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Objective Ultrasound-guided tibial nerve pulsed radiofrequency (US-guided TN PRF) and fluoroscopy-guided intralesional radiofrequency thermocoagulation (FL-guided intralesional RFT) adjacent to the painful calcaneal spur are two interventions for pain management in painful calcaneal spur and plantar fasciitis. This study aimed to compare the effectiveness of the two procedures. Design A prospective, randomized, single-blind study. Setting Single-center pain clinic. Subjects Forty-nine patients who met the inclusion criteria were randomized into two groups. Methods Group U (25 patients) received US-guided TN PRF at 42°C for 240 s, whereas Group F (24 patients) received FL-guided intralesional RFT at 80°C for 90 s. The most severe numeric rating scale (NRS) score during the first morning steps and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used to evaluate the effectiveness of the procedures. The study's primary outcome assessed treatment effectiveness via the NRS, whereas the secondary outcomes included changes in the AOFAS score and the incidence of procedure-related mild adverse events. Results NRS and AOFAS scores significantly improved in Groups U and F at 1 and 3 months compared with baseline (P  < .05), and there was no significant difference between the groups. At month 1, 50% or greater pain relief was achieved in 72% of patients in Group U and 75% of patients in Group F. No significant difference was observed in the incidence of mild adverse events between the groups. Conclusions US-guided TN PRF and FL-guided intralesional RFT have shown significant effectiveness in the treatment of painful calcaneal spur and plantar fasciitis. Larger randomized controlled trials are needed. Clinical Trial Number NCT06240507. [ABSTRACT FROM AUTHOR]

Knochen ist elastisch und verformbar. Kehrt aber ein Knochen nach Trauma, chronischem Zug, Druck oder Torsion nicht in die alte Position zurück, verbleiben Schmerzen im Knochen und in den beteiligten, nicht dehnbaren Faszien, Sehnen, Kapsel- und Bandstrukturen. Nachdem mit dem Strain-Relief-Konzept im vorigen Heft die theoretischen Grundlagen eines neuen manuellen Verfahrens zur Behandlung chronischer Schmerzen im Bewegungsapparat vorgestellt wurden [4] , widmet sich dieser Beitrag der praktischen Anwendung. Am Beispiel der unteren Extremität wird gezeigt, wie man manuell das ossäre Gewebe vom Strain befreien kann und damit erfolgreich Schmerzen mindert oder sogar beseitigt. Bone is elastic and deformable. However, if a bone does not return to its former position after trauma, chronic traction, pressure or torsion, pain will remain in the bone and in the non-stretchable fascia, tendons, capsule and ligament structures involved. Following the introduction of the theoretical basis of a new manual method for the treatment of chronic pain in the musculoskeletal system in the previous issue with the strain relief concept [4] , this article is dedicated to the practical application. Using the lower extremity as an example, it demonstrates how the osseous tissue can manually be freed from the strain, thus successfully reducing or even eliminating pain. [ABSTRACT FROM AUTHOR]

Objectives: Identify the effectiveness of neurokinetic therapy on pain and plantar fascia thickness in patients with plantar fasciitis. Method: An experimental study was performed on 80 patients with plantar fasciitis after screening based on selection criteria. The patients were randomly allocated into two groups: the neurokinetic therapy group (n = 40) and the foot core exercises group (n = 40). In both groups, the treatments were given for two weeks, five days each week. The pre-and post-test results were assessed. A statistical analysis was performed on the gathered data. Result: A significant statistical difference was observed between the groups; the post-test mean value of the Foot Function Index scale in the neurokinetic therapy group was 129.12, while in the foot core exercises group was 141.42. Additionally, the post-test mean value of the therapeutic ultrasound in the neurokinetic therapy group was 3, whereas in the foot core exercises group was 3.38. These values yielded a p-value of less than 0.001. Conclusion: This study demonstrated an improvement in both groups. However, the neurokinetic therapy group showed a significant improvement in pain, functionality, and plantar fascia thickness compared to the foot core exercises group. Level of evidence IV; Experimental study.

