1. 早晨下床第一步的刺痛：你可能得了脚底筋膜炎
想象一下，清晨你从睡梦中醒来，脚刚一落地，脚跟就像被针扎了一下，一阵剧痛袭来，让你不得不放慢脚步，甚至有些寸步难行。随着你慢慢活动，疼痛似乎减轻了一些，但站久了或者走路多了，那种酸胀和刺痛又会卷土重来。如果你有这样的经历，那么你很可能被一种叫做“脚底筋膜炎”的足部问题缠上了 1。
脚底筋膜炎听起来有些专业，但它其实是引起脚跟疼痛最常见的原因之一，全球大约每10个人中就有一个人会在一生中经历这种不适 1。很多人一听到“筋膜炎”，下意识就觉得是哪里发炎了。但其实，这个“炎”字有些误导性，它更多的是指筋膜组织因为反复受损而发生的一种退化性改变，而非我们通常理解的急性炎症 1。所以，与其说是“发炎”，不如说是脚底的“软组织劳损”更为贴切。要搞清楚脚底筋膜炎到底是怎么回事，我们首先得从它那些标志性的症状说起。
1.1 典型症状：从“晨僵痛”到“久站酸”的演变
脚底筋膜炎最经典的“招牌”症状，就是那令人印象深刻的“晨僵痛”——清晨下床迈出第一步时，脚后跟会传来刀割般的剧烈刺痛 23。这种痛感在刚起床或久坐不动后，比如看了一下午电视、坐长途车，突然站起来走路时尤为明显 23。你可能会发现，走上几步、活动开了之后，疼痛反而会减轻一些，脚底也变得“灵活”起来。然而，这并不意味着问题解决了。如果长时间站立、走路或进行剧烈运动，疼痛又会卷土重来，变成一种持续的酸胀或刺痛，让你不得不找地方坐下歇歇脚。用手按压脚底靠近足跟内侧的位置，通常也会有明显的压痛感 3。
听到这里，你可能会问，脚后跟痛那么多，怎么知道自己是不是脚底筋膜炎呢？这就要学会区分了。
最常见的与脚底筋膜炎相似的，还有以下几种：
- 跟腱炎： 它的疼痛部位通常在脚后跟的上方，也就是我们常说的“脚筋”位置。跟腱炎往往是由于跟腱过度使用或受伤引起的，疼痛多发生在脚跟后侧，而非脚底 2。
- 足跟脂肪垫炎： 足跟脂肪垫就像是脚跟天然的“减震器”和“缓冲垫”。如果它出了问题，比如因为年龄增长、肥胖或者长期高强度冲击导致脂肪垫萎缩变薄，那么脚后跟就会感到深部的、类似瘀伤的疼痛，通常是整个脚后跟区域的弥漫性疼痛，而不是像脚底筋膜炎那样集中在筋膜附着点位置 4567。有时，超声检查会发现足跟脂肪垫变薄。 8 严重时，甚至可能出现脂肪垫移位或骨折 9。
- 跟骨应力性骨折： 这种情况多见于运动员，特别是那些跑步、跳跃较多的运动爱好者。它的疼痛会随着活动量的增加而逐渐加剧，休息时疼痛也难以完全缓解，是一种持续性的深部疼痛。通常还会伴有局部的肿胀和压痛，比脚底筋膜炎的疼痛感更深、更剧烈 25。
- 跗管综合征： 这种情况下，除了脚底疼痛，你可能还会感到脚底有烧灼感、麻木或针刺感，尤其是在长时间站立或活动后更明显。这是因为脚踝内侧的神经被卡压住了 257。
- 儿童的跟骨骨骺炎（Sever's disease）： 这是一种发生在8到15岁儿童身上的常见脚跟痛。它通常与高强度运动、肥胖有关，疼痛部位也在脚后跟，但这是由于儿童跟骨生长板受到反复牵拉和压迫引起的炎症，与成人脚底筋膜炎的病理机制完全不同 510。
总而言之，如果你发现自己的脚后跟疼痛主要集中在脚底、靠近足跟内侧的位置，并且有明显的“晨僵痛”和“久坐后站起疼痛加剧”的特点，那么脚底筋膜炎的可能性就非常大了。
1.2 被误解的“炎症”：其实是筋膜的慢性损伤
既然我们已经对脚底筋膜炎的典型症状有了一个清晰的认识，那么接下来，我们就要来“正本清源”，聊聊它名字里那个容易让人误解的“炎”字。
很多人一看到“筋膜炎”，自然而然就会想到“发炎”，觉得脚底的筋膜是不是红肿热痛了。但其实，这个“炎”字在这里是一个历史遗留的误会。最新的研究发现，脚底筋膜炎的本质，并非我们通常理解的急性炎症反应，而更像是一种慢性退行性病变 11121314。
你可以这样理解：我们脚底有一条非常重要的组织，它就像一根强韧的橡皮筋，从脚跟骨一直延伸到脚趾，紧紧地贴合在脚底，支撑着足弓，并帮助我们在走路、跑步时吸收地面的冲击力。这根“橡皮筋”就是足底筋膜。它每天都要承受我们身体的全部重量，是脚底最繁忙的“工作者”之一。
当这根“橡皮筋”长期处于高压和过度使用的状态时，比如走路过多、跑步过猛、体重过大，或者穿的鞋子不合适，它就会像一根持续拉紧又放松的绳子，在与脚跟骨连接的地方，不断地受到细微的拉扯和冲击。久而久之，这些日积月累的微小损伤，就会导致足底筋膜的纤维组织发生结构上的改变——变得不再那么有弹性，甚至会出现一些小撕裂、变厚或组织退化的情况 11121415。
所以，与其说是“炎症”，不如说它是一种因为反复微创伤导致的慢性劳损和组织退变 1112131415。在显微镜下观察，医生们发现，这些受损的筋膜组织里，通常缺乏典型的炎症细胞，反而更多地看到的是退化、变性的细胞 111213。这就是为什么现在医学界更倾向于使用“足底筋膜病变（Plantar Fasciopathy）”这个词，来取代传统的“足底筋膜炎（Plantar Fasciitis）”，以更准确地描述这种疾病的本质 1。
明白了这一点，我们就知道，治疗脚底筋膜炎，不仅仅是要止痛，更重要的是要从根本上解决筋膜的“疲劳”和“损伤”，让它能够重新恢复健康和弹性。
2. 谁更容易被盯上？脚底筋膜炎的3大核心诱因
了解了脚底筋膜炎的本质是足底筋膜的慢性劳损和退化后，你可能会好奇，为什么有的人容易中招，有的人却能安然无恙呢？这背后，其实隐藏着一些关键的诱发因素。这些诱因就像是埋藏在日常生活中的“地雷”，一旦踩到，就可能引爆脚底筋膜的疼痛。我们可以把这些诱因归结为三大类，接下来就逐一揭秘。
2.1 生物力学异常：足弓与踝关节的“隐形压力”
我们的双脚是一个精密的“工程杰作”，每一个骨骼、关节、韧带和肌肉都协同工作，来支撑身体、吸收冲击和推动前进。如果这个精密的系统在结构上出现了一些“小偏差”，也就是我们常说的“生物力学异常”，就可能给足底筋膜带来额外的、隐形的压力，最终导致它的损伤。
这里面，最常见的几个“元凶”就是足弓形态和踝关节的灵活性。
足弓的“两端”都不是好事：扁平足与高弓足
踝关节背屈受限：小腿的“连带效应”
运动人群的典型案例：
以跑步爱好者为例，如果一个跑者本身有轻度扁平足，同时小腿肌肉又比较紧张，踝关节背屈受限。在每次跑步时，他的足弓会比正常人更容易塌陷，足底筋膜被过度拉伸；同时，由于小腿紧张，足底筋膜在步态周期中也要承担更多“代偿”性的拉力。日积月累，即使没有突然的高强度训练，足底筋膜也可能因为这种长期的“隐形压力”而逐渐损伤，最终表现为脚底筋膜炎。有研究表明，踝关节背屈活动度受限是足底筋膜炎最重要的风险因素之一 20。此外，跑步姿势中足踝过度的外翻（脚底向外翻转）也可能增加足底筋膜炎的风险 22。
2.2 长期负荷过载：体重、运动与职业的“累积伤害”
除了前面提到的足弓和踝关节这些“内在因素”外，我们身体所承受的外部负荷，也就是日常生活中脚底筋膜所经受的压力，也是决定它是否“罢工”的关键。长期、超量的负荷，就像给一根橡皮筋施加了无法承受的拉力，最终会导致它疲惫、磨损，甚至断裂。
以下几种情况，就属于脚底筋膜最常见的“累积伤害”来源：
体重：每增加一公斤，脚底压力大不同
- 我们的脚底筋膜在步态过程中承受着持续的张力，特别是在足部和跟腱之间传递着较大的力，并逐渐增加并在后期达到峰值 23。你可以想象一下，如果你的体重本身就比较大，那么脚底筋膜所要承担的压力自然就更大。
- 超重或肥胖是导致脚底筋膜炎的一个重要风险因素 2024。有研究显示，身体质量指数（BMI）超过30 kg/m²的人，患脚底筋膜炎的风险是正常体重人群的5.6倍 20。这意味着，即使你没有进行剧烈运动，仅仅是维持日常活动，过重的体重也会让你的足底筋膜长期处于一种“超负荷”的工作状态，加速它的退化和损伤。一项最新的研究甚至发现，在那些同时患有足底筋膜炎并伴有足跟骨刺的患者中，肥胖（BMI > 30）是导致他们出现疼痛症状的独立风险因素之一 25。
高强度跑跳运动：脚底的“马拉松”
久站职业：无声的“磨损”
2.3 年龄与恢复力下降：35岁后更要警惕
我们常说“人老腿先老”，这在脚底筋膜炎的问题上体现得尤为明显。随着年龄的增长，我们的身体机能会发生一系列自然的变化，其中就包括筋膜组织的弹性下降和自我修复能力的减弱。这就像一根用了几十年的橡皮筋，时间久了，它会变得僵硬、容易断裂，而不是像新的时候那样富有弹性。
通常来说，35岁以后，人体内的胶原蛋白合成速度开始减慢，筋膜组织也随之出现退行性变化。这意味着：
- 弹性降低： 年轻时富有弹性的足底筋膜，会逐渐变得僵硬、缺乏柔韧性。当它在日常活动中受到拉伸和冲击时，就更容易产生微小的撕裂，而不是像以前那样能轻松地“吸收”力量。
- 修复能力减弱： 即使筋膜受到了损伤，年轻时身体强大的自我修复机制能够迅速启动，修补受损组织。但随着年龄增长，这种修复能力会大打折扣，小小的损伤可能难以彻底愈合，日积月累就会演变成慢性问题。
因此，即使是对于那些不怎么运动、体重也正常的中老年人来说，一些看似平常的活动，也可能成为脚底筋膜炎的诱因。
举个常见的例子：
王阿姨退休后，为了锻炼身体，跟风买了一双时下流行的“软底跑鞋”，觉得穿着舒服。她平时只是在小区里散散步，但换了新鞋没多久，就发现早上起床脚后跟开始刺痛。她百思不得其解，心想自己又没剧烈运动，怎么会得筋膜炎呢？
其实，这就是年龄与恢复力下降的一个典型体现。王阿姨的足底筋膜可能已经因为年龄的增长而变得不那么“强韧”，而那双过于柔软的跑鞋，虽然穿着舒服，却可能因为缺乏足够的足弓支撑和稳定性，导致足底筋膜在步态中承受了额外的、不稳定的拉扯力。对于年轻、筋膜弹性好的人来说，这种轻微的负荷变化可能不足为道；但对于王阿姨这样筋膜已经开始退化的中老年人来说，就成了“压垮骆驼的最后一根稻草”，最终诱发了脚底筋膜炎。
所以，对于35岁以上的人群，即使没有高强度运动的习惯，也要特别留意脚底的感受，选择合适的鞋子，并适度进行足部拉伸和力量练习，以延缓筋膜的退化，降低患病的风险。
3. 从自我管理到专业干预：分阶段康复的科学方案
了解了脚底筋膜炎是怎么找上你的，接下来我们就要聊聊怎么把它“请走”了。面对这个磨人的小妖精，我们既不能坐以待毙，也不能病急乱投医。一个科学、分阶段的康复方案，才是最有效的“制胜法宝”。这个方案就像打仗一样，要根据敌情（疼痛程度）来调整策略，从最初的“紧急止损”到后期的“强身健体”，每一步都至关重要。
3.1 急性期（疼痛剧烈期）：先“刹车”再“修复”
当你感到脚底剧烈疼痛，特别是早上起床第一步都刺痛难忍时，这说明你的足底筋膜正处于高度“紧张”和“受伤”的状态。此时，最首要的任务是“刹车”，也就是立即减少对筋膜的刺激，缓解疼痛，防止进一步损伤。就像汽车爆胎了，你不能继续猛踩油门，而是要先靠边停车，检查损伤。
3.1.1 即时止痛：冰袋冷敷与夜间夹板的“黄金组合”
冰袋冷敷：给疼痛部位“降温消火”
- 作用原理： 尽管我们前面提到脚底筋膜炎并非急性炎症，但在疼痛剧烈时，局部组织可能会出现肿胀和微循环障碍。冰敷能有效收缩血管，减轻局部肿胀，从而达到快速止痛的效果 32。
- 操作要点：
- 准备一个冰袋（可以是专业的冰敷袋，也可以是用毛巾包裹的碎冰或冷冻蔬菜）。
- 将冰袋敷在脚底疼痛最剧烈的位置，通常是足跟内侧或足弓下缘。
- 每次敷15分钟左右，敷完后让皮肤休息至少1小时再进行下一次。
- 每天可以重复多次，特别是在活动后或感到疼痛加剧时进行。
- 切记不要将冰袋直接接触皮肤，以免冻伤。
夜间夹板：在睡眠中温柔地拉伸筋膜
- 作用原理： 你有没有发现，早上起床时脚底最痛？这是因为我们在睡觉时，脚踝通常处于跖屈位（脚尖向下），导致足底筋膜在夜间缩短。当早上突然踩地时，筋膜瞬间被拉伸，就容易引起剧烈疼痛。夜间夹板（Night Splint）的作用，就是让你在睡眠中也能保持踝关节轻度背屈位（脚尖向上勾），从而持续、温和地拉伸足底筋膜和跟腱，防止其在夜间缩短，显著减轻晨起时的疼痛 3334。
- 选择与佩戴：
- 市面上有多种夜间夹板可供选择，常见的有硬质和软质两种。建议在医生或康复师指导下选择适合自己的款式。
- 确保夹板佩戴舒适，不会压迫到脚踝或小腿。
- 每晚入睡前佩戴，并尽量坚持佩戴整夜。
- 有研究表明，夜间夹板与足弓垫联合使用，能更有效地缓解疼痛 33。
3.1.2 减少刺激：给脚底“放个假”
避免光脚行走与穿软底拖鞋：
- 在家里，很多人喜欢光着脚走来走去，或者穿没有支撑力的软底拖鞋。但对于急性期的脚底筋膜炎患者来说，这无异于火上浇油。光脚行走会让足底筋膜直接承受地面冲击，而软底拖鞋则无法提供足够的足弓支撑，导致筋膜持续被过度拉伸。
