Greater Postural Sway and Tremor during Balance Tasks in Patients with Plantar Fasciitis Compared to Age-Matched Controls

Plantar fasciitis (PF) is a common condition found in men and women and can reoccur throughout life. PF is commonly diagnosed by prolonged foot pain lasting more than 3 months and a plantar fascia over 0.4 mm thick, as measured using ultrasound imaging. This study examined the ability to balance and the occurrence of muscle tremor during different balance tasks in patients with PF compared to their control counterparts. Fifty subjects (25 patients with PF and 25 control subjects) participated in this study. Subjective pain (measured with a visual analog scale (VAS)), pressure pain threshold (PPT), and postural sway and tremor during eight different balance tasks were measured. Postural sway was measured by a balance platform, while tremor was measured as the mechanical movement of the platform in the 8 Hz frequency range. Thickness of plantar fascia, subjective pain, and PPT were significantly greater in the PF group compared to the controls (p < 0.001). Postural sway and 8 Hz tremor were significantly greater in the PF group compared to the control group for all eight balance tasks (p < 0.01). These results indicate that the lack of plantar fascia elasticity is probably the cause of the reduced balance and increased muscle tremor.

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Acupuncture Treatment for Plantar Fasciitis: A Randomized Controlled Trial with Six Months Follow-Up

Evidence-based Complementary and Alternative Medicine ◽

10.1093/ecam/nep186 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 10

Author(s):

Shi Ping Zhang ◽

Tsui-Pik Yip ◽

Qiu-Shi Li

Keyword(s):

Treatment Group ◽

Plantar Fasciitis ◽

Pain Threshold ◽

Acupuncture Treatment ◽

Pressure Pain Threshold ◽

Specific Effect ◽

Heel Pain ◽

Secondary Outcome ◽

Control Group ◽

Pressure Pain

Plantar fasciitis is a common cause of heel pain. It has been suggested that some acupoints have a specific effect on heel pain. The aim of this study was to determine the efficacy and specificity of acupuncture treatment for plantar fasciitis. Subjects were randomly assigned to the treatment group (n= 28) or control group (n= 25). The treatment group received needling at the acupoint PC 7, which is purported to have a specific effect for heel pain. The control group received needling at the acupoint Hegu (LI 4), which has analgesic properties. Treatment was administered five times a week for 2 weeks, with an identical method of manual needling applied to the two acupoints. The primary outcome measure was morning pain on a 100-point visual analog scale (VAS) at one month post-treatment. Secondary outcome measures included a VAS for activity pain, overall pain rating as well as pressure pain threshold using algometry. Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6 ± 4.0 versus 12.0 ± 3.0, mean ± SEM), overall pain (20.3 ± 3.7 versus 9.5 ± 3.6) and pressure pain threshold (145.5 ± 32.9 versus −15.5 ± 39.4). No serious adverse event was observed in either group. The results indicate that acupuncture can provide pain relief to patient with plantar fasciitis, and that PC 7 is a relatively specific acupoint for heel pain.

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Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals With Plantar Fasciitis

Foot & Ankle International ◽

10.1177/1071100717732762 ◽

2017 ◽

Vol 39 (1) ◽

pp. 75-82 ◽

Cited By ~ 7

Author(s):

Phoomchai Engkananuwat ◽

Rotsalai Kanlayanaphotporn ◽

Nithima Purepong

Keyword(s):

Achilles Tendon ◽

Plantar Fasciitis ◽

Pain Threshold ◽

Pressure Pain Threshold ◽

Plantar Fascia ◽

Complete Relief ◽

Level Of Evidence ◽

Pressure Pain ◽

Group 2 ◽

Group 1

Background: Since the plantar fascia and the Achilles tendon are anatomically connected, it is plausible that stretching of both structures simultaneously will result in a better outcome for plantar fasciitis. Methods: Fifty participants aged 40 to 60 years with a history of plantar fasciitis greater than 1 month were recruited. They were prospectively randomized into 2 groups. Group 1 was instructed to stretch the Achilles tendon while group 2 simultaneously stretched the Achilles tendon and plantar fascia. Results: After 4 weeks of both stretching protocols, participants in group 2 demonstrated a significantly greater pressure pain threshold than participants in group 1 ( P = .040) with post hoc analysis. No significant differences between groups were demonstrated in other variables ( P > .05). Concerning within-group comparisons, both interventions resulted in significant reductions in pain at first step in the morning and average pain at the medial plantar calcaneal region over the past 24 hours, while there were increases in the pressure pain threshold, visual analog scale–foot and ankle score, and range of motion in ankle dorsiflexion ( P < .001). More participants in group 2 described their symptoms as being much improved to being completely improved than those in group 1. Conclusion: The simultaneous stretching of the Achilles tendon and plantar fascia for 4 weeks was a more effective intervention for plantar fasciitis. Patients who reported complete relief from symptoms at the end of the 4-week intervention in the simultaneous stretching group (n = 14; 56%) were double that of the stretching of the Achilles tendon–only group (n = 7; 28%). Level of Evidence: II, lesser quality RCT or prospective comparative study.