Führt eine Dauerbelastung und -beanspruchung oder ein Trauma zur Überschreitung der Elastizitätsgrenze des Knochens, kann es zu einer leichten plastisch-elastischen Verformung der ossären Strukturen kommen. Kehrt der Knochen nicht in seine ursprüngliche neutrale Form zurück, entsteht bzw. verbleibt eine chronische Spannung in der trabekulären Matrix. Das wiederum führt zu einem dauerhaften Zug/Druck auf die beteiligten, nachweislich nicht dehnbaren Faszien-, Kapsel-, Band- und Sehnenstrukturen mit einer zwangsläufigen Aktivierung der darin verwobenen Schmerzrezeptoren. Chronische, mitunter therapieresistente Beschwerden im Knochen selbst und in den mit ihm verankerten Strukturen sind die Folge. In diesem Artikel wird mit dem (Knochen-)Strain Relief ein neues konservatives Behandlungskonzept vorgestellt, mit dessen Hilfe manuell pathologische, nicht sichtbare Knochen„verformungen" in die anatomische Ausgangslage zurückgebogen/-gedreht/-gedrückt werden können, um die permanenten Spannungen, Scherungen oder Zug auf Faszien und Sehnen zu minimieren und damit chronische Schmerzen sehr erfolgreich zu mindern oder sogar zu beseitigen. If a permanent load and stress exceeds the elastic limit of the bone, a slight plastic-elastic deformation of the osseous structures may occur. If the bone does not return to its original neutral shape a chronic tension in the trabecular matrix develops or remains. This in turn leads to permanent traction/pressure on the involved fascia, capsule, ligament and tendon structures, which have been shown to be non-extensible, with inevitable activation of the pain receptors interwoven within them. Chronic, sometimes therapy-resistant complaints in the bone area are the result. This article introduces (Bone) Strain Relief, a new conservative treatment concept that can be used to manually bend/rotate/push pathological, invisible bone "deformities" back into their original anatomical position in order to minimize the permanent tension/shear/pull on fascia and tendons and thus very successfully reduce or even eliminate chronic pain. [ABSTRACT FROM AUTHOR]

Aim: to evaluate the effect of using a medical vibration platform on the severity of pain, quality of life, functional and anatomical characteristics of the foot and ankle in patients with plantar fasciitis.Materials and methods: the study involved 91 patients with plantar fasciitis, among them 73 (80.2 %) women, 18 (19.8 %) men. The patients were divided into two groups: the main group consisted of 43 patients, the control group — 48 patients. In the main group, standard treatment was performed, including shock wave therapy, kinesio taping, standard exercises in the first week and exercises on a medical vibration platform in the second and third weeks, in the control group, exercises in the second and third weeks were performed with the patient standing on the floor. To assess the dynamics of treatment, a questionnaire was conducted using the VAS, the AOFAS scale, and the SF-36 questionnaire. Instrumental methods of examination included the evaluation of Friedland’s podological index, Y-balance test. All parameters were assessed before treatment, after treatment, and 3 months after treatment.Results: the use of exercise therapy on a medical vibration platform in the complex treatment of patients with plantar fasciitis, compared with exercise therapy on the floor, made it possible to statistically significantly reduce the level of pain after treatment (p < 0.05), increase the stability of the feet and ankle joint (p < 0.05 ), and in the long-term period allowed to significantly reduce the level of pain (p

Aim: to study the clinical and radiological parameters of patients with plantar fasciitis.Materials and methods: the study involved 91 patients with plantar fasciitis, 73 (80.2%) women, 18 (19.8%) men. The mean age of the patients was 53.42 ± 9.16 years, disease duration was 30.32 ± 8.06 days, BMI was 24.75 ± 4.55 kg/m2. Patients underwent history taking, pain level and quality of life were assessed using the visual analogue scale, the SF-36 questionnaire and the AOFAS scale. The functional state of the feet was assessed using plantoscopy, Y-balance test, Friedland index. X-ray parameters were assessed using magnetic resonance imaging.Results: the disease is common among women aged 51 to 60 years. In 100% of cases, there is no traumatic etiological factor, 42.9% of the subjects note an increase in body weight as the cause, 35.2% – the relationship of the onset of pain with wearing flat shoes; men are more likely to associate the onset of symptoms with an increase in physical activity (83.3%). Subjective sensation of pain on the VAS does not depend on gender (p = 0.280), age (p = 0.509), disease duration (p = 0.371), BMI (p = 0.974). X-ray parameters of patients are characterized in 49.5% by the absence of heel exostosis, in other cases, the development of a heel spur is more typical for women (p = 0.019), its length does not depend on the duration of the disease (p = 0.845), age (p = 0.054), BMI (p = 0.196), lifestyle (p = 0.324) and does not correlate with the severity of pain (p = 0.691). The level of pain is directly proportional to the thickness of the plantar fascia (p < 0.001, ρ = 0.459). Calcaneal edema is observed in 14.3 % of patients, soft tissue edema — in 18.7 %; there was no relationship between calcaneal edema (p = 0.604) and soft tissue edema (p = 0.541) with the severity of pain, and calcaneal edema directly correlates with BMI (p = 0.029).Conclusion: These studies suggest that among the predictors of the development of plantar fasciitis, the most significant are female gender, overweight, wearing flat shoes, and the disease itself is not always a consequence of the development of a heel spur.