- 建议： 即使在家里，也要穿戴有良好足弓支撑的拖鞋或运动鞋，给脚底提供必要的保护和支撑。
推荐支撑性好的运动鞋或定制足弓垫：
- 选择一双合适的鞋子对于脚底筋膜炎的康复至关重要。一双好的鞋子应该具备以下特点：
- 良好的足弓支撑： 能有效支撑足弓，减少足底筋膜的张力。
- 适度的缓震： 吸收地面的冲击力，减轻脚底负担。
- 稳固的后跟： 避免脚在鞋内滑动，提供稳定性。
- 足弓垫（鞋垫）： 如果你的日常鞋子缺乏足够的支撑，或者你有明显的足弓问题（如扁平足或高弓足），那么一个定制的或高质量的足弓垫能提供额外的帮助 3536。足弓垫可以帮助纠正足部生物力学异常，将压力均匀分散，从而减轻足底筋膜的负担。研究发现，定制的足弓垫与极简柔性鞋搭配使用，可以更有效地减少脚跟疼痛，改善足部功能 35。
- 注意事项： 在选择运动鞋或足弓垫时，最好咨询专业的足科医生或康复师，他们会根据你的足型和步态情况，给出个性化的建议。
- 选择一双合适的鞋子对于脚底筋膜炎的康复至关重要。一双好的鞋子应该具备以下特点：
记住，急性期的目标是让筋膜得到充分休息，减少刺激，为后续的修复打下基础。切不可操之过急，否则只会适得其反，让疼痛反复。
3.2 缓解期（疼痛减轻后）：针对性训练重建筋膜韧性
当急性期的剧烈疼痛逐渐平息，你能够不那么痛苦地迈开步子时，恭喜你，你的足底筋膜炎已经进入了缓解期。这个阶段，仅仅“刹车”和“休息”就不够了，我们需要积极地“修复”，通过针对性的训练，来重建筋膜的韧性、弹性和力量，让它变得更强大，能够更好地应对日常生活的挑战。就像汽车修理好爆胎后，还需要进行保养和加固，才能确保未来的行驶安全。
这个阶段的康复重点在于拉伸和运动调整。
3.2.1 拉伸组合：解锁筋膜活力的“三板斧”
拉伸是缓解期康复的核心，它能有效改善足底筋膜和小腿肌肉的柔韧性，减轻筋膜张力，促进血液循环，加速组织修复。这里，我们为你准备了一套“拉伸组合”，就像给你的足底筋膜做一套全面的“瑜伽”：小腿腓肠肌拉伸、足底筋膜拉伸，以及一个强化足底小肌肉的训练。
小腿腓肠肌拉伸（靠墙推膝）：解除脚底筋膜的“上游张力”
- 作用原理： 前面我们提过，小腿肌肉（特别是腓肠肌和比目鱼肌）的紧张会直接影响踝关节的活动度，从而增加足底筋膜的压力 21。拉伸小腿肌肉，就像是给足底筋膜“松绑”，解除它承受的额外张力。
- 动作要点：
- 面对墙壁站立，双手扶墙，双脚前后分开，疼痛侧的脚在后。
- 后脚脚跟不要离地，脚尖指向正前方。
- 保持后腿膝盖伸直，身体重心前移，直到感觉到小腿肚（腓肠肌）有明显的拉伸感。
- 保持这个姿势30秒，然后放松。
- 重复3-5次。
- 进阶版： 如果你觉得拉伸感不强，可以稍微增加前后脚的距离。
- 注意： 身体前倾时，膝盖不要超过脚尖，保持身体正直，不要弓背。
足底筋膜拉伸（毛巾卷踩压）：直接“唤醒”疲惫的筋膜
- 作用原理： 这个动作直接针对足底筋膜进行拉伸，可以有效改善其柔韧性，缓解足底疼痛。
- 动作要点：
- 坐在椅子上，将毛巾卷成圆筒状，放在脚底前脚掌下方，脚跟保持着地。
- 用手抓住脚趾，将其轻轻向小腿方向拉伸，直到感觉到足底筋膜（从脚跟到脚趾根部）有明显的拉伸感。
- 保持这个姿势30秒，然后放松。
- 重复3-5次。
- 另一种方式： 如果手抓不方便，也可以用另一只手轻柔地向后拉伸大脚趾，同时保持足弓上提。
- 注意： 拉伸过程中应感到是“拉伸”而不是“疼痛”。如果感到剧烈疼痛，请立即停止。
脚趾抓毛巾训练（强化足底小肌肉）：为足弓提供“内在支撑”
- 作用原理： 足底的内在小肌肉群就像是足弓的“稳定器”，它们的力量和协调性对于维持足弓结构至关重要。足部锻炼可能有助于改善足底内在肌肉功能。
- 动作要点：
- 坐在椅子上，双脚平放于地面，面前放一条小毛巾或几颗弹珠。
- 用疼痛侧的脚趾，尝试将毛巾或弹珠一点点地抓起来，然后放下。
- 重复进行10-15次，每天进行2-3组。
- 进阶版： 逐渐增加抓取物品的重量或尝试抓取更小的物品。
- 注意： 动作要缓慢而有控制，感受足底肌肉的发力。
拉伸频率建议：
- 初期（疼痛较明显时）：每天进行2-3次。
- 后期（疼痛减轻后）：可以减少到每天1-2次，作为日常保健和预防复发的重要环节。
重要提示： 研究表明，足底筋膜的特异性拉伸（PFSS）在疼痛缓解方面可能比小腿拉伸（CS）效果更好 37。然而，综合拉伸，特别是包含小腿拉伸在内的综合方案，对于缓解疼痛和预防复发具有重要意义。在进行任何拉伸和运动前，最好咨询专业的物理治疗师或医生，确保动作正确，避免二次损伤。
3.2.2 运动调整：从“跑”到“康复跑”的智慧转型
对于热爱运动，尤其是跑步的朋友们，当脚底筋膜炎进入缓解期时，最渴望的就是能重新回到跑道。但是，急于求成往往会带来反效果。此时的运动，更像是一种“康复跑”，需要智慧地调整，而不是盲目地回归。
降低配速、减少爬坡：减轻足底冲击
- 原理： 跑步时，每次落地都会给足底筋膜带来巨大的冲击力。配速越快、跑坡越多，冲击力就越大。在筋膜尚未完全康复时，这些额外的冲击会阻碍愈合，甚至导致病情反复。
- 建议：
- 放慢速度： 将跑步速度降至你感觉舒适、几乎没有疼痛的水平。如果完全无痛跑步做不到，那么尝试在疼痛等级3/10以下进行。
- 避免爬坡： 爬坡或下坡都会改变足部的受力模式，增加足底筋膜的张力。在康复期间，选择平坦的地面进行跑步。
- 减少跑量： 暂时减少跑步的距离和时间，循序渐进地增加。可以先从快走开始，逐渐过渡到慢跑。
游泳/骑自行车替代高强度跑跳：给脚底“减负”
- 原理： 游泳和骑自行车属于非负重运动，它们能让你在不给足底筋膜带来直接冲击的情况下，继续保持心肺功能和下肢肌肉力量。
- 建议：
- 如果你是跑者，可以暂时用游泳、骑自行车或椭圆机等交叉训练来替代高强度跑步，保持运动习惯，同时让足底筋膜得到休息和恢复。
- 选择游泳时，可以尝试使用浮板或只用手臂划水，进一步减轻腿部的负荷。
- 骑自行车时，调整好车座高度，确保膝关节和踝关节处于舒适的姿势，避免过度屈伸。
何时可以恢复正常运动？
这需要一个循序渐进的过程，疼痛是最好的指示剂。当你在进行日常活动和康复训练时，几乎不再感到疼痛，并且足底筋膜的力量和柔韧性都得到明显改善后，才能考虑逐步恢复正常运动。恢复初期，请务必注意：
- 从小量开始： 比如先恢复原来跑量的25%，然后每周增加不超过10%。
- 留意身体反馈： 如果出现疼痛，立即减少运动量或停止，并回到拉伸和休息的状态。
- 选择合适的鞋子： 运动鞋的缓冲和支撑性能至关重要，定期更换磨损的运动鞋。
- 热身和放松： 每次运动前充分热身，运动后认真拉伸和放松。
通过科学的拉伸组合和智慧的运动调整，你的足底筋膜会逐渐恢复健康，重新变得强韧有力，让你告别脚底刺痛的困扰，重拾运动的乐趣。
3.3 顽固期（3个月未缓解）：医学干预的“黄金选择”
如果你的脚底筋膜炎经过了3个月的自我管理和缓解期训练，疼痛依然没有明显好转，甚至越来越顽固，那么，是时候考虑寻求专业的医学干预了。就像有些顽固的杂草，单靠人工拔除很难根治，需要更专业、更强力的工具才能解决。在医学领域，有几种“黄金选择”可以帮助我们对抗顽固性脚底筋膜炎。
3.3.1 体外冲击波（ESWT）：给受损筋膜“注入活力”
体外冲击波治疗（Extracorporeal Shock Wave Therapy, ESWT）是目前临床上治疗顽固性脚底筋膜炎的一种非常有效的非侵入性方法。它就像是一种“声波按摩”，通过发射高能量的声波脉冲，作用于受损的足底筋膜。
- 作用机制： 冲击波的能量传递到筋膜组织后，会引发一系列生物学反应：
- 促进局部血液循环： 冲击波能刺激血管新生，增加受损区域的血流量，从而带来更多的氧气和营养物质，加速组织的修复和再生。
- 刺激愈合反应： 冲击波能够激活成纤维细胞等细胞，促进胶原蛋白的合成和排列，帮助修复受损的筋膜组织，使其恢复弹性。
- 缓解疼痛： 冲击波还能影响局部神经末梢，降低疼痛敏感性，从而达到止痛的效果 38。
- 治疗效果：
- 治疗次数与注意事项：
- 通常情况下，一个完整的冲击波治疗疗程包含3-5次治疗，每次间隔1周左右。
- 治疗过程中，你可能会感到局部有轻微的刺痛或不适，这是正常的反应。医生会根据你的耐受程度调整能量强度。
- 治疗后，部分患者可能会出现轻微的红肿或疼痛加剧，通常会在几天内自行缓解。
- 并非所有人都适合： 孕妇、有出血性疾病、安装心脏起搏器或治疗区域有感染的患者不适合进行冲击波治疗。务必在专业医生评估后进行。
3.3.2 联合疗法：1+1>2的协同效果
单一的治疗方法固然有效，但对于顽固性脚底筋膜炎，多种疗法强强联合，往往能达到1+1>2的协同效果。就像一支军队，单兵作战能力再强，也比不上陆海空多兵种协同作战。
超声波 + 传统运动（拉伸+深层按摩）的协同效果：
- 超声波治疗利用声波的机械振动和热效应，可以促进局部血液循环，松解软组织粘连，减轻疼痛。
- 一项2023年的随机对照试验发现，将体外冲击波和超声波治疗与传统的物理治疗（包括拉伸、强化训练和深层按摩）相结合，在改善足部功能和踝关节背屈活动范围方面，效果显著优于单一使用超声波或冲击波结合传统物理治疗的方案 40。
- 这意味着，通过不同治疗手段的优势互补，我们可以更全面地解决脚底筋膜炎的病理问题，加速康复进程。
对比单一疗法：
- 同样在2023年，欧洲的一项随机对照试验指出，相比于单一地进行拉伸或按摩，联合疗法（如冲击波结合拉伸）在改善疼痛和功能方面具有更快的康复速度和更好的长期效果。
- 例如，干针疗法（Dry Needling）结合拉伸运动，在疼痛强度、功能和足底筋膜的超声特征（厚度和回声）方面，都比单独拉伸组有更显著的改善 42。干针疗法通过刺激筋膜中的激痛点，可以帮助放松紧张的筋膜，促进局部血液循环和修复。
- 血小板富集血浆（PRP）注射也是近年来兴起的再生医学疗法，它利用患者自身的血小板中富含的生长因子，注射到受损筋膜处，以促进组织修复。有研究显示，PRP在治疗慢性难治性脚底筋膜炎方面具有潜力 43，甚至在减少视觉模拟评分（VAS）方面优于皮质类固醇注射和体外冲击波 44。但也有研究认为，皮质类固醇注射在肥胖患者中短期效果可能优于PRP 45，并且PRP的长期效果仍需更多研究证实 44。
皮质类固醇注射：
总结来说，当脚底筋膜炎进入顽固期，不再对简单的自我管理有反应时，专业的医学干预，特别是体外冲击波治疗，或者结合多种疗法的联合方案，往往能为患者带来新的希望。选择哪种方案，需要根据患者的具体情况，在专业医生的指导下进行。
4. 康复避坑指南：这些“常识”可能让你越治越痛
在与脚底筋膜炎斗争的过程中，我们常常会听到各种各样的“土方子”或“经验之谈”。有些看似有道理的“常识”，实际上可能是误区，不仅不能帮助康复，反而可能让你的脚底筋膜越治越痛，甚至加重病情。就像在迷宫里，选错了方向只会离出口越来越远。为了避免你在康复路上踩坑，我们特意总结了几个常见的误区，希望能为你拨开迷雾。
4.1 误区一：“多走路能练开筋膜”
“不是说生命在于运动吗？我脚底痛了，多走走、多活动活动，是不是就能把筋膜‘练开’了？”许多患者抱持着这样的想法，认为通过多走路、多活动能够促进血液循环，让疼痛部位“活络”起来。然而，对于正处于疼痛中的脚底筋膜炎患者来说，这恰恰是一个极大的误区。
- 真相：急性期过度行走会加重微损伤。
我们前面已经解释过，脚底筋膜炎的本质是足底筋膜的慢性劳损和微损伤。当你的筋膜已经受伤、处于疼痛状态时，过度行走，特别是光脚或穿着没有支撑的鞋子行走，就像是让一个骨折的病人继续跑步一样，只会让受伤的筋膜反复受到拉扯和冲击，加重原有的微损伤，甚至可能导致新的撕裂。- 在疼痛剧烈的急性期，康复的核心原则是“减少负荷”，给筋膜创造一个良好的愈合环境，而不是增加负荷。此时的“休息”并非完全不动，而是有策略地减少对筋膜的直接刺激。
- 即使在疼痛有所缓解的阶段，也应循序渐进地增加活动量。你应该把走路看作是一种逐渐恢复的训练，而不是治疗手段。每一次行走都应观察脚底的反应，如果出现疼痛，就意味着你的活动量超出了筋膜的承受能力，需要及时调整。
所以，请记住，在脚底筋膜炎疼痛期间，尤其是在急性期，不要盲目地“多走路”。给你的脚底筋膜一个“放假”的机会，让它有时间修复，这比任何“练开”的说法都更科学、更有效。
4.2 误区二：“越痛越要用力按摩”
“这里痛，是不是揉开了就不痛了？”很多患者在感到脚底疼痛时，会下意识地用手或小球用力按压，甚至请人进行“大力”按摩，希望能把筋膜“揉开”、“揉散”。这种“越痛越用力”的观念，在一些情况下确实有效果，但对于脚底筋膜炎来说，很可能适得其反，让你的疼痛加剧。
