今日の臨床サポート

足底腱膜炎

著者: 大関覚 獨協医科大学越谷病院 整形外科

監修: 酒井昭典 産業医科大学 整形外科学教室

著者校正/監修レビュー済:2017/01/26

概要・推奨   

疾患のポイント:
  1. 底腱膜は足底皮下に踵骨から足趾の底側まで拡がる丈夫な腱様の線維膜組織で、足の縦アーチを支える機能を持ち、つま先立ちや踏み返し動作の際にアキレス腱の張力を足底に伝える機能を持っている。
  1. 足底腱膜炎は踵部痛の最も多い原因で中年期以降の40歳代から60歳代に、過度の負荷をきっかけに踵の内側の痛みとして発症することが多いが、長距離ランナーやサッカー選手などではスポーツのストレスが過剰になると発症する。
  1. 症状は踵の痛みであるが、程度はさまざまである。特徴的なのは朝の第1歩の激痛で、少し時間が経つと軽減する。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
大関覚 : 特に申告事項無し[2021年]
監修:酒井昭典 : 講演料(旭化成ファーマ(株),第一三共(株),中外製薬(株)),奨学(奨励)寄付など(旭化成ファーマ(株),第一三共(株),中外製薬(株))[2021年]

病態・疫学・診察

疾患情報(疫学・病態)  
病態:
  1. 足底腱膜は足底皮下に踵骨から足趾の底側まで拡がる丈夫な腱様の線維膜組織で、足の縦アーチを支える機能を持ち、つま先立ちや踏み返し動作の際にアキレス腱の張力を足底に伝える機能を持っている[1]。また、踏み返し動作時には、足趾のMTP関節が背屈するため、足底の縦アーチが高くなる「巻き上げ現象」と呼ばれる動きが起こる。有限要素法を用いたシミュレーションでは、足底腱膜には踏み返し期の直前に体重の70%の張力がかかると示唆され、踵の高い靴で母趾が背屈するとさらに高い張力がかかると解析されている[2]。足底腱膜炎は踵部痛の最も多い原因で中年期以降の40歳代から60歳代に、過度の負荷をきっかけに踵の内側の痛みとして発症することが多い[3]が、長距離ランナーやサッカー選手などではスポーツのストレスが過剰になると発症する[4]。発症の危険因子としては、立ち仕事、足関節の背屈制限、肥満などが挙げられている[5]。足底腱膜炎と呼ばれるが組織学的検討では、腱様組織の変性所見が主で炎症所見に乏しく繰り返す張力負荷により起こった微少損傷である[6]。アキレス腱の拘縮を伴っていることが多い。早期に、治療しないとしばしば慢性化し治療に難渋する。しかし、症状がどんどん悪化していくことはまれで、6カ月以降も症状はさほど変化しないといわれている[7]
 
足底腱膜の機能

アキレス腱の力を足底に伝え、趾MP関節の背屈時には巻き上げ現象を起こす。足底腱膜炎となると赤矢印部の起始部内側に圧痛が著明になる。

出典

 
症状:
  1. 主訴は踵の痛みであるが、程度はさまざまである。特徴的なのは朝の第1歩の激痛で、少し時間が経つと軽減する。しかし、朝の痛みは軽度でも次第に増強し、夕方には足を地面につくのが困難なほどの疼痛となることが多い[8]。夜間に就眠障害が出るほどの痛みになることは少ない。新しい革靴に換えた、フローリングの部屋に引っ越したなど、歩行時に踵の衝撃が増大するきっかけがあることが多い。また、ランニング時間が長いスポーツを行っていて、さらに負荷が増大した際や、負荷環境の変化に遇った場合にも発症しやすい。合宿練習での最後に記録会のレースをしたあと、へたったシューズで長く走ったあと、逆に新しいランニングシューズに換えた直後、硬いグラウンドの上でスパイク付きのシューズでサッカーをしたあとなどは、しばしば経験する発症機転である[9]
問診・診察のポイント  
診察法
  1. 視診では、立位での踵の内外反を後方から観察し、足部の回内や回外の異常を観察する。触診では距骨下関節や足根骨間関節の可動性を確認し、踵骨内側の足底腱膜起始部に圧痛点があることが多い[10]。踵骨の内外側壁に圧迫力をかけて痛みが誘発されるか調べるsqueeze testは、疲労骨折や骨嚢腫などの鑑別に有効である[3]

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文献 

著者: Ahmet Erdemir, Andrew J Hamel, Andrew R Fauth, Stephen J Piazza, Neil A Sharkey
雑誌名: J Bone Joint Surg Am. 2004 Mar;86-A(3):546-52.
Abstract/Text 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.

PMID 14996881  J Bone Joint Surg Am. 2004 Mar;86-A(3):546-52.
著者: Yen-Nien Chen, Chih-Wei Chang, Chun-Ting Li, Chih-Han Chang, Cheng-Feng Lin
雑誌名: Foot Ankle Int. 2015 Jan;36(1):90-7. doi: 10.1177/1071100714549189. Epub 2014 Sep 4.
Abstract/Text BACKGROUND: The plantar fascia is a primary arch supporting structure of the foot and is often stressed with high tension during ambulation. When the loading on the plantar fascia exceeds its capacity, the inflammatory reaction known as plantar fasciitis may occur. Mechanical overload has been identified as the primary causative factor of plantar fasciitis. However, a knowledge gap exists between how the internal mechanical responses of the plantar fascia react to simple daily activities. Therefore, this study investigated the biomechanical responses of the plantar fascia during loaded stance phase by use of the finite element (FE) modeling.
METHODS: A 3-dimensional (3-D) FE foot model comprising bones, cartilage, ligaments, and a complex-shaped plantar fascia was constructed. During the stance phase, the kinematics of the foot movement was reproduced and Achilles tendon force was applied to the insertion site on the calcaneus. All the calculations were made on a single healthy subject.
RESULTS: The results indicated that the plantar fascia underwent peak tension at preswing (83.3% of the stance phase) at approximately 493 N (0.7 body weight). Stress concentrated near the medial calcaneal tubercle. The peak von Mises stress of the fascia increased 2.3 times between the midstance and preswing. The fascia tension increased 66% because of the windlass mechanism.
CONCLUSION: Because of the membrane element used in the ligament tissue, this FE model was able to simulate the mechanical structure of the foot. After prescribing kinematics of the distal tibia, the proposed model indicated the internal fascia was stressed in response to the loaded stance phase.
CLINICAL RELEVANCE: Based on the findings of this study, adjustment of gait pattern to reduce heel rise and Achilles tendon force may lower the fascia loading and may further reduce pain in patients with plantar fasciitis.