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The Effect of Dry Needling on Pain, Range of Motion of Ankle Joint, and Ultrasonographic Changes of Plantar Fascia in Patients With Plantar Fasciitis

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0156 ◽

2021 ◽

pp. 1-6

Author(s):

Afsaneh Moosaei Saein ◽

Ziaeddin Safavi-Farokhi ◽

Atefeh Aminianfar ◽

Marzieh Mortezanejad

Keyword(s):

Range Of Motion ◽

Ankle Joint ◽

Visual Analog Scale ◽

Plantar Fasciitis ◽

Plantar Flexion ◽

Plantar Fascia ◽

Trigger Points ◽

Dry Needling ◽

Analog Scale ◽

Significant Difference

Context: Plantar fasciitis (PF) is a common and devastating disease. Despite different treatments, there is no clear evidence for the effect of these treatments on PF. One of the therapy methods used in physiotherapy is dry needling (DN). So the purpose of this study is to investigate the effect of DN on the pain and range of motion of the ankle joint and plantar fascia thickness in subjects with PF who are suffering from the trigger points of the gastrocnemius and soleus muscles. Methods: In this study, 20 volunteer females with PF were randomly assigned into DN treatment and control groups. Measurements were range of motion in dorsiflexion and plantar flexion, plantar fascia thickness, and visual analog scale measured before, immediately, and 1 month after the end of the intervention in both groups. Results: There were significant differences in the plantar fascia thickness and visual analog scale between the 2 groups. Plantar fascia thickness (P = .016) and visual analog scale (P = .03) significantly decreased in the treatment group. However, there was no significant difference in plantar flexion (P = .582) and dorsiflexion range of motion (P = .173) between groups. Conclusion: The result of this study showed that DN can reduce pain and plantar fascia thickness in women with PF who are suffering from trigger points of the gastrocnemius and soleus muscles. Level of evidence: Level 1, randomized controlled trial.

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Retrospective Analysis of Plantar Fascia by Ultrasound Imaging in Patients with Plantar Fasciitis

Journal of the American Podiatric Medical Association ◽

10.7547/16-083 ◽

2018 ◽

Vol 108 (5) ◽

pp. 349-354 ◽

Cited By ~ 2

Author(s):

Michael Henry Slayton ◽

Richard C. Amodei ◽

Keegan B. Compton ◽

Luke D. Cicchinelli

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Plantar Fasciitis ◽

Plantar Fascia ◽

Control Group ◽

Ultrasound Images ◽

Acute Injuries ◽

Patient Database ◽

Thickness Measurements ◽

Unilateral Conditions

Background: We compared diagnostic ultrasound images of the plantar fascia with available patient histories for symptomatic patients previously diagnosed as having plantar fasciitis. Plantar fascia thickness and depth, the prevalence of perifascial hypoechoic lesions, and injury timelines in patients were reviewed. Methods: Images and histories for 126 symptomatic patients were collected from a patient database. We documented plantar fascia depth and thickness and the visualization of hypoechoic perifascial lesions. After image analysis, the obtained plantar fascia thickness measurements were compared with various patient attributes for possible relationships, including age, weight, and body mass index. In addition, plantar fascia thickness measurements were separated based on injury timeline as well as symptomatic/asymptomatic foot for patients with unilateral conditions to check for significant differences between subgroups. These were, in turn, compared with a control group of 71 individuals with no heel pain or diagnosis of plantar fasciitis. Results: Overall, mean ± SD symptomatic thickness (n = 148) was 6.53 ± 1.56 mm. Mean ± SD symptomatic depth (n = 136) was 13.36 ± 2.14 mm. For the control group, mean ± SD thickness was 3.20 ± 0.66 mm and depth was 10.30 ± 2.00 mm. Comparison of thickness based on injury timeline showed two significant differences: acute injuries (≤3 months) are significantly thicker than chronic injuries (>3 months), and only acute symptomatic thicknesses are significantly different from their asymptomatic thickness counterparts. Age, weight, and body mass index did not show significant correlations to thickness. Analysis of ultrasound images showed that 93% of symptomatic feet had hypoechoic lesions. Conclusions: Injury timeline and the presence of hypoechoic lesions may play important roles in patient discomfort, diagnosis, and treatment of plantar fasciitis.