Background and Objectives: We aimed to compare the effectiveness of ESWT (Extracorporeal Shock Wave Therapy) and RFA (Radiofrequency Thermal Ablation) on pain, disability, and activity limitation in the treatment of plantar fasciitis in patients with calcaneal spurs. Materials and Methods: Patients who apply to Orthopedics and Traumatology and Physical Medicine and Rehabilitation departments with a complaint of heel pain are included in this retrospective study. We included patients diagnosed with calcaneal spurs who received treatment with ESWT (n = 80) and RFA (n = 79) between 1 August 2021 and 1 September 2022. All patients were evaluated using the Visual Analog Scale (VAS), Foot Function Index (FFI), and the Roles and Maudsley score (RM) before and after treatment. An evaluation was performed on average 6 months after treatment. Results: This study included 79 RFA patients (34 females and 45 males) with a mean age of 55.8 ± 9.6 years and 80 ESWT patients (20 females and 60 males) with a mean age of 49.1 ± 9.5 years. There was a significant decrease in VAS scores after treatment in both the RFA and ESWT groups (z: −4.98, z: −5.18, respectively, p < 0.001). The reductions in FFI pain, FFI activity restriction, FFI disability, and RM scores were significant in both groups, although the scores after treatment were lower in the RFA group. Conclusions: This study demonstrates that ESWT and RFA significantly reduced pain, disability, and activity restriction in the treatment of plantar fasciitis in patients with calcaneal spurs. ESWT proved particularly effective in alleviating pain, whereas RFA had more pronounced effects on reducing disability and activity limitations. The choice of treatment should be based on the patient's specific complaints. [ABSTRACT FROM AUTHOR]

There is growing interest in adopting validated and reliable patient-reported outcome measures following surgery. While the Foot and Ankle Outcome Score (FAOS) has previously been validated for use in multiple foot/ankle conditions, it has not yet been validated in patients with infracalcaneal heel pain. In this study we aimed to validate the FAOS by looking at 4 psychometric properties of the survey: construct validity, content validity, reliability, and responsiveness, using patients in our practice with a clinical diagnosis of plantar fasciitis. A total of 150 patients (mean age 49.7 ± 12.1 years [36 men and 114 women]) were included in one or more of the 4 components of this study. All FAOS subscales demonstrated adequate construct validity when compared with the physical health component of the 12-Item Short Form Health Survey (SF-12), and 2 out of 5 subscales demonstrated moderate correlation with the mental health component of SF-12 (all Spearman rho >0.3, and p values <0.05). Most FAOS subscales demonstrated content validity and were found to contain relevant questions from the patient's perspective. All 5 subscales demonstrated good test-retest reliability with intraclass correlation coefficients ≥ 0.827. Finally, 4 out of the 5 subscales (all but other symptoms) were responsive to change at a mean follow up of 12.2 months after surgery (p <.05). We conclude that the FAOS is a responsive, reliable, and valid instrument for use in infracalcaneal heel pain. We believe that due to its ease of use and broad applicability, the FAOS could be more widely adopted in foot/ankle practices as patient-centered healthcare delivery and research becomes increasingly prioritized in the US and abroad. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Plantar fasciitis and calcaneal spur are common causes of heel pain in the community. People use the Internet to obtain medical information about diseases. We reviewed Internet information sources on plantar fasciitis and calcaneal spur for quality and readability. The first 50 websites for each search term ("calcaneal spur", "heel spur", and "plantar fasciitis") were scanned on www.google.com. Six different valid tools were used for information quality and readability assessment. We searched for HONCode (Health On the Net Foundation Code) stamps on included websites. The total mean points for DISCERN were 50.52 ± 14.62, and the total mean points for JAMA (Journal of the American Medical Association) were 2.42 ± 1.26. In total, 25.72% of 97 websites had HONCode stamps. The average scores for the readability indicators were calculated to be Flesch–Kincaid Grade Level (FKGL): 7.27 ± 1.71, Gunning Fog: 8.46 ± 2.17, Simple Measure of Gobbledygook (SMOG): 6.89 ± 1.24, and Coleman Liau Index: 15.56 ± 1.85. In our study, when the website resources were examined, there were profit websites the most and website quality and readability were moderate level. A significant proportion of the websites have a financial bias and provide low-quality information. A mechanism for monitoring the quality and readability of online information must be established and managed systematically. [ABSTRACT FROM AUTHOR]

Plantar heel pain (PHP), or plantar fasciopathy, is a common condition in active and sedentary populations, contributing to short- and long-term reductions in quality of life. The condition's aetiology and pathophysiology are the subjects of a significant body of research. However, much of this research has been conducted with sedentary participants, and comparatively little research exists in a population of highly-trained athletes focused on performance outcomes. Models for PHP and proposed mechanisms, such as high body mass index or systemic disease, are mostly absent from an athletic population. Even less is known about the origins of pain in PHP. Pain is believed to be a complex multifactorial process and may be experienced differently by sedentary and highly active populations, particularly endurance athletes. Consequently, conservative through to surgical treatment for athletes is informed by literature for a different population, potentially hindering treatment outcomes. The aim of this review, therefore, is to summarise what is known about PHP in athletic populations and propose potential directions for future research. Embase, PubMed, and Scopus using MeSH search terms for PHP and competitive sport and common synonyms. Two explanatory models for PHP were found. These primarily propose mechanical factors for PHP. It remains unclear how gait, body composition, and psychological factors may differ in an athletic population with and without PHP. Therefore, research in these three areas is needed to inform clinical and training interventions for this population. [ABSTRACT FROM AUTHOR]