© The Author(s) 2014.
PMID 25189539  Foot Ankle Int. 2015 Jan;36(1):90-7. doi: 10.1177/10711・・・
著者: Rachelle Buchbinder
雑誌名: N Engl J Med. 2004 May 20;350(21):2159-66. doi: 10.1056/NEJMcp032745.
Abstract/Text
PMID 15152061  N Engl J Med. 2004 May 20;350(21):2159-66. doi: 10.1056・・・
著者: Daniel L Riddle, Matthew Pulisic, Peter Pidcoe, Robert E Johnson
雑誌名: J Bone Joint Surg Am. 2003 May;85-A(5):872-7.
Abstract/Text 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 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 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.

PMID 12728038  J Bone Joint Surg Am. 2003 May;85-A(5):872-7.
著者: Harvey Lemont, Krista M Ammirati, Nsima Usen
雑誌名: J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7.
Abstract/Text The authors review histologic findings from 50 cases of heel spur surgery for chronic plantar fasciitis. Findings include myxoid degeneration with fragmentation and degeneration of the plantar fascia and bone marrow vascular ectasia. Histologic findings are presented to support the thesis that "plantar fasciitis" is a degenerative fasciosis without inflammation, not a fasciitis. These findings suggest that treatment regimens such as serial corticosteroid injections into the plantar fascia should be reevaluated in the absence of inflammation and in light of their potential to induce plantar fascial rupture.

PMID 12756315  J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7.
著者: Sandra E Klein, Ann Marie Dale, Marcie Harris Hayes, Jeffrey E Johnson, Jeremy J McCormick, Brad A Racette
雑誌名: Foot Ankle Int. 2012 Sep;33(9):693-8. doi: DOI: 10.3113/FAI.2012.0693.
Abstract/Text BACKGROUND: Plantar heel pain is a common disorder of the foot. The purpose of this study was to explore the relationship between duration of symptoms in plantar fasciitis patients and demographic factors, the intensity and location of pain, extent of previous treatment, and self-reported pain and function.
METHODS: The charts of patients presenting with plantar heel pain between June 2008 and October 2010 were reviewed retrospectively and 182 patients with a primary diagnosis of plantar fasciitis were identified. Patients with symptoms less than 6 months were identified as acute and patients with symptoms greater than or equal to 6 months were defined as having chronic symptoms. Comparisons based on duration of symptoms were performed for age, gender, body mass index (BMI), comorbidities, pain location and intensity, and a functional score measured by the Foot and Ankle Ability Measure (FAAM).
RESULTS: The two groups were similar in age, BMI, gender, and comorbidities. Pain severity, as measured by a visual analog scale, was not statistically significant between the two groups (6.6 and 6.2). The acute and chronic groups of patients reported similar levels of function on both the activity of daily living (62 and 65) and sports (47 and 45) subscales of the FAAM. Patients in the chronic group were more likely to have seen more providers and tried more treatment options for this condition.
CONCLUSION: As plantar fasciitis symptoms extend beyond 6 months, patients do not experience increasing pain intensity or functional limitation. No specific risk factors have been identified to indicate a risk of developing chronic symptoms.

PMID 22995253  Foot Ankle Int. 2012 Sep;33(9):693-8. doi: DOI: 10.3113・・・
著者: L H Gill, G M Kiebzak
雑誌名: Foot Ankle Int. 1996 Sep;17(9):527-32.
Abstract/Text Four hundred eleven patients with a clinical diagnosis of plantar fasciitis were assessed for predisposing factors. Each patient completed an outcomes assessment survey instrument that ranked effectiveness of various nonsurgical treatment modalities. Listed in descending order of effectiveness, the treatment modalities assessed were short leg walking cast, steroid injection, rest, ice, runner's shoe, crepe-soled shoe, aspirin or nonsteroidal anti-inflammatory drug, heel cushion, low-profile plastic heel cup, heat, and Tuli's heel cup. Treatment with a cast ranked the best. The Tuli's heel cup ranked the poorest. Most of the treatments were found to be unpredictable or minimally effective. The ineffectiveness of nonsurgical treatments noted in this outcomes study is at variance with most published clinical studies in which generally favorable results are reported after nonsurgical treatment for plantar fasciitis.

PMID 8886778  Foot Ankle Int. 1996 Sep;17(9):527-32.
著者: A M McBryde
雑誌名: Instr Course Lect. 1984;33:278-82.
Abstract/Text Plantar fasciitis is a typical repetitive-stress running injury and a difficult problem to treat. A full, nonoperative treatment program requires unusual patient cooperation and motivation. Surgical treatment is necessary in a small number of intractable cases.

PMID 6152808  Instr Course Lect. 1984;33:278-82.
著者: K S Johal, S A Milner
雑誌名: Foot Ankle Surg. 2012 Mar;18(1):39-41. doi: 10.1016/j.fas.2011.03.003. Epub 2011 Apr 13.
Abstract/Text BACKGROUND: Plantar fasciitis is a common diagnosis in patients presenting with heel pain. The presence of co-existing calcaneal spurs has often been reported but confusion exists as to whether it is a casual or significant association.
METHODS: The lateral heel radiographs of nineteen patients with a diagnosis of plantar fasciitis and nineteen comparison subjects with a lateral ankle ligament sprain matched for age and sex, were reviewed independently by two observers. Objective measurements of calcaneal spur length and a subjective grading of spur size were recorded.
RESULTS: There was a significantly higher prevalence of calcaneal spurs in the cases than the comparison group (89% versus 32%; McNemar chi-square=9.09, df=2, p=0.00257). There was good inter- and intra-observer agreement.
CONCLUSION: The current study has demonstrated a significant association between plantar fasciitis and calcaneal spur formation. Further research is warranted to assess whether the association is causal.

Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
PMID 22326003  Foot Ankle Surg. 2012 Mar;18(1):39-41. doi: 10.1016/j.f・・・
著者: M P Recht, B G Donley
雑誌名: J Am Acad Orthop Surg. 2001 May-Jun;9(3):187-99.
Abstract/Text Magnetic resonance (MR) imaging of the foot and ankle is playing an increasingly important role in the diagnosis of a wide range of foot and ankle abnormalities, as well as in planning for their surgical treatment. For an optimal MR study of the foot and ankle, it is necessary to obtain high-resolution, small-field-of-view images using a variety of pulse sequences. The most common indication for MR imaging of the foot and ankle is for the evaluation of tendon and bone abnormalities, such as osteomyelitis, occult fractures, and partial and complete tears of the Achilles, tibialis posterior, and peroneal tendons. Magnetic resonance imaging has also been shown to be helpful in the diagnosis of several soft-tissue abnormalities that are unique to the foot and ankle, such as plantar fasciitis, plantar fibromatosis, interdigital neuromas, and tarsal tunnel syndrome.

PMID 11421576  J Am Acad Orthop Surg. 2001 May-Jun;9(3):187-99.
著者: So-Yeon Lee, Hee Jin Park, Hyon Joo Kwag, Hyun-Pyo Hong, Hae-Won Park, Yong-Rae Lee, Kyung Jae Yoon, Yong-Taek Lee
雑誌名: Clin Imaging. 2014 Sep-Oct;38(5):715-8. doi: 10.1016/j.clinimag.2012.12.004. Epub 2014 Jul 18.
Abstract/Text BACKGROUND: The purpose of this study was to investigate whether ultrasound (US) elastography is useful for the early diagnosis of plantar fasciitis.
MATERIAL AND METHODS: We retrospectively reviewed US elastography findings of 18 feet with a clinical history and physical examination highly suggestive of plantar fasciitis but with normal findings on conventional US imaging as well as 18 asymptomatic feet.
RESULT: Softening of the plantar fascia was significantly greater in the patient than in the control group [Reviewers 1 and 2: 89% (16/18) vs. 50% (9/18), P=.027, respectively].
CONCLUSION: US elastography is useful for the early diagnosis of plantar fasciitis.

Copyright © 2014 Elsevier Inc. All rights reserved.
PMID 25047908  Clin Imaging. 2014 Sep-Oct;38(5):715-8. doi: 10.1016/j.・・・
著者: LH Gill
雑誌名: J Am Acad Orthop Surg. 1997 Mar;5(2):109-117.
Abstract/Text Plantar fasciitis is a common cause of heel pain, which frustrates patients and practitioners alike because of its resistance to treatment. It has been associated with obesity, middle age, and biomechanical abnormalities in the foot, such as tight Achilles tendon, pes cavus, and pes planus. It is considered to be most often the result of a degenerative process at the origin of the plantar fascia at the calcaneus. However, neurogenic and other causes of subcalcaneal pain are frequently cited. A combination of causative factors may be present, or the true cause may remain obscure. Although normally managed with conservative treatment, plantar fasciitis is frequently resistant to the wide variety of treatments commonly used, such as nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics, corticosteroid injections, casts, physical therapy, ice, and heat. Although there is no consensus on the efficacy of any particular conservative treatment regimen, there is agreement that nonsurgical treatment is ultimately effective in approximately 90% of patients. Since the natural history of plantar fasciitis has not been established, it is unclear how much of symptom resolution is in fact due to the wide variety of commonly used treatments.

PMID 10797213  J Am Acad Orthop Surg. 1997 Mar;5(2):109-117.
著者: Steven K Neufeld, Rebecca Cerrato
雑誌名: J Am Acad Orthop Surg. 2008 Jun;16(6):338-46.
Abstract/Text Plantar fasciitis is the most common cause of plantar heel pain. Its characteristic features are pain and tenderness, predominately on the medial aspect of the calcaneus near the sole of the heel. Considering a complete differential diagnosis of plantar heel pain is important; a comprehensive history and physical examination guide accurate diagnosis. Many nonsurgical treatment modalities have been used in managing the disorder, including rest, massage, nonsteroidal anti-inflammatory drugs, night splints, heel cups/pads, custom and off-the-shelf orthoses, injections, casts, and physical therapy measures such as shock wave therapy. Most reported treatment outcomes rely on anecdotal experience or combinations of multiple modalities. Nevertheless, nonsurgical management of plantar fasciitis is successful in approximately 90% of patients. Surgical treatment is considered in only a small subset of patients with persistent, severe symptoms refractory to nonsurgical intervention for at least 6 to 12 months.

PMID 18524985  J Am Acad Orthop Surg. 2008 Jun;16(6):338-46.
著者: D E Baxter, G B Pfeffer
雑誌名: Clin Orthop Relat Res. 1992 Jun;(279):229-36.
Abstract/Text Sixty-nine heels (53 patients) with chronic heel pain had a surgical release of the first branch of the lateral plantar nerve. The average duration of heel-pain symptoms was 23 months (range, six months to eight years). No patient had less than six months of conservative treatment before surgery. The average duration of preoperative conservative treatment was 14 months. Forty-four patients (83%) had taken nonsteroidal antiinflammatory agents. Sixty-three heels (91%) had used heel cups and/or orthoses. Fifty-nine heels (86%) had received one or more injections of a steroid preparation. Thirty-four heels had developed pain initially during a sports activity. Postoperatively, 61 heels (89%) had excellent or good results; 57 heels (83%) had complete resolution of pain. The average follow-up period was 49 months. In general, heel pain resolves with conservative treatment. In recalcitrant cases, however, entrapment of the first branch lateral plantar nerve should be suspected. Surgical release of this nerve can be expected to provide excellent relief of pain and facilitate return to normal activity.

