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脚底筋膜炎的成因？以及如何康复？
结论先行： 脚底筋膜炎（Plantar Fasciitis）本质上不是一种简单的“发炎”，而更像是脚底那根“大橡皮筋”因为长期过度拉扯而出现了劳损和退化。好消息是，90%的患者不需要手术，仅靠保守治疗（如休息、拉伸、换鞋、鞋垫等）就能在几个月内好转 。康复的核心策略是“先减负，后强化”：急性期通过休息和矫形鞋垫减少脚底受力，缓解疼痛；稳定期通过针对性的小腿和脚底肌肉力量训练（特别是高负荷力量训练），让这根“橡皮筋”重新变得强韧 。
以下为您详细拆解其成因与具体的康复方案。
一、 什么是脚底筋膜炎？（它为什么这么痛？）
想象一下，你的脚底有一层厚厚的、像牛筋一样的白色结缔组织，它从脚后跟一直连到脚趾根部，这就是足底筋膜。它的作用像一张弓的弦，支撑着脚底的拱形结构（足弓），在你走路、跑步时像弹簧一样吸收地面的冲击力。
典型的症状是什么？ 最经典的表现是“早晨第一步痛”：当你早晨起床下地走第一步，或者坐了很久突然站起来时，脚后跟内侧会有剧烈的刺痛感 。这是因为在休息时，受损的筋膜处于缩短状态，当你突然站立，体重瞬间压下来，这根刚开始愈合或僵硬的“橡皮筋”被猛烈拉伸，从而产生剧痛。走几步后，筋膜被拉开了，疼痛通常会减轻，但如果站立或走路太久，疼痛又会回来 。
二、 它是怎么得的？（成因与风险因素）
虽然名字里带有“炎”字，但现代医学研究发现，很多慢性患者的组织切片里并没有发现很多炎症细胞，反而是组织的退化和胶原蛋白排列紊乱 。简单说，就是脚底这根“弦”用得太狠，出现了微小的撕裂，而身体来不及修复，导致它变得脆弱、变厚 。
主要有以下几个“罪魁祸首”导致了这种过载：
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体重压力（超重/肥胖）： 这是最直接的原因。高体重指数（BMI）会显著增加患病风险 。因为你走的每一步，脚底都要承受数倍于体重的冲击力，体重越大，“橡皮筋”崩得越紧。
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小腿太紧（脚踝灵活性差）： 这是很多人忽视的原因。如果你小腿肚子的肌肉（腓肠肌）太紧，会导致脚踝向上勾（背屈）的角度受限。为了完成走路动作，身体会强迫足底筋膜过度拉伸来代偿，久而 be之就拉伤了 。
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过度使用（长时间站立或运动）： 长时间站立工作者（如教师、厨师），或者跑步爱好者（尤其是突然增加跑量时），脚底筋膜长期处于高张力状态，没有足够的时间休息恢复 。
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脚的结构问题： 扁平足（塌陷的足弓会过度拉扯筋膜）或高足弓（足弓太高导致避震能力差），都容易诱发此病 。
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年龄因素： 最常见于 40岁到70岁 的人群 。随着年龄增长，足底的脂肪垫（脚后跟天然的肉垫）会萎缩变薄，缓冲能力下降，筋膜更容易受损 。
辟谣：关于“骨刺” 很多人拍X光片发现脚后跟有“骨刺”（跟骨骨刺），就以为是骨刺扎着肉痛。其实，骨刺更多是长期筋膜拉扯的结果，而不是疼痛的原因。很多有骨刺的人脚并不痛，而很多脚底筋膜炎患者并没有骨刺 。所以，治疗重点是修复软组织，而不是去切除骨刺。
三、 如何康复？（科学的行动指南）
康复过程需要耐心，因为足底筋膜血液供应较差，恢复较慢，通常需要几个月的时间。
第一阶段：急性期管理（痛得厉害时怎么办？）
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休息与调整活动（Activity Modification）： 这是最重要的一步。如果是因为跑步引起的，必须暂停或减少跑量。避免长时间站立。给受损组织喘息的机会 。
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换双好鞋与鞋垫（Orthotics）： 不要穿平底布鞋或硬底皮鞋。在鞋子里加一个能支撑足弓的鞋垫，或者使用后跟垫（Heel cup），可以有效减少筋膜的张力。对于扁平足患者，定制的矫形鞋垫效果更好 。
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冰敷按摩（Ice Massage）： 将一瓶矿泉水冻成冰，踩在脚底来回滚动按摩。这既能冰敷镇痛，又能轻微放松足底肌肉。每天几次，每次10-15分钟 。