Introduction and objective: Plantar fasciitis affects both young active patients and older people leading a sedentary lifestyle. It is result from chronic overload of the plantar fascia. About 80% of patients with plantar fasciitis improve within 12 months with non-surgical treatment. Nonsurgical management includes e.g. activity modification, cooling, non-steroidal anti-inflammatory drugs, stretching and strengthening exercises and manual therapy. Materials and methods: PubMed database was searched. The criteria for qualifying the articles for the review were the following keywords: plantar fasciitis, muscle stretching, exercise, manual therapy, heel spur. 11 articles from 2017 to 2022 were analyzed. Description of the state of knowledge: Calf stretching is one of the treatments for plantar fasciitis with the best results in the long run. In turn, strengthening exercises turn out to be more effective in a short time. One should also not forget about influence other methods of conservative treatment, such as cooling, orthoses or physical therapy, that support and accelerate the treatment process. Summary: Strengthening exercises of the plantar fascia are more effective than stretching in terms of reducing pain and improving function in the short term, while stretching exercises show better results in the long term. The best results are obtained by combining stretching of the triceps calf muscle with other methods of conservative treatment. There are no studies supporting the hypothesis that stretching alone is more effective in the treatment process than other methods and placebo.

Background: The differential diagnosis of heel and foot pain is extensive, but the most common is mechanical etiology. The anatomic location of the pain can aid in diagnosis. Plantar fasciitis is the most common diagnosis, resulting in medial plantar heel pain, particularly with the first weight-bearing steps after rest. Objective: We tried to describe most common causes of non-traumatic heel pain in our locality. Patients and methods: The current study was prospectively conducted between May 2019 and May 2020. The study enrolled 100 patients who were complaining of heel pain. Full history evaluation and clinical assessment were done in all patients Results: Mean age of enrolled patients was 39.92 ± 14.49 years with range between 18 and 68 years. The majority (52%) of enrolled patients were females and 48 (48%) patients were males. Based on clinical, laboratory and radiological findings of enrolled patients; 45 (45%) had planter fasciitis, 32 (32%) had heel spur and 23 (23%) had Achilles tendinitis. Conclusion: Non-traumatic heel pain is a common issue in the clinical practice. Planter fasciitis is considered the most frequent etiology of such pain in our setting. Comparative studies between different available modalities for management of heel pain are warranted. [ABSTRACT FROM AUTHOR]

Aim: Plantar enthesophyte is a common degenerative disorder. Surgical and medical treatment options are associated with either poor outcome or high percentage of relapse. Observations have indicated a beneficial effect of radiation therapy. We therefore wanted to evaluate pain reduction using orthovolt or cobalt-based radiation treatment for painful plantar enthesophyte and determine long-term response as well as prognostic parameters in this condition. Methods: We identified a total of 102 consecutive patients treated for a total of 117 symptomatic heel spurs. 59 patients were treated with cobalt radiation, 31 patients with orthovolt therapy and 12 patients with both radiation systems. Primary outcome measure was pain reduction being scored using the modified Rowe Score prior therapy, at the end of each treatment series as well as after 6 weeks. Secondary outcome measure was long-term outcome, evaluated in patients with a follow-up period of longer than 3 years. Results: Before radiation therapy, 61 patients (60.4%) had a score of 0, significant strong pain. At the time of completion of radiation treatment, 3 patients (2.7%) were pain-free (score of 30), whereas 8 patients (7.9%) had still severe pain (score 0). 6 weeks after radiation therapy, 33 patients (32.7%) were pain-free and 8 patients (7.9%) had severe pain (score 0), while at the time data of collection, 74 patients (73%) were free of pain and 1 patient (1%) had strong pain (score 0). Duration of pain before the start of radiation treatment was a significant prognostic factor (p = 0.012) for response to treatment. Conclusion: Radiotherapy of painful plantar enthesophyte is a highly effective therapy with little side effects providing long-term therapeutic response. The only significant prognostic parameter for response to treatment is the duration of pre-radiation therapy pain. Early integration of radiation therapy in the treatment seems to result in superior pain reduction. [ABSTRACT FROM AUTHOR]