真相：暴力按压可能刺激筋膜周围神经，反而加剧疼痛。
脚底筋膜虽然强韧，但它周围分布着丰富的神经末梢。当筋膜本身已经处于受损和敏感状态时，过度或暴力的按压，特别是直接在疼痛最剧烈的附着点处进行按压，不仅无法促进愈合，反而可能：- 刺激周围神经： 导致神经兴奋，加重疼痛感受。
- 加剧微损伤： 就像前面提到的，已经受伤的筋膜组织，再受到暴力挤压，可能会导致新的微撕裂，延缓愈合过程。
- 引发炎症反应： 虽然脚底筋膜炎的本质不是急性炎症，但暴力的刺激也可能诱发局部的炎症反应，导致肿胀和疼痛加剧。
推荐做法：轻柔的筋膜放松（如网球滚动足底）。
当然，这不意味着完全不能按摩。正确的按摩方式应该是轻柔的筋膜放松，旨在改善局部血液循环，促进筋膜的放松和柔韧性，而不是暴力地“揉开”它。- 网球或高尔夫球滚动： 这是居家进行足底筋膜放松的常用方法。坐在椅子上，将网球（或高尔夫球，如果能承受更强的刺激）放在脚底，然后用脚掌轻轻地前后滚动，从脚跟到脚趾，感受足底筋膜的放松。
- 力度： 力量要适中，以感到轻微的酸胀感为宜，绝不能引起剧烈疼痛。如果感到疼痛，请立即减轻力度。
- 频率： 每天可以进行几次，每次5-10分钟。
- 专业手法： 在专业物理治疗师的指导下，进行针对性的软组织松动术或手法治疗，可能会更有效。研究表明，软组织松动技术是治疗足跟痛的有效方法 48。一项将传统泰式按摩与超声波治疗对比的研究也发现，两者在短期内都能有效缓解疼痛，但超声波治疗配合伸展运动在缓解疼痛和增加踝关节活动度方面效果更优 49。这说明，即便涉及按摩，也需要专业的指导和配合其他治疗手段。
因此，在康复过程中，请摒弃“越痛越用力”的错误观念。对待受伤的筋膜，我们需要的是温柔的放松和引导，而不是粗暴的施压。
4.3 误区三：“只治脚不调全身”
许多人在治疗脚底筋膜炎时，往往只把注意力放在脚底，哪里痛就治哪里。然而，我们的身体是一个环环相扣的整体，脚底筋膜炎的发生，可能不仅仅是足部局部的问题，还与整个下肢的生物力学，甚至身体姿态息息相关。如果只关注脚底，而忽视了其他潜在的“幕后推手”，那么即使短时间内疼痛缓解了，也可能很快复发。
真相：小腿紧张（如腓肠肌缩短）是筋膜压力的重要来源，忽视小腿拉伸会导致康复后易复发。
我们之前在“生物力学异常”一节中已经提到，小腿肌肉的紧张，特别是腓肠肌和比目鱼肌的柔韧性不足，会导致踝关节背屈受限，从而增加足底筋膜的张力。你可以把足底筋膜想象成一根缆绳，它的一端连着脚跟，另一端连着脚趾。而小腿肌肉就像是这根缆绳的“上游”张力调节器。如果小腿肌肉过紧，这根缆绳（足底筋膜）就会持续处于被拉紧的状态，更容易损伤。- 连接机制： 腓肠肌和比目鱼肌通过跟腱连接到跟骨，而足底筋膜也附着在跟骨上。当小腿肌肉紧张时，可能会影响足部的力学平衡，进而间接增加足底筋膜的负担。例如，在脚趾背屈时，足底筋膜远端（靠近脚趾处）的剪切波速度显著增加，但在足底筋膜跟骨附着处（近端）则没有明显变化，这表明脚趾背屈可能导致足底筋膜内部张力分布不均 50。这种力学上的相互作用，提示我们小腿的灵活性对足底健康的重要性。
- 康复盲区： 很多患者在治疗时，只关注足底的拉伸、按摩，却忽视了小腿肌肉的放松和拉伸。这就像只修补了被拉断的绳子，却没有解决绳子“上游”持续的拉扯力一样，问题很可能会反复出现。
- 长期影响： 长期的小腿紧张不仅会加重足底筋膜炎，还可能影响整个下肢的力线和步态，导致其他关节（如膝关节、髋关节）的代偿性问题。
康复建议：需同步调整下肢力线。
因此，在康复过程中，务必将小腿肌肉的拉伸和放松纳入你的日常计划。这包括：- 腓肠肌拉伸： 就像我们在3.2.1节中提到的“靠墙推膝”动作，确保膝盖伸直。
- 比目鱼肌拉伸： 同样是“靠墙推膝”动作，但这次要屈膝进行，因为比目鱼肌是双关节肌肉，屈膝时才能更好地拉伸到它。
- 泡沫轴或筋膜球放松： 可以用泡沫轴或筋膜球滚动小腿肌肉，缓解其紧张度。
- 足踝力量训练： 增强足踝周围肌肉的力量，特别是足底小肌肉，有助于更好地支撑足弓，稳定足部结构。
除了小腿肌肉，臀部肌肉力量不足、核心稳定性差、甚至是全身姿态不正确，都可能间接影响到足部的生物力学，增加足底筋膜的负担。因此，一个全面的康复方案应该包含对整个下肢力线和身体姿态的评估和调整。
记住，治疗脚底筋膜炎不能“头痛医头，脚痛医脚”。把你的身体看作一个整体，关注那些可能被忽视的“幕后推手”，才能从根本上解决问题，让你的脚底筋膜彻底告别疼痛，重获健康。
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参考文献
1Plantar Fasciitis.PubMed
Thomas Trojian, Alicia K Tucker
Am Fam Physician. 2019 Jun 15;99(12):744-750.
Plantar fasciitis is a common problem that one in 10 people will experience in their lifetime. Plantar fasciopathy is an appropriate descriptor because the condition is not inflammatory. Risk factors include limited ankle dorsiflexion, increased body mass index, and standing for prolonged periods of time. Plantar fasciitis is common in runners but can also affect sedentary people. With proper treatment, 80% of patients with plantar fasciitis improve within 12 months. Plantar fasciitis is predominantly a clinical diagnosis. Symptoms are stabbing, nonradiating pain first thing in the morning in the proximal medioplantar surface of the foot; the pain becomes worse at the end of the day. Physical examination findings are often limited to tenderness to palpation of the proximal plantar fascial insertion at the anteromedial calcaneus. Ultrasonography is a reasonable and inexpensive diagnostic tool for patients with pain that persists beyond three months despite treatment. Treatment should start with stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflammatory drugs. Many standard treatments such as night splints and orthoses have not shown benefit over placebo. Recalcitrant plantar fasciitis can be treated with injections, extracorporeal shock wave therapy, or surgical procedures, although evidence is lacking. Endoscopic fasciotomy may be required in patients who continue to have pain that limits activity and function despite exhausting nonoperative treatment options.
2Diagnosing heel pain in adults.PubMed
Tracy Aldridge
Am Fam Physician. 2004 Jul 15;70(2):332-8.
Heel pain is a common condition in adults that may cause significant discomfort and disability. A variety of soft tissue, osseous, and systemic disorders can cause heel pain. Narrowing the differential diagnosis begins with a history and physical examination of the lower extremity to pinpoint the anatomic origin of the heel pain. The most common cause of heel pain in adults is plantar fasciitis. Patients with plantar fasciitis report increased heel pain with their first steps in the morning or when they stand up after prolonged sitting. Tenderness at the calcaneal tuberosity usually is apparent on examination and is increased with passive dorsiflexion of the toes. Tendonitis also may cause heel pain. Achilles tendonitis is associated with posterior heel pain. Bursae adjacent to the Achilles tendon insertion may become inflamed and cause pain. Calcaneal stress fractures are more likely to occur in athletes who participate in sports that require running and jumping. Patients with plantar heel pain accompanied by tingling, burning, or numbness may have tarsal tunnel syndrome. Heel pad atrophy may present with diffuse plantar heel pain, especially in patients who are older and obese. Less common causes of heel pain, which should be considered when symptoms are prolonged or unexplained, include osteomyelitis, bony abnormalities (such as calcaneal stress fracture), or tumor. Heel pain rarely is a presenting symptom in patients with systemic illnesses, but the latter may be a factor in persons with bilateral heel pain, pain in other joints, or known inflammatory arthritis conditions.