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夜间夹板（Night Splints）： 如果你早晨第一步痛得非常厉害，可以尝试佩戴夜间夹板。这种装置能在你睡觉时把脚固定在90度，保持筋膜处于拉伸状态，避免它在夜间缩短僵硬，从而缓解晨起剧痛 。
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贴扎技术（Taping）： 使用肌内效贴（Kinesio tape）或动态贴布（Dynamic tape）对脚底进行贴扎，可以辅助支撑足弓，减轻疼痛并改善功能 。
第二阶段：核心康复训练（治本的关键）
当疼痛稍微缓解，必须开始进行拉伸和力量训练。如果不做这一步，疼痛很容易复发。
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足底筋膜特异性拉伸（这是最有效的拉伸动作）：
- 动作： 坐着，把患侧的腿架在另一条腿上（二郎腿姿势）。用手握住患侧脚的脚趾（特别是大脚趾），用力向小腿方向掰，直到感觉到脚底紧绷。用另一只手摸一下脚底紧绷的筋膜，确认拉伸到位。
- 频率： 每次保持10秒，重复10次，每天做3组。研究表明这对缓解疼痛非常有效 。
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小腿肌肉拉伸（针对“因”的治疗）：
- 动作： 面向墙壁站立，双手扶墙。做“弓箭步”，患腿在后，膝盖伸直，脚后跟不要离地，身体重心前移，感受小腿肚后方的强烈拉伸感。
- 频率： 每天坚持做，这能增加脚踝的灵活性，从源头减少对足底筋膜的拉扯 。
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高负荷力量训练（High-load Strength Training）—— 进阶必做： 如果你只是拉伸，效果可能不够持久。最新的高质量研究 发现，强化训练比单纯拉伸更能促进胶原蛋白重组，长期效果更好。
- 动作（毛巾提踵）： 赤脚站在台阶边缘，脚趾下方垫一条卷起来的毛巾（这很重要，毛巾能强迫脚趾背屈，拉紧筋膜）。脚后跟悬空。然后用脚尖的力量慢慢踮起脚尖（3秒上去），再慢慢放下（3秒下来），在最低点停留2秒。
- 强度： 这需要循序渐进。刚开始双脚做，后来单脚做，甚至可以背个书包增加重量。目标是每组做8-12次，感到肌肉酸胀为止。
第三阶段：针对顽固性疼痛（如果半年都没好）
如果以上自我治疗坚持了6个月还不好，医学上称为“顽固性足底筋膜炎”，可以考虑以下医疗手段：
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体外冲击波治疗（Shock Wave Therapy）： 这是一种利用声波能量的治疗仪。它像“隔山打牛”一样，将能量打入脚底深层组织。虽然打的时候可能会有点痛，但它能刺激局部微损伤，强迫身体启动修复机制，促进血管再生。大量研究证实，冲击波对于长期的、慢性的足底筋膜炎效果非常好，是仅次于保守治疗的首选进阶方案 。
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超声波治疗（Ultrasound）： 结合传统的物理治疗，超声波深层热疗也能帮助改善足底功能 。
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注射治疗（打封闭）： 医生可能会建议注射皮质类固醇（激素）。这能迅速消炎止痛，但不建议频繁使用。因为反复注射可能会导致脚后跟的脂肪垫萎缩（失去了天然缓冲垫），甚至增加筋膜断裂的风险 。
四、 总结
脚底筋膜炎虽然痛苦，但它是可以战胜的。
- 不要拖： 越早开始干预，恢复越快。
- 管住嘴，迈开腿（但要注意方式）： 控制体重，避免长时间连续站立。
- 坚持练： 拉伸小腿和抓毛巾/提踵训练是康复的基石，哪怕不痛了，坚持做也能预防复发。
- 求助医生： 如果自己练了几个月没用，去医院康复科尝试冲击波治疗，这是目前公认有效的非手术疗法。
只有极少数（约5%）经过一年以上所有保守治疗都无效的患者，才需要考虑手术松解筋膜 。
References
1Diagnosis and management of plantar fasciitis.PubMed
John V Thompson, Sundeep S Saini, Christopher W Reb, et al.