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Aim: Heel spur is exostosis of the calcaneus. Plantar fasciitis and heel spur constitute a very common cause of plantar pain, which may be managed with radiation therapy (RT). In this study, we assessed the radiotherapeutic management of refractory painful heel spur and plantar fasciitis. Methods: In this retrospective study, we report our single center experience with RT for refractory painful heel spur and plantar fasciitis management over a period of 45 years and describe patient and treatment characteristics. Results: Between 1974 and 2019, a total of 4904 patients received RT at our department using cobalt-60 teletherapy machine for the management of refractory painful heel spur and plantar fasciitis. Out of the total 4904 patients, 2012 patients (41%) were male and 2892 patients (59%) were female. The median age was 51 (range: 41-85) years. All patients had received previous therapies for refractory painful heel spur and plantar fasciitis before the management with RT. Total RT dose was 8 Gy delivered in 2 consecutive days with daily fractions of 4 Gy using 2 opposing anterior-posterior RT fields to both heels without bolus material. Treatment response was assessed 3 to 5 weeks after the completion of RT. Response to RT was complete in 3579 patients (73%), partial in 1188 patients (24.2%), and none in 137 patients (2.8%). No therapyrelated toxicity was observed in the whole series. Conclusion: RT for refractory painful heel spur and plantar fasciitis may offer effective palliation of pain and may be considered as a viable therapeutic option for selected patients exhausted with other treatment modalities. [ABSTRACT FROM AUTHOR]

For aim of this paper and analysis of the treatment methods in question articles from Pumbed basis were used. Pumbed basis, which works under the auspices of US National Library of Medicine and National Institute of Health, helped to analyze the treatment methods for chronic condition of heel spur and plantar fascia. The analytical process was based on bibliographical descript. Results of 1204 numbers were summarized because of specialist criterion. Heel spurs are bony growths growing out of the plantar fascia and other soft tissues lining nearby which conduct to the plantar fascia ignition. The occurrence of these is connected with burdensome feeling of pain that can be felt when making first steps after getting up in the morning. It is a serious condition that applies to more and more people. Being overweight, training sports straining feet are the reasons contributing to this condition. Yet, it is not a general rule for the risk group. Treating methods in this sphere give many opportunities for physical therapist and doctors. The best sustainable method is physical therapy supported by medical aids. However, not every case gives intended results. If the sustainable methods are not enough, the surgical treatment should be introduced. There is no doubt that any method of treatment is individually reclaimed by every patient.

Heel spur is also known as a result of plantar calcaneal bone spur which is a common complaint associated with pain at heel. Heel spur is more common in females. Anti-inflammatory drugs, local steroid injections, physical therapy, low-dose radiotherapy and shock wave therapy are the commonly used treatment choices. There is no evidence that acupuncture is an effective treatment method for heel spur in the literature. However, we know that acupuncture can be used for many orthopaedic diseases like frozen shoulder, tennis elbow, sciatic pain, joint sprains, several forms of bursitis and arthritis. In this case, we aimed to demonstrate whether acupuncture is effective in a patient with heel spur. To the best of our knowledge, this is the first case in which only acupuncture is used alone for the treatment of heel spur up to date in the literature. [ABSTRACT FROM AUTHOR]

• Endoscopic partial plantar fascia release using a deep fascial approach is effective for relieving plantar fasciitis pain symptoms. • Substantial effect after 3 months but further improvement 12 months after surgery. • Based on ultrasonography the resected fascia seems to regenerate and regain a load sharing function. • The calcaneal spur does not recur during the first year after surgery. Endoscopic operations for plantar fasciitis generally have good clinical outcome. The aim of this study was to record the effect of endoscopic partial fasciotomy and heel spur removal and evaluate by ultrasonography whether the fascia regenerates and the heel spur reforms. Eleven consecutive patients were evaluated before and 3, 6 and 12 months after surgery. Operations were performed endoscopically using a deep fascial approach with a medial and a lateral portal. Bony spurs were removed and the medial half of the plantar fascia was transected. All patients followed a standardized rehabilitation program. Median Foot Function Index values decreased from 119 pre-surgery to 69 and 12 (p = 0.004), at 3 months and 1 year post-operatively respectively. Median VAS-score for first step pain was likewise reduced from median 71 mm to 29 mm and 7 mm (p = 0.004), respectively. Median fascial thickness at the medial insertion was 6.0 mm (range 4.6–6.8 mm) pre-operatively. A heel spur was present in 9 cases. One year postoperatively a well-defined fascia in the area of resection was demonstrated in 8 cases. In the rest of the cases scar tissue made it impossible to clearly outline the fascia. Nine of the feet showed good medial fascial tensioning. There was no evidence of recurrence of the bony spur. Endoscopic partial plantar fascia resection reduced pain symptoms and increased function significantly 3 months after operation, with additional effect achieved 12 months after surgery. Based on ultrasonography the resected fascia regenerated/healed, and a calcaneal spur did not recur. [ABSTRACT FROM AUTHOR]