PMID 1600660  Clin Orthop Relat Res. 1992 Jun;(279):229-36.
著者: Amar Patel, Benedict DiGiovanni
雑誌名: Foot Ankle Int. 2011 Jan;32(1):5-8. doi: 10.3113/FAI.2011.0005.
Abstract/Text BACKGROUND: Current evidence suggests that limited ankle dorsiflexion is an etiologic factor for plantar fasciitis. This limitation can arise from either an isolated contracture of the gastrocnemius or from a contracture of the gastrocnemius-soleus complex. This study's aim was to determine the proportion of patients with plantar fasciitis that have an associated isolated gastrocnemius contracture.
MATERIALS AND METHODS: This investigation was a prospective evaluation of patients with either acute or chronic plantar fasciitis. Two hundred fifty-four patients with plantar fasciitis were included. Patients were assessed for the existence of limited ankle dorsiflexion which was further characterized by noting the presence of an isolated gastrocnemius contracture or contracture of the gastrocnemius-soleus complex. The patient's duration of symptoms, type of occupation, and body mass index were also documented. Patients with acute plantar fasciitis were defined as having symptom duration of 9 months or less while those with chronic plantar fasciitis were those with over 9 months of symptoms. The Wilcoxon rank sum and chi square tests were used to compare characteristics between the acute and chronic populations.
RESULTS: Eighty-three percent (211 of 254 patients) had limited ankle dorsiflexion. Fifty-seven percent (145 of 254) had an isolated contracture of the gastrocnemius, 26% (66 of 254) had a contracture of the gastrocnemius-soleus complex, and 17% (43 of 254) did not have a dorsiflexion limitation. Patients were further stratified into acute versus chronic symptom duration at the time of presentation. Equinus contracture was noted in 83% (129 of 155) of acute cases, and 82% (82 of 99) of chronic cases. An isolated contracture of the gastrocnemius was found in 60% (93 of 155) of acute, and 52% (52 of 99) of chronic cases. A gastrocnemius-soleus complex contracture was noted in 23% (36 of 155) of acute cases, and 30% (30 of 99) of chronic cases. Patients with chronic plantar fasciitis had a significantly higher number (p<0.05) of medical comorbidities than those with acute plantar fasciitis.
CONCLUSION: Limited ankle dorsiflexion is commonly associated with plantar fasciitis and more than half of these patients had evidence of an isolated gastrocnemius contracture. These findings can be utilized to develop and further refine non-operative and operative treatment strategies for those with recalcitrant plantar fasciitis.

PMID 21288428  Foot Ankle Int. 2011 Jan;32(1):5-8. doi: 10.3113/FAI.20・・・
著者: Benedict F Digiovanni, Deborah A Nawoczenski, Daniel P Malay, Petra A Graci, Taryn T Williams, Gregory E Wilding, Judith F Baumhauer
雑誌名: J Bone Joint Surg Am. 2006 Aug;88(8):1775-81. doi: 10.2106/JBJS.E.01281.
Abstract/Text BACKGROUND: In a previous investigation, eighty-two patients with chronic proximal plantar fasciitis for a duration of more than ten months completed a randomized, prospective clinical trial. The patients received instructions for either a plantar fascia-stretching protocol or an Achilles tendon-stretching protocol and were evaluated after eight weeks. Substantial differences were noted in favor of the group managed with the plantar fascia-stretching program. The goal of this two-year follow-up study was to evaluate the long-term outcomes of the plantar fascia-stretching protocol in patients with chronic plantar fasciitis.
METHODS: Phase one of the clinical trial concluded at eight weeks. At the eight-week follow-up evaluation, all patients were instructed in the plantar fascia-stretching protocol. At the two-year follow-up evaluation, a questionnaire consisting of the pain subscale of the Foot Function Index and an outcome survey related to pain, function, and satisfaction with treatment was mailed to the eighty-two subjects who had completed the initial clinical trial. Data were analyzed with use of a mixed-model analysis of covariance for each outcome of interest.
RESULTS: Complete data sets were obtained from sixty-six patients. The two-year follow-up results showed marked improvement for all patients after implementation of the plantar fascia-stretching exercises, with an especially high rate of improvement for those in the original group treated with the Achilles tendon-stretching program. In contrast to the eight-week results, the two-year results showed no significant differences between the groups with regard to the worst pain or pain with first steps in the morning. Descriptive analysis of the data showed that 92% (sixty-one) of the sixty-six patients reported total satisfaction or satisfaction with minor reservations. Fifty-one patients (77%) reported no limitation in recreational activities, and sixty-two (94%) reported a decrease in pain. Only sixteen of the sixty-six patients reported the need to seek treatment by a clinician.
CONCLUSIONS: This study supports the use of the tissue-specific plantar fascia-stretching protocol as the key component of treatment for chronic plantar fasciitis. Long-term benefits of the stretch include a marked decrease in pain and functional limitations and a high rate of satisfaction. This approach can provide the health-care practitioner with an effective, inexpensive, and straightforward treatment protocol.