J Am Osteopath Assoc. 2014 Dec;114(12):900-6. doi: 10.7556/jaoa.2014.177.
Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a specialist may be necessary.
2Diagnosis and treatment of plantar fasciitis.PubMed
James D Goff, Robert Crawford
Am Fam Physician. 2011 Sep 15;84(6):676-82.
Plantar fasciitis, a self-limiting condition, is a common cause of heel pain in adults. It affects more than 1 million persons per year, and two-thirds of patients with plantar fasciitis will seek care from their family physician. Plantar fasciitis affects sedentary and athletic populations. Obesity, excessive foot pronation, excessive running, and prolonged standing are risk factors for developing plantar fasciitis. Diagnosis is primarily based on history and physical examination. Patients may present with heel pain with their first steps in the morning or after prolonged sitting, and sharp pain with palpation of the medial plantar calcaneal region. Discomfort in the proximal plantar fascia can be elicited by passive ankle/first toe dorsiflexion. Diagnostic imaging is rarely needed for the initial diagnosis of plantar fasciitis. Use of ultrasonography and magnetic resonance imaging is reserved for recalcitrant cases or to rule out other heel pathology; findings of increased plantar fascia thickness and abnormal tissue signal the diagnosis of plantar fasciitis. Conservative treatments help with the disabling pain. Initially, patient-directed treatments consisting of rest, activity modification, ice massage, oral analgesics, and stretching techniques can be tried for several weeks. If heel pain persists, then physician-prescribed treatments such as physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections should be considered. Ninety percent of patients will improve with these conservative techniques. Patients with chronic recalcitrant plantar fasciitis lasting six months or longer can consider extracorporeal shock wave therapy or plantar fasciotomy.
3Plantar fasciitis.PubMed
S Cutts, N Obi, C Pasapula, et al.
Ann R Coll Surg Engl. 2012 Nov;94(8):539-42. doi: 10.1308/003588412X13171221592456.
INTRODUCTION: In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major management options. We also review the literature and discuss the condition. METHODS: A literature search was performed using PubMed and MEDLINE(®). The following keywords were used, singly or in combination: 'plantar fasciitis', 'plantar heel pain', 'heel spur'. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken. FINDINGS: Plantar fasciitis is a common and often disabling condition. Because the natural history of plantar fasciitis is not understood, it is difficult to distinguish between those patients who recover spontaneously and those who respond to formal treatment. Surgical release of the plantar fascia is effective in the small proportion of patients who do not respond to conservative measures. New techniques such as endoscopic plantar release and extracorporeal shockwave therapy may have a role but the limited availability of equipment and skills means that most patients will continue to be treated by more traditional techniques.
4Plantar fasciitis: evaluation and treatment.PubMed
Steven K Neufeld, Rebecca Cerrato
J Am Acad Orthop Surg. 2008 Jun;16(6):338-46. doi: 10.5435/00124635-200806000-00006.
Plantar fasciitis is the most common cause of plantar heel pain. Its characteristic features are pain and tenderness, predominately on the medial aspect of the calcaneus near the sole of the heel. Considering a complete differential diagnosis of plantar heel pain is important; a comprehensive history and physical examination guide accurate diagnosis. Many nonsurgical treatment modalities have been used in managing the disorder, including rest, massage, nonsteroidal anti-inflammatory drugs, night splints, heel cups/pads, custom and off-the-shelf orthoses, injections, casts, and physical therapy measures such as shock wave therapy. Most reported treatment outcomes rely on anecdotal experience or combinations of multiple modalities. Nevertheless, nonsurgical management of plantar fasciitis is successful in approximately 90% of patients. Surgical treatment is considered in only a small subset of patients with persistent, severe symptoms refractory to nonsurgical intervention for at least 6 to 12 months.
