The medical management of patients with chronic plantar fasciitis

BACKGROUND.

Plantar fasciitis is a common cause of under-surface heel pain with a lifetime prevalence of 10%, and arises from dysrepair of the plantar fascia leading to abnormal thickening and structure.(1-3) Whilst most cases will settle over 6-12 months, a significant proportion of patients will go on to have much longer symptoms.(4-6) A wide range of treatment options for patients with plantar fasciitis exist, with a variable evidence base for their use.(2, 7)

METHODS.

This thesis first reviews the evidence base for a range of treatment options for patients with plantar fasciitis. Following this review, the thesis describes of six clinical studies, involving nearly 300 participants, investigating the outcomes for patients with plantar fasciitis, who were treated in a single secondary care NHS hospital clinic in the UK, with three different interventions: Tension Night Splint (TNS), radial-Extra-Corporeal Shockwave Therapy (rESWT), or Autologous Blood Injection (ABI). Each intervention has a pair of experimental studies: a case series study, followed by a randomised controlled trial. Additionally, the results following rESWT and ABI are compared in a prospective cohort study using data from the interventional RCTs to assess if differences occur between these two, relatively new, interventions.

RESULTS.

Results are available from the three RCTs comparing the different studied interventions against control groups. Although a number of within-group differences were seen, the time*group ANOVA analyses for each of the three RCT studies has failed to demonstrate any significant differences between the intervention and control groups at any time-point studied.

DISCUSSION.

The results from the clinical studies presented here demonstrate significant improvements from baseline in a number of the outcome measures studied, however they did not show significant differences between the intervention and control groups in any of the three RCTs. These studies have failed to demonstrate effectiveness of any of these three treatments in the management of patients with chronic plantar fasciitis treated in this department which raises important questions about effective treatment options in this condition.

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