PMID 16882901  J Bone Joint Surg Am. 2006 Aug;88(8):1775-81. doi: 10.2・・・
著者: Ryan M Flanigan, Deborah A Nawoczenski, Linlin Chen, Hulin Wu, Benedict F DiGiovanni
雑誌名: Foot Ankle Int. 2007 Jul;28(7):815-22. doi: 10.3113/FAI.2007.0815.
Abstract/Text BACKGROUND: A recent study found nonweightbearing stretching exercises specific to the plantar fascia to be superior to the standard program of weightbearing Achilles tendon-stretching exercises in patients with chronic plantar fasciitis. The present study used a cadaver model to demonstrate the influence of foot and ankle position on stretching of the plantar fascia.
METHODS: Twelve fresh-frozen lower-leg specimens were tested in 15 different configurations representing various combinations of ankle and metatarsophalangeal (MTP) joint dorsiflexion, midtarsal transverse plane abduction and adduction, and forefoot varus and valgus. Measurements were recorded by a differential variable reluctance transducer (DVRT) implanted into the medial band of the plantar fascia, and primary measurement was a percent deformation of the plantar fascia (stretch) with respect to a reference position (90 degrees ankle dorsiflexion, 0 degrees midtarsal and forefoot orientation, and 0 degrees MTP dorsiflexion).
RESULTS: Ankle and MTP joint dorsiflexion produced a significant increase (14.91%) in stretch compared to the position of either ankle dorsiflexion alone (9.31% increase, p < 0.001) or MTP dorsiflexion alone (7.33% increase, p < 0.01). There was no significant increase in stretch with positions of abduction or varus (2.49%, p = 0.27 and 0.55%, p = 0.79).
CONCLUSION: This study provides a mechanical explanation for enhanced outcomes in recent clinical trials using plantar fascia tissue-specific stretching exercises and lends support to the use of ankle and MTP joint dorsiflexion when employing stretching protocols for nonoperative treatment in patients with chronic proximal plantar fasciitis.

PMID 17666175  Foot Ankle Int. 2007 Jul;28(7):815-22. doi: 10.3113/FAI・・・
著者: G Pfeffer, P Bacchetti, J Deland, A Lewis, R Anderson, W Davis, R Alvarez, J Brodsky, P Cooper, C Frey, R Herrick, M Myerson, J Sammarco, C Janecki, S Ross, M Bowman, R Smith
雑誌名: Foot Ankle Int. 1999 Apr;20(4):214-21.
Abstract/Text Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospective randomized trial to compare several nonoperative treatments for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most reported duration of symptoms of 6 months or less. Patients with systemic disease, significant musculoskeletal complaints, sciatica, or local nerve entrapment were excluded. We randomized patients prospectively into five different treatment groups. All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner. One group was treated with stretching only. The other four groups stretched and used one of four different shoe inserts, including a silicone heel pad, a felt pad, a rubber heel cup, or a custom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages improved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; (3) felt insert, 81%; (4)stretching only, 72%; and (5) custom orthosis, 68%. Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.

PMID 10229276  Foot Ankle Int. 1999 Apr;20(4):214-21.
著者: Dennis J Janisse, Erick Janisse
雑誌名: J Am Acad Orthop Surg. 2008 Mar;16(3):152-8.
Abstract/Text Shoe modification and foot orthoses can play an important role in the nonsurgical management of foot and ankle pathology. Therapeutic footwear may be used to treat patients with diabetes, arthritis, neurologic conditions, traumatic injuries, congenital deformities, and sports-related injuries. These modalities may improve patient gait and increase the level of ambulation. They also may be used to treat acute problems such as plantar fasciitis or metatarsalgia and as preventive tools in patients with diabetic neuropathy. Shoe selection is primarily based on the condition of the patient, the foot shape and type, and the patient's daily activities. Modifications include flares, which provide stability; extended shanks to reduce bending stresses; rocker soles to rock the foot from heel strike to toe-off; and relasting, or reshaping, shoes to accommodate deformities. The four main types of custom orthoses are the accommodative, which cushions and protects the foot; the semi-rigid, which cushions and protects as well as provides support, control, and weight redistribution; the rigid, which offers arch support; and the partial foot prosthesis, which addresses partial amputations and helps protect the foot.

PMID 18316713  J Am Acad Orthop Surg. 2008 Mar;16(3):152-8.
著者: Brian G Donley, Tim Moore, James Sferra, Jon Gozdanovic, Richard Smith
雑誌名: Foot Ankle Int. 2007 Jan;28(1):20-3. doi: 10.3113/FAI.2007.0004.
Abstract/Text BACKGROUND: Plantar fasciitis frequently responds to a broad range of conservative therapies, and there is no single universally accepted way of treating this condition. Modalities commonly used include rest, ice massage, stretching of the Achilles tendon and plantar fascia, nonsteroidal anti-inflammatory medications (NSAIDs), corticosteroid injections, foot padding, taping, shoe modifications (steel shank and anterior rocker bottom), arch supports, heel cups, custom foot orthoses, night splints, ultrasound, and casting. To our knowledge, no prospective, randomized, placebo controlled double-blind study has evaluated the efficacy of oral NSAIDs in the treatment of plantar fasciitis.
METHODS: Twenty-nine patients with the diagnosis of plantar fasciitis were treated with a conservative regimen that included heel-cord stretching, viscoelastic heel cups, and night splinting. They were randomly assigned to either a placebo group or an NSAID group. In the NSAID group, celecoxib was added to the treatment regimen.
RESULTS: Pain and disability mean scores improved significantly over time in both groups, although there was no statistical significance between the placebo and NSAID groups at 1, 2, or 6 months. There was a trend towards improved pain relief and disability in the NSAID group, especially in the interval between the 2 and 6-month followup. Pain improved from baseline to 6 months by a factor of 5.2 and disability by 3.8 in the NSAID group compared to 3.6 and 3.5, respectively, in the placebo group. Even though at baseline the pain and disability scores were higher in the NSAID group, the final pain and disability scores were subjectively lower in the NSAID group than in the placebo group (1.43 for pain and 1.16 for disability in the NSAID group, compared to 1.86 and 1.49, respectively, in the placebo group).
CONCLUSIONS: These results provide some evidence that the use of an NSAID may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen.