5The pathomechanics of plantar fasciitis.PubMed
Scott C Wearing, James E Smeathers, Stephen R Urry, et al.
Sports Med. 2006;36(7):585-611. doi: 10.2165/00007256-200636070-00004.
Plantar fasciitis is a musculoskeletal disorder primarily affecting the fascial enthesis. Although poorly understood, the development of plantar fasciitis is thought to have a mechanical origin. In particular, pes planus foot types and lower-limb biomechanics that result in a lowered medial longitudinal arch are thought to create excessive tensile strain within the fascia, producing microscopic tears and chronic inflammation. However, contrary to clinical doctrine, histological evidence does not support this concept, with inflammation rarely observed in chronic plantar fasciitis. Similarly, scientific support for the role of arch mechanics in the development of plantar fasciitis is equivocal, despite an abundance of anecdotal evidence indicating a causal link between arch function and heel pain. This may, in part, reflect the difficulty in measuring arch mechanics in vivo. However, it may also indicate that tensile failure is not a predominant feature in the pathomechanics of plantar fasciitis. Alternative mechanisms including 'stress-shielding', vascular and metabolic disturbances, the formation of free radicals, hyperthermia and genetic factors have also been linked to degenerative change in connective tissues. Further research is needed to ascertain the importance of such factors in the development of plantar fasciitis.
6Calf stretching and plantar fascia-specific stretching for plantar fasciitis: A systematic review and meta-analysis.PubMed
Akkradate Siriphorn, Sukanya Eksakulkla
J Bodyw Mov Ther. 2020 Oct;24(4):222-232. doi: 10.1016/j.jbmt.2020.06.013. Epub 2020 Jul 30.
BACKGROUND: Plantar fasciitis (PF) is the most common cause of heel pain. A calf stretching (CS) and a plantar fascia-specific stretching (PFSS) are two stretching techniques commonly administered by health care providers. OBJECTIVE: To evaluate the literature on the application of these two stretching techniques in the treatment of PF and investigate their effectiveness and efficacy. METHOD: A search of PubMed, Web of Sciences, PEDro, CINHAL and Scopus was conducted. Studies that applied stretching as a co-intervention were excluded. The risk of bias was assessed to determine the internal validity of the included trials. The GRADE approach was adopted to determine the overall quality. Pooled analysis was performed to determine the treatment effects of CS and PFSS in terms of the mean difference in the visual analog scale pain score. RESULTS: Eight articles were found that represented randomized controlled trial and met the inclusion criteria. There was very low-quality evidence that the combined CS and PFSS was less effective in the short term than the other therapies. Comparison between CS and PFSS revealed moderate quality evidence for a larger effect of pain score reduction for PFSS treatment over CS, while very low-quality evidence supported that combined CS and PFSS or CS alone was superior to sham stretching. CONCLUSION: There was moderate to very low-quality evidence of the effectiveness of stretching for PF. The treatment effect of stretching was large and comparable to other therapies. Future trials of higher quality are needed to clarify findings or to confirm findings.
7Management of plantar fasciitis in the outpatient setting.PubMed
Ang Tee Lim, Choon How How, Benedict Tan
Singapore Med J. 2016 Apr;57(4):168-70; quiz 171. doi: 10.11622/smedj.2016069.
Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality.
8Plantar fasciitis: A review of treatments.PubMed
Lindsey Luffy, John Grosel, Randall Thomas, et al.
JAAPA. 2018 Jan;31(1):20-24. doi: 10.1097/01.JAA.0000527695.76041.99.
Plantar fasciitis is the most common cause of heel pain in the United States. Many treatments are available and differ in efficacy and cost. This article discusses the theorized causes for plantar fasciitis and various treatments.
9Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis.PubMed
Karrie L Hamstra-Wright, Kellie C Huxel Bliven, R Curtis Bay, et al.
Sports Health. 2021 May-Jun;13(3):296-303. doi: 10.1177/1941738120970976. Epub 2021 Feb 3.
