Plantar fasciitis medical therapy: Difference between revisions
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Plantar fasciitis Microchapters |
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Plantar fasciitis medical therapy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Many different treatments have been effective, and although it typically takes six to eighteen months to find a favorable resolution,[1] plantar fasciitis has a generally good long-term prognosis. The mainstays of treatment are stretching the Achilles tendon and plantar fascia, resting, keeping off the foot as much as possible, discontinuing aggravating activity, cold compression therapy, contrast bath therapy, weight loss, arch support and heel lifts, and taping. To relieve pain and inflammation, non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of very limited benefit.[2] One small, placebo-controlled study has shown a beneficial effect from glucosamine.
Care should be taken to wear supportive and stable shoes. Patients should avoid open-back shoes, sandals, and flip-flops.
Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, if not combined with a local anesthetic and injected slowly with a small-diameter needle.[3] Recurrence rates may be lower if injection is performed under ultrasound guidance.[4]
In cases of chronic plantar fasciitis of at least 10 months duration, one recent study has shown high success rates with a stretch of the plantar fascia.[5][6]
Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease morning pain. Pain with first steps of the day can be markedly reduced by stretching the Achilles tendon before getting out of bed. Patients should be encouraged to lessen activities which place more pressure on the balls of the feet. Over-the-counter arch support may help, and prescription orthoses are often prescribed. These can be made of many different materials, some of which may be hard and may press on the origin of the plantar fascia. Softer, custom devices, of plastizote, poron, or leather, may be more helpful. Orthoses should always be broken in slowly.
Therapeutic ultrasound has been shown in a controlled study to be ineffective as a treatment for plantar fasciitis.[7] More recently, however, extracorporeal shockwave therapy (ESWT) has been used with some success in patients with symptoms lasting more than 6 months.[8] The treatment is a nonsurgical procedure, but must be done either under local anaesthesia either with or without intravenous sedation (twilight sedation). The basic premise behind ESWT is that in chronic pain (over six months) the brain no longer perceives the pain (even though the patient feels pain) and so no longer is sending signals to fight the pain. ESWT basically re-inflames the area and in doing so increases blood flow to the area as a means to heal the area. It can take as long as six months following the procedure to see results. Like any procedure there are varying degrees of success.
References
- ↑ Young, Craig C., Rutherford, Darin S. & Niedfeldt, Mark W. (2001). "Treatment of Plantar Fasciitis". American Family Physician. 63 (3): 467–74, 477–8.
- ↑ Lynch, D., Goforth, W., Martin, J., Odom, R., Preece, C., & Kottor M. (1998). "Conservative treatment of plantar fasciitis. A prospective study". Journal of the American Podiatric Medical Association. 88 (8): 375–380. PMID 9735623.
- ↑ Genc H, Saracoglu M, Nacir B, Erdem HR, Kacar M (2005). "Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection". Joint Bone Spine. 72 (1): 61–5. PMID 15681250.
- ↑ Tsai WC, Hsu CC, Chen CP, Chen MJ, Yu TY, Chen YJ (2006). "Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance". J Clin Ultrasound. 34 (1): 12–6. PMID 16353228.
- ↑ Janet Cromley (November 13, 2006). "A foot hold that spurs healing". Los Angeles Times.
- ↑ Digiovanni BF, Nawoczenski DA, Malay DP, Graci PA, Williams TT, Wilding GE, Baumhauer JF (2006). "Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up". The Journal of bone and joint surgery. American volume. 88 (8): 1775–81. PMID 16882901.
- ↑ Crawford F (2004). "Plantar heel pain and fasciitis". Clin Evid (11): 1589–602. PMID 15652071.
- ↑ Norris, DM, Eickmeier, KM and Werber B (2005). "Effectiveness of Extracorporeal Shockwave Treatment in 353 Patients with Chronic Plantar Fasciitis". Journal of the American Podiatric Medical Association. 95 (6): 517–524. PMID 16291842.