3Diagnosis 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.
4What do we actually know about a common cause of plantar heel pain? A scoping review of heel fat pad syndrome.PubMed
Alison H Chang, Steven Zartov Rasmussen, Asger Emil Jensen, et al.
J Foot Ankle Res. 2022 Aug 16;15(1):60. doi: 10.1186/s13047-022-00568-x.
BACKGROUND: The heel fat pad is an important structure of the foot as it functions as a cushion to absorb shock and distribute plantar force during ambulation. Clinical practice guidelines or decision support platforms emphasize that heel fat pad syndrome (HFPS) is a distinct pathology contributing to plantar heel pain. We aimed to identify and synthesize the prevalence, etiology and diagnostic criteria, and conservative management of HFPS. METHODS: A comprehensive search was conducted in May 2021 and updated in April 2022, using MEDLINE, Scopus, Cinahl, EMBASE, Cochrane Library, SPORTDiscus, and PEDro and ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform (ICTRP) for pertinent registrations. We included all study types and designs describing the prevalence; etiology and diagnostic criteria; and non-pharmacological, non-surgical interventions for HFPS. RESULTS: We found a small body of original research for HFPS (n = 7). Many excluded full-text articles were expert-opinion articles or studies of heel fat pad in participants with plantar fasciitis/fasciopathy or unspecified heel pain. HFPS may be the second leading cause of plantar heel pain, based on two studies. A number of differentiating pain characteristics and behaviors may aid in diagnosing HFPS vs. plantar fasciopathy. Thinning heel fat pad confirmed by ultrasonography may provide imaging corroboration. Randomized controlled trials assessing the efficacy of viscoelastic heel cups or arch taping for managing HFPS do not exist. CONCLUSIONS: The research literature for HFPS is sparse and sometimes lacking scientific rigor. We have identified a substantial knowledge gap for this condition, frequent inattention to distinguishing HFPS from plantar fasciopathy when describing plantar heel pain, and an absence of robust clinical trials to support the commonly recommended conservative management of HFPS.
5Heel Pain: Diagnosis and Management.PubMed
Priscilla Tu
Am Fam Physician. 2018 Jan 15;97(2):86-93.
The differential diagnosis of heel pain is extensive, but a mechanical etiology is the most common. The specific anatomic location of the pain can help guide diagnosis. The most common diagnosis is plantar fasciitis, which leads to medial plantar heel pain, especially with the first weight-bearing steps after rest. Other causes of plantar heel pain include calcaneal stress fractures (progressively worsening pain after an increase in activity or change to a harder walking surface), nerve entrapment or neuroma (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), and plantar warts. Achilles tendinopathy is a common cause of posterior heel pain; other tendinopathies result in pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to Haglund deformity (a prominence of the calcaneus that may lead to retrocalcaneal bursa inflammation) or Sever disease (calcaneal apophysitis common in children and adolescents). Medial midfoot heel pain, particularly with prolonged weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve. Sinus tarsi syndrome manifests as lateral midfoot heel pain and a feeling of instability, particularly with increased activity or walking on uneven surfaces.
6Heel fat pad syndrome beyond acute plantar fascitis.PubMed
Ramon Balius, Mireia Bossy, Carles Pedret, et al.
Foot (Edinb). 2021 Sep;48:101829. doi: 10.1016/j.foot.2021.101829. Epub 2021 May 25.
Heel pain is a frequent cause of pain and disability in adult active population. In patients with this clinical presentation, several causes must be ruled out, among them plantar fasciitis the most common. Other etiologies of plantar heel pain are the entrapment of muscular branch of the lateral plantar nerve (Baxter nerve) or fat pad atrophy, being the last one the second cause of heel pain after plantar fasciitis. A case series of patients with pathological findings of the heel fat pad area using MRI and US to provide a differential diagnosis of heel pain. Observational case series study. Nine patients visited presented with pain in the plantar aspect of the heel. The plantar aspect of the heel was evaluated in detail with US and MRI. Main inclusion criteria were to present acute or chronic pain on the plantar aspect. In five cases the right heel was affected, in three cases the left heel. One case presented bilateral complaints. All patients presented mechanical pain. Specifically, four of them also described a constant clunk during footstep. Heel fat pad lesion was confirmed with MRI and US in the medial aspect, observed in five patients. In four patients, the heel fat pad was globally affected respectively. This case series tries to put some light on other heel conflicts beside plantar fasciitis that should be ruled out, being one of those, heel fat pad atrophy. Our presentation highlight the role that bed side ultrasound can play in the definition of a specific pattern confirmed with MRI after the US.
7A review of plantar heel pain of neural origin: differential diagnosis and management.PubMed
Ali M Alshami, Tina Souvlis, Michel W Coppieters
Man Ther. 2008 May;13(2):103-11. doi: 10.1016/j.math.2007.01.014. Epub 2007 Mar 30.
Plantar heel pain is a symptom commonly encountered by clinicians. Several conditions such as plantar fasciitis, calcaneal fracture, rupture of the plantar fascia and atrophy of the heel fat pad may lead to plantar heel pain. Injury to the tibial nerve and its branches in the tarsal tunnel and in the foot is also a common cause. Entrapment of these nerves may play a role in both the early phases of plantar heel pain and recalcitrant cases. Although the contribution of nerve entrapment to plantar heel pain has been well documented in the literature, its pathophysiology, diagnosis and management are still controversial. Therefore, the purpose of this article was to critically review the available literature on plantar heel pain of neural origin. Possible sites of nerve entrapment, effectiveness of diagnostic clinical tests and electrodiagnostic tests, differential diagnoses for plantar heel pain, and conservative and surgical treatment will be discussed.
8The relationship between ultrasonography with or without contrast and the clinical outcome in plantar fasciitis.PubMed
Finn Johannsen, Stig Peter Magnusson
Scand J Med Sci Sports. 2022 Nov;32(11):1660-1667. doi: 10.1111/sms.14221. Epub 2022 Aug 9.
BACKGROUND: Plantar fasciitis (PF) is a common disorder without objective parameters for disease severity. PURPOSE: To investigate whether structural changes in the plantar fascia and heel fat pad determined by ultrasound scanning with or without contrast are related to outcome measures in patients with symptomatic PF and to investigate whether there is an association between changes in US findings and improvement in pain and function. METHODS: All patients (n = 90) in a randomized controlled trial treated with training and/or glucocorticosteroid injection were assessed for morning pain, function pain, Foot Function Index (FFI), and ultrasound measured thickness of the fascia and heel fat pad at entry and after 6 months. Thirty patients were included in a longitudinal study that assessed pain, function, and microvascular volume (MV) by contrast-enhanced ultrasound at entry and after 5 months of treatment. RESULTS: None of the ultrasound parameters at the initial examination were related to clinical outcomes at 5-6 months. Changes in US measured thickness of the fascia but not the fat pad correlated with improvement in all outcome measures at 6 months (FFI: r = 0.30, p = 0.005, morning pain: r = 0.21, p = 0.046, function pain: r = 0.28, p = 0.007). MV did not change despite significant improvement in symptoms. CONCLUSION: Changes in ultrasound measured fascia thickness are associated with clinical improvement in PF patients.
9Subluxing fractured plantar fat pad: a case series and description of novel sonographic findings.PubMed
Walter I Sussman, David J Park, Paul M Rucci, et al.
Skeletal Radiol. 2021 Jun;50(6):1241-1247. doi: 10.1007/s00256-020-03639-x. Epub 2020 Nov 2.
Plantar fat pad syndrome has received little attention in the literature. A variety of structural changes of the plantar fat pad have been described in the literature, including atrophy, contusion, and fractured fat pad. This case series presents 4 patients (5 heels) with subluxation of a fractured plantar fat pad on dynamic ultrasound. Patients with subluxing fractured fat pad typically present with heel pain and a "snapping" or "popping" sensation when weight-bearing. Other causes of heel pain were excluded, and all patients in this series had an MRI that initially did not report any findings in the fat pad. Retrospective review of the MRI showed evidence of diffuse low T1 and T2 infiltration. To the authors' knowledge, subluxation of the plantar fat pad and the respective correlation to MRI findings have not been described in the literature. Here we describe the sonographic findings of this novel condition.
10Sever's Disease (Calcaneal Apophysitis).PubMed
Denise R Ramponi, Caron Baker
Adv Emerg Nurs J. 2019 Jan/Mar;41(1):10-14. doi: 10.1097/TME.0000000000000219.
Sever's disease, or calcaneal apophysitis, is the primary cause of heel pain in pediatric patients between the ages of 8 and 15 years. Primary risk factors in pediatric athletes are obesity and high levels of physical activity. Sever's injury primarily results from high-impact sports such as soccer, track, cross-country, gymnastics, tennis, and ballet. This injury mainly occurs during puberty with an open growth plate in the immature calcaneus. Clinical diagnosis can be confirmed by performing a "squeeze test" of the heel on physical examination. Diagnostic imaging findings include increased sclerosis and fragmentation of the calcaneal apophysis on plain radiograph x-rays. Ice, activity restriction, stretching, nonsteroidal anti-inflammatory drugs, immobilization, and heel cups are all methods that can be utilized in treating the pain caused by Sever's. No long-term effects have been associated with Sever's disease.
11Plantar Fasciitis: An Updated Review.PubMed
Wen-Che Tseng, Yun-Chang Chen, Tsung-Min Lee, et al.
J Med Ultrasound. 2023 Oct 6;31(4):268-274. doi: 10.4103/jmu.jmu_2_23. eCollection 2023 Oct-Dec.
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.
12The 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.
13Biologics in the Treatment of Plantar Fasciitis.PubMed
Alan Ng, Robert Cavaliere, Lauren Molchan
Clin Podiatr Med Surg. 2021 Apr;38(2):245-259. doi: 10.1016/j.cpm.2020.12.009. Epub 2021 Feb 13.
Plantar fasciitis has been considered an acute inflammatory disorder. However, the local histologic findings represent a more chronic, degenerative state without inflammation. Patients may be stuck in a chronic state of cyclical inflammation leading to tissue degeneration, refractory symptoms, and disability. This idea process has influenced the treatment approach of some practitioners who have implemented the idea of regenerative medicine and use of biologic adjuvants in the treatment of plantar heel pain. Biologic therapies provide many different cellular components, growth factors, and proteins to restore normal tissue biology and are a useful adjunct in the treatment of recalcitrant plantar fasciitis.
14Plantar FasciitisPubMed
Benjamin K. Buchanan, Reddog E. Sina, Donald Kushner
Plantar fasciitis occurs due to degenerative irritation at the origin of the plantar fascia, located at the medial calcaneal tuberosity of the heel and the surrounding perifascial structures. The plantar fascia plays an essential role in the normal biomechanics of the foot and comprises three segments arising from the calcaneus. The fascia is essential in supporting the arch and providing shock absorption. Despite featuring the -itis suffix in the diagnosis, this condition stands out for its absence of inflammatory cells. Plantar fasciitis is prevalent in the United States, with millions experiencing heel pain annually. The cause of plantar fasciitis is multifactorial, but most cases result from overuse stress. The classic presentation is of sharp localized pain at the heel. Occasionally, a heel spur may be found (see . Lateral Radiograph, Heel Spur and Large Heel Spur and Plantar Calcaneal Spur). Plantar fasciitis is not easy to treat, and patient dissatisfaction is common with most treatments. Nonsurgical management handles most cases, but the recurrence of pain proves frustrating.
15Primary Care Management of Plantar Fasciitis.PubMed
Thomas J Melvin, Zach J Tankersley, Zain N Qazi, et al.
W V Med J. 2015 Nov-Dec;111(6):28-32.
Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed.
16Flat Feet and a Diagnosis of Plantar Fasciitis in a Marine Corps Recruit.PubMed
Ann R Lurati
Workplace Health Saf. 2015 Apr;63(4):136-8. doi: 10.1177/2165079915576923.
A 22-year-old man sought care at an orthopedic clinic for acute plantar fasciitis. He reported that he had begun an intensive exercise program to prepare himself for Marine Corps Officer Candidate School. Pes Planus, or flat feet, was noted on physical examination. This article reviews the diagnoses of pes planus and plantar fasciitis as well as current intervention strategies.
