The Science of Plantar Fasciitis

This is the same collection of medical science we reference in the office while trying to understand plantar fasciitis and heel pain. We keep this list curated and up to date. We also provide an easy-to-understand summary of the science study so anyone can quickly get an idea of the results or points. We urge you to not stop at our summarization and to continue reading the medical science publications for yourself.

High-load strength training improves outcome in patients with plantar fasciitis

Link: http://www.ncbi.nlm.nih.gov/pubmed/25145882


The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P=0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P>0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function.

A prospective study on time to recovery in 254 injured novice runners.

Link: http://www.ncbi.nlm.nih.gov/pubmed/24923269


OBJECTIVE: Describe the diagnoses and the time to recovery of running-related injuries in novice runners.

DESIGN: Prospective cohort study on injured runners.

METHOD: This paper is a secondary data analysis of a 933-person cohort study (DANO-RUN) aimed at characterizing risk factors for injury in novice runners. Among those sustaining running-related injuries, the types of injuries and time to recovery is described in the present paper. All injured runners were diagnosed after a thorough clinical examination and then followed prospectively during their recovery. If they recovered completely from injury, time to recovery of each injury was registered.

RESULTS: A total of 254 runners were injured. The proportion of runners diagnosed with medial tibial stress syndrome was 15%, 10% for patellofemoral pain, 9% for medial meniscal injury, 7% for Achilles tendinopathy and 5% for plantar fasciitis. Among the 220 runners (87%) recovering from their injury, the median time to recovery was 71 days (minimum =9 days, maximum =617 days).

CONCLUSIONS: Medial tibial stress syndrome was the most common injury followed by patellofemoral pain, medial meniscal injury and Achilles tendinopathy. Half of the injured runners were unable to run 2x500 meters without pain after 10 weeks. Almost 5% of the injured runners received surgical treatment.

Considerations in footwear and orthotics.

Link: http://www.ncbi.nlm.nih.gov/pubmed/24209730


This article is based on educating readers and physicians about the use of footwear and orthotics for themselves and their patients, to treat diseases and enhance functionality in sports and daily life.

High-load strength training improves outcome in patients with plantar fasciitis

Link: http://www.ncbi.nlm.nih.gov/pubmed/25145882


OBJECTIVE: To evaluate the effect of different methods of physical therapy on plantar fasciitis.

METHODS: From June 2009 to March 2012,30 patients with plantar fasciitis were randomly divided into 3 groups including phonophoresis (PH) combined with stretching exercise, ultrasound (US) combined with stretching exercise,stretching exercise, 10 patiens in each group. In stretching exercise group, there were 2 males and 8 females with an average age of (46.7+/-6.5) years old,the mean constitutional index duration was (26.7+/-2.8) kg/m2. In US combined with stretching exercise group, there were 4 males and 6 females with an average age of (45.8+/-6.1) years old,the mean constitutional index duration was (26.4+/-3.4) kg/m2. In PH combined with stretching exercise group,there were 3 males and 7 females with an average age of (48.4+/-8.0) years old,the mean constitutional index duration was (25.4+/-3.0) kg/m2. Patients in PH and US were treated for 10 min everyday by ultrasound, 5 times per week, lasted for 4 weeks; and patients by ultrasound therapy in PH were treated with diclofenac diethylamine at the same time. All the 30 patients received instruction for stretching exercises at home. Pain and ability to function were evaluated before treatment, immediately afterwards,and three months later. Morning pain was evaluated by VAS, and the sub-scale of FFI evaluated the affected foot function.

RESULTS: Patients’s general status and original pain state of plantar fasciitis before treatment had no significant difference among three groups. There were statistical differences of morning pain and FFI-disability score between PH group and stretching exercise group at 1 month (P<0.05), and no statistical differences among three groups at 3 months (P>0.05). Compared with before therapy,the pain and disability score of three groups significantly improved in the three points of time (P<0.05).

CONCLUSION: Stretching exercises and combining with PH or US are effective for pain and disability in patients with plantar fasciitis and that addition of PH to exercise therapy betters the effectiveness.

Diagnosis of heel pain.

Link: http://www.ncbi.nlm.nih.gov/pubmed/22010770


Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest. Other causes of plantar heel pain include calcaneal stress fracture (progressively worsening pain following an increase in activity level or change to a harder walking surface), nerve entrapment (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), neuromas, and plantar warts. Achilles tendinopathy is a common condition that causes posterior heel pain. Other tendinopathies demonstrate pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to a Haglund deformity, a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease, a calcaneal apophysitis in children. Medial midfoot heel pain, particularly with continued weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. The syndrome manifests as lateral midfoot heel pain. Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated.

Foot injuries in runners.

Link: http://www.ncbi.nlm.nih.gov/pubmed/23531971


Injuries of the foot are common among both elite and recreational runners. Overuse accounts for most of these injuries. Plantar fasciitis and tendinopathies of the midfoot and forefoot have a high incidence in running athletes. These injuries may present with significant pain but often resolve with rest and rehabilitation. Bone injuries caused by overuse also have a high prevalence among runners. The metatarsals, tarsal navicular, and sesamoids are most at risk for stress damage. Most running injuries are self-limited and pose little detriment if diagnosis is delayed. Navicular and sesamoid stress fractures may impart significant long-term consequences, and thus, a clinical suspicion of either fracture warrants definitive diagnosis and treatment. Barefoot running recently has garnered increased attention, but currently, there is a lack of prospective studies regarding its injury reduction.

Trigger point therapy and plantar heel pain: A case report.

Link: http://www.ncbi.nlm.nih.gov/pubmed/21030246


The cause of plantar heel pain and fasciitis has continued to be a diagnostic challenge even though it is one of the most common musculoskeletal disorders of the foot and ankle. The subject has evoked strong emotions and sparked intense debate regarding the likely causes and effective treatment options. Myofascial trigger point as a treatment option for plantar heel pain and fasciitis has been inconspicuous. The full extent of its significance and potential is largely unexplored in podiatric literature and medicine. Myofascial trigger point may offer an alternative explanation of the etiology of plantar heel pain and fasciitis.

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