Introduction: Plantar Fasciitis (PF) is an overuse syndrome as it develops over time. It is most frequently seen in both the non-athletic and athletic populations. PF is a multifactorial and self-limiting disorder that several factors are involved in its onset. Many well-established treatments are available for plantar heel pain. The purpose of this review is to determine the effectiveness of dry needling for the management of PF. Materials and Methods: This article is a review study, in which we present the studies that compare dry needling with other treatments for the management of plantar heel pain. We included all of the studies on patients with plantar heel pain and plantar fasciitis that investigated the effects of dry needling. Finally, seven articles were included in this review. The study designs were randomized controlled, quasi-experimental, and case-control. The Physiotherapy Evidence-based Database (PED) scale was used to measure the methodological quality of the studies. Results: The PEDro scoring of the articles ranged between 2.10-7.10. The results of this review show that dry needling may be useful in improving the pain of individuals with plantar heel pain and plantar fasciitis. Conclusion: Further high-quality research studies are needed to determine the effectiveness of dry needling in the management of plantar heel pain. Because a variety of protocol treatments of dry needling were used in the studies, we cannot recommend dry needling schedule prescriptions for the management of individuals with plantar heel pain and plantar fasciitis. [ABSTRACT FROM AUTHOR]

Plantar fasciitis is chronic degenerative tendinopathy of the plantar fascia. Although it has many treatment modalities, none has been very effective due to the largely unknown pathogenesis of this condition. 68Ga-DOTA-RGD2 has an upcoming role in assessing disease activity and treatment response in rheumatoid arthritis. In the present case, we demonstrate the potential role of angiogenesis imaging in understanding the pathogenesis of plantar fasciitis and provide new opportunities for novel imaging options. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Troublesome heel spur is a nuisance condition that affects people of all ages. Treatment of patients with heel spur is a difficult and lengthy process requiring patience from both the patient and the therapist. Sometimes, the only and ultimate method of treatment is surgery, although spurs tend to recur. The aim of the study is a comparative analysis of the analgesic efficacy of ultrasound and shock wave therapy in patients with heel spur. The cause of pain in the course of calcaneal spur is inflammation of the attachment of the plantar fascia, which plays an important role in the process of walking and is seriously strained during different types of movement. Treatment of patients is a difficult and lengthy process.Materials and Methods: The study was conducted on a group of 47 patients of both sexes, aged 38-60 years (mean 51.3) with a plantar calcaneal spur confirmed by X-ray images. Patients were randomly assigned into two groups using a simple randomization: Group 1-ultrasound therapy group (a series of ten treatments) and Group 2-the radial shock wave group (series of four treatments). In all patients, pain intensity was assessed three times: before therapy, after the first and second weeks of treatment. A version of Laitinen's pain assessment questionnaire and the Huskisson visual analogue scale (VAS) were used. Of the group of studied respondents, 47 patients of both sexes and aged 38-60 years (mean age 51.3) with a heel spur (confirmed on X-rays), who had pain for at least a month, were randomly included in the study. The patients were classified into: Group 1-US therapeutic group (a series of ten treatments) and Group 2-with RSWT (a series of five treatments). Pain intensity was assessed three times: before the treatment, after the first and second week of the treatment with the application of the VAS and the Leitinen Pain Questionnaire.Results: However, a decrease in pain sensation was reported in all test intervals, and its largest decrease occurred in both groups within 1 week of beginning treatment. More dynamic change in this period was recorded in Group 1.Conclusion: The conclusion is that while ultrasound and shock wave therapy show significant analgesic efficacy in patients with heel spur, fewer shock wave therapy sessions are needed than ultrasound sessions for effective relief, suggesting that the shock wave therapy has greater analgesic efficacy. A similar analgesic effect was achieved with the administration of a smaller number of shock wave treatments and a full series of ultrasound treatments. [ABSTRACT FROM AUTHOR]

Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal shockwave therapy (ESWT) is an established second-line treatment option for plantar fasciitis. Longer term results of focused ESWT are rare in literature. This study assessed the treatment success-rates of single session ESWT compared to repetitive ESWT treatment sessions, the mid-term results as well as treatment- or patient-related factors influencing the outcome of focused ESWT for plantar fasciitis.Methods: 284 patients (363 feet) received ESWT for plantar fasciitis and answered a questionnaire on socio-demographic and anamnestic data immediately before as well as 19-77 weeks after the first application of ESWT.Results: 76 percent of patients treated only once and 74 percent of all patients reported satisfying pain relief (with up to three treatment sessions). This was consistent in the mid-term and over different physicians as well as independent of assessed patient- or treatment-related factors.Discussion: Applying repeated ESWT in weekly intervals by default may be helpful in reducing healing time for those patients requiring more than one treatment session. Prospective research is needed to find out whether further treatment sessions are justifiable in patients who indicate no improvement after two or three treatment sessions.Conclusions: In many cases, focused ESWT needs to be applied only once. Further research should focus on the number of treatment sessions as well as the minimum energy flux density needed. [ABSTRACT FROM AUTHOR]

The article deals with data on prevalence, etiopathogenesis, clinical manifestations and principles of heel spur treatment, there had been described clinical case, and also there were given guidelines on Chondrocerin (Mili Healthcare Ltd, Great Britain) use in treatment of this pathology.

