Does the self-limiting condition of plantar fasciitis necessitate intrusive management techniques?

¹Department of Orthopaedics, All India Institute of Medical Sciences, Rajkot (AIIMS Rajkot), Gujarat, India, ²Department of Anatomy, All India Institute of Medical Sciences, Rajkot (AIIMS Rajkot), Gujarat, India, ³Department of Radiology, All India Institute of Medical Sciences, Rajkot (AIIMS Rajkot), Gujarat, India

^&Corresponding author
Sundip Charmode, Department of Anatomy, All India Institute of Medical Sciences, Rajkot (AIIMS Rajkot), Gujarat, India

Introduction    

Plantar fasciitis, a multifactorial enthesopathy that is primarily degenerative in nature, is characterized by inflammation of both the perifascial tissues surrounding the plantar fascia (PF) and its origin at the medial calcaneal tuberosity. It can be caused by trauma or other complex conditions, but it commonly comes from an overuse injury that is typically caused by a repetitive strain that causes PF microtears. Becker et al. 2018 and Ling et al. 2018 in their respective studies stated that risk factors for plantar fasciitis include obesity, heel pad atrophy, aging, extended weight-bearing or standing, pes planus, pes cavus, heel spurs, tight gastrocnemius, soleus, and/or other posterior leg muscles, as well as occasionally seronegative spondyloarthropathies [1,2]. Orchard, 2012 in their trail stated that the absence of inflammatory cells in this condition makes it stand out despite the suffix "itis" in the diagnosis [3].

Research work done at National and International level: researchers across the globe have explored several methods of management of plantar fasciitis both aggressively: (Sharma et al. 2023) [4]; and conservatively notably; (Salehi et al. 2023) [5]; (Thong-On et al. 2023) [6]; (Thammajaree et al. 2023) [7]; (Raissi G et al. 2023) [8]; (Şah et al. 2023) [9]; (Fouda et al. 2023) [10].

Methods     

A scoping review of publications on the topic of plantar fasciitis treatment was conducted using PubMed and Medline databases using the MeSH terms like Plantar Fascia, Non-invasive, and invasive treatment. The initial filters applied were of English language and human subjects. Forty-one (41) publications were found in the initial survey. After the application of inclusion and exclusion criteria, eight (8) clinical trials were shortlisted for synthesis in this study.

Inclusion criteria for review: clinical trials on invasive and non-invasive modalities of treatment of plantar fasciitis. Only publications in the English language and full and free online articles were included. Articles published between 1^st January 2023 and 31^st May 2023 were included.

Exclusion criteria for review: publications other than clinical trials were excluded. Abstracts and paid articles were excluded. Clinical trials focusing on conditions other than plantar fasciitis were excluded. Articles published before 1^st January 2023 and after 31^st May 2023 were excluded.

Data collection tools: a data extraction form/checklist was formulated by all the authors and was used to extract the desired data from the shortlisted articles. The data extraction was done by only two reviewers (AM and SC) from all eight articles using the checklist. Disagreements were addressed through dialogue and the participation of a third independent reviewer (SM). The data collected were regarding the modality of treatment, whether invasive or non-invasive; the procedure of treatment; which patients will benefit from the modality and which patients will not benefit; and the relative cost of the modality of treatment.

Data entry and analysis: information extracted using the data extraction sheet or checklist was tabulated in Table 1.

Ethical considerations: ethical approval is not required for the review study of articles on databases. Ethical approval was however sought for the observational prospective survey of patients reporting with plantar fasciitis in the orthopedic out patient department (OPD) of the Institute.

Results     

Out of the eight clinical trials, one trial was conducted on a comparison of the effect of platelet-rich plasma, ozone, and cortisone injections on sinus tarsi syndrome, hence was excluded from this study. Out of the remaining seven clinical trials, five clinical trials studied or compared the effect of various non-invasive modalities in plantar fasciitis patients, whereas, two trials studied and compared the effect of invasive modalities of treatment in plantar fasciitis. One trial: compared the effect of platelet-rich plasma versus corticosteroid injection [4]; one trial: studied and compared the effect of Ultrasound dextrose injection versus corticosteroid injection in chronic PF [8]; one study compared the effect of radial extracorporeal shock therapy versus high-intensity laser therapy in PF patients [7]; one trail; studied the effects of customized insoles with medial wedges on lower extremity kinematics and ultrasonographic findings in plantar fasciitis persons [6]; one randomized control trail compared the effects 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 [5]. The various modalities of management of plantar fasciitis are summarized in Table 1.

Discussion     

Problem statement: plantar fasciitis is a self-limiting condition, for which a lot of intervention has been tried from time to time but without reliable and reproducible results.

Current scenario in developing countries: currently, treatment protocols in developing countries is being guided and based on the research and recommendation published by surgeons across the globe. The most common interventions used at present are Insoles, steroid injections, and various physio therapeutic modalities. More commonly, surgeons in rural as well as urban centres adhere to more aggressive management of plantar fasciitis, which is not required in most of cases. Hence, patients either revert with relapse or with complications like heel pad atrophy, fascial rupture, etc. Moreover, an aggressive line of management puts additional financial brunt on the patient, which actually is not required at all. With the aim to promote a non-invasive manner of management and propose conservative, non-invasive, physical therapy through a patient care program that is being run at our OPD.

Authors proposition: to counter the above practice in the medical field, a patient care program was initiated and is currently undergoing in the Outdoor Patient Department of Orthopedics. This program aims to promote conventional, non-invasive modalities of management to the patients reporting plantar fasciitis. This program was commenced based on the conclusions of an ongoing observational prospective survey of patients presenting with plantar fasciitis in the orthopedic department. The algorithm on the basis of which patients reporting with plantar fasciitis were treated at the Institute is mentioned below (Figure 1).

Conclusion     

Since it´s a self-limiting condition, so an approach to wait and watch and avoid aggravating conditions will be more appropriate in most of the conditions. The physical measure which is worth recommending and is physiological is log roll exercise and plantar stretching exercise.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

Abhishek Kumar Mishra: conceptualization, and drafting; Sundip Hemant Charmode: conceptualization, design and drafting the manuscript; Akshat Gupta: conceptualization, and design; Vishwa Chauhan, Simmi Mehra: interpretation of radiological aspects. All the authors have read and agreed to the final manuscript.

Acknowledgments     

We wish to extend our gratitude to our Respected Executive Director Sir for constantly motivating and guiding us for initiating research projects and publications.

Table and figure     

Table 1: list of currently available modalities of management of plantar fasciitis

Figure 1: algorithm for screening of patients presenting with pain in plantar aspect of the heel and sole

References