PMID 17257533  Foot Ankle Int. 2007 Jan;28(1):20-3. doi: 10.3113/FAI.2・・・
著者: J I Acevedo, J L Beskin
雑誌名: Foot Ankle Int. 1998 Feb;19(2):91-7.
Abstract/Text From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

PMID 9498581  Foot Ankle Int. 1998 Feb;19(2):91-7.
著者: Ho Seong Lee, Young Rak Choi, Sang Woo Kim, Jin Yong Lee, Jeong Ho Seo, Jae Jung Jeong
雑誌名: Foot Ankle Int. 2014 Mar;35(3):258-63. doi: 10.1177/1071100713514564. Epub 2013 Nov 25.
Abstract/Text BACKGROUND: Prior to 1994, plantar fascia ruptures were considered as an acute injury that occurred primarily in athletes. However, plantar fascia ruptures have recently been reported in the setting of preexisting plantar fasciitis. We analyzed risk factors causing plantar fascia rupture in the presence of preexisting plantar fasciitis.
METHODS: We retrospectively reviewed 286 patients with plantar fasciitis who were referred from private clinics between March 2004 and February 2008. Patients were divided into those with or without a plantar fascia rupture. There were 35 patients in the rupture group and 251 in the nonrupture group. The clinical characteristics and risk factors for plantar fascia rupture were compared between the 2 groups. We compared age, gender, the affected site, visual analog scale pain score, previous treatment regimen, body mass index, degree of ankle dorsiflexion, the use of steroid injections, the extent of activity, calcaneal pitch angle, the presence of a calcaneal spur, and heel alignment between the 2 groups.
RESULTS: Of the assessed risk factors, only steroid injection was associated with the occurrence of a plantar fascia rupture. Among the 35 patients with a rupture, 33 had received steroid injections. The odds ratio of steroid injection was 33.
CONCLUSION: Steroid injections for plantar fasciitis should be cautiously administered because of the higher risk for plantar fascia rupture.
LEVEL OF EVIDENCE: Level III, retrospective comparative study.

PMID 24275488  Foot Ankle Int. 2014 Mar;35(3):258-63. doi: 10.1177/107・・・
著者: Jorge Elizondo-Rodriguez, Yariel Araujo-Lopez, J Alberto Moreno-Gonzalez, Eloy Cardenas-Estrada, Oscar Mendoza-Lemus, Carlos Acosta-Olivo
雑誌名: Foot Ankle Int. 2013 Jan;34(1):8-14. doi: 10.1177/1071100712460215.
Abstract/Text BACKGROUND: The objective of this study was to compare intramuscularly applied botulinum toxin A (BTX-A) in the gastroc-soleus complex with intralesional steroids for the treatment of plantar fasciitis.
METHODS: The patients were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 6 months. The evaluation scores included the Visual Analog Scale (VAS), Maryland Foot and Ankle, Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, patients were instructed to perform plantar fascia stretching exercises over the course of the study. The final number of patients was 36, of whom 19 received BTX-A (10 men and 9 women) and 17 (6 men and 11 women) received steroids.
RESULTS: When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study.
CONCLUSION: A combination of BTX-A and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids.
LEVEL OF EVIDENCE: Level I, therapeutic studies.

PMID 23386757  Foot Ankle Int. 2013 Jan;34(1):8-14. doi: 10.1177/10711・・・
著者: Robert Gordon, Charles Wong, Eric J Crawford
雑誌名: Foot Ankle Int. 2012 Mar;33(3):202-7.
Abstract/Text BACKGROUND: Ultrasonographic measurement of the plantar fascia can be used to objectively diagnose plantar fasciitis. The purpose of this study was to determine the long-term effectiveness of Extracorporeal Pulse Activated Therapy (EPAT) for the treatment of plantar fasciitis using ultrasonographic measurement as an objective outcome measure, with a minimum followup of 12 months.
METHODS: Patients with chronic recalcitrant plantar fasciitis were prospectively recruited and underwent EPAT. Ultrasound measurement of the plantar fascia and patient-rated pain scores were collected before treatment and at followup (minimum of 12 months post-treatment). Twenty-five subjects (35 feet) met the inclusion criteria. The average followup time was 29.4 +/- 13.1 (M +/- SD; range, 12 to 54) months.
RESULTS: The average thickness of the plantar fascia of the symptomatic heels was 7.3 +/- 2.0 mm before treatment and 6.0 +/- 1.3 mm after treatment (p < 0.001). The average change in thickness of the treated heels was -1.3 mm (-0.8 to -1.8 mm; 95% CI, p < 0.0001). No correlation was found between length of followup and change in ultrasound measured plantar fascia thickness (r = -0.04, p = 0.818).
CONCLUSION: For patients with a greater than 12-month history of heel pain, EPAT can effectively decrease plantar fascia thickness as demonstrated objectively by ultrasound evaluation and reduce patient-reported pain. No relationship between length of followup and change in plantar fascia thickness was found after 12 months.

PMID 22734281  Foot Ankle Int. 2012 Mar;33(3):202-7.
著者: Hiroshi Ohuchi, Ken Ichikawa, Kotaro Shinga, Soichi Hattori, Shin Yamada, Kazuhisa Takahashi
雑誌名: Arthrosc Tech. 2013;2(3):e227-30. doi: 10.1016/j.eats.2013.02.006. Epub 2013 Jun 22.
Abstract/Text Various surgical treatment procedures for plantar fasciitis, such as open surgery, percutaneous release, and endoscopic surgery, exist. Skin trouble, nerve disturbance, infection, and persistent pain associated with prolonged recovery time are complications of open surgery. Endoscopic partial plantar fascia release offers the surgeon clear visualization of the anatomy at the surgical site. However, the primary medial portal and portal tract used for this technique have been shown to be in close proximity to the posterior tibial nerves and their branches, and there is always the risk of nerve damage by introducing the endoscope deep to the plantar fascia. By performing endoscopic partial plantar fascia release under ultrasound assistance, we could dynamically visualize the direction of the endoscope and instrument introduction, thus preventing nerve damage from inadvertent insertion deep to the fascia. Full-thickness release of the plantar fascia at the ideal position could also be confirmed under ultrasound imaging. We discuss the technique for this new procedure.