Background: Our first trial on radiotherapy for painful heel spur published in 2012 comparing the analgesic effect of a standard dose (6 × 1.0Gy within three weeks) to that of a very low one (6 × 0.1Gy within three weeks) resulted in a highly significant superiority of the standard dose arm. In the meantime, experimental data have shown that lower single doses in the range of 0.5 - 0.7Gy might be even more effective than the current standard dose of 1.0 Gy. Therefore, we conducted a second trial comparing the analgesic effect of standard single doses of 1.0Gy to that of low single doses of 0.5Gy using uniform total doses of 6Gy. Patients and methods: One hundred twenty-seven patients were randomized to receive radiation therapy either with a total dose of 6.0Gy applied in 6 fractions of 1.0Gy twice weekly (standard dose) or with the same total dose applied in 12 fractions of 0.5Gy three times weekly (experimental dose). In all patients lateral opposing 6MV photon beams were used. The results were measured using Visual analogue scale (VAS), Calcaneodynia score (CS) and SF-12 health survey. The first phase of this trial ended after a three months' follow-up; it will be continued up to 48 weeks. Results: Nine patients had to be excluded after randomization either due to the withdrawal of informed consent to radiotherapy by the patients or radiotherapy with an incorrect dosage. The groups were comparable concerning biographical and disease data. The mean calcaneodynia score (CS) was higher in the experimental group (p = 0.002). After three months' follow-up, we saw a very favorable pain relief in both arms (decline of VAS score: standard arm 42 points, experimental arm 44 points (n.s.), but we did not notice any statistically significant difference between the arms neither concerning the pain parameters nor the quality of life parameters. No relevant acute side effects were recorded. Conclusions: Favorable laboratory results could not be translated into an enhanced pain relief in our patients. This trial was terminated after the interim analysis (127 patients randomized). Further trials will be necessary to explore the best fractionation schedule. This trial has been approved by the expert panel of the DEGRO as well as by the Ethics committee of the Saarland Physicians' chamber. [ABSTRACT FROM AUTHOR]

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Objective: To investigate the short and medium-term effects of ESWT on heel pain and tenderness in patients with plantar fasciitis. Subjects and methods: Forty-one subjects (13 men, 28 women) who were diagnosed as suffering with plantar fasciitis symptoms longer than six weeks were participated in the study. The patients were treated in 3 sessions at intervals of 1week with 2000 impulses per session at a pressure of 2.0 bars and a frequency of 15 Hertz. The evaluation consisted of assessments of pain (VAS) and was performed before treatment and weekly intervals for 3 weeks, then 3 months after last session. Results: All mean post-treatment VAS scores were significantly lower than the pre-treatment scores (pre-treatment mean VAS=75.34, week1 mean VAS=49.43, week2 mean VAS=38.53, week3 mean VAS=23.04, and month3 mean VAS=20.39). There was no significant difference between mean VAS score at 1 week after last session (week3) and mean VAS score at 3 months after last session (month3) (23.04 ± 16.41 and 20.39, ± 22.98, respectively p>0,001). Conclusion: Three treatments with 2000 impulses of low-energy shock waves were a safe and effective method for treatment of hell pain caused by chronic plantar fasciitis. [ABSTRACT FROM AUTHOR]

Abstract: Plantar fasciitis (or Heel Pain Syndrome) is a common foot disorder. Whereas most patients with this condition have satisfactory outcomes with conventional treatment, the condition can become recalcitrant. For these patients, the use of Pulsed Radio Frequency Energy (PRFE) appears to be a safe, noninvasive, and effective treatment option. While PRFE has been used to provide pain relief for other clinical conditions, little clinical information is available regarding its effectiveness for the treatment of plantar fasciitis. Reported here are outcomes for six cases of recalcitrant plantar fasciitis (duration 6 months or longer) that were unresponsive to conventional treatment alone, for which complete or near complete pain relief was achieved following adjunctive PRFE therapy. [Copyright &y& Elsevier]

Plantar fasciitis is the most common cause of heel pain and occurs in all types of athletic and active individuals. However, simply walking and standing on a hard surface may also cause symptoms. Plantar fasciitis is an inflammation and .irritation of the plantar fascia, the connective tissue that supports the arch. Some orthopaedic texts suggest the possibility of micro-tears in the fascia at or near its attachment to the calcaneus. Fifty percent of patients may also have a calcaneal heel spur. Acupuncture treatment uses the extraordinary point Shimian M-LE-5 as the 'target' zone for local treatment. This point is located at the centre of the heel in the region of the attachment of the plantar fascia to the calcaneus. Palpation will reliably help to determine the precise site for needle insertion, Variations of paired needles at Shimian M-LE-5, possibly with electrical stimulation and/ or thread moxa, are often effective as local points. Numerous other secondary points may be considered on the Kidney, Bladder and other related channels. The inclusion of complementary procedures, such as orthotics for the correction of the biomechanics of the foot, can also enhance clinical results. [ABSTRACT FROM AUTHOR]