CONTEXT: Plantar fasciitis (PF) is a common condition in active individuals. The lack of agreement on PF etiology makes treatment challenging and highlights the importance of understanding risk factors for preventive efforts. OBJECTIVE: The purpose of this systematic review and meta-analysis was to determine what factors may put physically active individuals at risk of developing PF. DATA SOURCES: CENTRAL, CINAHL, EMBASE, Gray Lit, LILACS, MEDLINE (PubMed), ProQuest, Scopus, SPORTDiscus, and Web of Science were searched through April 2018 and updated in April 2020. STUDY SELECTION: Studies were included if they were original research investigating PF risk factors, compared physically active individuals with and without PF, were written in English, and were accessible as full-length, peer-reviewed articles. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 3, because of inconsistent definitions and blinding used in the included observational studies. DATA EXTRACTION: Data on sample characteristics, study design and duration, groups, PF diagnosis, and risk factors were extracted. The methodological quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement. When means and standard deviations of a particular risk factor were presented 2 or more times, that risk factor was included in the meta-analysis. RESULTS: Sixteen studies were included in the systematic review and 11 risk factors in the meta-analysis. Increased plantarflexion range of motion (weighted mean difference [MD] = 7.04°; 95% CI, 5.88-8.19; < 0.001), body mass index (MD = 2.13 kg/m; 95% CI, 1.40-2.86; < 0.001; = 0.00%), and body mass (MD = 4.52 kg; 95% CI, 0.55-8.49; = 0.026) were risk factors for PF. CONCLUSION: Interventions focused on addressing a greater degree of plantarflexion range of motion, body mass index, and body mass and their load on the force-absorbing plantar surface structures may be a good starting point in the prevention and treatment of active individuals with PF.
10High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.PubMed
M S Rathleff, C M Mølgaard, U Fredberg, et al.
Scand J Med Sci Sports. 2015 Jun;25(3):e292-300. doi: 10.1111/sms.12313. Epub 2014 Aug 21.
The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch group) or shoe inserts and high-load progressive strength training (the strength group) performed every second day. High-load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow-ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6-52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9-36) in the strength group and 16 points (95% CI: 0-32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self-reported outcome after 3 months compared with plantar-specific stretching. High-load strength training may aid in a quicker reduction in pain and improvements in function.
11Effect of radial shock wave and ultrasound therapy combined with traditional physical therapy exercises on foot function and dorsiflexion range in plantar fasciitis: a prospective randomized clinical trial.PubMed
K Z Fouda, Z A Ali, R T Elshorbagy, et al.
Eur Rev Med Pharmacol Sci. 2023 May;27(9):3823-3832. doi: 10.26355/eurrev_202305_32287.
OBJECTIVE: This study aimed to assess the effect of radial shock wave and ultrasound therapy combined with traditional physical therapy on foot function and range of motion in chronic plantar fasciitis. PATIENTS AND METHODS: Sixty-nine participants with chronic plantar fasciitis (25-56 years) were allocated randomly into three groups. Group (A) received ultrasound (US) therapy plus conventional physical therapy exercises (in the form of stretching, strengthening exercise, and deep friction massage), Group (B) received a radial shock wave (RSW) therapy plus conventional physical therapy exercises, and Group (C) received a combination of both RSW and US therapy in addition to conventional physical therapy exercises, with 3 sessions per week for US therapy and one session for RSW therapy, in addition to 45 minutes of exercises for all groups for 4 consecutive weeks. Foot function was assessed using the foot function index (FFI), and ankle dorsiflexion range of motion was measured using the Baseline® bubble inclinometer at baseline and 4 weeks following treatment. RESULTS: ANOVA revealed significant differences (p<0.05) in the measured outcomes among the groups after treatment. Tukey's honest significant difference post-hoc test demonstrated a highly statistically significant (p<0.001) improvement in the assessed outcomes of group C in the post-intervention settings when compared to the other groups. After 4 weeks of intervention, the mean (SD) of FFI in groups A, B, and C were (64.54±4.91, 61.93±4.17, and 45.16±4.57) respectively, and the active range of motion (ROM) of the ankle dorsiflexion were (35.27±3.22, 36.59±2.91, and 41.85±3.04) respectively. CONCLUSIONS: The addition of RSW to US with the conventional physical therapy program improved foot function and ankle dorsiflexion range of motion significantly for patients with chronic plantar fasciitis.
