatively, a soft ankle bandage is applied and weight bearing as tolerated is allowed 2 days after the procedure.

Introduction: Previous studies showed that rocker shoes with a stiff forefoot rocker profile significantly reduce peak plantar flexion moment at the ankle (PFM) and peak ankle dorsiflexion (DF). Both parameters are related to Achilles tendon and Plantar Fascia unloading. The shape of an outsole with a forefoot rocker is described with multiple rocker design parameters. The aim of this research is, to determine the relation between different forefoot rocker radii on peak DF and peak PFM at a self-selected walking speed.Methods: 10 participants walked in standard shoes and three experimental pairs of shoes with different forefoot rocker radii. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with Statistical Parametric Mapping (SPM) (? = .05; post-hoc ? = .05/ 6).Results: Peak value analyses showed significant decreases in peak DF, peak PFM, and peak ankle power generation for the rocker conditions. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle joint. SPM showed a significant decrease (% gait cycle) in DF (40?69 %), PFM (7?15 %; 41?68 %; 69?81 %), ankle power (10?15 %; 32?51 %; 55?64 %; 64?67 %; 72?80 %) and foot-to-horizontal angle (FHA) (0?4 %; 40?62 %; 92?100 %) and an increased shank-to-vertical angle (SVA) (44?84 %) for the rocker conditions.Conclusion: The results of this study suggest that rocker shoes with a proximally placed apex significantly reduce DF and PFM during the third rocker compared with control shoes. This effect is mainly explained by a change in the FHA. Smaller radii cause the largest reductions in DF and PFM, so therefore, a uniform standardisation of the forefoot rocker radius is essential.

Loads on the plantar fascia could be influenced by running speed and relate to its pathology. This study calculated and compared plantar fascia strains under different running speed conditions using a dynamic finite element foot model and computational simulations. The model was previously validated featuring twenty bones, bulk soft tissue, muscles/ligaments, and a solid part of plantar fascia. A runner performed running trials under one preferred speed (PS), two lower (PS - 10% and PS - 20%) and two higher (PS + 10% and PS + 20%) speed conditions. The movement data were processed to drive musculoskeletal modelling and calculated boundary/loading conditions for the subsequent finite element analyses. The results show that peak strains of the plantar fascia increased with increasing running speed. From PS – 20% to PS + 20%, peak strain in the proximal and distal fascia regions increased by 96.78% and 58.89% respectively. Running speed could directly affect plantar fascia loading, which should be considered in running regimens and rehabilitation programmes. However, prescribing speed control for runners is worth pondering as it influences the trade-off between maximum single-step loads and loading frequency, which in coalescence determine the risk of plantar fascia injury and warranted further investigations.

Human steady-state locomotion modes are symmetrical, leading to symmetric mechanical function of human feet in general; however, track distance running in a counterclockwise direction exposes the runner’s feet to asymmetrical stress. This may induce asymmetrical adaptation in the runners’ foot arch functions, but this has not been experimentally tested. Here, we show that the plantar fascia (PF), a primary structure of the foot arch elasticity, is stiffer for the left than the right foot as a characteristic of runners, via a cross-sectional study on 10 track distance runners and 10 untrained individuals. Shear wave velocity (index of tissue stiffness: SWV) and thickness of PF and foot dimensions were compared between sides and groups. Runners showed higher PF SWV in their left (9.4 ± 1.0 m/s) than right (8.9 ± 0.9 m/s) feet, whereas untrained individuals showed no bilateral differences (8.5 ± 1.5 m/s and 8.6 ± 1.7 m/s, respectively). Additionally, runners showed higher left to right (L/R) ratio of PF SWV than untrained men (105.1% and 97.7%, respectively). PF thickness and foot dimensions were not significantly different between sides or groups. These results demonstrate stiffer PF in the left feet of runners, which may reflect adaptation to their running-specific training that involves asymmetrical mechanical loading.