The purpose of this prospective cohort study was to determine if hamstring tightness was an increased risk in plantar fasciitis. It was thought that there is an increased risk of plantar fasciitis when hamstring tightness is present. A total of 105 patients (68 women, 37 men) were included in the study, 79 of whom were diagnosed with plantar fasciitis. Body mass index (BMI) was calculated and the presence of plantar fasciitis, equinus, and calcaneal spurs were assessed. The popliteal angle was measured using standard diagnostic techniques. Without controlling for covariates, BMI, the presence of a calcaneal spur, tightness in the gastrocnemius, gastrocnemius—soleus, and hamstring all had statistically significant association with plantar fasciitis. After controlling for covariates, patients with hamstring tightness were about 8.7 times as likely to experience plantar fasciitis (P < .0001). Patients with BMI >" xbd="358" xhg="338" ybd="2322" yhg="2284"/>35 were approximately 2.4 times as likely to experience plantar fasciitis compared with those with BMI <35 (P = .04). This study demonstrates that hamstring tightness plays a significant role in the presence of plantar fasciitis and should be addressed along with equinus and obesity when providing treatment to patients with this diagnosis. [ABSTRACT FROM PUBLISHER]

Abstract: Background: The inferior calcaneal spur has long been associated with inferior heel pain. Traditionally, many physicians have believed the spur to be associated with the plantar aponeurosis, though more recently others report the spur to lie within the intrinsic musculature of the plantar rear foot. While previous anatomical studies have generally involved cadaveric specimens, there is a relative paucity of research which has specifically analysed the spur of surgical samples from symptomatic heels. Objectives: This study was carried out to investigate the nature, affiliation and histopathology of the heel spur and the tissue in which the spur resides. Methods: Heel spur samples were taken from five healthy participants undergoing open heel surgery for recalcitrant inferior heel pain involving the presence of a heel spur. Results: The inferior calcaneal spur was found to lie consistently within the origin of the intrinsic musculature of the first layer of the plantar aspect of the foot. The plantar aponeurosis proper was observed to course inferior to the heel spur and had attachment to the spur along the spur''s inferior margin. Microscopically, the entheses of the intrinsic musculature of the first layer and the plantar aponeurosis were amalgamated to form a single broad origin of the inferior medial calcaneal tubercle. The spurs lacked a cortical shell and endochondral ossification was a prominent feature. Overt fracture of the heel spur itself was a common finding. Conclusions: Observations largely suggest a weight-bearing compressive disturbance, with secondary traction of the respective enthesis–bone unit as the underlying cause of spur growth. In this series, spurs were noted to manifest by means of endochondral ossification. [Copyright &y& Elsevier]

The aim of this paper is to assess the benefit to treat plantar fasciitis with low-dose energy extracorporeal shock wave therapy (ESWT) and the efficacy of such treatment to abate the painful symptoms allowing a rapid return to the running activity. Our study included 54 running athletes treated for plantar fasciitis associated with a heel spur who received four sessions (once weekly) of low-dose ESWT, and followed prospectively on average 45 days, 6 and 24 months after their last session. The clinical results were excellent in 59% of cases, good in 12%, satisfactory in 21% and distinctly unsatisfactory in 8%. No patient was observed a significant modification of the heel spur at the follow-up X-ray. The ultrasound examination at 24 months showed a disappearance of the inflammation signs in 61% of cases. A strong correlation between ultrasound improvement and clinical results were found. Low-energy ESWT seems to be a good mean to treat plantar fasciitis in runners with a 71% of good or excellent results and a persistent improvement lasting 24 months. A randomized multicentric study seems to be necessary to define the type of energy that should be used in the future to treat plantar fasciitis, in particular in the athletic patients, to allow a faster return to sports activities. [ABSTRACT FROM AUTHOR]

The use of radiotherapy for plantar fasciitis has never been reported in Australasia and is scarcely found in the English language medical literature, but it is commonly used in Europe, especially in Germany. In Europe, treatment courses consisting of multiple small fractions have been associated with high levels of pain relief. In the present report, the use of single fractions or radiotherapy was evaluated by reviewing seven consecutive patients referred for treatment and by applying objective and subjective criteria for pain relief. One patient died of unrelated causes soon after treatment and one declined to receive radiotherapy. Four patients each received a single dose of 8 Gy resulting in complete pain relief. One patient was treated with 8 Gy and 12 weeks later was retreated achieving partial pain relief. A follow-up interview was conducted after a mean of 15.6 months, ranging from 1.5 to 30 months. No acute or late effects occurred; however, the possibility that delayed effects may yet occur, particularly carcinogenesis, cannot be excluded. Radiotherapy for this common condition should be investigated further as it might be safer and more effective than other methods currently in use. [ABSTRACT FROM AUTHOR]