Hansen Liselotte, Krogh Thøger Persson, Ellingsen Torkell, Bolvig Lars, Fredberg Ulrich
Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.
Department of Rheumatology, Odense University Hospital, Odense, Denmark.
Orthop J Sports Med. 2018 Mar 6;6(3):2325967118757983. doi: 10.1177/2325967118757983. eCollection 2018 Mar.
Plantar fasciitis (PF) affects 7% to 10% of the population. The long-term prognosis is unknown.
Our study had 4 aims: (1) to assess the long-term prognosis of PF, (2) to evaluate whether baseline characteristics (sex, body mass index, age, smoking status, physical work, exercise-induced symptoms, bilateral heel pain, fascia thickness, and presence of a heel spur) could predict long-term outcomes, (3) to assess the long-term ultrasound (US) development in the fascia, and (4) to assess whether US-guided corticosteroid injections induce atrophy of the heel fat pad.
Cohort study; Level of evidence, 3.
From 2001 to 2011 (baseline), 269 patients were diagnosed with PF based on symptoms and US. At follow-up (2016), all patients were invited to an interview regarding their medical history and for clinical and US re-examinations. Kaplan-Meier survival estimates were used to estimate the long-term prognosis, and a multiple Cox regression analysis was used for the prediction model.
In all, 174 patients (91 women, 83 men) participated in the study. All were interviewed, and 137 underwent a US examination. The mean follow-up was 9.7 years from the onset of symptoms and 8.9 years from baseline. At follow-up, 54% of patients were asymptomatic (mean duration of symptoms, 725 days), and 46% still had symptoms. The risk of having PF was 80.5% after 1 year, 50.0% after 5 years, 45.6% after 10 years, and 44.0% after 15 years from the onset of symptoms. The risk was significantly greater for women ( < .01) and patients with bilateral pain ( < .01). Fascia thickness decreased significantly in both the asymptomatic and symptomatic groups ( < .01) from 6.9 mm and 6.7 mm, respectively, to 4.3 mm in both groups. Fascia thickness ( = .49) and presence of a heel spur ( = .88) at baseline had no impact on prognosis. At follow-up, fascia thickness and echogenicity had normalized in only 24% of the asymptomatic group. The mean fat pad thickness was 9.0 mm in patients who had received a US-guided corticosteroid injection and 9.4 mm in those who had not been given an injection ( = .66).
The risk of having PF in this study was 45.6% at a mean 10 years after the onset of symptoms. The asymptomatic patients had PF for a mean 725 days. The prognosis was significantly worse for women and patients with bilateral pain. Fascia thickness decreased over time regardless of symptoms and had no impact on prognosis, and neither did the presence of a heel spur. Only 24% of asymptomatic patients had a normal fascia on US at long-term follow-up. A US-guided corticosteroid injection did not cause atrophy of the heel fat pad. Our observational study did not allow us to determine the efficacy of different treatment strategies.
足底筋膜炎（PF）影响7%至10%的人群。其长期预后尚不清楚。
我们的研究有4个目标：（1）评估PF的长期预后；（2）评估基线特征（性别、体重指数、年龄、吸烟状况、体力工作、运动诱发症状、双侧足跟疼痛、筋膜厚度和足跟骨刺的存在）是否可预测长期结果；（3）评估筋膜的长期超声（US）变化；（4）评估超声引导下皮质类固醇注射是否会导致足跟脂肪垫萎缩。
队列研究；证据等级，3级。
2001年至2011年（基线期），269例患者根据症状和超声诊断为PF。在随访期（2016年），邀请所有患者进行病史访谈，并进行临床和超声复查。采用Kaplan-Meier生存估计来评估长期预后，并采用多因素Cox回归分析建立预测模型。
共有174例患者（91例女性，83例男性）参与研究。所有患者均接受了访谈，137例接受了超声检查。从症状出现起平均随访9.7年，从基线期起平均随访8.9年。随访时，54%的患者无症状（症状平均持续时间725天），46%的患者仍有症状。从症状出现起，1年后患PF的风险为80.5%，5年后为50.0%，10年后为45.6%，15年后为44.0%。女性（P<0.01）和双侧疼痛患者（P<0.01）的风险显著更高。无症状组和有症状组的筋膜厚度均显著降低（P<0.01），分别从6.9mm和6.7mm降至两组均为4.3mm。基线时筋膜厚度（P=0.49）和足跟骨刺的存在（P=0.88）对预后无影响。随访时，无症状组中只有24%的患者筋膜厚度和回声正常。接受超声引导下皮质类固醇注射的患者平均脂肪垫厚度为9.0mm，未接受注射的患者为9.4mm（P=0.66）。
本研究中，症状出现后平均10年时患PF的风险为45.6%。无症状患者患PF的平均时间为725天。女性和双侧疼痛患者的预后明显更差。无论有无症状，筋膜厚度随时间均降低，且对预后无影响，足跟骨刺的存在也无影响。长期随访时，无症状患者中只有24%的患者超声显示筋膜正常。超声引导下皮质类固醇注射未导致足跟脂肪垫萎缩。我们的观察性研究无法确定不同治疗策略的疗效。