BackgroundThis study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis.MethodsWe performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia.The series included 62 males (57.9%) and 45 females (42.1%) treated between April 2014 and February 2018, with a mean follow-up of 21.05 ± 10.96 months (7–66) and a minimum follow-up of 24 months. The mean age was 48.10 ± 10.27 years (27–72).Clinical assessments and ultrasound examination were carried out before treatment, after 1 week, and then after 1, 3, 12, and 24 months. The clinical assessment was based on a visual analog scale and the Foot and Ankle Disability Index.ResultsHeel pain improved in 92.5% (99) of patients, but not in 7.4% (8 patients). In the group of patients whose heel pain improved, 9 experienced overload on the lateral column and dorsum of the foot, which improved with the use of plantar orthoses and a rehabilitation program. We recorded no nerve complications (e.g., paresthesia), vascular injuries, or wound-related problems.ConclusionUltrasound-guided partial plantar fasciotomy with a needle is safe, since structures are under direct visualization of the surgeon and the risk of damage is minimal. Stitches are not necessary, and recovery is fast. Consequently, costs are low, and the patient can return to work quickly. This technique may represent a valid option for treatment of plantar fasciitis.

Background: Plantar fasciopathy is the most common cause of plantar heel pain. No enough evidence in literature strongly supports the effectiveness of any specific treatment for such conditions. Objective: To assess the efficacy and safety of a modified surgical technique for endoscopic release of plantar fascia. Patients and methods: A total of 29 feet in 25 patients with plantar fasciopathy for at least one year and resistant for at least two modalities of conservative treatment for six months were involved in this prospective study. All patients had been diagnosed clinically and the study was carried at the Department of Orthopedics, AL-Hussein University Hospital, Faculty of Medicine, Al-Azhar University in the period between December 2019 and September 2020. Results: The mean AOFAS preoperative score had improved from 51.36 to 89.44 after six months follow-up. While The VAS score dropped from 85 preoperative to 12.6. Eighty four (84%) of patients had satisfactory outcomes according to Roles and Madsuley criteria. No major complications were recorded. Conclusion: Endoscopic plantar fascia release could be a viable alternative for management of chronic resistant plantar fasciopathy.

Plantar fasciitis (PF) is characterized by plantar medial heel pain, usually present in the morning at the first few steps. Obese individuals, who stand for prolonged periods and who walk on hard surfaces, typically suffer from PF, the most common cause of plantar heel pain in adults. The diagnosis can be achieved through patient clinical history and clinical findings. Stretching exercises, activity modification, and use of several analgesics resolve symptoms in over 80% of patients, while biomechanical factors can be corrected by insoles or various kinds of orthotics or night splints. In the outnumbered group of patients who develop intractable PF, other available strategies are extracorporeal shock wave therapy and corticosteroid injections. Surgical management of PF consists of plantar fascia release, but efficacy is still debated. In recent years, biological treatments have been getting popularity in many orthopedic conditions. How to cite this article: Tarulli FR, Aletto C, Maffulli N. Plantar Fasciitis: Orthobiologics. J Foot Ankle Surg (Asia Pacific) 2021;8(1):24–27.

Introduction Rupture of the plantar fascia is a rare condition. It can also occur spontaneously and with no history of disease of the plantar fascia, above all in athletes. This review aims to systematically analyze all cases described in the literature regarding the rupture of the plantar fascia, evaluating incidence, risk factors, and treatments, considering which procedures show the best outcomes and the highest success rate. Materials and methods A systematic review of PubMed, Google Scholar, and Cochrane review computerized databases was performed, focusing on articles about cases of rupture of the plantar fascia; 18 studies fulfilled all the criteria and were analyzed. There were no randomized controlled trials. Results A total of 155 patients (157 foot) were included in this systematic review. Considering all the studies included, 12 patients had a spontaneous rupture, 138 patients had a diagnosis of plantar fasciitis, and 130 patients were treated with local injections of corticosteroid before the rupture. Only 2 cases of bilateral rupture were reported. In all, 15 studies reported conservative treatment, with a total of 154 patients (156 feet) included. Operative treatment was reported in 3 studies, with 3 patients (3 feet) treated. Conclusions Ruptures of the plantar fascia are very rare in asymptomatic patients and more common in patients treated with injection of steroids in the plantar fascia. Conservative treatment, although not standardized in the literature, led to good outcomes in most cases. Chronic ruptures of the fascia should be considered for operative treatment. Levels of Evidence: Level III

Objective: The primary aim of the present study was to compare the echo intensity (EI) and echovariation (EV) of the intrinsic foot muscles (IFMs) between individuals with and without plantar fasciitis (PF), using ultrasound imaging. The secondary objective was to study the intra-rater reliability of the echotexture variables. Methods: A case–control study was conducted with 64 participants, who were divided into the following two groups: A, the PF group (n = 32); B, the healthy group (n = 32). Results: The comparison between the two groups did not identify significant differences (p > 0.05) between the flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), quadratus plantae (QP) and abductor hallucis brevis (AHB) variables for the EI and EV. Moreover, excellent intra-rater reliability was reported for the following ultrasound imaging EI variables: ABH (ICC = 0.951), FHB (ICC = 0.949), FDB (ICC = 0.981) and QP (ICC = 0.984). Conclusions: The muscle quality assessment using the EI and EV variables did not identify differences in the FHB, FDB, AHB and QP muscles between individuals with and without PF through USI evaluation. The reliability of all the IFM measurements was reported to be excellent.