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Sonographic Evaluation of Plantar Fasciitis and its Relation to Body Mass Index and Heel Pad Thickness

Nepalese Journal of Radiology ◽

10.3126/njr.v9i2.27427 ◽

2020 ◽

Vol 9 (2) ◽

pp. 32-39

Author(s):

Prashant Khatiwada ◽

Dinesh Chataut ◽

Kamal Subedi

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Plantar Fasciitis ◽

Plantar Fascia ◽

Skin Surface ◽

Control Group ◽

Heel Pad ◽

And Control ◽

Calcaneal Tuberosity ◽

Symptomatic Side

Introduction: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis (PFs) using both quantitative and qualitative parameters, and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT). Methods: In this case controlled analytical study, we sonographically evaluated 100 patients with clinical plantar fasciitis (unilateral: 90, bilateral: 10 with mean age 46.9yrs) and control group of 60 (120 heels) healthy volunteers with mean age 45.3yrs. Plantar Fascia Thickness (PFT), HPT, hypoechogenity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. PFT was measured 5mm distal to the calcaneal insertion of plantar aponeurosis. The unloaded HPT was measured from the skin surface to the nearest calcaneal tuberosity. Results: Mean Plantar Fascia Thickness (PFT) and Heel Pad Thickness (HPT) are greater on the symptomatic side for patients with unilateral and bilateral PFs than on the asymptomatic side for patients with unilateral PFs, and also control subjects (PFT values are 4.41 ± 0.59, 4.63 ± 0.55, 2.83 ± 0.36, 2.62± 0.37 mm, and HPT values 17.64 ± 1.07, 17.28 ± 1.10, 16.91 ± 1.06, 16.73 ± 1.13 mm, respectively) (p <0.0001). Mean BMI values of the case and control groups are 26.14 ± 1.9 and 24.42 ± 0.89 Kg/m2, respectively (p <0.05). We found hypoechogenicity of plantar fascia in 80 cases (72.7%), calcaneal spur in 69 cases (62.7%), biconvexity in 11 cases (10%) and perifascial fluid in 16 cases (14.5%) within the plantar fasciitis group (110 symptomatic heels). Conclusion: Increased plantar fascia thickness, increased heel pad thickness and hypoechogenicity of plantar fascia are consistent sonographic findings in plantar fasciitis. Its occurrence has significant relation to high BMI.

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Use of Low-Frequency Electrical Stimulation for the Treatment of Plantar Fasciitis

Journal of the American Podiatric Medical Association ◽

10.7547/0990481 ◽

2009 ◽

Vol 99 (6) ◽

pp. 481-488 ◽

Cited By ~ 7

Author(s):

Michael Stratton ◽

Thomas G. McPoil ◽

Mark W. Cornwall ◽

Kyle Patrick

Keyword(s):

Electrical Stimulation ◽

Functional Activity ◽

Plantar Fasciitis ◽

Soft Tissues ◽

Low Frequency ◽

Plantar Fascia ◽

Muscular Contraction ◽

Control Group ◽

Foot Orthoses ◽

Activity Levels

Background: Recent research has discussed the use of low-frequency electrical stimulation to increase blood flow by eliciting muscular contraction in soft tissues. This randomized clinical trial examined the efficacy of low-frequency electrical stimulation combined with stretching exercises and foot orthoses in individuals diagnosed as having plantar fasciitis for less than 6 months. Methods: Twenty-six participants aged 18 to 65 years diagnosed as having plantar fasciitis were randomly assigned to two treatment groups: a control group receiving only stretching and orthoses and a treatment group receiving low-frequency electrical stimulation in addition to stretching and orthoses. To assess treatment response, a visual analog scale was used to determine first-step morning pain, and changes in daily activity levels were monitored by using a validated outcome measure. All of the participants were assessed before starting treatment, after 4 weeks of treatment, and 3 months after the conclusion of treatment. Results: Participants in the control and experimental groups demonstrated pain reduction and improvements in functional activity levels after 4 weeks and 3 months. Conclusions: Regardless of whether low-frequency electrical stimulation was used as an intervention, the use of plantar fascia–specific stretching and prefabricated foot orthoses provided short-term (3-month) pain relief and improvement in functional activity levels. (J Am Podiatr Med Assoc 99(6): 481–488, 2009)

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Plantar Fasciitis: Are Pain and Fascial Thickness Associated With Arch Shape and Loading?

