Relationships between Plantar Pressure Distribution and Rearfoot Alignment in the Taiwanese College Athletes with Plantar Fasciopathy during Static Standing and Walking

Background: Plantar fasciopathy (PF) is usually related to changes in foot arch, foot shape and rearfoot posture. However, little research has been implemented by using large-scale datasets, and even less has been conducted centering on plantar pressure distributions (PPDs) of different genders of PF athletes. This study aimed to investigate the relationships among the arch index (AI), the PPDs and the rearfoot postural alignment in hundreds of college athletes with PF during static standing and walking. Methods: Cross-sectional study of 100 male and 102 female athletes with PF was undertaken. The PF athletes’ pain assessment and self-reported health status were examined for evaluating their musculoskeletal painful areas. Results: The PF athletes’ PPDs mainly concentrated on inner feet in static standing, and transferred to lateral forefeet during the midstance phase of walking. The males’ PPDs from the static standing to the midstance phase of walking mainly transferred to anterolateral feet. The females’ PPDs mainly transferred to posterolateral feet. The PF athletes’ static rearfoot alignment matched the valgus posture pattern. The medial band of plantar fascia and calcaneus were the common musculoskeletal pain areas. Conclusions: Characteristics of higher plantar loads beneath medial feet associated with rearfoot valgus in bipedal static stance could be the traceable features for PF-related foot diagrams. Higher plantar loads mainly exerted on the lateral forefoot during the midstance phase of walking, and specifically concentrated on outer feet during the transition from static to dynamic state. Pain profiles seem to echo PPDs, which could function as the traceable beginning for the possible link among pronated low-arched feet, PF, metatarsalgia, calcanitis and Achilles tendinitis.

Plantar fasciopathy—looking beyond the obvious? A case report

Background The biggest challenge in treating this diagnosis is the lack of literature focusing on regional interdependence. The current literature suggests a narrow and localized approach targeting plantar fascia and ankle/foot complex. The literature available on conservative treatment focused on utilizing various inflammatory modalities such as injections and extracorporeal shockwave therapy. The surgical approach targets Baxter’s nerve decompression techniques and releases techniques to the gastrocnemius and plantar fascia. The article focuses on utilizing manual therapy techniques to the lumbosacral spine and plantar fascia. In addition, the neurodynamic flossing targeted lateral plantar nerve mobility. Case presentation The patient is a 54-year-old African American female seen for right heel pain at Texas’s outpatient orthopedic physical therapy clinic. The patient had the diagnosis of plantar fasciopathy with negative Windlass testing. The patient was provided manual therapy interventions to the lumbosacral spine and plantar fascia to improve weight-bearing patterns and overall functional outcomes. Conclusion The manual therapy interventions to the lumbosacral spine and plantar fascia and flossing techniques to the lateral plantar nerve improved symptoms of heel pain. The patient showed improved outcomes with this approach.

Frequency of plantar fasciitis due to improper shoes among different universities students

Back ground: study was conducted to determine the frequency of plantar fasciitis among three different universities students due to improper shoes. It was cross-sectional study. Plantar fasciitis is the inflammation of plantar fascia; plantar fascia is a thick connective tissue that forms the medial arch of foot. Improper shoes cause constant pressure and irritation on plantar fascia that leads to inflammation. When someone wears improper shoes, pronation activity of the foot decreased and it can lead to plantar fasciitis. Objective: The objective of study was to determine the frequency of plantar fasciitis due to improper shoes among three different universities students. Material and Methods: Study was cross-sectional and the data was collected from university students. Data was collected by using questionnaire and by applying statistical procedures results were concluded. Results: There were the following results in this study as, 35.5% participants without pain, 45% with mild pain, 16% with moderate pain and 3.6% with severe pain. There were 84% participants with single etiology, 13% participants with multiple etiology and 3% participants with nerve entrapment. There were 31 participants with no pain, 49 participants with mild pain, 11 participants with moderate pain and 2 participants with severe pain between ages 20-25 years. And between ages 26-30 there were 29 participants with no pain, 27 with mild pain, 16 with moderate pain and 4 participants with severe pain. Conclusion: Study concluded that 55.6% participants were between ages of 20-25 years. 54.4% participants were females, 59.2% participants were with no pain, 84% participants were with single etiology that is plantar fasciopathy. There were mostly participants suffered with mild pain and only 3.6% participants showed response with severe pain. There were mostly participants suffered with single etiology and the number of affected participants with plantar fasciitis slightly increased with age.

