Effectiveness of Mechanical Treatment for Plantar Fasciitis: A Systematic Review

Context: Plantar fasciitis is one of the most common foot injuries. Several mechanical treatment options, including shoe inserts, ankle-foot orthoses, tape, and shoes are used to relieve the symptoms of plantar fasciitis. Objectives: To investigate the effectiveness of mechanical treatment in the management of plantar fasciitis. Evidence Acquisition: The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. A systematic search was performed in PubMed, CINAHL, Embase, and Cochrane up to March 8, 2018. Two independent reviewers screened eligible articles and assessed risk of bias using the Cochrane Collaboration’s risk of bias tool. Evidence Synthesis: A total of 43 articles were included in the study, evaluating 2837 patients. Comparisons were made between no treatment and treatment with insoles, tape, ankle-foot orthoses including night splints and shoes. Tape, ankle-foot orthoses, and shoes were also compared with insoles. Follow-up ranged from 3 to 5 days to 12 months. Cointerventions were present in 26 studies. Conclusions: Mechanical treatment can be beneficial in relieving symptoms related to plantar fasciitis. Contoured full-length insoles are more effective in relieving symptoms related to plantar fasciitis than heel cups. Combining night splints or rocker shoes with insoles enhances improvement in pain relief and function compared with rocker shoes, night splints, or insoles alone. Taping is an effective short-term treatment. Future studies should aim to improve methodological quality using blinding, allocation concealment, avoid cointerventions, and use biomechanical measures of treatment effects.

P143 The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of an open-label, parallel group, randomised controlled trial

Background Patients with mild-to-moderate carpal tunnel syndrome (CTS) are commonly treated with night splints and/or local corticosteroid injection. In the INSTINCTS (INjection versus SplinTing in Carpal Tunnel Syndrome) trial, we previously reported that a single corticosteroid injection is more effective than night splinting at 6 weeks but not at 6 months. The aims of follow-up at 12 and 24 months were to examine whether corticosteroid injection is clinically and cost-effective in reducing symptoms in the longer-term compared to night splinting and to compare rates of CTS surgery. Methods INSTINCTS was a pragmatic clinical trial in adults ≥18 years with mild-to-moderate CTS diagnosed using standardised clinical criteria. Participants were recruited from primary care or musculoskeletal interface services and randomised 1:1 to receive either a single carpal tunnel injection of 20mg methylprednisolone acetate or a night splint. Follow-up questionnaires were mailed at 6 weeks and 6, 12 and 24 months. Key clinical outcomes at 12 and 24 months were the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity (0-10 numeric rating scale (NRS)) and the number of patients referred for and receiving CTS surgery. Longitudinal mixed effect models were fitted to estimate overall treatment effect at each time point by including interaction terms between treatment and time, adjusted for age, gender, symptom duration and baseline score. The cumulative number (%) of participants i) referred or ii) undergoing CTS surgery were examined by treatment group. Cost-utility analysis was conducted from an NHS perspective to determine the cost-effectiveness of injection versus night splinting. Results 118 participants were randomised to night splinting and 116 to corticosteroid injection. In the splint group, 88 (78%) and 81 (74%) completed follow-up at 12 and 24 months respectively compared to 87 (77%) and 78 (72%) in the injection group. There were no statistically significant differences between splint and injection groups in BCTQ score at 12 (adjusted mean difference -0.09; 95%CI -0.30, 0.12) or 24 months (0.06; -0.16, 0.28) or hand pain NRS (12 months 0.03; -0.79, 0.85. 24 months 0.41; -0.45, 1.26). By 24-month follow-up, a greater proportion of the injection group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery than the splint group. Injection was more costly (mean difference £68.59 (-120.84, 291.24)) with lower quality-adjusted life-years (QALYs) than splinting over 24 months (mean difference -0.022 (-0.074, 0.024)). Conclusion To our knowledge, this is the longest-reported follow-up of a randomised trial investigating the conservative management of CTS, with the largest sample size. Over 24-months, there were no differences in symptoms between groups and injection was not cost-effective compared with splinting. Surgical referral and intervention rates were low overall, but slightly more frequent in the injection group. Disclosures C.L. Burton None. T. Rathod-Mistry None. M. Blagojevic-Bucknall None. L.S. Chesterton None. G. Davenport None. K.S. Dziedzic None. S.M. Jowett Consultancies; Sue Jowett received payment as an independent advisor for a Pfizer chronic pain advisory board meeting in November 2018. H.L. Myers None. R.A. Oppong Consultancies; Raymond Oppong received payment as an independent advisor for a Pfizer Tanezumab HEOR Advisory Board Meeting in October 2018. D.A. Van der Windt None. E.M. Hay None. E. Roddy None.

Conservative Treatment for Plantar Fasciitis

Category: Hindfoot Introduction/Purpose: The objective of this study was to compare the results obtained in the treatment of plantar fasciitis, by: group I, muscle stretching (plantar and gastrocnemius); Group II, use of the dorsiflexion night splints; and group III, permanent elevation use of shoe heel, 2 cm or more, in relation to forefoot. Methods: One hundred and fifty patients participated in the prospective and randomized study. After randomizing the method, the patients received treatment orientation. Prescription: 150 mg diclofenac sodium, single daily dose, for 7 days. Group II, they underwent daily physiotherapy with plantar stretching and electrotherapy, associated to the use of the night splints. The evaluations were at 30 and 60 days. In the first evaluation, eight patients underwent local infiltration of betamethasone dipropionate, betamethasone disodium phosphate: five from Group I and three from Group II. All patients were evaluated on the AOFAS score of the hindfoot. Results: First evaluation: group I, 52% showed little improvement (AOFAS: initial 53.5, 30 days 56.6); Group II, 38% were dissatisfied and uncomfortable with the night splints (AOFAS: initial 55.6, 30 days 63.3). In group III, 22% of the patients reported pain arising in the morning and after periods of sitting (AOFAS: initial 57.7, 30 days 81.6). Second evaluation: Group I, AOFAS 56.9; Group II AOFAS 72.2; group III AOFAS 88.6. Conclusion: heel elevation presented a satisfactory result, superior to the other methods used; difficulty for patient’s adhesion because it eliminates usage of shoes with no heels; AOFAS / scale close to all patients treated.

A New Method in the Design of a Dynamic Pedorthosis for Children With Residual Clubfoot

Clubfoot is a common pediatric orthopaedic deformity. Despite the popularity of Ponseti’s method and night splints such as the Denis–Browne method, there is still an 11–47% rate of deformity relapse reported in the literature. The technique to make traditional orthotics is dependent on a nonweight-bearing casting or foot imprint. These splints outdate clinical treatment trends and only apply to patients who are of nonwalking age. This study shows that a new procedure utilizing computer aided design and the finite element method can be employed to develop a customized weight-bearing dynamic orthotic. In addition, the plantar pressure distribution and the trajectory of the center of this pressure distribution are used to design the orthotic. It is shown that the trajectory of the center of pressure, traditionally used in gait analysis, can be used not only to quantify the severity of the foot deformity but to design a custom orthotic as well. Also, the new procedure allows the custom orthotic to be designed and analyzed within a day. The new orthotic design is composed of soft foam interior layers and a polymer supportive exterior layer. It is proved that rapid prototyping technologies employing selective laser sintering can be used to construct these layers to produce a custom orthotic within a 24 h time frame.