PMID 24265989  Arthrosc Tech. 2013;2(3):e227-30. doi: 10.1016/j.eats.2・・・
著者: Mihir M Patel
雑誌名: Am J Orthop (Belle Mead NJ). 2015 Mar;44(3):107-10.
Abstract/Text Chronic plantar fasciitis is a major health care problem worldwide and affects nearly 10% of the US population. Although most cases resolve with conservative care, the numerous treatments for refractory plantar fasciitis attest to the lack of consensus regarding these cases. The emerging goals for this condition are a minimally invasive percutaneous intervention that is safe, effective, and well-tolerated and has minimal morbidity and a low complication rate. We conducted a prospective study in which patients were allowed either to continue with noninvasive treatment or to undergo focal aspiration and partial fasciotomy with an ultrasonic probe. This is the first report of a plantar fascia partial release guided by ultrasonic energy delivered by a percutaneously inserted probe under local anesthesia. The procedure appears to be a safe, effective, well-tolerated treatment for a condition that is refractory to other options.

PMID 25750942  Am J Orthop (Belle Mead NJ). 2015 Mar;44(3):107-10.
著者: Lucas Bader, Ken Park, Yang Gu, Martin J O'Malley
雑誌名: Foot Ankle Int. 2012 Jan;33(1):37-43. doi: 10.3113/FAI.2012.0037.
Abstract/Text BACKGROUND: The majority of cases of plantar fasciitis can be treated nonoperatively; however, a small number of patients remain refractory to nonoperative treatment and operative intervention is indicated. Historically, open treatment has been recommended, but more recently endoscopic plantar fasciotomy (EPF) has produced promising results.
METHODS: Forty-eight patients (56 feet) were identified who underwent endoscopic plantar fasciotomy. Forty-one patients (49 feet) were available for followup. There were 15 men and 26 women, with an average age of 53.8 (range, 42 to 68) years. The mean followup time was 49.5 (range, 6 to 142) months. An AOFAS Hind foot Scale was used for analysis. The influence of gender, duration of symptoms, severity of symptoms, and bilateral verses unilateral release were examined.
RESULTS: Pain resolved completely in 37 feet, decreased in 11 feet, and increased in one foot. The mean postoperative AOFAS Hindfoot score improved 39 points (54 to 93, p < 0.001). Patients with severe symptoms achieved higher mean improvement than the moderate symptom group (p < 0.0001). Patients with symptoms greater than 24~months trended towards lower mean improvement and lower post operative AOFAS Hindfoot scores. Both gender and laterality did not significantly influence outcome. There was one superficial infection, one third and fourth metatarsal stress fracture in the same patient, and transient lateral hindfoot pain in five patients.
CONCLUSION: EPF was an effective operation with reproducible results, low complication rate, and little risk of iatrogenic nerve injury with proper technique.

PMID 22381234  Foot Ankle Int. 2012 Jan;33(1):37-43. doi: 10.3113/FAI.・・・
著者: Rajesh Bazaz, Richard D Ferkel
雑誌名: Foot Ankle Int. 2007 May;28(5):549-56. doi: 10.3113/FAI.2007.0549.
Abstract/Text BACKGROUND: Conservative treatment for plantar fasciitis usually provides improvement, but some patients progress to surgery. Open release is most commonly performed but is associated with prolonged recovery and complications. Endoscopic plantar fascia release (EPFR) has become popular recently. We present our results.
METHODS: Twenty patients (23 feet) had EPFR. Sixteen patients (19 feet) were available for followup after at least 1 year. Ten were women and 6 were men, with an average age of 44.7 (range 28 to 70) years. The average followup was 47 months. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and Maryland Foot Score were used for evaluation. Gender, obesity, severity, length of preoperative symptoms, and workers compensation (WC) status were studied.
RESULTS: The average AOFAS and Maryland scores improved postoperatively (66 to 88, p<0.05; 62 to 83, p<0.05, respectively). Women improved 25 (AOFAS) and 23 points (Maryland) points. Men improved 16 (AOFAS) and 17 points (Maryland) points. Obese patients improved 38 and 28 points, respectively. Normal weight patients improved 16 and 19 points, respectively. Postoperative scores for patients with high preoperative severity improved from 58 to 81 (AOFAS) and from 52 to 73 (Maryland). Patients with moderate preoperative severity achieved scores from 72 to 93 and from 70 to 91. Patients who had symptoms longer than 2 years before EPFR had lower postoperative scores. Non-WC patients improved 25 (AOFAS) and 24 (Maryland) points. WC patients improved 18 and 16 points, respectively.
CONCLUSIONS: EPFR provides significantly improved patient outcomes. Patients with more severe symptoms before EPFR and those with symptoms for longer than 2 years had worse results. Obesity had no negative effect on outcome. WC patients had inferior results compared to non-WC patients. Women achieved better results than men. This finding may be biased because most WC patients were men.

PMID 17559761  Foot Ankle Int. 2007 May;28(5):549-56. doi: 10.3113/FAI・・・
著者: Manuel Monteagudo, Ernesto Maceira, Virginia Garcia-Virto, Rafael Canosa
雑誌名: Int Orthop. 2013 Sep;37(9):1845-50. doi: 10.1007/s00264-013-2022-2.
Abstract/Text PURPOSE: The purpose of this study was to compare results of partial proximal fasciotomy (PPF) with proximal medial gastrocnemius release (PMGR) in the treatment of chronic plantar fasciitis (CPF).
METHOD: This retrospective study compares 30 patients with CPF that underwent PPF with 30 that underwent isolated PMGR. Both groups were matched in terms of previous treatments and time from onset of symptoms to surgery. Different standardised evaluation scales (VAS, Likert, AOFASh) were used to evaluate results.
RESULTS: Plantar fasciotomy had satisfactory results in just 60 % of patients, with an average ten weeks needed to resume work and sports. Patient satisfaction in the PMGR group reached 95 %, being back to work and sports at three weeks on average. Functional and pain scores were considerably better for PMGR and fewer complications registered.
CONCLUSION: In our series, isolated PMGR is a simple and reliable procedure to treat patients with CPF. It provides far better results than conventional fasciotomy with less morbidity and better patient satisfaction, and thus has become our surgical procedure of choice in recalcitrant CPF.