12Common Painful Foot and Ankle Conditions: A Review.PubMed
Minton Truitt Cooper
JAMA. 2023 Dec 19;330(23):2285-2294. doi: 10.1001/jama.2023.23906.
IMPORTANCE: Morton 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. OBSERVATIONS: Morton 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 RELEVANCE: Morton 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.
13Effects of therapeutic interventions on pain due to plantar fasciitis: A systematic review and meta-analysis.PubMed
Janice de S Guimarães, Fabio L Arcanjo, Gustavo Leporace, et al.
Clin Rehabil. 2023 Jun;37(6):727-746. doi: 10.1177/02692155221143865. Epub 2022 Dec 26.
OBJECTIVE: To determine the effects of different therapeutic interventions that have ever been evaluated in randomized controlled trials on pain due to plantar fasciitis. METHODS: We searched different electronic databases until September 2022. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the overall certainty evidence. RESULTS: A total of 236 studies met the study criteria, including 15,401 patients. Botulinum toxin MD -2.14 (CI: -4.15, -0.14), micronized dehydrated human amnion/chorion membrane injection MD -3.31 (CI: -5.54, -1.08), dry needling MD -2.34 (CI: -4.64, -0.04), low-dye taping MD -3.60 (CI: -4.16, -3.03), low-level laser therapy MD -2.09 (CI: -2.28, -1.90), myofascial releases MD -1.79 (CI: -2.63, -0.94), platelet-rich plasma MD -2.40 (CI: -4.16, -0.63), radiofrequency MD -2.47 (CI: -4.65, -0.29), and stretching MD -1.14 (CI: -2.02, -0.26) resulted in being effective treatments for pain when compared to the control in the short term. In the medium and long term, only extracorporeal shock wave therapy MD -0.97 (CI: -1.13, -0.81)/MD -2.49 (CI: -3.17, -1.82) was effective for improving pain when compared to the control. CONCLUSIONS: Considering the available studies, this systematic review and meta-analysis showed that different therapeutic interventions seem to be useful strategies for improving pain in patients with plantar fasciitis. In the medium and long term, only extracorporeal shock wave therapy was effective in improving pain when compared to the control.
14The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations.PubMed
Joshua Kirkpatrick, Omid Yassaie, Seyed Ali Mirjalili
J Anat. 2017 Jun;230(6):743-751. doi: 10.1111/joa.12607. Epub 2017 Mar 29.
The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain.
15Extracorporeal shock wave therapy on pain and foot functions in subjects with chronic plantar fasciitis: systematic review of randomized controlled trials.PubMed
Haimanot Melese, Abayneh Alamer, Kefale Getie, et al.
Disabil Rehabil. 2022 Sep;44(18):5007-5014. doi: 10.1080/09638288.2021.1928775. Epub 2021 May 26.
PURPOSE: The aim of this review was to synthesize current evidence on the efficacy of extracorporeal shock wave therapy on pain, and foot function in subjects with plantar fasciitis. MATERIALS AND METHODS: A comprehensive search of PubMed/Medline, CINAHL, AMED, PEDro, Cochrane Library, and Scopus were done to identify randomized controlled trials of extracorporeal shock wave therapy in subjects with plantar fasciitis. PEDro scale was used to evaluate the methodological quality of included trials. Visual Analogue Scale and Foot Function Index were the primary outcome measures of this review. Due to varying of entailed trials, meta-analysis was not carried out. RESULTS: Eleven randomized controlled trials with 658 patients were included. Extracorporeal shock wave therapy exhibited a moderate confirmation to better pain, and foot function of individuals with chronic plantar fasciitis. CONCLUSION: Extracorporeal shock wave therapy could be a promising rehabilitation intervention and might support to improve pain, and foot function of subjects with chronic plantar fasciitis.IMPLICATIONS FOR REHABILITATIONExtracorporeal shock wave therapy (ESWT) exerted beneficial effects on pain and functional outcomes for chronic plantar fasciitis.ESWT could be effectively performed with no side effects.ESWT could be an alternative to the conventional management of chronic plantar fasciitis.
16[Effectiveness of different physical therapy in conservative treatment of plantar fasciitis: systematic review].PubMed
Ana María Díaz López, Patricia Guzmán Carrasco
Rev Esp Salud Publica. 2014 Jan-Feb;88(1):157-78. doi: 10.4321/S1135-57272014000100010.