Plantar fasciitis adalah suatu kondisi peradangan pada plantar fascia yang disebabkan oleh penguluran yang berlebihan yang dapat mengakibatkan robekan dan iritasi pada plantar fascia. Pasien dengan plantar fasciitis mengeluhkan rasa nyeri yang tajam di bagian belakang tumit dan arcus kaki. Apabila dibiarkan akan menyebabkan gangguan musculoskeletal lebih lanjut. Penelitian ini bertujuan untuk mengetahui penatalaksanaan myofascial release technique dan muscle energy technique pada penderita gangguan nyeri akibat plantar fasciitis bilateral. Metode yang digunakan adalah metode studi kasus dengan 1 orang responden menggunakan alat ukur Visual Analog Scale (VAS) untuk mengukur nyeri. Hasil dari penelitian yang dilakukan di Kelurahan Sungai Lulut, Kota Banjarmasin ialah myofascial release technique dan muscle energy technique selama 12 kali terapi dalam 4 minggu dapat mengurangi nyeri pasien plantar fasciitis.

Objective: The purpose of the present study was to evaluate the thickness of the plantar fascia (PF) at the insertion of the calcaneus and the midfoot and forefoot fascial locations, in addition to the thickness of the tibialis anterior, by ultrasound imaging in individuals with and without lateral ankle sprain (LAS). Methods: A sample of 44 participants was recruited and divided in 2 groups: 22 feet with a prior diagnosis of grade 1 or 2 LAS (case group) and 22 feet without this condition (healthy group). The thickness and cross-sectional area were evaluated by ultrasound imaging in both groups. Results: Ultrasound measurements of the PF at the calcaneus, midfoot, and forefoot showed statistically significant differences (P < .05), with a decrease in thickness in the LAS group relative to the healthy group. For the thickness and cross-sectional area of the tibialis anterior, no significant differences (P < .05) were observed between groups. Conclusion: The thickness of the PF at the calcaneus, midfoot, and forefoot is reduced in individuals with LAS relative to the healthy group. Sin financiación 1.437 JCR (2020) Q3, 21/28 Integrative & Complementary Medicine 0.448 SJR (2020) Q2, 3/9 Chiropractics No data IDR 2020 UEM

Background Plantar fasciitis (PF) is the most common cause of heel pain. A calf stretching (CS) and a plantar fascia-specific stretching (PFSS) are two stretching techniques commonly administered by health care providers. Objective To evaluate the literature on the application of these two stretching techniques in the treatment of PF and investigate their effectiveness and efficacy. Method A search of PubMed, Web of Sciences, PEDro, CINHAL and Scopus was conducted. Studies that applied stretching as a co-intervention were excluded. The risk of bias was assessed to determine the internal validity of the included trials. The GRADE approach was adopted to determine the overall quality. Pooled analysis was performed to determine the treatment effects of CS and PFSS in terms of the mean difference in the visual analog scale pain score. Results Eight articles were found that represented randomized controlled trial and met the inclusion criteria. There was very low-quality evidence that the combined CS and PFSS was less effective in the short term than the other therapies. Comparison between CS and PFSS revealed moderate quality evidence for a larger effect of pain score reduction for PFSS treatment over CS, while very low-quality evidence supported that combined CS and PFSS or CS alone was superior to sham stretching. Conclusion There was moderate to very low-quality evidence of the effectiveness of stretching for PF. The treatment effect of stretching was large and comparable to other therapies. Future trials of higher quality are needed to clarify findings or to confirm findings.