Physical Therapy ◽

10.2522/ptj.20060136 ◽

2007 ◽

Vol 87 (8) ◽

pp. 1002-1008 ◽

Cited By ~ 52

Author(s):

Scott C Wearing ◽

James E Smeathers ◽

Patrick M Sullivan ◽

Bede Yates ◽

Stephen R Urry ◽

...

Keyword(s):

Plantar Fasciitis ◽

Matched Control ◽

Weight Bearing ◽

Plantar Fascia ◽

Heel Pain ◽

Structural Factors ◽

Local Loading ◽

Analog Scale ◽

Pressure Plate ◽

Arch Shape

Background and Purpose: Although plantar fascial thickening is a sonographic criterion for the diagnosis of plantar fasciitis, the effect of local loading and structural factors on fascial morphology are unknown. The purposes of this study were to compare sonographic measures of fascial thickness and radiographic measures of arch shape and regional loading of the foot during gait in individuals with and without unilateral plantar fasciitis and to investigate potential relationships between these loading and structural factors and the morphology of the plantar fascia in individuals with and without heel pain. Subjects: The participants were 10 subjects with unilateral plantar fasciitis and 10 matched asymptomatic controls. Methods: Heel pain on weight bearing was measured by a visual analog scale. Fascial thickness and static arch angle were determined from bilateral sagittal sonograms and weight-bearing lateral foot roentgenograms. Regional plantar loading was estimated from a pressure plate. Results: On average, the plantar fascia of the symptomatic limb was thicker than the plantar fascia of the asymptomatic limb (6.1±1.4 mm versus 4.2±0.5 mm), which, in turn, was thicker than the fascia of the matched control limbs (3.4±0.5 mm and 3.5±0.6 mm). Pain was correlated with fascial thickness, arch angle, and midfoot loading in the symptomatic foot. Fascial thickness, in turn, was positively correlated with arch angle in symptomatic and asymptomatic feet and with peak regional loading of the midfoot in the symptomatic limb. Discussion and Conclusion: The findings indicate that fascial thickness and pain in plantar fasciitis are associated with the regional loading and static shape of the arch.

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The Correlation Between Plantar Fascia Thickness and Symptoms of Plantar Fasciitis

Journal of the American Podiatric Medical Association ◽

10.7547/1010385 ◽

2011 ◽

Vol 101 (5) ◽

pp. 385-389 ◽

Cited By ~ 32

Author(s):

Sarah Mahowald ◽

Bradford S. Legge ◽

John F. Grady

Keyword(s):

Visual Analogue Scale ◽

Plantar Fasciitis ◽

Analogue Scale ◽

Ultrasound Examination ◽

Plantar Fascia ◽

Pain Level ◽

Treatment Protocols ◽

Average Improvement ◽

Subjective Pain ◽

Efficacy Of Treatment

Background: The purpose of this study was to determine whether changes in plantar fascia thickness are a reliable gauge of efficacy of treatment protocols for plantar fasciitis. Methods: Thirty-nine feet (30 patients) with plantar fasciitis received an ultrasound examination to measure the thickness of the medial band of the plantar fascia. Each patient assessed his or her pain using the visual analogue scale. Following various treatments, a second ultrasound examination was performed and the thickness of the plantar fascia was again measured and subjective pain level assessed. Results: Twenty-nine feet (74.4%) showed a decrease in plantar fascia thickness and a decrease in pain. One foot (2.6%) experienced an increase in fascia thickness and reported an increase in pain. Four feet (10.3%) had an increase in thickness of the plantar fascia and reported no change in pain level. Three feet had minor increases in fascia thickness but reported a decrease in pain (7.7%). One foot (2.6%) had no change in fascia thickness but a decrease in pain and one foot (2.6%) had a decrease in the plantar fascia but no change in pain level. The average reduction in fascia thickness was 0.82 mm ±1.04 mm, correlating with an average improvement in pain of 3.64 ± 2.7 (P < 0.005). Conclusions: This study provides evidence that changing thickness of the plantar fascia is a valid objective measurement to assess effectiveness of new or existing treatment protocols. (J Am Podiatr Med Assoc 101(5): 385–389, 2011)

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Effects of upper cervical translatoric mobilization on headache, quality of life, cervical mobility and pressure pain threshold in patients with cervicogenic headache: A randomized controlled trial.

