Plantar Fasciitis: An Updated Review

Abstract

Plantar fasciitis (PF) is a common musculoskeletal disease. Histologic findings of patients with PF showed mainly chronic degenerative processes rather than inflammation. In addition to mechanical factors, such as repetitive stress and reduced ankle dorsiflexion, PF is also linked to rheumatologic diseases and genetic factors. Ultrasound is becoming a standard imaging technique for assessing PF. Major sonographic findings included increased plantar fascia thickness and hypoechoic plantar fascia. In addition to traditional B-mode ultrasound, sonoelastography can also be utilized to diagnose PF. Ultrasound can also be used to guide therapeutic interventions. Over 80% of patients with PF improved under nonsurgical treatment. Treatment options for PF include physical therapy, modalities (laser, therapeutic ultrasound), extracorporeal shock wave therapy (ESWT), injections, transcatheter arterial embolization, and surgery. For injections, corticosteroid was mostly used in the past but has been replaced gradually by other techniques such as platelet-rich plasma or dextrose prolotherapy. There is also more and more evidence about ESWT in treating PF. Surgery serves as an option for recalcitrant PF cases, and endoscopic fasciotomy seemed to have good outcomes. Ultrasound plays an important role in diagnosing of PF and evaluating the treatment effect, and the use of sonoelastography in addition to traditional B-mode ultrasound may help in the early detection of PF and assessment of the treatment effect.

A Review of Common Interventions and Preventive Options Used in the Treatment of Plantar Fasciitis

“…Based on the research, X-rays are useful diagnostic techniques for excluding acute osseous abnormalities, such as calcaneal stress fractures, that might cause heel discomfort [7]. Moreover, an MRI can help rule out other pathologies in cases with unusual or resistant heel pain, such as calcaneal edema, plantar fascia tears, or arteriovenous malformations [18]. Differential diagnosis of PF can be conducted from aspects of skeletal orign, soft tissue orign, and neurogenic orign [1].…”

“…After using a pressure meter, heel pain was reduced to excellent or good, and the visual analog scale (VAS) score was lowered by 60% throughout everyday activities and the first step of the morning [24]. In addition, a network meta-analysis comprising 19 trials demonstrated that ESWT significantly reduced pain in the short term (<6 weeks) and intermediate term (2-4 months) when compared to placebo [18]. According to another recent RCT, patients with thinner plantar fascia reported less pain following ESWT, and both the highintensity (0.56 mJ/mm2) and low-intensity (0.12 mJ/mm2) groups showed comparable improvements in pain and function [18].…”

“…In addition, a network meta-analysis comprising 19 trials demonstrated that ESWT significantly reduced pain in the short term (<6 weeks) and intermediate term (2-4 months) when compared to placebo [18]. According to another recent RCT, patients with thinner plantar fascia reported less pain following ESWT, and both the highintensity (0.56 mJ/mm2) and low-intensity (0.12 mJ/mm2) groups showed comparable improvements in pain and function [18]. Nevertheless, additional research is still required to determine the ideal ESWT regimen for treating PF because of the significant heterogeneity in pertinent studies.…”

Comparison of the Short-Term Effect between Iontophoresis and Radial Extracorporeal Shockwave Therapy in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial

“…Although the diagnosis of this chronic degenerative process is simple and clinical, a differential diagnosis with other pathologies (skeletal origin, soft tissue origin, or neurogenic origin) needs to be carried out in order to provide adequate treatment. The diagnosis is based on the patient’s symptoms, and after 8 weeks of pain it is to be considered chronic PF; this is also the case if the ultrasound image shows a degenerate, hypoechogenic (low brightness intensity of the image of the plantar fascia related to ultrasound waves and associated with pain), and thick fascia [ 3 ].…”

“…There are different treatment modalities for plantar fasciitis that must be taken into account in the therapeutic treatment plan, starting with conservative measures and ending with long-term surgical management, such as Achilles’ lengthening [ 3 ]. The conservative treatments are the first option, and these include plantar orthoses [ 4 , 5 ], muscle stretching [ 6 , 7 ], functional taping [ 8 ], radial extracorporeal shockwave therapy (rESWT) [ 9 , 10 , 11 ], laser therapy [ 12 ], systemic pharmacological therapy [ 13 ], and percutaneous injection [ 14 , 15 ].…”