Aim of the work: To assess the clinical, radiographic and sonographic presentation of plantar fascia in axial spondyloarthritis (ax-SpA) and to identify the radiographic and ultrasonographic signs most associated with clinical disease parameters. Patients and methods: The study included 74 patients with ax-SpA. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Functional Index (BASFI) and Ankylosing Spondylitis Quality of Life (ASQoL) were assessed. Clinical assessment of plantar fascia included the plantar fascia palpation pain severity on a visual analogic scale (VAS); and the enthesitis-specific scores: The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and the Spondyloarthritis Research Consortium of Canada (SPARCC) score. All patients were explored by lateral heel radiographs and musculoskeletal ultrasound (US) at plantar fascia insertions. Results: The mean age was 36 ± 11.4 years. Plantar fascia enthesis was painful in 17% of cases. Standard radiographs showed plantar fascia involvement in 37% and US in 71% of patients. The clinical involvement of plantar fascia correlated with BASDAI (p = 0.02), as well as BASFI (p = 0.03) and ASQoL (p

Background This study aimed to compare the efficacy and safety of polydeoxyribonucleotide (PDRN) injection and corticosteroid injection for plantar fasciitis. Methods This study included 44 patients with plantar fasciitis, randomly allocated to the PDRN and corticosteroid groups. Evaluation using the visual analogue scale (VAS) pain score and Manchester-Oxford foot questionnaire (MOXFQ) was conducted at baseline, 1, 2, 6 weeks and 6 months. The thickness and echogenicity of the plantar fascia in ultrasonography and complications were recorded. Results Corticosteroid injection elicited more pain relief than did PDRN injection at 2 (p = 0.010) and 6 weeks (p = 0.016); however, it showed no superiority at 6 months (p = 0.523). MOXFQ showed similar outcomes. The thickness and echogenicity did not differ between groups and no complications were reported in either group. Conclusions We demonstrated that PDRN injection could be an effective and safe option for plantar fasciitis and was comparable to corticosteroid injection after 6 months follow up. Level of evidence II, comparative study.

Level of Evidence: Level V, expert opinion.

Background: Heel pain is a highly prevalent problem in most developing and under-developing countries. There are many studies done that show beneficial effects by different manual and physical modalities and therapies yet there is more of research to be done on new modalities and therapies that are drug-free rapid in its effect. Objectives: The purpose of this study was to evaluate and compare the effect of matrix rhythm therapy with strengthening exercises v/s interferential current therapy (ICT) with laser therapy and strengthening exercise. Methods: 30 participants with the age group 30 to 50 years old, experienced heel pain at least of one-month duration were randomly assigned to receive matrix rhythm therapy v/s ICT and LASER therapy. Strengthening exercises for plantar fascia were the same for both the groups. Intervention for both the groups was given alternatively for 15 sessions at the center by a certified therapist. Visual Analogue Scale (VAS) for the early morning first step pain and stiffness and Planter Fasciitis Pain/Disability Scale and revised Foot Function Index (FFI). Results: The pain subscale scores of the FFI showed significantly better results for the patients managed with the matrix rhythm therapy. Analysis of the response rates to the outcome measures also revealed significant differences with respect to pain, activity limitations, and patient satisfaction, with greater improvement seen in the group managed with the matrix rhythm therapy strengthening exercise. Conclusion: In the present study both the therapies showed the beneficial effects. However, matrix rhythm therapy was more significant than IFT and Laser therapy.

Background and Objective: This study compares passive stretching, corticosteroid injection and therapeutic ultrasound in plantar fasciitis. Materials and Methods: A total of 75 patients (age range, 18-60 years; 38 females) with PF were randomly assigned to receive either passive stretching (n = 25) or corticosteroid injection (n = 25) or therapeutic ultrasound (n=25). Passive stretching included both plantar fascia specific stretching exercise and Achilles tendon stretching exercise each applied in 10 sets of 10-second stretch and a 10-second rest 3 times a day for 6 months and supervised two times per week for 4 weeks to ensure that patients were doing the passive stretching exercise properly as they were advised. The corticosteroid injection group received a single palpation guided mixture of 40 mg of methylprednisolone and 2 ml of 2% lignocaine injection at baseline. Therapeutic ultrasound group received continuous mode, base frequency of 1MHz, power 2 w/cm2, applied during three minutes each on calcaneus medial tuberosity and on the 2 cm distal to tuberosity three times a week, for four weeks duration (total 12 sessions). Also the patients in all the 3 groups were advised to use silicon heel pads as a common modality of treatment. The patients’ functional outcome was assessed using the Foot and Ankle Ability Measure (FAAM), and relief of pain was evaluated using the Visual Analog Scale (VAS). Outcomes of interest were recorded before the treatment and at 1 month, 3 month & 6 month follow-ups. Results: Age, sex and body mass index did not significantly impact pain relief or functional outcome (P > 0.05). Out of 75 planned subjects only 68 patients could be followed up. Planned pair-wise comparisons demonstrated significant improvements in pain relief and functional outcomes in terms of both VAS (P passive stretching >therapeutic ultrasound. But for the long term improvements (6 months), passive stretching was more effective than corticosteroid injection and therapeutic ultrasound was not effective. Hence passive stretching exercise is recommended as a primary line of treatment as it is a non-invasive modality, avoids complications associated with steroid injection and has long lasting effects.