17The relationship between the flexible flatfoot and plantar fasciitis: ultrasonographic evaluation.PubMed
Yu-Chi Huang, Lin-Yi Wang, Her-Cherng Wang, et al.
Chang Gung Med J. 2004 Jun;27(6):443-8.
BACKGROUND: The purpose of this study was to investigate the relationship between flexible flatfoot and plantar fasciitis. METHODS: Twenty-three subjects with flexible flatfoot and 23 subjects with normal arched feet were enrolled. Footprint analysis was used to evaluate the foot conditions in both groups to calculate the individual arch index. We compared the sonographic images of plantar fascia in the flexible flatfoot group with the normal arch group using high-frequency ultrasound. RESULTS: The analysis results indicated that the thickening of the plantar fascia in the flexible flatfoot group was significantly different from the normal arch group. In the flexible flatfoot group, 10 of 23 patients (43.4%) had plantar fasciitis, but only two subjects (8.7%) in the normal arch group had plantar fasciitis. CONCLUSIONS: There was a higher incidence of plantar fasciitis in the flexible flatfoot group than the normal arch control group in this study.
18Foot disorders associated with overpronated and oversupinated foot function: the Johnston County osteoarthritis project.PubMed
Yvonne M Golightly, Marian T Hannan, Alyssa B Dufour, et al.
Foot Ankle Int. 2014 Nov;35(11):1159-65. doi: 10.1177/1071100714543907. Epub 2014 Jul 18.
BACKGROUND: The occurrence of musculoskeletal foot disorders differs by race and obesity, and these disorders may be related to pronated (low arch) or supinated (high arch) foot structure. This cross-sectional analysis examined relationships of foot disorders and foot function by race and obesity in a community-based observational study of adults 50+ years old with and without osteoarthritis. METHODS: Members of a prospective cohort study in North Carolina were included in this analysis (N = 1466, 67.2% women, 29.5% African American, mean age 68.5 years). Foot disorders were identified with a validated assessment tool, and each foot was categorized as overpronated, oversupinated, and referent using the center of pressure excursion index from foot pressure scans during normal-paced walking. Logistic regression models estimated associations between foot function and each foot disorder with age, body mass index (BMI), gender, and race as covariates. RESULTS: Compared to referent, an overpronated foot was associated with hallux valgus (adjusted odds ratio [aOR] 1.36, 95% confidence interval [CI] 1.13-1.65) and overlapping toes (aOR 1.36, 95% CI 1.12-1.64), especially in the obese. An oversupinated foot was inversely associated with hallux valgus (aOR 0.85, 95% CI 0.74-0.97). An oversupinated foot was less likely to be associated with bunionettes among the obese and was more likely to be associated with plantar fasciitis in Caucasians. CONCLUSION: Foot function was related to hallux valgus and overlapping toes, especially among the obese. In clinical patients as well as in the community of older adults, treatments for both the foot disorder and the pronated/supinated foot may be needed. LEVEL OF EVIDENCE: Level II, comparative cohort study.
19Is there an association between plantar fasciitis and knee osteoarthritis?PubMed
Saoussen Miladi, Sirine Bouzid, Alia Fazaa, et al.
Musculoskeletal Care. 2023 Dec;21(4):1045-1052. doi: 10.1002/msc.1784. Epub 2023 May 22.
BACKGROUND: Knee osteoarthritis (OA) and plantar fasciitis share similar risk factors including ageing, occupation, obesity, and inappropriate shoe wear. However, the association between knee OA and heel pain caused by plantar fasciitis has received limited attention to date. AIM: We aimed to assess the prevalence of plantar fasciitis using ultrasound in patients with knee OA and to identify factors associated with plantar fasciitis in these patients. PATIENTS AND METHODS: We conducted a cross-sectional study including patients with Knee OA, fulfiling the European League Against Rheumatism criteria. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and the Lequesne indexes were used to evaluate pain and function of the knees. The Manchester Foot Pain and Disability Index (MFPDI) was used to estimate foot pain and disability. Each patient underwent a physical examination, plain radiographs of the knees and the heels, and an ultrasound examination of both heels to find signs of plantar fasciitis. Statistical analysis was performed using SPSS. RESULTS: We included 40 knee OA patients, with a mean age of 59.85 ± 9.65 years [32-74] and a male-to-female ratio of 0.17. The mean WOMAC was 34.03 ± 19.9 [4-75]. The mean Lequesne for knees was 9.62 ± 4.57 [3-16.5]. Among our patients, 52% (n = 21) experienced heel pain. The heel pain was severe in 19% (n = 4). The mean MFPDI was 4.67 ± 4.16 [0-8]. Limited ankle dorsiflexion and plantar flexion were noted in 47% of patients (n = 17) each. High and low arch deformities were seen in 23% (n = 9) and 40% (n = 16) of patients. Ultrasound revealed a thickened plantar fascia in 62% (n = 25). An abnormal hypoechoic plantar fascia was noted in 47% (n = 19), with the loss of normal fibrillar architecture in 12 cases (30%). No Doppler signal was exhibited. Patients with plantar fasciitis had significantly limited dorsiflexion (n = 2 (13%) versus n = 15 (60%), p = 0.004) and plantar flexion (n = 3 (20%) versus n = 14 (56%), p = 0.026). The range of supination was also less important in the plantar fasciitis group (17.73 ± 4.1 vs. 12.8 ± 6.46, p = 0.027). The low arch was statistically more present in patients with plantar fasciitis (G1: 36% [n = 9] vs. G0: 0% [n = 0], p = 0.015). However, the high arch deformity was statistically more present in patients without plantar fasciitis (G1: 28% [n = 7] vs. G0: 60% [n = 9], p = 0.046). Multivariate analysis showed that the risk factor for plantar fasciitis in knee OA patients was limited dorsiflexion (OR = 3.889, 95% CI [0.017-0.987], p = 0.049). CONCLUSION: In conclusion, our work showed that plantar fasciitis is frequent in knee OA patients, with reduced ankle dorsiflexion being the main risk factor for plantar fasciitis in these patients.
20Risk factors for Plantar fasciitis: a matched case-control study.PubMed
Daniel L Riddle, Matthew Pulisic, Peter Pidcoe, et al.
J Bone Joint Surg Am. 2003 May;85(5):872-7. doi: 10.2106/00004623-200305000-00015.
BACKGROUND: Plantar fasciitis is one of the more common soft-tissue disorders of the foot, yet little is known about its etiology. The purpose of the present study was to use an epidemiological design to determine whether risk factors for plantar fasciitis could be identified. Specifically, we examined the risk factors of limited ankle dorsiflexion with the knee extended, obesity, and time spent weight-bearing. METHODS: We used a matched case-control design, with two controls for each patient. The matching criteria were age and gender. We identified fifty consecutive patients with unilateral plantar fasciitis who met the inclusion criteria. The data that were collected included height, weight, whether the subject spent the majority of the workday weight-bearing, and whether the subject was a jogger or runner. We used a reliable goniometric method to measure passive ankle dorsiflexion bilaterally. The main outcome measure was the adjusted odds ratio of plantar fasciitis associated with varying degrees of limitation of ankle dorsiflexion, different levels of body mass, and the subjects' reports on weight-bearing. RESULTS: Individuals with </=0 degrees of dorsiflexion had an odds ratio of 23.3 (95% confidence interval, 4.3 to 124.4) when compared with the referent group of individuals who had >10 degrees of ankle dorsiflexion. Individuals who had a body-mass index of >30 kg/m (2) had an odds ratio of 5.6 (95% confidence interval, 1.9 to 16.6) when compared with the referent group of individuals who had a body-mass index of </=25 kg/m (2). Individuals who reported that they spent the majority of their workday on their feet had an odds ratio of 3.6 (95% confidence interval, 1.3 to 10.1) when compared with the referent group of those who did not. CONCLUSIONS: The risk of plantar fasciitis increases as the range of ankle dorsiflexion decreases. Individuals who spend the majority of their workday on their feet and those whose body-mass index is >30 kg/m (2) are also at increased risk for the development of plantar fasciitis. Reduced ankle dorsiflexion, obesity, and work-related weight-bearing appear to be independent risk factors for plantar fasciitis. Reduced ankle dorsiflexion appears to be the most important risk factor.
21Plantar fasciopathy: A current concepts review.PubMed
Manuel Monteagudo, Pilar Martínez de Albornoz, Borja Gutierrez, et al.
EFORT Open Rev. 2018 Aug 29;3(8):485-493. doi: 10.1302/2058-5241.3.170080. eCollection 2018 Aug.
Plantar fasciopathy is very prevalent, affecting one in ten people in their lifetime.Around 90% of cases will resolve within 12 months with conservative treatment.Gastrocnemius tightness has been associated with dorsiflexion stiffness of the ankle and plantar fascia injury.The use of eccentric calf stretching with additional stretches for the fascia is possibly the non-operative treatment of choice for chronic plantar fasciopathy.Medial open release of approximately the medial third of the fascia and release of the first branch of the lateral plantar nerve has been the most accepted surgical treatment for years.Isolated proximal medial gastrocnemius release has been reported for refractory plantar fasciopathy with excellent results and none of the complications of plantar fasciotomy. Cite this article: 2018;3:485-493. DOI: 10.1302/2058-5241.3.170080.
22Running Distance and Biomechanical Risk Factors for Plantar Fasciitis: A 1-yr Prospective 4HAIE Cohort Study.PubMed
Jan Plesek, Joseph Hamill, Michal Burda, et al.
Med Sci Sports Exerc. 2025 Apr 1;57(4):756-766. doi: 10.1249/MSS.0000000000003617. Epub 2024 Dec 4.
INTRODUCTION: Plantar fasciitis (PF) is one of the most common running-related injuries. PURPOSE: The aim of this prospective study was to determine the incidence of PF and identify potential risk or protective factors for PF in runners and non-runners. METHODS: Data from 1206 participants from the 4HAIE cohort study (563 females/643 males; 715 runners/491 non-runners; 18–65 yr of age) were included in the analysis. We collected biomechanical data during overground running using a three-dimensional motion capture system at the baseline and running distance data via retrospective questionnaires and followed the participants for 12 months following the baseline data collection. Participants were asked weekly about any sports-related injury (including PF). A binary logistic regression was performed to reveal potential associations between running distance and biomechanical risk factors and PF while controlling for running distance, sex, and age. RESULTS: The total incidence of PF was 2.3% (28 PF from 1206 participants), 2.5% in runners and 2.0% in non-runners (P = 0.248). Runners who ran more than 40 km·wk−1 had six times higher odds of suffering PF than individuals who ran 6–20 km·wk−1 (P = 0.009). There was a significant association between maximal ankle eversion and PF; that is, runners with a greater eversion angle during the stance period had higher risk of PF (P = 0.024). No other biomechanical variables indicated significant associations with PF. CONCLUSIONS: Regular running with a moderate weekly volume and more toeing out of the foot relative to the shank may reduce the risk against PF in runners, which may be useful for researchers, runners, coaches, and health professionals to minimize PF injury risk.
23Dynamic loading of the plantar aponeurosis in walking.PubMed
Ahmet Erdemir, Andrew J Hamel, Andrew R Fauth, et al.
J Bone Joint Surg Am. 2004 Mar;86(3):546-52. doi: 10.2106/00004623-200403000-00013.
BACKGROUND: The plantar aponeurosis is known to be a major contributor to arch support, but its role in transferring Achilles tendon loads to the forefoot remains poorly understood. The goal of this study was to increase our understanding of the function of the plantar aponeurosis during gait. We specifically examined the plantar aponeurosis force pattern and its relationship to Achilles tendon forces during simulations of the stance phase of gait in a cadaver model. METHODS: Walking simulations were performed with seven cadaver feet. The movements of the foot and the ground reaction forces during the stance phase were reproduced by prescribing the kinematics of the proximal part of the tibia and applying forces to the tendons of extrinsic foot muscles. A fiberoptic cable was passed through the plantar aponeurosis perpendicular to its loading axis, and raw fiberoptic transducer output, tendon forces applied by the experimental setup, and ground reaction forces were simultaneously recorded during each simulation. A post-experiment calibration related fiberoptic output to plantar aponeurosis force, and linear regression analysis was used to characterize the relationship between Achilles tendon force and plantar aponeurosis tension. RESULTS: Plantar aponeurosis forces gradually increased during stance and peaked in late stance. Maximum tension averaged 96% +/- 36% of body weight. There was a good correlation between plantar aponeurosis tension and Achilles tendon force (r = 0.76). CONCLUSIONS: The plantar aponeurosis transmits large forces between the hindfoot and forefoot during the stance phase of gait. The varying pattern of plantar aponeurosis force and its relationship to Achilles tendon force demonstrates the importance of analyzing the function of the plantar aponeurosis throughout the stance phase of the gait cycle rather than in a static standing position. CLINICAL RELEVANCE: The plantar aponeurosis plays an important role in transmitting Achilles tendon forces to the forefoot in the latter part of the stance phase of walking. Surgical procedures that require the release of this structure may disturb this mechanism and thus compromise efficient propulsion.