10.21203/rs.3.rs-21657/v1 ◽

2020 ◽

Author(s):

Miguel Malo-Urriés ◽

José Miguel Tricás-Moreno ◽

Elena Estébanez-de-Miguel ◽

Elena Bueno-Gracia ◽

Pablo Fanlo-Mazas ◽

...

Keyword(s):

Quality Of Life ◽

Treatment Group ◽

Pain Threshold ◽

Pressure Pain Threshold ◽

Cervicogenic Headache ◽

Control Group ◽

Pressure Pain ◽

Upper Cervical ◽

Related Quality

Abstract Objective The purpose of this study was to evaluate the effects of upper cervical translatoric spinal mobilization (UC-TSM) on headache, quality of life, cervical mobility and pressure pain threshold in subjects with cervicogenic headache (CEH). Methods Eighty-two volunteers (41.5 ± 15.3 years; 20 males and 62 females) with CEH participated in the study and were randomly assigned to control or treatment group. The treatment group received 3 sessions of UC-TSM and the control group remained the same sessions, in the same position and time but received no treatment. Primary outcomes were Headache Impact Test for headache-related quality of life and flexion-rotation test for upper cervical mobility. Secondary outcomes included intensity, frequency and duration of headache, general cervical mobility and pressure pain thresholds over cervical spine. They were measured at baseline, at the end of the treatment and one month after the intervention. Results UC-TSM group increased significantly headache-related quality of life (p < .001; d = .857). Headache intensity, frequency and duration improved in UC-TSM group (p = .000-.013), in contrast to control group which did not obtain significant changes (p = .234-.965). UC-TSM group presented significant increases in upper cervical mobility (p < .001). Between-group effect sizes were considered large at T1 (d = 0.90–1.21) and moderate to large at T2 (d = 0.78–1.17). Conclusions Three sessions of UC-TSM increased headache-related quality of life and upper cervical mobility in subjects with CEH. Intensity, duration and frequency of headache, cervical mobility and PPT also improved. Further research considering the limitations of the present clinical trial is required to confirm this tendency.

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Genicular artery embolization as a novel treatment for mild to moderate knee osteoarthritis: protocol design of a randomized sham-controlled clinical trial

Trials ◽

10.1186/s13063-021-05942-x ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

T. A. van Zadelhoff ◽

A. Moelker ◽

S. M. A. Bierma-Zeinstra ◽

P. K. Bos ◽

G. P. Krestin ◽

...

Keyword(s):

Mr Imaging ◽

Knee Osteoarthritis ◽

Pain Threshold ◽

Pressure Pain Threshold ◽

Scale Efficiency ◽

Control Group ◽

Artery Embolization ◽

Sham Treatment ◽

Pressure Pain ◽

Genicular Artery

Abstract Introduction Knee osteoarthritis is a common disease with pain as the most prevalent symptom. Previous cohort studies have shown genicular artery embolization to reduce pain symptoms in patients with mild to moderate knee osteoarthritis. Patients resistant to conservative therapy but not eligible yet for surgical treatment due to young age or comorbidities may profit from an effective and sustained pain reduction treatment. This study is a randomized sham-controlled trial to evaluate the efficacy of genicular artery embolization in patients with knee osteoarthritis. Methods and analysis Fifty-eight patients with mild-to-moderate knee osteoarthritis will be recruited and randomly allocated to the treatment or control group in a 1:1 ratio. Participants in the treatment group will undergo genicular artery embolization. Patients in the control group will undergo sham treatment. Outcome measurements will be assessed at baseline and after 1, 4, 8, and 12 months with questionnaires, pressure pain threshold testing, and MR imaging. The MR imaging protocol is designed to (semi)quantitatively assess osteoarthritis in the knee joint. The primary outcome is the change from baseline of the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale after 4 months. Secondary outcomes include change in osteoarthritis-related questionnaires, pressure pain threshold, and OA-related MRI features, particularly synovitis and bone marrow lesions. Ethics and dissemination This trial will determine the efficacy of genicular artery embolization compared to a sham treatment. This is of importance to assess before proceeding to larger-scale efficiency studies and, ultimately, implementing this treatment into day to day clinical practice. Trial registration ClinicalTrials.gov NCT03884049. Registered on 21 March 2019

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