A Prospective Randomized Controlled Trial Comparing Physical Therapy With Independent Home Stretching for Plantar Fasciitis

Kaiser, Philip; Keyser, Cornelia; Crawford, Alexander M; Bluman, Eric M.; Smith, Jeremy T.; Chiodo, Christopher P.

doi:10.5435/jaaos-d-21-00009

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…Among 30 patients randomized to undergo home stretching and 27 randomized to undergo physical therapy guided by a physical therapist, home stretching improved average VAS pain scores at 6 weeks (23-point decrease; P < .001) and 1 year (28-point decrease; P < .001) (Figure 2C). VAS scores were not significantly different between home stretching and physical therapy groups at any points . The minimal clinically important difference (MCID) for plantar heel pain is −8 mm (95% CI, −12 to −4) on a VAS …”

Section: Discussionmentioning

confidence: 87%

“…VAS scores were not significantly different between home stretching and physical therapy groups at any points. 24 The minimal clinically important difference (MCID) for plantar heel pain is −8 mm (95% CI, −12 to −4) on a VAS. 25 Foot orthoses replace the insole of the patient's shoe to decrease strain on the plantar fascia and reduce ground reaction forces beneath the calcaneal tuberosity.…”

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confidence: 99%

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Common Painful Foot and Ankle Conditions

Cooper

2023

JAMA

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ImportanceMorton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to nonoperative treatment.ObservationsMorton neuroma, consisting of interdigital neuronal thickening and fibrosis, is characterized by burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes (commonly the third and fourth toes). First-line nonoperative therapy consists of reducing activities that cause pain, orthotics, and interdigital corticosteroid injection; however, approximately 30% of patients may not respond to conservative treatment. Plantar fasciitis accounts for more than 1 million patient visits per year in the US and typically presents with plantar heel pain. Fifteen years after diagnosis, approximately 44% of patients continue to have pain. First-line nonoperative therapy includes stretching of the plantar fascia and foot orthotics, followed by extracorporeal shockwave therapy, corticosteroid injection, or platelet-rich plasma injection. Midportion Achilles tendinopathy presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel. The primary nonoperative treatment involves eccentric strengthening exercises, but extracorporeal shockwave therapy may be used.Conclusions and RelevanceMorton neuroma, plantar fasciitis, and Achilles tendinopathy are painful foot and ankle conditions. First-line therapies are activity restriction, orthotics, and corticosteroid injection for Morton neuroma; stretching and foot orthotics for plantar fasciitis; and eccentric strengthening exercises for Achilles tendinopathy.

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Section: Discussionmentioning

confidence: 87%

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confidence: 99%

Common Painful Foot and Ankle Conditions

Cooper

2023

JAMA

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“…Patients were randomly divided into 2 equal-sized groups using the simple-randomization opaque sealed-envelope technique. 6 , 10 On obtaining verbal consent for study participation, a research assistant opened an envelope containing the group allocation and then notified the surgical team of group assignment. Patients were randomized to either the PRiSM group or the Traditional group.…”

Section: Methodsmentioning

confidence: 99%

Carbon Footprint of Minor Foot and Ankle Surgery: A Randomized Controlled Trial

Parker,

Bluman,

Chiodo

et al. 2024

Foot & Ankle Orthopaedics

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Background: Climate change poses a substantial threat to human health, and operating rooms (ORs) have an outsized environmental impact. The Program for Research in Sustainable Medicine (PRiSM) designed a protocol for minor foot and ankle surgery intended to reduce waste, streamline instrument trays, and minimize laundry. We conducted a randomized controlled trial to compare the carbon footprint of procedures performed using the PRiSM protocol vs a traditional protocol. Methods: Forty adult patients undergoing foreign body removal, hammertoe correction, toe amputation, hardware removal, mass excision, or gastrocnemius recession were randomized to the PRiSM or our “Traditional” protocol. The PRiSM protocol used a smaller instrument tray, fewer drapes and towels, and minimal positioning blankets. No changes were made to surgical site preparation or operative techniques. Environmental impact was estimated using the carbon footprint, measured in kilograms of carbon dioxide equivalents (CO2e). Emissions associated with OR waste, instrument processing, and laundry were calculated. Results: On average, PRiSM cases had a smaller carbon footprint than Traditional cases (17.3 kg CO2e [SD = 3.2] vs 20.6 kg CO2e [SD = 2.0], P < .001). Waste-associated emissions from PRiSM cases were reduced (16.0 kg CO2e [SD = 2.7] vs 18.4 kg CO2e [SD = 1.8], P = .002), as were modeled instrument processing–related emissions (0.34 vs 0.91 kg CO2e). One superficial surgical site infection occurred in each group. Conclusion: We found a small but statistically significant reduction in the environmental impact of minor foot and ankle surgery when using the PRiSM vs Traditional protocol. The environmental impact of these cases was dominated by plastic waste–related emissions. Orthopaedic surgeons should think critically about what components of their surgical setup are truly necessary for patient care, as minor changes in product utilization can have significant impacts on waste and greenhouse gas emissions. Level of Evidence: Level I, randomized controlled trial.

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“…At 6 months after the injection, both groups demonstrated significant and similar improvements in the VAS pain scores and the Foot and Ankle Disability Index health-related quality-of-life scores compared with baseline. Kaiser et al 13 performed a prospective randomized controlled trial comparing a 6-week formal physical therapy program (27 patients) with a 6-week home stretching program (30 patients) for the treatment of plantar fasciitis. At 6 months, both groups significantly and identically improved from baseline in terms of VAS pain scores, Foot and Ankle Ability Measure scores, and Short Form-36 (SF-36) scores, and results were maintained through the 1-year follow-up.…”

Section: Hindfootmentioning

confidence: 99%