BACKGROUND: Plantar fasciitis is the most common disease of non-traumatic pain in the ankle-foot. It is more common in women aged 40-70 years and diffuse progressive start the foot or ankle that gradually worsens preventing progress. The aim of this work is to determine whether different physical therapies used in the conservative treatment of plantar fasciitis of at least one month duration in adults are effective individually and / or in combination. METHODS: A systematic review databases in The Cochrane Library, Medline, Lilacs, IBECS, IME, PEDro and ENFISPO no date restriction, in Spanish and English languages. Randomized controlled trials were included of adult patients diagnosed with plantar fasciitis, intervention studies, prospective and systematic reviews. Assessment of study eligibility was developed by two reviewers independently and unblinded standardized. To classify, we used the PEDro scale critical, form of methodological quality plus a critical review of each summary and if this was not conclusive assessment of the full text. RESULTS: 32 full-text articles were reviewed. Most used techniques are the stretches and shock waves, although the best results are obtained by combining several techniques. Shock waves are effective when other techniques have failed. CONCLUSION: Physical therapies used in the various studies have proven effective to varying degrees either to reduce pain or relieve the symptoms of plantar fasciitis.
17Medical imaging for plantar heel pain: a systematic review and meta-analysis.PubMed
Chris Drake, Glen A Whittaker, Michelle R Kaminski, et al.
J Foot Ankle Res. 2022 Jan 22;15(1):4. doi: 10.1186/s13047-021-00507-2.
BACKGROUND: Medical imaging can be used to assist with the diagnosis of plantar heel pain. The aim of this study was to synthesise medical imaging features associated with plantar heel pain. METHODS: This systematic review and meta-analysis conducted searches in MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to 12th February 2021. Peer-reviewed articles of cross-sectional observational studies written in English that compared medical imaging findings in adult participants with plantar heel pain to control participants without plantar heel pain were included. Study quality and risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Sensitivity analyses were conducted where appropriate to account for studies that used unblinded assessors. RESULTS: Forty-two studies (2928 participants) were identified and included in analyses. Only 21% of studies were rated 'good' on quality assessment. Imaging features associated with plantar heel pain included a thickened plantar fascia (on ultrasound and MRI), abnormalities of the plantar fascia (on ultrasound and MRI), abnormalities of adjacent tissue such as a thickened loaded plantar heel fat pad (on ultrasound), and a plantar calcaneal spur (on x-ray). In addition, there is some evidence from more than one study that there is increased hyperaemia within the fascia (on power Doppler ultrasound) and abnormalities of bone in the calcaneus (increased uptake on technetium-99 m bone scan and bone marrow oedema on MRI). CONCLUSIONS: People with plantar heel pain are more likely to have a thickened plantar fascia, abnormal plantar fascia tissue, a thicker loaded plantar heel fat pad, and a plantar calcaneal spur. In addition, there is some evidence of hyperaemia within the plantar fascia and abnormalities of the calcaneus. Whilst these medical imaging features may aid with diagnosis, additional high-quality studies investigating medical imaging findings for some of these imaging features would be worthwhile to improve the precision of these findings and determine their clinical relevance.
18Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review.PubMed
Hye Chang Rhim, Jaehyung Shin, Jane Kang, et al.
Br J Sports Med. 2024 Feb 7;58(3):154-163. doi: 10.1136/bjsports-2023-107567.