Running is one of the most popular sports worldwide, with many health benefits. Injuries are also common, with running-related injuries reported in up to 79% of runners annually. Extracorporeal shockwave treatment can be used to treat soft tissue conditions, with the strongest level of evidence for management of plantar fasciitis. However, most studies have focused on nonathletes or studied a single condition, and few investigations have reported outcomes for extracorporeal pulse-activated therapy. In this case series, we evaluated the outcomes of 94 runners receiving extracorporeal pulse-activated therapy for lower-extremity running-related injuries, including plantar fasciitis and lower-extremity tendinopathy (Achilles, posterior tibialis, patellar, hamstring). We hypothesized that most runners with foot and ankle injuries would respond favorably to treatment and that success rates would be similar across conditions. Overall, 74 runners (79%) met their respective minimal clinically important difference for functional outcome measures, with no differences in response by age, sex, body mass index, or chronicity of condition. Further, no differences were noted in proportion achieving the minimal clinically important difference between foot and ankle (Achilles, posterior tibialis, and plantar fascia) compared with proximal injuries (53 [84.3%] versus 31 [72%], p = .15). A mean of 4 treatments resulted in achieving the minimal clinically important difference, with 95% achieving it by 5 treatments. No differences in bars of pressure, frequency, or other aspects of treatments were observed to predict response. Our findings suggest that a majority of runners with lower-extremity injuries respond favorably to extracorporeal pulse-activated therapy, including those with foot and ankle injuries.

Background In recent decades, nonoperative Ponseti casting has become the standard of care in the treatment of idiopathic clubfoot. However, the rate of recurrence, even after successful Ponseti treatment is not insignificant. The purpose of this study was to determine the future rate, timing, and type of surgery needed in patients whose idiopathic clubfeet treated by Ponseti casting were considered successful at the age of 2 years. Methods Inclusion criteria for this retrospective study were patients under 3 months with idiopathic clubfoot treated exclusively by Ponseti casting, who had successful outcomes at 2 years of age without surgery, and who had at least 5 years of follow-up. The total number of surgical interventions in the age range 2 to 5 and above 5 years, the number and type of procedures performed, and the timing of surgery were reviewed. Results Three hundred thirty-six patients with a total of 504 clubfeet fulfilled the inclusion criteria. One hundred twenty-two of these 336 patients (36.3%) eventually underwent surgical intervention. Between 2 and 5 years of age, 79 patients (23.5%) with 104 feet (20.6%) underwent surgery. The most common procedures performed between 2 and 5 years were limited (a la carte) in scope: tibialis anterior tendon transfer, posterior release, plantar fascia release, and repeat tendo-Achilles lengthening. At age above 5 years, 53 patients (20.1%) with 65 feet (16.9%) underwent surgery. Ten of these 53 patients had already undergone surgery between 2 and 5 years of age. The procedures most commonly performed were similar. Conclusions In patients with idiopathic clubfoot who reached 2 years of age with successful outcomes from Ponseti cast treatment, ∼35% eventually underwent surgical intervention, mostly limited (a la carte), to regain or maintain a plantigrade foot. The most commonly performed procedures include tibialis anterior tendon transfer, posterior capsular release, plantar fascia release and repeat tendo-Achilles lengthening, either in isolation or in combination. However, before considering surgery, the need for these procedures can, and should, be minimized by recasting recurrent deformities using Ponseti method. Level of evidence Level III.