Stretching and relaxing the plantar fascia may change plantar fascia thickness but not pressure pain thresholds: a cross-sectional study of patients with plantar fasciopathy

Background Despite the established relevance of ultrasonography and assessment of pressure pain thresholds in patients with plantar fasciopathy, patient and probe positioning has been mostly ignored and are not necessarily reported in research. The primary aim of this study was to compare plantar fascia thickness in stretched and relaxed positions in patients with plantar fasciopathy. The secondary aim was to compare plantar heel pressure pain thresholds in these positions. Methods In this cross-sectional study, we measured the plantar fascia thickness with ultrasonography, and localised pressure pain thresholds using pressure algometry of 20 patients with plantar fasciopathy. These were assessed bilaterally, with the plantar fascia in both a stretched and relaxed position. In the stretched position, toes were maximally dorsiflexed, while in the relaxed position participants’ feet were hanging freely over the end of the table. Results The plantar fascia of the most symptomatic foot was significantly thicker when stretched compared with the relaxed position (sagittal: mean difference 0.2 mm, 95%CI: 0.1–0.4, P = 0.013; frontal: mean difference − 0.27, 95%CI: − 0.49 to − 0.06, P = 0.014). The plantar fascia was significantly thinner in the frontal plane compared with the sagittal plane in both positions (stretched: mean difference − 0.2 mm, 95%CI: − 0.42 to − 0.03, P = 0.025; relaxed: mean difference − 0.3 mm, 95%CI:-0.49 to − 0.08, P = 0.008). There was no difference between pressure pain thresholds in stretched or relaxed positions in either foot (P > 0.4). Conclusions The plantar fascia was significantly thicker in a stretched compared with a relaxed position and in the sagittal compared with the frontal plane, but differences were smaller than the standard deviation. Pressure pain thresholds were not different between the positions. These results highlight the importance of how ultrasonography is performed and reported in research to allow for replication. Trial registration The study was pre-registered September 25th, 2017 on ClinicalTrials.gov (NCT03291665).

Outcomes of platelet-rich plasma for plantar fasciopathy: a best-evidence synthesis

Background Plantar fasciopathy (PF) is a very common disease, affecting about 1/10 people in their lifetime. Platelet-rich plasma (PRP) had been demonstrated to be useful in achieving helpful effects for plantar fasciopathy. The purpose of this study was to compare the pain and functional outcomes between PRP and corticosteroid (CS) or placebo for plantar fasciopathy through meta-analysis and provide the best evidence. Methods Literature was searched systematically to explore related studies that were published in Cochrane Library, PubMed, Embase, Medline, SpringerLink, OVID, and ClinicalTrials.gov. Articles regarding comparative research about the outcomes of PRP therapy and CS or placebo injection were selected. Data of pain and functional outcomes was extracted and imported into Reviewer Manager 5.3 to analyze. Results Thirteen RCTs were included and analyzed. Analysis results showed significant superiority of PRP in outcome scores when compared with CS (VAS: MD = − 0.85, P < 0.0001, I2 = 85%; AOFAS: MD = 10.05, P < 0.0001, I2 = 85%), whereas there is no statistical difference in well-designed double-blind trials (VAS: MD = 0.15, P = 0.72, I2 = 1%; AOFAS: MD = 2.71, P = 0.17, I2 = 0%). In the comparison of the PRP and the placebo, the pooled mean difference was − 3.76 (P < 0.0001, 95% CI = − 4.34 to − 3.18). Conclusions No superiority of PRP had been found in well-designed double-blind studies, whereas it is implied that the outcomes of PRP are better than placebo based on available evidence.

Local hyperalgesia, normal endogenous modulation with pain report beyond its origin: a pilot study prompting further exploration into plantar fasciopathy

Background and aimsPersistent tendinopathies were previously considered solely as peripheral conditions affecting the local tendinous tissue until quantitative sensory testing identified involvement of altered pain processing. In similar fashion, pain in patients with persistent plantar fasciopathy may also involve more than local tissue. The aim of this pilot study was to investigate potential differences in conditioned pain modulation and pressure and thermal pain thresholds, between individuals with PF and healthy pain-free controls, as a precursor to a larger-scale study.MethodsWe assessed 16 individuals with plantar fasciopathy and 11 pain-free controls. Plantar fasciopathy diagnosis was: palpation pain of the medial calcaneal tubercle or the proximal plantar fascia, duration ≥3 months, pain intensity ≥2/10, and ultrasound-measured plantar fascia thickness ≥4 mm. Quantitative sensory tests were performed locally at the plantar heel and remotely on the ipsilateral elbow. Assessments included pain thresholds for pressure, heat and cold, and conditioned pain modulation measured as change in local resting pressure pain threshold with cold water hand immersion. Participants rated pain intensity at pain threshold. Additionally, the area and distribution of plantar fasciopathy pain was drawn on a digital body chart of the lower limbs. Descriptive analyses were performed and between-group differences/effects expressed as standardised mean differences (d).ResultsThere was no conditioned pain modulation difference between participants with plantar fasciopathy and controls (d = 0.1). Largest effects were on local pressure pain threshold and reported pain intensity on pressure pain threshold (d > 1.8) followed by pain intensity for heat and cold pain thresholds (d = 0.3–1.5). According to the digital body chart, pain area extended beyond the plantar heel.ConclusionsThe unlikelihood of a difference in conditioned pain modulation yet a pain area extending beyond the plantar heel provide a basis for exploring altered pain processing in a larger-scale study.ImplicationsThis was the first study to investigate the presence of altered pain processing in individuals with plantar fasciopathy using a conditioned pain modulation paradigm and thermal pain thresholds. We found no indication of an altered pain processing based on these measures, however, patients rated pain higher on thresholds compared to controls which may be important to clinical practice and warrants further exploration in the future.