Plantar fasciopathy
CONSULT TREATMENT PROTOCOL
INDICATIONS
GLOBAL INDICATIONS
Tendon disorders
- Calcifying tendinitis of the shoulder
- Chronic distal biceps tendinopathy
- Chronic proximal hamstring tendinopathy
- Golfer’s elbow
- Greater trochanteric pain syndrome
- Insertional Achilles tendinopathy
- Medial tibial stress syndrome
- Mid-body Achilles tendinopathy
- Patella tip syndrome
- Plantar fasciopathy
- Primary long bicipital tenosynovitis
- Subacromial pain syndrome
- Tennis elbow
BACK
GLOSSARY OF DISEASES
BACKMORE INFORMATION
Plantar fasciopathy (PF) is an acute or chronic, painful disorder of the plantar fascia that spans between the medial calcaneal tubercle and the proximal phalanges of the toes.
It is the most common cause of plantar heel pain and accounts for approximately 11-15% of foot symptoms presenting to physicians. The main clinical symptom is heel pain, particularly in the morning or after a period of rest. Often patients report improvement of pain after walking. Pain is usually located at the origin of the plantar fascia, i.e., at the medial calcaneal tubercle. Passive dorsiflexion of the toes may aggravate the pain in some patients, particularly in those with chronic PF. Patients suffering from chronic PF may also present with heel pad swelling.
Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of plantar heel pain or to establish the diagnosis of PF when in doubt. Histologic examination of biopsy specimens from patients undergoing plantar fascia release surgery for chronic symptoms has shown that chronic PF is associated with degenerative changes in the fascia. Accordingly, the disease is better characterized as “fasciopathy” than “fasciitis”, resembling the situation in overuse tendon problems.
In the United States, more than two million individuals are treated for PF on an annual basis. Up to 10% of the population will experience plantar heel pain during the course of a lifetime. Both athletes and the elderly commonly present to physicians with PF.
The treatment of PF should start with conservative treatment modalities including rest, physiotherapy, stretching, exercises, shoe inserts/orthotics, night splints, non-steroidal anti-inflammatory drugs, and local corticosteroid injections. Patients not responding to conservative treatment for six months (between 10% and 20% of all patients) shall then be subjected to radial shock wave therapy (RSWT). Surgery should be considered for recalcitrant cases of PF.
CLINICAL EVIDENCE
Akinoglu et al., Pain Med 2017: Epub ahead of print on May 29
Comparison of the Acute Effect of Radial Shock Wave Therapy and Ultrasound Therapy in the Treatment of Plantar Fasciitis: A Randomized Controlled Study.
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Ibrahim et al., J Orthop Res 2017;35:1532-1538.
Long-term results of radial extracorporeal shock wave treatment for chronic plantar fasciopathy: A prospective, randomized, placebo-controlled trial with two years follow-up.
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Eslamian et al., Pain Med 2016;17:1722-1731.
Extra Corporeal Shock Wave Therapy Versus Local Corticosteroid Injection in the Treatment of Chronic Plantar Fasciitis, a Single Blinded Randomized Clinical Trial.
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Konjen et al., J Med Assoc Thai 2015;98:S49-S56.
A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial
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Rompe et al., Int J Surg 2015;24:135-142.
Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain
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Grecco et al., Clinics 2013;68:1089-1095.
One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy
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Ibrahim et al., Foot Ankle Int 2010;31:391-397.
Chronic plantar fasciitis treated with two sessions of radial extracorporeal shock wave therapy
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Rompe et al., J Bone Joint Surg Am 2010;92:2514-2522.*
Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy
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Shaheen, Indian J Physiother Occupat Therap 2010;4:8-12.
Low-energy radial extracorporeal shock wave treatment for chronic plantar fasciitis: a randomized control trial
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Greve et al., Clinics 2009;64:97-103.
Comparison of radial shockwaves and conventional physiotherapy for treating plantar fasciitis
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Gerdesmeyer et al., Am J Sports Med 2008;36:2100-2109.
Radial Extracorporeal Shock Wave Therapy Is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis : Results of a Confirmatory Randomized Placebo-Controlled Multicenter Study
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Marks et al., Acta Orthop Belg 2008;74:98-101.**
Extracorporeal shock-wave therapy (ESWT) with a new-generation pneumatic device in the treatment of heel pain. A double blind randomised controlled trial.
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Chow and Cheing, Clin Rehabil 2007;21:131-141.
Comparison of different energy densities of extracorporeal shock wave therapy (ESWT) for the
management of chronic heel pain
Mehra et al., Surgeon 2003;1:290-292.
The use of a mobile lithotripter in the treatment of tennis elbow and plantar fasciitis.
READ ABSTRACTTREATMENT PROTOCOL
| STANDARD TREATMENT | MYOFASCIAL THERAPY | |
|---|---|---|
| Number of treatment sessions | 3 to 5 | 3 to 5 |
| Interval between two sessions | 1 week | 1 week |
| Air pressure Evo Blue® | 2 to 4 bar | 3 to 4 bar |
| Air pressure Power+ | 1.5 to 3 bar | 2 to 4 bar |
| Impulses | 2000 on the painful spot | 2000 |
| Frequency | 8Hz to 12Hz | 12Hz to 20Hz |
| Applicator | 15mm | 36mm |
| Skin pressure | Moderate to high | Moderate to high |