Background The aim of the present systematic literature review is to give an overview of ruptures of the plantar fascia. For this purpose, a detailed description of the patient collective is provided. However, the focus of this analysis is based on the current therapy concepts. Based on the results the authors propose a standardized therapy concept. Material and Methods A systematic literature review was performed using the PubMed database using the terms: ("rupture plantar fascia" OR "plantar fascia tear" OR "rupture plantar aponeurosis"). All articles published in the PubMed database until 07.11.2018 were included. The articles were evaluated with regard to three research question: (1) Which patients are affected by a rupture of the plantar fascia? (2) Which therapy concept was used to treat rupture of the plantar fascia? And (3) which result was achieved and how was this measured? Results A total of 78 studies were identified, of which the full text of 17 were analysed. 12 publications were cases reports, 5 studies were retrospective analyses. Data from 124 patients could be included. The average age of patients was 39.6 years. In 63.2% (n = 12) of the studies, patients with a high level of athletic activity or even professional athletes were analyzed. 94.4% of all patients were treated conservatively. The average duration of immobilization in a rigid walker was 2.6 weeks. In the majority of cases, pain-adapted weight-bearing was allowed in the rigid walker. Conclusion There are few available studies concerning the rupture of plantar fascia. The quality of data is poor. The maximum duration of immobilization of 3 weeks in a rigid walker with pain-adapted weight-bearing appears to be the most applied therapy concept. Further studies are needed to evaluate the efficacy of the therapy and to optimize the therapy concept.

Objetive. The objective of this randomized clinical trial is to check the acute effects of manual pressure and traction technique on balance and plantar footprint variables. Design A Single-blind clinical study with two groups. Setting Private practice Participants Forty healthy participants (28 females and 12 males) were recruited to carry out a single-blind study. Interventions. Experimental group performed a bilateral plantar fascia manual pressure and traction technique. Control group performed a tactile stimulation. The position of the participant, the therapist and the time of application of the techniques (5 minutes) were the same for both interventions. Main Outcome Measures. We measured stabilometry variables and static footprint. The footprint variables were divided in rear, middle and front foot areas. Results Significant differences were found in stabilometry variables. There was an improvement in experimental group at X displacement with eyes open (p=0.014) and surface eyes closed (p=0.046) variables. Conclusions After technique the experimental group improved the stabilometry variables, specifically, surface with eyes closed and X displacement with eyes open. The static footprint variables have not shown differences after the technique compared to the control group. Sin financiación 3.966 JCR (2020) Q1, 5/68 Rehabilitation 1.305 SJR (2020) Q1, 20/210 Physical Therapy, Sports Therapy and Rehabilitation No data IDR 2020 UEM

Long‐distance running (LDR) can induce transient lowering of the foot arch, which may be associated with mechanical fatigue of the plantar fascia (PF). However, this has not been experimentally tested in vivo. The purpose of this study was to test our hypothesis that LDR induces transient and site‐specific changes in PF stiffness and morphology and that those changes are related to the lowering of the foot arch. Ten male recreational long‐distance runners and 10 untrained men were requested to run overground for 10 km. Before and after running, shear wave velocity (SWV: an index of soft tissue stiffness) and thickness of PF at three different sites from its proximal to distal end were measured using supersonic shear imaging and B‐mode ultrasonography. Foot dimensions including the navicular height were measured using a three‐dimensional foot scanner. SWV at the proximal site of PF and navicular height was significantly decreased in both groups after running, with a higher degree in untrained men (−21.9% and −14.1%, respectively) than in runners (−4.0% and −6.3%, respectively). The relative change (%Δ) in SWV was positively correlated with %Δnavicular height in both groups (r = .69 and r = .65, respectively). Multiple regression analysis revealed that %ΔSWV at the proximal site solely explained 72.7% of the total variance in %Δnavicular height. It is concluded that LDR induces transient and site‐specific decreases in PF stiffness. These results suggest that the majority of running‐induced lowering of the foot arch is attributable to the reduction of PF stiffness at the proximal site.

PURPOSE: The aim of this study is to compare elasticity features between patients with plantar fasciitis (PFis) and an asymptomatic healthy control group using shear wave elastography (SWE) and to correlate SWE values with clinical scores. METHODS: Consecutive patients diagnosed with PFis and asymptomatic subjects were enrolled in the present study. Both groups underwent clinical, ultrasound (US), and SWE evaluation. A plantar fascia thickness > 4 mm was considered pathognomonic of PFis. SWE stiffness elasticity (Young’s modulus in kPa and shear wave velocity in m/s) was measured 1 cm distally from the calcaneal insertion. Correlations with VAS and the 17-Italian Foot Function Index (17-FFI) were determined. RESULTS: A total of 19 patients satisfied the inclusion criteria for the patient group and were enrolled in the study, and 21 healthy subjects were used as a control group. Statistically significant differences were found for shear wave velocity between the patient and the control group, with SWE findings of 3.8 (5.1; 1.5) m/s and 4.7 (4.07; 7.04) m/s, respectively (p = 0.006). Strong positive correlations were found between the SWE findings and both the pain and the functional scale (VAS: p = 0.001; FFI: p = 0.012). CONCLUSION: SWE allows quantitative assessment of the stiffness of the plantar fascia and can show PFis alterations, increasing the diagnostic performance of B-mode US. In addition, SWE shows a strong correlation with clinical scores, improving patient assessment and follow-up.

