Rompe Jan D
OrthoTrauma Evaluation Center, Mainz, Germany.
Sports Med Arthrosc Rev. 2009 Jun;17(2):100-4. doi: 10.1097/JSA.0b013e3181a3d60e.
Plantar fasciopathy is the most common cause of plantar heel pain. Featuring pain and tenderness on the medial plantar aspect of the calcaneus, clinical diagnosis seems straightforward. The role of various management strategies should be considered in the light of the selflimiting nature of plantar fasciopathy with more than 80% of patients experiencing resolution within 12 months, regardless of management. As there are no data from high-quality, randomized, controlled trials that support the efficacy of surgical management, the most prudent approach is to employ conservative modalities first. Recently, several randomized, controlled trials proved efficacy of extracorporeal shockwave treatment after the failure of more common conservative methods. Shockwave treatment helped to avoid surgery and its associated risks such as transient swelling of the heel pad, calcaneal fracture, injury of the posterior tibial nerve or its branches, and flattening of the longitudinal arch with resultant midtarsal pain. Surgical treatment is therefore considered in only a small subset of patients with persistent, severe symptoms refractory to nonsurgical intervention for at least 6 to 12 months.
足底筋膜炎是足跟底部疼痛最常见的原因。其特征为跟骨内侧足底面疼痛和压痛，临床诊断似乎很简单。鉴于足底筋膜炎具有自限性，超过80%的患者无论接受何种治疗，都会在12个月内症状缓解，因此应考虑各种治疗策略的作用。由于缺乏高质量随机对照试验的数据支持手术治疗的疗效，最谨慎的方法是首先采用保守治疗方式。最近，几项随机对照试验证明，在更常见的保守方法失败后，体外冲击波治疗是有效的。冲击波治疗有助于避免手术及其相关风险，如足跟垫短暂肿胀、跟骨骨折、胫后神经或其分支损伤以及纵弓变平导致的中跗骨疼痛。因此，只有一小部分持续出现严重症状、经非手术干预至少6至12个月仍难治愈的患者才考虑手术治疗。