24[PLANTAR FASCIOPATHY - DIAGNOSIS AND TREATMENT].PubMed
Dana Avraham, Ruslan Sokolov, Izhar Arieli, et al.
Harefuah. 2025 Feb;164(2):103-107.
Plantar Fasciitis is a common reason for heel pain. The pain caused by structural changes in the plantar fascia aponeurosis insertion to the calcaneus bone. Risk factors include obesity, prolonged standing, dorsiflexion limited range of motion, excessive running, and pes planus or pes cavus. Diagnosis is based on the patient's history and physical examination. The patient will complain of heel pain during their first steps after sleep or prolonged rest, palpation will provoke pain on the plantar medial aspect of the calcaneus. Physicians rarely use imaging to verify the diagnosis. The use of imaging may take place in cases of intractable pain regardless of conservative treatment in order to eliminate different causes for heel pain. Conservative treatment is effective for over 90% of the patients. Patients with plantar fasciitis chronic pain for over 6 mounts may consider a Pain Clinic or planter fasciotomy surgery.
25Association of Obesity and Plantar Fasciitis in Patients With Plantar Heel Spurs.PubMed
Wonyong Lee, Neha Metgud, Michelle Moore
Foot Ankle Orthop. 2023 Dec 9;8(4):24730114231213625. doi: 10.1177/24730114231213625. eCollection 2023 Oct.
BACKGROUND: Although its pathophysiology is not clear, the presence of a plantar heel spur has been considered a cause of heel pain in plantar fasciitis. This study investigated demographic and radiographic differences between a plantar fasciitis patient group with plantar heel spur and the age/sex-matched control group with plantar heel spur. METHODS: Patients who visited the office under the diagnosis of plantar fasciitis and had a plantar heel spur were compared to an age/sex-matched control group who visited the office with other foot and ankle issues except for heel pain. All patients in both the control and case groups had radiographically proven presence of a plantar heel spur. Demographics and radiographic findings between the 2 groups were compared, and a multivariable logistic regression analysis was performed to identify independent risk factors that are associated with plantar fasciitis symptoms. RESULTS: A total of 100 patients were included in the plantar fasciitis study group (PF+S) and age/sex-matched control group (C+S). BMI was higher in the study group than in the control group: 35.2 vs 30.9 ( = .002). The size of the plantar heel spur was larger in the study group than in the control group: 5.9 vs 4.6 mm ( = .017). A multivariable regression analysis identified that obesity (BMI > 30, odds ratio [OR] = 2.675) and the size of plantar heel spur >5.3 mm (OR = 2.642) were associated with PF+S. CONCLUSION: We found an association of both obesity and increased average plantar heel spur length on lateral radiographs in patients with painful plantar fasciitis compared to patients without plantar fasciitis but with plantar heel spurs. The presence of a plantar heel spur alone did not account for the symptoms of plantar fasciitis. LEVEL OF EVIDENCE: Level III, comparative case study.
26The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners.PubMed
Ana Paula Ribeiro, Francis Trombini-Souza, Vitor D Tessutti, et al.
Clin Biomech (Bristol). 2011 Feb;26(2):194-9. doi: 10.1016/j.clinbiomech.2010.08.004. Epub 2010 Sep 16.
BACKGROUND: Plantar fasciitis is the third most frequent injury in runners. Despite its high prevalence, its pathogenesis remains inconclusive. The literature reports overload as the basic mechanism for its development. However, the way that these plantar loads are distributed on the foot surface of runners with plantar fasciitis and the effects of pain on this mechanical factor has not yet been investigated. Therefore, the aim of this study was to evaluate and compare the plantar pressure distributions during running in runners with symptom or history of plantar fasciitis and runners without the disease. METHODS: Forty-five recreational runners with plantar fasciitis (30 symptomatic and 15 with previous history of the disease) and 60 runners without plantar fasciitis (control group) were evaluated. Pain was assessed by a visual analogue scale. All runners were evaluated by means of the Pedar system insoles during running forty meters at a speed of 12(5%) km/h, using standard sport footwear. Two-way ANOVAS were employed to investigate the main and interaction effects between groups and plantar areas. FINDINGS: No interaction effects were found for any of the investigated variables: peak pressure (P = 0.61), contact area (P = 0.38), contact time (P = 0.91), and the pressure-time integral (P = 0.50). INTERPRETATION: These findings indicated that the patterns of plantar pressure distribution were not affected in recreational runners with plantar fasciitis when compared to control runners. Pain also did not interfere with the dynamic patterns of the plantar pressure distributions.
27Common Running Injuries: Evaluation and Management.PubMed
Michael J Arnold, Aaron L Moody
Am Fam Physician. 2018 Apr 15;97(8):510-516.
Running is a common form of exercise but predisposes athletes to several running-related injuries. Most running injuries are due to overuse and respond to conservative treatment. Tendinopathies in the patellar, Achilles, and hamstring tendons are common, and are primarily treated with eccentric exercise. Iliotibial band syndrome and patellofemoral pain syndrome are less common than patellar tendinopathy and are treated by strengthening exercises for the core and legs in addition to flexibility exercises. Acute hamstring strains and medial tibial stress syndrome require a period of relative rest, followed by stretching and graded return to activity. Tibial stress fractures require an extended period of relative rest, followed by a more gradual return to activity. Early mobilization improves recovery from ankle sprains, and exercise therapy and functional bracing while running for six to 12 months prevents reinjury. Plantar fasciopathy (plantar fasciitis) can be significantly improved with stretching, heel raises, and orthoses that provide arch support.
28Foot injuries in runners.PubMed
Jeff Kindred, Cameron Trubey, Stephen M Simons
Curr Sports Med Rep. 2011 Sep-Oct;10(5):249-54. doi: 10.1249/JSR.0b013e31822d3ea4.
Injuries of the foot are common among both elite and recreational runners. Overuse accounts for most of these injuries. Plantar fasciitis and tendinopathies of the midfoot and forefoot have a high incidence in running athletes. These injuries may present with significant pain but often resolve with rest and rehabilitation. Bone injuries caused by overuse also have a high prevalence among runners. The metatarsals, tarsal navicular, and sesamoids are most at risk for stress damage. Most running injuries are self-limited and pose little detriment if diagnosis is delayed. Navicular and sesamoid stress fractures may impart significant long-term consequences, and thus, a clinical suspicion of either fracture warrants definitive diagnosis and treatment. Barefoot running recently has garnered increased attention, but currently, there is a lack of prospective studies regarding its injury reduction.
29Systematic review: plantar fasciitis and prolonged weight bearing.PubMed
E R Waclawski, J Beach, A Milne, et al.
Occup Med (Lond). 2015 Mar;65(2):97-106. doi: 10.1093/occmed/kqu177. Epub 2015 Feb 17.
BACKGROUND: Plantar fasciitis (PF) is one of the most common causes of foot pain. Work can involve factors that may predispose to foot pain. AIMS: To systematically review the evidence of the association between weight bearing (walking or standing) and PF among workers. METHODS: Literature search of relevant indexing databases from inception to May 2012, grey literature, websites of relevant organizations and reference lists for all identified articles. Two reviewers independently selected studies for full review, assessed methodological quality and graded evidence. Findings were summarized qualitatively. RESULTS: Four studies were included; all were assessed as high or unclear risk of bias. Three studies were case-control studies; two used clinic populations and one used volunteers. The other study was cross-sectional involving the workforce of an assembly plant. A number of associations between PF and risk factors were identified including sex, obesity, foot biomechanics and job factors (e.g. job tenure). Two case-control studies and the cross-sectional study found an association with weight bearing, but the assessment of weight bearing varied (e.g. time on feet, time walking or standing). There was low-quality evidence to confirm a causal relationship (Royal College of General Practitioners (RCGP) * grade). CONCLUSIONS: This systematic review found low-quality evidence of an association between PF and weight-bearing tasks such as walking and standing on hard surfaces. The only occupations specifically identified as having higher risk were those associated with the engine assembly plant. Further research is required to fully determine the association between weight bearing and PF.
30Plantar fasciitis in physicians and nurses: a nationwide population-based study.PubMed
Kuo-Chang Sung, Jui-Yuan Chung, I-Jung Feng, et al.
Ind Health. 2020 Apr 2;58(2):153-160. doi: 10.2486/indhealth.2019-0069. Epub 2019 Sep 20.
Physicians and nurses in Taiwan have heavy workload and long working hours, which may contribute to plantar fasciitis. However, this issue is unclear, and therefore, we conducted this study to delineate it. We conducted a nationwide population-based study by identifying 26,024 physicians and 127,455 nurses and an identical number of subjects for comparison (general population) via the National Health Insurance Research Database. The risk of plantar fasciitis between 2006 and 2012 was compared between physicians and general population, between nurses and general population, and between physicians and nurses. We also compared the risk of plantar fasciitis among physician subgroups. Physicians and nurses had a period prevalence of plantar fasciitis of 8.14% and 13.11% during the 7-yr period, respectively. The risk of plantar fasciitis was lower among physicians (odds ratio [OR]: 0.660; 95% confidence interval [CI]: 0.622-0.699) but higher among nurses (OR: 1.035; 95% CI: 1.011-1.059) compared with that in the general population. Nurses also had a higher risk than the physicians after adjusting for age and sex (adjusted odds ratio [AOR]: 1.541; 95% CI: 1.399-1.701). Physician subspecialties of orthopedics and physical medicine and rehabilitation showed a higher risk. Female physicians had a higher risk of plantar fasciitis than male physicians. This study showed that nurses, physician specialties of orthopedics and physical medicine and rehabilitation, and female physicians had a higher risk of plantar fasciitis. Improvement of the occupational environment and health promotion are suggested for these populations.
31Risk factors for plantar fasciitis among assembly plant workers.PubMed
Robert A Werner, Nancy Gell, Anne Hartigan, et al.
PM R. 2010 Feb;2(2):110-6; quiz 1 p following 167. doi: 10.1016/j.pmrj.2009.11.012.
OBJECTIVE: The objective of this study was to determine the relative contributions of work activity (time spent standing, walking, or sitting), floor surface characteristics, weight, body mass index, age, foot biomechanics, and other demographic and medical history factors to the prevalence of plantar fasciitis. DESIGN: A cross-sectional observational study design was used. SETTING: The study site was an automobile engine assembly plant. PARTICIPANTS: Full-time employees of the assembly plant who had been working at least 6 months. ASSESSMENT OF RISK FACTORS: The independent variables included baseline demographics, medical history, ergonomic exposures, psychosocial factors, discomfort ratings, shoe characteristics, and foot biomechanics. MAIN OUTCOME MEASUREMENTS: The dependent variable was the finding of plantar fasciitis on physical examination. RESULTS: The study demonstrated that forefoot pronation on physical examination, high metatarsal pressure on the gait assessment, increasing time spent standing on hard surfaces, increased time spent walking, medium tenure at the plant, and an increased number of times getting in and out of the vehicle (for the truck/forklift drivers) increased the risk of presenting with plantar fasciitis. Rotation of shoes during the work week was found to reduce the risk of presenting with plantar fasciitis. Increased supervisor support showed a trend toward reducing the prevalence of plantar fasciitis. CONCLUSIONS: Plantar fasciitis is relatively common in the manufacturing setting. These findings suggest several options for primary and secondary prevention strategies. Shoe rotation may be an effective strategy that may be used as either a primary or secondary strategy. The use of shoe orthoses with a medial longitudinal arch and metatarsal pad may be used as a preventive or treatment strategy. Work stations that decrease the percentage of time walking or standing on hard surfaces (eg, allowing workers to alternate between sitting and standing postures or providing cushioning mats for concrete surfaces) may lower the risk for plantar fasciitis.
32Treatment of plantar fasciitis in recreational athletes: two different therapeutic protocols.PubMed
Panagiotis Karagounis, Maria Tsironi, George Prionas, et al.
Foot Ankle Spec. 2011 Aug;4(4):226-34. doi: 10.1177/1938640011407320.