Objectives The prevalence of myofascial pain syndrome varies from 21% 93%. Several studies have shown that myofascial induction is effective in treating myofascial pain syndrome. Although these techniques have shown some effectiveness in clinical practice, there have been little study into their effects, and have deep effects. The purpose of this study was to investigate if the application of a single myofascial induction technique for each foot, targeted to the plantar fascia resulted in changes in balance and footprint variables. Design A quasi-experimental study. Setting An outpatient clinic. Subjects 20 healthy participants (12 females and 8 males) were evaluated pre and post Myofascial induction technique for each foot in plantar fascia during 5 min. Methods We measured static footprint and stabilometry variables in asymptomatic subjects. The footprint surface area was divided: bilateral rear foot, bilateral midfoot, bilateral fore foot. Results We found differences in the footprint variables: maximun pressure in forefoot (p = 0.025), surface in forefoot (p = 0.03). The myofascial induction has no effects on stabilometry variables. Conclusions The immediate effects of the longitudinal technique of myofascial induction of the plantar fascia are the increase of surface and maximum pressure in fore foot.

Objectives This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique. Patients and methods Twenty-six feet of 22 patients (4 males, 18 females; mean age 46.2±18 years; range, 16 to 70 years) who were diagnosed as hallux valgus between March 2013 and April 2016 and who underwent distal oblique metatarsal osteotomy were included in this retrospective study. American Orthopedic Foot and Ankle Society/Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS/HMIS) was used for clinical and functional evaluation. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, first metatarsal length and forefoot bone and soft tissue width were measured for radiological evaluation. Results The mean follow-up time was 33.1±9.8 months. The AOFAS/HMIS score increased significantly postoperatively (p=0.001). In the footwear section of the AOFAS/HMIS, the median preoperative score of 5 (range, 0-5) increased to 10 (range, 5-10) at the postoperative period (p=0.001). Hallux valgus angle, IMA, DMAA, and first metatarsal length significantly decreased when compared to preoperative measurements. Forefoot bone width also decreased significantly from 9.3 cm (range, 7.5-11.5 cm) to 8.8 cm (6.8-10.3 cm) (p=0.001). Conclusion Distal oblique metatarsal osteotomy is a safe method for hallux valgus deformity. Forefoot width reduction, decrease of soft tissue tension, sesamoid reduction, and plantar fascia relaxation are the crucial benefits of this method.

Background/and purpose Musculoskeletal ultrasound imaging (MSK US) is an emerging diagnostic tool in physical therapy, which allows for dynamic visualization of tissues in real time. Plantar fasciitis is a common condition causing heel and arch pain and has been related with degenerative changes in the plantar fascia resulting in tissue thickening. Instrument Assisted Soft Tissue Mobilization (IASTM) is an intervention that allows clinicians deep penetration to treat tissues. The mechanical forces caused by IASTM might cause localized tissue trauma leading to stimulation of the body's natural inflammation and healing processes. The purpose of this case report is to demonstrate the use of ultrasound imaging to guide the decision-making process and to discern the optimal location for the application of IASTM. Case description The subject was a 46-year-old female yoga practitioner and runner, who presented with right foot pain. The clinical impression was formulated based on the combination of traditional physical therapy examination procedures and MSK US imaging findings of the plantar fascia demonstrating thickness and tendinosis like changes within the plantar fascia 3 cm distally from the calcaneus. Outcomes The subject was seen for eight treatment sessions over four weeks, at which time the goals of normal ankle dorsiflexion, no pain with palpation of the plantar fascia, negative windlass test, and no reported pain during gait were achieved. Discussion This case report illustrates the use of MSK US imaging as a method to objectively assess tissue quality and guide decision-making when managing patients with plantar fascia related pain. MSK US was used to determine the optimal location for the application of IASTM during the conservative management of a runner with plantar fasciitis. Level of evidence Therapy, Level 5.