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Thickness of plantar fascia is not predictive of functional outcome in plantar fasciitis treatment

PainSci » bibliography » Ermutlu et al 2018
Tags: diagnosis, plantar fasciitis, foot, leg, limbs, pain problems, overuse injury, injury, tendinosis

Two articles on PainSci cite Ermutlu 2018: 1. Complete Guide to Plantar Fasciitis2. Plantar Fasciitis Patients Have Thick Soles

PainSci notes on Ermutlu 2018:

This 2018 study tested two different therapies (steroid injection and ultrasound) while also considering plantar fascia thickness. Basically they wanted to know if thicker fascia made the condition harder to treat. They expected it to be, but it was not. Surprise! Some people with the thickest fascia did well, and some with thinner fascia did poorly. And more thinning in response to treatment didn’t always lead to the best outcomes. “Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool.”

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: The aim of this study was to define a quantitative parameter to indicate which cases of plantar fasciitis will benefit from local corticosteroid injection or ESWT and to compare the efficacy of two different treatment modalities.

METHODS: Seventy patients (mean age: 49.10; range: 41-58) with chronic plantar fasciitis unresponsive to conservative treatment for 3 months were treated with either betamethasone injection or extracorporeal shock wave therapy (ESWT). Correlation between AOFAS scores, fascia thickness, duration of symptoms, age and calcaneal spur length were assessed.

RESULTS: Degree of fascial thickening (mean 4.6 mm for all patients) did not influence baseline AOFAS scores (r = -0.054). Plantar fascia thickness significantly decreased in both groups after treatment (1.2 mm for steroid, 1.2 mm for ESWT) (p < 0.01 for both groups). Percentage of change in AOFAS scores (68% for steroid and 79% for ESWT, p = 0.069) and fascial thickness (24% for steroid and 26% for ESWT, p = 0.344) were similar between two groups. Functional recovery was not correlated with baseline fascial thickness (r = 0.047) or degree of fascial thinning after treatment (r = -0.099). Percentage of change in AOFAS scores was correlated only with baseline AOFAS scores (r = -0.943).

CONCLUSIONS: Plantar fascia thickness increases significantly in plantar fasciitis and responds to treatment. Both ESWT and betamethasone injection are effective in alleviating symptoms and reducing plantar fascia thickness in chronic plantar fasciitis. However, the only predictive factor for functional recovery in terms of AOFAS scores is patients' functional status prior to treatment. Measuring of plantar fascia is not helpful as a diagnostic or prognostic tool and MRI imaging should be reserved for differential diagnosis.

LEVEL OF EVIDENCE: Level III, Therapeutic study.

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