Plantar fasciitis (PF) commonly causes inferior heel pain and occurs in up to 10% of the US population. Treatment protocols in most studies include the use of ice therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching and strengthening protocols. The aim of the current study was to examine the effectiveness of 2 different therapeutic approaches on the treatment of PF in recreational athletes using the Pain and Disability Scale for the evaluation. A total of 38 participants with PF were randomly allocated to 2 different groups of 19 male participants in each group. Group 1 was treated with ice, non-steroidal anti-inflammatory medication, and a stretching and a strengthening program. Group 2 received the same therapeutic procedures as group 1, reinforced by acupuncture treatment. The primary outcomes, nominated a priori, were pain description and mobility-function at 1 and 2 months. Outcomes were measured with the pain scale for PF. The mean total score of the acupuncture group at the third measurement was statistically minor compared with the mean total score of the first group. Acupuncture should be considered as a major therapeutic instrument for the decrease of heel pain, combined with traditional medical approaches.
33Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis.PubMed
Winson C C Lee, W Y Wong, Eddy Kung, et al.
J Rehabil Res Dev. 2012;49(10):1557-64. doi: 10.1682/jrrd.2011.09.0181.
Foot orthoses and night splints have been used separately to treat patients with plantar fasciitis, but were not always successful. Combined use of both orthoses might give better outcomes. This study evaluated the effectiveness of a soft and self-adjustable dorsiflexion night splint in combination with an accommodative foot orthosis for patients with plantar fasciitis. Twenty-eight patients were assigned to group A (foot orthosis only) and group B (combination of foot orthosis and dorsiflexion night splints). A foot function index (FFI) questionnaire was used to evaluate the pain and functions of feet just before, 2 weeks after, and 8 weeks after the treatments. Results showed that subjects in group B had significantly reduced pain scores at week 2 (p < 0.001) and week 8 (p < 0.001). In group A, no statistical differences were noted in the pain (p = 0.15), disability (p = 0.56), activity limitation (p = 0.75), and total FFI (p = 0.35) scores for the three time periods. The application of foot orthoses with adjustable dorsiflexion night splints was found to be more effective than the application of foot orthoses alone in relieving foot pain in patients with plantar fasciitis.
34[The effectiveness of dorsiflexion night splint added to conservative treatment for plantar fasciitis].PubMed
Tahsin Beyzadeoğlu, Alper Gökçe, Halil Bekler
Acta Orthop Traumatol Turc. 2007;41(3):220-4.
OBJECTIVES: We evaluated the effectiveness and results of night splint applications for the treatment of plantar fasciitis. METHODS: The study included 44 patients (53 feet) with plantar fasciitis. The mean symptom duration was 7.2+/-5.9 weeks (range 1 to 24 weeks). Calcaneal spurs were detected in 12 feet. All the patients received classic conservative treatment and all were recommended to use a night splint that kept the ankle in 5-degree of dorsiflexion for eight weeks. Twenty-five patients (14 females, 11 males; 31 feet) did not accept to use a night splint, whereas 19 patients (12 females, 7 males; 22 feet) did. Evaluations were made with the AOFAS ankle-hindfoot rating scale and a visual analog scale (VAS) before and after two months of treatment. The mean follow-up periods were 33.8 months (range 12 to 54 months) and 32.7 months (range 13 to 53 months) for those who completed treatment with and without the use of a night splint, respectively. RESULTS: Although there were no significant differences between the two groups with regard to the initial AOFAS and VAS scores, patients using a night splint exhibited significantly higher improvements in both scores at the end of the second month (p=0.01 and p=0.001, respectively). Heel pain recurred in three feet (13.6%) and in nine feet (29%) with and without night splint applications, respectively. Overall, the presence of a calcaneal spur, bilateral involvement, and body mass index were not correlated with patient satisfaction and recurrences. There was no correlation between the presence of a calcaneal spur and body mass index. However, symptom duration till treatment showed a significant correlation with recurrences (r=0.326, p=0.031). CONCLUSION: Patients without previous treatments for plantar fasciitis obtain significant relief of heel pain in the short term with the use of a night splint incorporated into conservative methods; however, this application does not have a significant effect on prevention of recurrences after a two-year follow-up.
35The Effect of Short and Long-Term Therapeutic Treatment with Insoles and Shoes on Pain, Function, and Plantar Load Parameters of Women with Plantar Fasciitis: A Randomized Controlled Trial.PubMed
Ana Paula Ribeiro, Silvia Maria Amado João
Medicina (Kaunas). 2022 Oct 28;58(11):1546. doi: 10.3390/medicina58111546.
UNLABELLED: Plantar fasciitis (PF) is a prevalent musculoskeletal disease, with inflammation at the origin of the plantar fascia, that affects sedentary people, particularly middle-aged women. Foot pain and functional limitations lead patients to seek treatment. Investigate the therapeutic effect of conservative treatment combining a custom insole with minimalist flexible shoes and the shoes alone in a gait-training protocol, in the short and long term, in women with PF. Design: A randomized, controlled, and single-blind trial. SETTING: Biomechanics laboratory. PARTICIPANTS: 36 women, 26 with acute PF and 10 controls. INTERVENTION: Gait-training protocol wearing the minimalist shoes alone (SG, = 12, age: 46.4 ± 9.6, height: 1.60 ± 0.2, BMI: 28.8 ± 4.2), with a custom insole in the shoes (CIG, = 14, age: 48.9 ± 9.8, height: 1.60 ± 0.1, BMI: 26.7 ± 5.6), and control (CG, = 10, age: 46.1 ± 10.7, height: 1.61 ± 0.2, BMI: 26.4 ± 4.8). Evaluations were performed at baseline (T0) and after three (T3) and six (T6) months. The intervention had a duration of six months (six hours a day, seven days a week). Primary outcomes were rearfoot pain (visual analogue scale), the Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br), and 6 min walk test (6MWT). The secondary outcomes were plantar pressure distribution during gait, measured by the pressure platform, and foot posture. The CIG was effective for reducing pain and improving the FPI after T6 compared to CG. The FPI, FHSQ-Br and 6MWT demonstrated improvements after T6 in both the CIG and SG, compared to the CG. After T6, contact area (rearfoot) and maximum force (forefoot) reduced with CIG. Maximum force (midfoot and rearfoot) reduced with CIG and SG, as did peak pressure (forefoot and midfoot) in relation to CG. A customized insole associated with minimalist flexible shoes during a gait-training protocol can be recommended as a more effective treatment than minimalist flexible shoes alone over the short and long term, for reduction in calcaneus pain, increased function and foot health, and improved walking through reduced plantar load in women with PF.
36Effectiveness of Mechanical Treatment for Plantar Fasciitis: A Systematic Review.PubMed
Dorianne Schuitema, Christian Greve, Klaas Postema, et al.
J Sport Rehabil. 2019 Oct 18;29(5):657-674. doi: 10.1123/jsr.2019-0036. Print 2020 Jul 1.
CONTEXT: Plantar fasciitis is one of the most common foot injuries. Several mechanical treatment options, including shoe inserts, ankle-foot orthoses, tape, and shoes are used to relieve the symptoms of plantar fasciitis. OBJECTIVES: To investigate the effectiveness of mechanical treatment in the management of plantar fasciitis. EVIDENCE ACQUISITION: The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. A systematic search was performed in PubMed, CINAHL, Embase, and Cochrane up to March 8, 2018. Two independent reviewers screened eligible articles and assessed risk of bias using the Cochrane Collaboration's risk of bias tool. EVIDENCE SYNTHESIS: A total of 43 articles were included in the study, evaluating 2837 patients. Comparisons were made between no treatment and treatment with insoles, tape, ankle-foot orthoses including night splints and shoes. Tape, ankle-foot orthoses, and shoes were also compared with insoles. Follow-up ranged from 3 to 5 days to 12 months. Cointerventions were present in 26 studies. CONCLUSIONS: Mechanical treatment can be beneficial in relieving symptoms related to plantar fasciitis. Contoured full-length insoles are more effective in relieving symptoms related to plantar fasciitis than heel cups. Combining night splints or rocker shoes with insoles enhances improvement in pain relief and function compared with rocker shoes, night splints, or insoles alone. Taping is an effective short-term treatment. Future studies should aim to improve methodological quality using blinding, allocation concealment, avoid cointerventions, and use biomechanical measures of treatment effects.
37Calf 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.
38Efficacy of radial shock wave therapy on rat models of adjuvant arthritis.PubMed
Yu Hiraoka, Nobuyasu Ochiai, Miyako Narita, et al.
J Orthop Sci. 2024 Nov;29(6):1513-1520. doi: 10.1016/j.jos.2023.11.008. Epub 2023 Dec 1.
BACKGROUND: Extracorporeal shock wave therapy (ESWT) is an effective treatment for musculoskeletal pain, tendinopathy, and fasciitis with an anti-inflammatory effect. ESWT can be categorized into two groups: radial pressure wave (RPW) and focused shock wave (FSW). Although there have been several studies on the inflammation and pain-improvement mechanisms of FSW, there are few studies on the pain-improvement mechanisms of RPW. This study aimed to elucidate the efficacy of RPW in a rat model of adjuvant arthritis. METHODS: Ninety-six rats were randomly categorized into three groups: RPW, control, and sham as follows: (I) RPW group, which received RPW application after complete Freund's adjuvant (CFA) injection; (II) Control group, which received only CFA injection; and (III) Sham group, which received only saline injection. All rats were evaluated at 0, 4, 7, 14, 28, and 56 days post-RPW application based on foot circumference, von Frey test, and immunohistochemistry of nerve fibers for calcitonin gene-related peptide (CGRP) and protein gene product (PGP) 9.5 in plantar skins. RESULTS: There were no significant differences in foot circumference between the RPW and control groups at any time point. The RPW group showed significant improvements in the von Frey test results on days 7 and 14. The total CGRP-immunoreactive (ir) and PGP9.5-ir nerve fiber lengths in the RPW group decreased on day 0; however, both were increased in the control group. The CGRP-ir and PGP9.5-ir nerve fibers in the RPW group were significantly shorter than those in the control group until day 14 after RPW. CONCLUSIONS: RPW improved the mechanical hypersensitivity between days 7 and 14 after application. Like FSW, RPW also induced the degeneration of sensory nerve fibers in the skin in the early period after irradiation, and reinnervation occurred between 14 and 28 days. Thus, our results demonstrate one of the pain relief mechanisms after RPW application.
39Extracorporeal 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.
40Effect 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.
41Extracorporeal 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.
42Effects of dry needling and stretching exercise versus stretching exercise only on pain intensity, function, and sonographic characteristics of plantar fascia in the subjects with plantar fasciitis: a parallel single-blinded randomized controlled trial.PubMed
Saman Salehi, Azadeh Shadmehr, Gholamreza Olyaei, et al.
Physiother Theory Pract. 2023 Mar;39(3):490-503. doi: 10.1080/09593985.2021.2023930. Epub 2022 Jan 31.
OBJECTIVES: Plantar fasciitis is a common problem in the foot region which has negative considerable impact on foot function. METHODS: In this parallel blinded randomized controlled trial, a total of thirty-seven subjects with plantar fasciitis (forty feet) were enrolled randomly to either the control group (stretching exercise) or the experimental group (stretching exercise plus dry needling). All interventions lasted six weeks and both groups were followed for two weeks. Primary outcomes were first step pain, pain, and activity daily function subscales of the FAOS questionnaire and secondary outcomes were plantar fascia thickness, and echogenicity. RESULTS: The mixed model ANOVAs showed significant group × time interactions for all primary outcomes. In both groups, first step pain and both subscales of the FAOS questionnaire were improved compared to baseline measurements. There were considerable differences between the two groups and the experimental group experienced more improvements in primary outcomes compared to the control group. For secondary outcomes, plantar fascia thickness at insertion significantly decreased, and the echogenicity in the two regions significantly increased in the experimental group compared to the control group. CONCLUSION: These results suggest that the combination of dry needling and stretching exercises can be an effective conservative treatment for plantar fasciitis subjects.
43Platelet-rich plasma and plantar fasciitis.PubMed
Raymond R Monto
Sports Med Arthrosc Rev. 2013 Dec;21(4):220-4. doi: 10.1097/JSA.0b013e318297fa8d.
Plantar fasciitis is the most common cause of heel pain and can prove difficult to treat in its most chronic and severe forms. Advanced cases of plantar fasciitis are often associated with ankle stiffness, heel spurs, and other conditions and can lead to extensive physical disability and financial loss. Most available traditional treatments, including orthoses, nonsteroidal anti-inflammatory drugs, and steroid injections have a paucity of supportive clinical evidence. More invasive treatments, ranging from corticosteroid and botulinum-A toxin injections to shockwave therapy and plantar fasciotomy, have demonstrated varying clinical success in severe cases but carry the potential for serious complication and permanent disability. Platelet-rich plasma has recently been demonstrated to be helpful in managing chronic severe tendinopathies when other techniques have failed. This review examines the pathophysiology, diagnostic options, nonoperative treatment modalities, and surgical options currently used for plantar fasciitis. It also focuses on the clinical rationale and available evidence for using autologous platelet-rich plasma to treat severe refractory chronic plantar fasciitis.
44Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis.PubMed
Agustin Herber, Oscar Covarrubias, Mohammad Daher, et al.
Foot Ankle Surg. 2024 Jun;30(4):285-293. doi: 10.1016/j.fas.2024.02.004. Epub 2024 Feb 15.
INTRODUCTION: Plantar fasciitis (PF) is the most common cause of heel pain in adults. There are numerous non-operative treatments available including platelet rich plasma (PRP) injections. PPR has demonstrated effectiveness for a range of musculoskeletal conditions including plantar fasciitis. PURPOSE/OBJECTIVE: To compare the effectiveness of PRP to other conservative treatment options for the management of PF. METHODS: A systematic search of PubMed and Google Scholar was performed for randomized control trials (RCT) comparing PRP to other treatment modalities. Studies met inclusion criteria if mean and standard deviations for visual analog scale (VAS) pain scores, plantar fascia thickness (PFT), Foot Function Index (FFI), or American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were reported. Mean differences (MD) were used to compare VAS pain, PFT, FFI, and AOFAS between PRP and other treatments. RESULTS: Twenty-one RCTs which altogether included 1356 patients were included in the meta-analysis. PRP demonstrated significantly greater improvements in VAS pain scores compared to extracorporeal shock wave therapy (ESWT) (SMD: 0.86; CI: [0.30, 1.41]; p = 0.002), corticosteroid injections (CSI) (SMD: 1.08; CI: [0.05, 2.11]; p = 0.04), and placebo (SMD: 3.42; CI: [2.53, 4.31]; p < 0.00001). In terms of FFI, no significant differences existed among PRP, ESWT, CSI, dextrose prolotherapy (DPT), and meridian trigger points (MTP) in enhancing foot functionality. However, PRP demonstrated a marked advantage over phonophoresis, showing a substantial improvement in FFI scores (SMD: 3.07, 95% CI: 2.34-3.81). PRP did not demonstrate superiority over ESWT, CSI, or MTP for improving PFT, but it was notably more effective than phonophoresis (SMD: 3.18, 95% CI: 2.43-3.94). PRP demonstrated significantly greater improvements in AOFAS scores over CSI (SMD: 3.31, CI: [1.35, 5.27], p = 0.0009) and placebo (SMD: 3.75; CI: [2.81, 4.70]; p < 0.00001). CONCLUSION: PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement. LEVEL OF EVIDENCE: Level I Meta-Analysis.
45The Effect of Corticosteroid Local Injection Versus Platelet-Rich Plasma for the Treatment of Plantar Fasciitis in Obese Patients: A Single-Blind, Randomized Clinical Trial.PubMed
Ali Tabrizi, Sina Dindarian, Sedra Mohammadi
J Foot Ankle Surg. 2020 Jan-Feb;59(1):64-68. doi: 10.1053/j.jfas.2019.07.004.
Chronic plantar heel pain (CPHP) is one of the most common painful and disabling foot conditions, for which various treatments have been proposed. We aimed to investigate the efficacy of local injection of platelet-rich plasma (PRP) compared with the conventional method of local corticosteroid injection in obese patients who were resistant to other nonsurgical treatments. In this single-blind, randomized clinical trial, 32 obese patients with chronic plantar heel pain were randomly allocated to 2 groups of 16 participants each. In 1 group, 40 mg of dimethylprednisolone was injected once into the painful heel, whereas the other group received 3 separate injections of PRP, with each injection administered 1 week apart. The groups were compared at baseline and at 24 weeks after the injection, or course of injections, was administered. Exposures, total morning pain, and foot function index were not statistically significantly different between the groups at baseline; however, at 24 weeks after the treatment, final pain and morning pain scores were statistically significantly (p < .001) better in the corticosteroid group, and the mean foot function index scores were 65.4 ± 3.2 and 58.3 ± 2.9 (p < .001) in patients treated with corticosteroid and PRP, respectively. In obese patients with plantar fasciitis, injection with corticosteroid was more effective than PRP at reducing pain and improving function.
46An approach to the diagnosis and treatment of plantar fasciitis.PubMed
James L Glazer
Phys Sportsmed. 2009 Jun;37(2):74-9. doi: 10.3810/psm.2009.06.1712.
Plantar fasciitis is a painful condition affecting many athletes. Anatomic and biomechanical factors combined with overuse can contribute to its genesis. Correction of gait disturbances, changes in footwear, use of tension night splints, and stretching of tight calf and plantar tissues have all be proven to relieve symptoms. Anti-inflammatory modalities, including medications, iontophoresis, and corticosteroid injection generally provide temporary improvement. Recent studies on the efficacy of extracorporeal shock wave therapy are conflicting. Injections with platelet-rich plasma or sclerotic agents are currently under investigation for use in this and other similar conditions. A small percentage of patients with refractory symptoms may benefit from surgical release of the plantar fascia. Diagnosis and correction of biomechanical factors leading to this condition should be a mainstay of treatment and may prevent recurrences.
47Corticosteroid injection is the best treatment in plantar fasciitis if combined with controlled training.PubMed
Finn E Johannsen, Robert B Herzog, Nikolaj M Malmgaard-Clausen, et al.
Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):5-12. doi: 10.1007/s00167-018-5234-6. Epub 2018 Nov 15.
PURPOSE: Plantar fasciitis is a very common (lifetime incidence ~ 10%) and long-lasting injury with major impact on daily function. Combining corticosteroid injection and physical training (strength training and stretching) was hypothesized to result in a superior effect compared to each treatment separately. METHODS: A single blinded randomized controlled superiority trial conducted in 2013-2014 with a 2-year follow-up (end Sept 2016). 123 consecutive patients (20-65 years) referred to two study centers in Denmark: Institute of Sports Medicine, Bispebjerg Hospital, University of Copenhagen and a private rheumatology clinic with symptoms of plantar fasciitis, and ultrasound measured thickness above 4.0 mm were invited. 25 did not fulfill the inclusion criteria (mainly ultrasound criteria) and 8 refused participation. 90 patients were randomized (pulling sealed envelopes) to 3 groups: (1) 3 months strength training and stretching (n = 30), (2) corticosteroid injections with monthly intervals until thickness < 4.0 mm (maximum 3 injections) (n = 31), (3) combination of the two treatments (n = 29). During the 3 months intervention period load reduction was recommended (cushioning shoes and insoles and abstaining from running and jumping). The main outcome was improvement in Pain at function on a 100-mm VAS score and in Foot Function Index (FFI, range 0-230) at 6 months (Clinicaltrials.gov Identifier: NCT01994759). RESULTS: All groups improved significantly over time, but the combination of corticosteroid injection and training (strength training and stretching) had a superior effect at all time points. The mean difference between the combined treatment and training was 40 points in FFI (95% confidence interval (CI) 63-17 points, p < 0.001) and 20 mm for VAS function pain (CI 35-5 mm, p < 0.01). The mean difference between the combined treatment and corticosteroid injections only was 29 points in FFI (CI 52-7 points, p < 0.01) and 17 mm for VAS function pain (CI 32-2 mm, p < 0.05). All differences were clinically relevant. CONCLUSION: The best treatment for plantar fasciitis is the combination of corticosteroid injections and training (strength training and stretching). This combined treatment is superior both in the short- and in the longterm. Corticosteroid injections combined with controlled training are recommended as first line treatment in patients with plantar fasciitis. LEVEL OF EVIDENCE: 1.
48Manual therapy for plantar heel pain.PubMed
Yosefa Pollack, Anat Shashua, Leonid Kalichman
Foot (Edinb). 2018 Mar;34:11-16. doi: 10.1016/j.foot.2017.08.001. Epub 2017 Aug 5.
BACKGROUND: Manual therapy employed in the treatment of plantar heel pain includes joint or soft tissue mobilizations. Efficacy of these methods is still under debate. AIMS: To determine whether manual therapy, consisting of deep massage, myofascial release or joint mobilization is effective in treating plantar heel pain. METHODS: A critical review of all available studies with an emphasis on randomized controlled trials (RCTs) was performed. PubMed, PEDro, and Google Scholar databases were searched for keywords relating to plantar heel pain, joint, and soft tissue mobilizations. There were no search limitations or language restrictions. The reference lists of all retrieved articles were searched. The PEDro score was used to assess the quality of the reviewed papers. RESULTS: A total of six relevant RCTs were found: two examined the effectiveness of joint mobilization on plantar heel pain and four the effectiveness of soft tissue techniques. Five studies showed a positive short-term effect after manual therapy treatment, mostly soft tissue mobilizations, with or without stretching exercises for patients with plantar heel pain, compared to other treatments. One study observed that adding joint mobilization to the treatment of plantar heel pain was not effective. The quality of all studies was moderate to high. CONCLUSIONS: According to reviewed moderate and high-quality RCTs, soft tissue mobilization is an effective modality for treating plantar heel pain. Outcomes of joint mobilizations are controversial. Further studies are needed to evaluate the short and long-term effect of different soft tissue mobilization techniques.
49Randomised control trial to compare the efficacy of traditional Thai massage and ultrasound therapy for treating plantar heel pain.PubMed
Supamas Somphai, Wiraphong Sucharit, Punnee Peungsuwan, et al.
BMC Complement Med Ther. 2025 Feb 4;25(1):42. doi: 10.1186/s12906-025-04754-9.
BACKGROUND: Massage is suggested to be an effective treatment for chronic plantar heel pain (PHP). There is, however, no scientific evidence to support this claim. In the present study Traditional Thai Massage (TTM) has been compared with Ultrasound therapy (US) for treating PHP. METHODS: Sixty PHP patients with a Myofascial Trigger Point (MTrP) present in the calf were randomly assigned to receive a 40-minute single treatment of either US or TTM. Pain Intensity (VAS), Pressure Pain Threshold (PPT), Ankle Dorsiflexion Range of Motion (DROM), and Foot Skin Temperature (FST), were measured before, immediately after, and 24 h after treatment. RESULTS: Compared to baseline, both groups showed a significant reduction in pain intensity immediately (CVAS) and 24 h after treatment (MVAS24) (p < 0.01), as well as a significant increase in PPT of the heel immediately after treatment (p < 0.05). However, only the US treatment group showed an increase in PPT in the calf immediately after treatment (p < 0.05). Furthermore, only the US group showed a significant increase in DROM immediately and 24 h after treatment (p < 0.001). The reduction in CVAS and increase in DROM immediately (p < 0.05) and 24 h after treatment (p < 0.01) were significantly greater in the US than the TTM group. CONCLUSIONS: The significant efficacy of US with stretching for providing pain relief in the treatment of PHP is confirmed. For the first time, TTM has also been demonstrated to be effective in providing pain relief for patients with PHP and may have a potentially useful complementary role, in treating PHP. TRIAL REGISTRATION: TCTR20210909001 (First Submitted Date: September 2021).
50Effect of toe dorsiflexion on the regional distribution of plantar fascia shear wave velocity.PubMed
Kentaro Chino, Lilian Lacourpaille, Jun Sasahara, et al.
Clin Biomech (Bristol). 2019 Jan;61:11-15. doi: 10.1016/j.clinbiomech.2018.11.003. Epub 2018 Nov 8.
BACKGROUND: The plantar fascia is exposed to repetitive tensile stress induced by cyclic loads associated with daily activities, such as walking and running. Due to overuse or abnormal foot alignment, insertional and distal (i.e., mid-substance) regions within the plantar fascia may exhibit microtears, which leads to plantar fasciopathy. Ultrasound shear wave elastography is an imaging technique to measure shear wave velocity propagating through biological tissues, considered herein as an index of tensile stress. This study aimed to quantify the effect of toe dorsiflexion on the regional distribution of plantar fascia shear wave velocity. METHODS: Shear wave velocity of the plantar fascia was measured in the insertional and distal regions using ultrasound shear wave elastography in sixteen healthy participants (7 males and 9 females). The measurements were performed while the toes were maintained in neutral or dorsiflexed positions. FINDINGS: When considering the insertional region, there was no significant difference in shear wave velocity between neutral toe position [mean (SEM): 5.4 (0.6) m/s] and dorsiflexed toe position [5.5 (0.5) m/s] (P = 0.88; effect size = 0.05). When considering the distal region, there was a significant difference in shear wave velocity between the neutral position [7.8 (0.4) m/s] and dorsiflexed position [9.9 (0.3) m/s] (P = 0.002; effect size = 0.88). The difference in shear wave velocity between the insertional and distal regions showed a large effect size for either neutral (P = 0.010; effect size = 0.75) or dorsiflexed toe position (P = 0.003; effect size = 0.86). INTERPRETATION: In contrast to clinical beliefs, these findings suggest that toe dorsiflexion induces non-homogeneous changes in tensile stress within the plantar fascia.