PMID 23959221  Int Orthop. 2013 Sep;37(9):1845-50. doi: 10.1007/s00264・・・
著者: Craig R Lareau, Gregory A Sawyer, Joanne H Wang, Christopher W DiGiovanni
雑誌名: J Am Acad Orthop Surg. 2014 Jun;22(6):372-80. doi: 10.5435/JAAOS-22-06-372.
Abstract/Text Heel pain is commonly encountered in orthopaedic practice. Establishing an accurate diagnosis is critical, but it can be challenging due to the complex regional anatomy. Subacute and chronic plantar and medial heel pain are most frequently the result of repetitive microtrauma or compression of neurologic structures, such as plantar fasciitis, heel pad atrophy, Baxter nerve entrapment, calcaneal stress fracture, and tarsal tunnel syndrome. Most causes of inferior heel pain can be successfully managed nonsurgically. Surgical intervention is reserved for patients who do not respond to nonsurgical measures. Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution.

Copyright 2014 by the American Academy of Orthopaedic Surgeons.
PMID 24860133  J Am Acad Orthop Surg. 2014 Jun;22(6):372-80. doi: 10.5・・・
著者: Kelvin Tai Loon Chew, Darren Leong, Cindy Y Lin, Kay Kiat Lim, Benedict Tan
雑誌名: PM R. 2013 Dec;5(12):1035-43. doi: 10.1016/j.pmrj.2013.08.590. Epub 2013 Aug 22.
Abstract/Text OBJECTIVES: To evaluate the efficacy of autologous conditioned plasma (ACP) compared with extracorporeal shockwave (ESWT) and conventional treatments for plantar fasciitis.
DESIGN: Randomized trial.
SETTING: Sports medicine center in a tertiary care hospital.
PATIENTS: Fifty-four subjects (age range, 29-71 years) with unilateral chronic plantar fasciitis with more than 4 months of symptoms.
METHODS: Subjects randomized to 3 groups: 19 to ACP and conventional treatment (ACP group), 19 to ESWT and conventional treatment (ESWT group), and 16 to conventional treatment alone. Conventional treatment included stretching exercises and orthotics if indicated.
MAIN OUTCOME MEASUREMENTS: Outcomes were pain-Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasound plantar fascia thickness assessed at baseline before treatment and at 1 month, 3 months, and 6 months after treatment.
RESULTS: VAS, AOFAS ankle-hindfoot scale, and plantar fascia thickness improved in all groups. Significant VAS pain score improvements in the ACP group compared with conventional treatment at month 1 (P = .037) and for the ESWT group compared with conventional treatment at months 1, 3, and 6 (P = .017, P = .022, and P = .042). The AOFAS ankle-hindfoot scale score improved in the ACP group at months 3 and 6 (P = .004 and P = .013) and, for the ESWT group, at months 1 and 3 (P = .011 and P = .003) compared with conventional treatment. Significant improvements in plantar fascia thickness were seen in the ACP group at months 1 and 3 compared with conventional treatments (P = .015 and P = .014) and at months 3 and 6 compared with the ESWT group (P = .019 and P = .027). No adverse events reported.
CONCLUSIONS: Treatment of plantar fasciitis with ACP or ESWT plus conventional treatments resulted in improved pain and functional outcomes compared with conventional treatment alone. There was no significant difference between ACP and ESWT in terms of VAS and AOFAS ankle-hindfoot scale improvements, although the ACP group demonstrated greater reductions in plantar fascia thickness.

Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
PMID 23973504  PM R. 2013 Dec;5(12):1035-43. doi: 10.1016/j.pmrj.2013.・・・
著者: Ertuğrul Akşahin, Dağhan Doğruyol, Halil Yalçın Yüksel, Onur Hapa, Ozgür Doğan, Levent Celebi, Ali Biçimoğlu
雑誌名: Arch Orthop Trauma Surg. 2012 Jun;132(6):781-5. doi: 10.1007/s00402-012-1488-5. Epub 2012 Mar 8.
Abstract/Text INTRODUCTION: In this study, the results of local injection of platelet-rich plasma (PRP) and corticosteroids in the treatment of plantar fasciitis were compared.
PATIENTS AND METHODS: Sixty patients who were diagnosed as plantar fasciitis and treated conservatively for at least 3 months and had no response to conservative treatment modalities were involved in this study. The first 30 consecutive patients were treated by local injection of 2 mL of 40 mg Methylprednisolone with 2 mL of 2% prilocaine (metilprednizalone) and the second 30 patients were treated by injecting 3 mL PRP after 2 mL of 2% prilocaine injection. Patients were evaluated according to the modified criteria of the Roles and Maudsley scores and visual analog scale before injection and 3 weeks and 6 months following injection.
RESULTS: The mean VAS heel pain scores measured 6 months after treatment were 3.4 in steroid group and 3.93 in PRP group, and the scores in both groups were significantly lower when compared with pretreatment levels (6.2 in steroid group and 7.33 in PRP group). There was no significant difference between steroid and PRP groups in visual analog scale scores and modified criteria of the Roles and Maudsley scores measured at 3 weeks and 6 months (P > 0.05).
CONCLUSION: Our results revealed that both methods were effective and successful in treating plantar fasciitis. When the potential complication of corticosteroid treatment was taken into consideration, PRP injection seems to be safer and at least having same effectivity in the treatment of plantar fasciitis.

PMID 22399039  Arch Orthop Trauma Surg. 2012 Jun;132(6):781-5. doi: 10・・・

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