The shock waves stimulate healing by producing vibration that encourages circulation. It is thought to stimulate neovascularization, increase growth factors, and destruct unmyelinated nerve fibers substance P fibers.
Shock waves can be delivered from low- to high-energy waves, and the wave modality can be focused or radial. There is no consensus on the optimal shock wave intensity, modality, or pulse cycle protocol for the treatment of plantar fasciitis. Some studies have shown no benefit of ESWT for plantar fasciitis.
One of these, an RCT of people randomized to placebo or ultrasound-guided ESWT, found that both groups had improvement in heel pain, but that there was no benefit after treatment completion.
Findings from a meta-analysis indicate that a force of 0. A recent meta-analysis evaluated nine RCTs that included sham treatment as the comparator and concluded that focused application of ESWT should be recommended as remedial treatment after failure of traditional conservative therapy, thus possibly avoiding surgical intervention. However, this finding was limited by the small study size. Corticosteroids are commonly used to decrease pain and inflammation.
Although plantar fasciitis is a degenerative rather than inflammatory process, there is evidence of a short-term therapeutic effect of corticosteroids. A meta-analysis showed that ultrasound-guided injections are superior to palpation-guided injections for pain relief and reducing plantar fascia thickness. Rupture occurs in an estimated 2. Autologous blood-derived products platelet-rich plasma and whole blood have the potential to stimulate tissue regeneration. In theory, these injections could be superior to corticosteroid injections in the treatment of plantar fasciitis because it is not an inflammatory process.
A meta-analysis compared pain scores three months after treatment with autologous blood-derived products, corticosteroid injections, or ESWT. However, a recent meta-analysis of 39 trials suggested minimal, if any, benefit from platelet-rich plasma injections compared with control interventions, based on very low-quality evidence.
Whole blood injections may not have additional costs beyond the cost of the injections because unlike platelet-rich plasma, whole blood does not require additional processing, which can be expensive. Botulinum toxin has been used to treat many chronic pain conditions. Its mechanisms of action include inhibition of pain peptide release from nerve terminals and sensory ganglia, anti-inflammatory and antiglutaminergic effects, and reduction of sympathetic neural discharge.
Several small RCTs and a meta-analysis indicate that botulinum toxin injections improve pain and overall foot function at three and eight weeks in patients with plantar fasciitis. Open, percutaneous, or endoscopic plantar fasciotomy without inferior calcaneal exostectomy is the preferred surgical method. A return to full activity may take up to three months.
Potential complications include plantar arch collapse and scarring of the incision site. Endoscopic fasciotomy has become the standard surgical treatment. An RCT comparing open vs.
This article updates previous articles on this topic by Goff and Crawford 6 ; Cole, et al. The search was limited to meta-analyses, systematic reviews, randomized controlled trials, and reviews published in the past 10 years. Search dates: October and April Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. He is also a chief medical officer for Drexel University Athletics. Reprints are not available from the authors.
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Int J Clin Pract. Long-term follow-up of heel spur surgery. A year retrospective study. Since a quarter of all the bones in the human body are down in your feet, when a great deal of force, weight and pressure are placed on them, your chance of injury increases.
Approximately 2 million people in the United States will suffer from Plantar Fasciitis, one of the most common foot pains. It connects the plantar tendon to either the heel bone or to the base of the toes.
Then the pain starts to linger, and you feel more pain in the heel.
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