Wrobel James S, Fleischer Adam E, Matzkin-Bridger Jonathon, Fascione Jeanna, Crews Ryan T, Bruning Nicholas, Jarrett Beth
University of Michigan Medical School, Domino's Farm, Lobby G, Suite 1500, 24 Frank Lloyd Wright Dr., Ann Arbor, MI 48105(∗).
Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL(†).
PM R. 2016 May;8(5):436-44. doi: 10.1016/j.pmrj.2015.09.011. Epub 2015 Sep 25.
Plantar fasciitis is a common, disabling condition, and the prognosis of conservative treatment is difficult to predict.
To determine whether initial clinical findings could help predict patient response to conservative treatment that primarily consisted of supportive footwear and stretching.
Patients were recruited and seen at 2 outpatient podiatric clinics in the Chicago, Illinois, metropolitan area.
Seventy-seven patients with nonchronic plantar fasciitis were recruited. Patients were excluded if they had a heel injection in the previous 6 months or were currently using custom foot orthoses at the time of screening. Sixty-nine patients completed the final follow-up visit 3 months after receiving the footwear intervention.
Treatment failure was considered a <50% reduction in heel pain at 3 month follow-up. Logistic regression models evaluated the possible association between more than 30 clinical and physical examination findings prospectively assessed at enrollment, and treatment response.
Inability to dorsiflex the ankle past -5° (odds ratio [OR] 3.9, P = .024), nonsevere (≤7 on ordinal scale) first-step pain (OR 3.8, P = .021), and heel valgus in relaxed stance (OR 4.0, P = .014) each predicted treatment failure in multivariable analysis (receiver operating characteristic area under the curve = .769). Limited ankle dorsiflexion also correlated with greater heel pain severity at initial presentation (r = - 0.312, P = .006).
Patients with severe ankle equinus were nearly 4 times more likely to experience a favorable response to treatment centered on home Achilles tendon stretching and supportive therapy. Thus, earlier use of more advanced therapies may be most appropriate in those presenting without severe ankle equinus or without severe first step pain. The findings from our study may not be clinically intuitive because patients with less severe equinus and less severe pain at presentation did worse with conservative care.
足底筋膜炎是一种常见的致残性疾病，保守治疗的预后难以预测。
确定初始临床检查结果是否有助于预测患者对主要包括支撑性鞋具和拉伸治疗的保守治疗的反应。
在伊利诺伊州芝加哥市大都会区的2家门诊足病诊所招募并诊治患者。
招募了77例非慢性足底筋膜炎患者。如果患者在过去6个月内进行过足跟注射或在筛查时正在使用定制足部矫形器，则将其排除。69例患者在接受鞋具干预3个月后完成了最终随访。
治疗失败定义为随访3个月时足跟疼痛减轻<50%。逻辑回归模型评估了入组时前瞻性评估的30多项临床和体格检查结果与治疗反应之间的可能关联。
踝关节背屈不能超过-5°（优势比[OR] 3.9，P = 0.024）、非重度（顺序量表评分≤7）的第一步疼痛（OR 3.8，P = 0.021）以及放松站立时足跟外翻（OR 4.0，P = 0.014）在多变量分析中均预测治疗失败（曲线下面积=0.769）。踝关节背屈受限也与初始表现时更严重的足跟疼痛程度相关（r = -0.312，P = 0.006）。
重度马蹄足患者对以家庭跟腱拉伸和支持性治疗为中心的治疗产生良好反应的可能性几乎高出近4倍。因此，对于没有重度马蹄足或没有重度第一步疼痛的患者，更早使用更先进的治疗方法可能最为合适。我们研究的结果在临床上可能不直观，因为表现为较轻马蹄足和较轻疼痛的患者在保守治疗中效果较差。