OBJECTIVE: To determine the efficacy of extracorporeal shockwave therapy (ESWT) and investigate outcomes following the use of ESWT for athletes and physically active individuals. DESIGN: Systematic review. DATA SOURCES: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and searched four databases: PubMed (NLM), Embase (Elsevier), CINAHL Complete (EBSCO) and Web of Science (Clarivate). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Included studies were randomised controlled trials, cohort and case-control studies, cases series and reports that evaluated outcomes following ESWT for athletes, physically active individuals and occupational groups requiring regular physical activity such as military cadets. RESULTS: 56 studies with 1874 athletes or physically active individuals were included. Using the Oxford level of evidence rating, included studies were 18 level I (32.1%), 3 level II (5.4%), 10 level III (17.9%), 13 level IV (23.2%) and 12 level V (21.4%). Based on the level I studies, ESWT may be effective alone in plantar fasciitis, lateral epicondylitis and proximal hamstring tendinopathy and as an adjunct to exercise treatment in medial tibial stress syndrome and osteitis pubis in athletes or physically active individuals. In most studies, athletes were allowed to continue activities and training and tolerated ESWT with minimal side effects. CONCLUSION: ESWT may offer an efficacious treatment alone or as an adjunct to concurrent exercise therapy in selected sports-related injuries and without major adverse events. Further high-level research is needed to better define the role and clinical outcomes of ESWT.
19Extracorporeal Shockwave Therapy for Foot and Ankle Disorders: A Systematic Review and Meta-Analysis.PubMed
Tengku Nazim B Tengku Yusof, Dexter Seow, Khushdeep S Vig
J Am Podiatr Med Assoc. 2022 May-Jun;112(3). doi: 10.7547/18-191.
BACKGROUND: Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of numerous orthopaedic pathologies. However, clinical evidence of the use of ESWT for various foot and ankle disorders has been limited with a consensus on its efficacy yet available. Therefore, the purpose of this study is to systematically review the literature, to provide a critical evaluation and meta-analysis for the use of ESWT in foot and ankle disorders. METHODS: The PubMed and Embase databases were systematically reviewed and clinical studies that reported ESWT use for various foot and ankle disorders included. RESULTS: A total of 24 clinical studies that included 12 randomized controlled trials and 12 case series were identified. Analysis of the evidence has indicated that ESWT can help manage plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton's neuroma. Meta-analysis of the change in pre- to post-VAS overall scores for plantar fasciitis significantly favored ESWT compared to placebo/conservative treatment with a MD -3.10 (95% CI, -4.36 to -1.83; I2 = 68%; P < 0.00001). CONCLUSIONS: The current evidence has suggested that ESWT can provide symptomatic benefit to plantar fasciitis treatment, with minimal and unremarkable side effects. Overall, ESWT has been demonstrated to be a safe treatment option with a favorable complication profile. Further well-designed studies of ESWT for the treatment of calcaneal spurs, Achilles tendinopathy and Morton's neuroma are warranted to more soundly and safely support its current use. Future studies are suggested to investigate the optimization of ESWT treatment protocols.
20Effect of Dynamic Taping versus Kinesiology Taping on Pain, Foot Function, Balance, and Foot Pressure in 3 Groups of Plantar Fasciitis Patients: A Randomized Clinical Study.PubMed
Dong-Ho Kim, Yongwoo Lee
Med Sci Monit. 2023 Nov 2;29:e941043. doi: 10.12659/MSM.941043.
BACKGROUND Biomechanical dynamic tape supports muscles, joints, and ligaments and is used in ankle and foot injuries. Kinesiology tape (KT), also known as elastic tape, is widely used in sports medicine. Plantar fasciitis, due to inflammation of the plantar fascia, is a common cause of heel pain. This study aimed to compare the effects of dynamic taping and KT on pain, function, and balance in 3 groups of patients with plantar fasciitis. MATERIAL AND METHODS Sixty-nine patients with plantar fasciitis were randomly assigned to the dynamic taping with physical therapy (PT) group, the KT with PT group, and the control group (23 each). All groups received conservative physical therapy. Dynamic taping and KT were performed twice a week for 4 weeks, and the taping was removed after 12 h of application. Patients' pain, foot function, and balance were assessed using the visual analog scale (VAS), foot function index (FFI), and Y-balance test (YBT), respectively, before and immediately after the intervention. RESULTS In the FFI and YBT, the treatment provided to the dynamic taping with PT group with PT showed a greater effect than in the KT with PT group with PT (P<0.05), and the control group showed the lowest effect. Dynamic taping and KT with PT did not show significant differences in VAS and foot pressure, but both were more effective than the control group (P<0.05). CONCLUSIONS The results of this study suggest that dynamic taping with PT is the most effective method for FFI and YBT in patients with plantar fasciitis, and that dynamic taping and KT with PT are effective methods for treating pain and foot pressure.