fascitis plantar: intervencionismo. posibilidades y evidencia
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Fascitis Plantar: intervencionismo.
Posibilidades y evidencia
José M. Climent
HGUAlicante
Sumario
Infiltraciones con fármacos y otras técnicas
Procedimientos y dianas terpéuticas
Sustancias y modalidades Corticoide
Proloterapia
Toxina
Hialuronato
Plasma rico en plaquetas
P seca
Radiofrecuencia
Otras
Corticoides
Cochrane Databaseof SystematicReviews
Injected corticosteroidsfor treatingplantar heel pain in adults
(Review)
David JA, Sankarapandian V, Christopher PRH, Chatterjee A, Macaden AS
David JA, Sankarapandian V, Christopher PRH, ChatterjeeA, Macaden AS.
Injected corticosteroids for treating plantar heel pain in adults.
CochraneDatabaseof SystematicReviews 2017, Issue6. Art. No.: CD009348.
DOI: 10.1002/14651858.CD009348.pub2.
www.cochranelibrary.com
Injected cort icosteroids for treat ing plantar heel pain in adults (Review)
Copyright © 2017The CochraneCollaboration. Published by John Wiley & Sons, Ltd.
2017
of confirmation of allocation concealment. With two exceptions, werated theavailableevidenceasvery low quality, implying in each
casethat weare ’very uncertain about theestimate’.
The39trialscovered18comparisons, with sixof theseven trialswith threeor four groupsprovidingevidencetowardstwocomparisons.
Eight trials(724 participants) compared steroid injection versusplaceboor no treatment. Steroid injection may lead to lower heel pain
visual analogue scores(VAS) (0 to 100; higher scores= worsepain) in theshort-term (< 1 month) (MD -6.38, 95% CI -11.13 to -
1.64; 350 participants; 5 studies; I² =65%; lowquality evidence). Based on aminimal clinically significant difference(MCID) of 8 for
averageheel pain, the95% CI includesamarginal clinical benefit. Thispotential benefit wasdiminished when datawererestricted to
threeplacebo-controlled trials. Steroid injection madenodifferencetoaverageheel pain in themedium-term(1to6monthsfollow-up)
(MD -3.47, 95% CI -8.43 to 1.48; 382 participants; 6 studies; I² = 40%; low quality evidence). Therewasvery low quality evidence
for no effect on function in themedium-term and for an absence of seriousadverseevents(219 participants, 4 studies). No studies
reported on other adverseevents, such aspost-injection pain, and on return to previousactivity. Therewasvery low quality evidence
for fewer treatment failures(defined variously aspersistent heel pain at 8 weeks, steroid injection at 12 weeks, and unrelieved pain at 6
months) after steroid injection.
Theavailableevidence for other comparisonswasrated asvery low quality. Weare thereforevery uncertain of theestimates for the
relativeeffectson peoplewith heel pain of steroidscompared with other interventionsin:
1. Tibial nerveblock with anaesthetic (2 trials); orthoses(4 trials); oral NSAIDs(2 trials); and intensivephysiotherapy (1 trial).
2. Physical modalities: ESWT (5 trials); laser (2 trials); and radiation therapy (1 trial).
3. Other invasiveprocedures: locally injectableNSAID (1 trial); platelet-rich plasmainjections(5 trials); autologousblood injections
(2 trials); botulinum toxin injections(2 trials); cryopreserved human amniotic membraneinjection (1 trial); localised pepperingwith
aneedle(1 trial); dry needling (1 trial); and mini scalpel needlerelease(1 trial).
We are also uncertain about theestimates from trials testing different techniquesof local steroid injection: ultrasonography-guided
versuspalpation-guided (5 trials); and scintigraphy-guided versuspalpation-guided (1 trial).
Anexploratoryanalysisinvolvingpoolingdatafrom21trialsreportingonadverseeventsrevealedtworupturesof plantar fascia(reported
in 1 trial) and threeinjection siteinfections(reported in 2 trials) in 699 participantsallocated tosteroid injection studyarms. Fivetrials
reported atotal of 27 participantswith lessseriousshort-term adverseeventsin the699 participantsallocated steroid injection study
arms. Reported treatmentswereanalgesia, iceor both. Given thehigh risk of selectivereporting for theseoutcomesand imprecision,
thisevidencewasrated at very low quality.
Authors’ conclusions
Wefound lowquality evidencethat local steroid injectionscompared with placebo or no treatment may slightly reduceheel pain up to
onemonth but not subsequently. Theavailableevidencefor other outcomesof thiscomparison wasvery low quality. Whereavailable,
theevidencefromcomparisonsof steroid injectionswith other interventionsused to treat heel pain and of different methodsof guiding
theinjection wasalsovery lowquality. Although seriousadverseeventsrelatingtosteroid injection wererare, thesewereunder-reported
and ahigher risk cannot beruled out.
Further research should focuson establishing theeffects(benefitsand harms) of injected steroidscompared with placebo in typical
clinical settings, subsequent to acourse of unsuccessful conservative therapy. Ideally, thisshould bepreceded by research, including
patient involvement, aimed to obtain consensuson thepriority questionsfor treatingplantar heel pain.
P L A I N L A N G U A G E S U M M A R Y
Steroid injectionsfor painful solesof heelsin adults
Review question
Wewanted to assesstheeffectsof injected steroidsfor treatingadultswith painful solesof heels(plantar heel pain).
Background
2Injected corticosteroidsfor treating plantar heel pain in adults(Review)
Copyright © 2017 The Cochrane Collaboration. Published by John W iley & Sons, Ltd.
Figure 4. Forest plot of comparison: 1 Local steroid injection versus placebo, outcome: 1.1 Heel pain
Pooled data from six trials showed slightly better pain scores at
short-term follow-up after steroid injection (MD -6.38, 95% CI
-11.13 to -1.64; 350 participants; I² = 65%; low quality evidence
downgraded one level for serious risk of bias and one level for
serious inconsistency and imprecision). Although the 95% CI
includes the 8 mm MCID, the clinical importance of this re-
sult is marginal. The trial results are dominated by Abdihakin
2012; using therandom-effectsmodel, which givesamoreequal
distribution of weights, shows an increased effect in favour of
steroid injection (MD -9.22, 95% CI -18.00 to -0.45; analysis
not shown). However, asensitivity analysispresenting data from
the four placebo-controlled trialsonly (thusremoving data from
Kriss2003 and McMillan 2012), showssteroid injection madeno
clear difference to heel pain in the short-term, the 95% CI now
including thelineof no effect (MD -4.21, 95% CI -9.43 to 1.00;
265 participants, I² = 41%; analysisnot shown).
At medium-term follow-up, pooled datafrom seven trialsshowed
no clear between-group differencesin heel pain (MD -3.47, 95%
CI -8.43 to 1.48; 382 participants; I² =40%; low quality evidence
downgraded one level for serious risk of bias and one level for
inconsistency and seriousimprecision). The95% CI included the
lineof no effect but also thepossibility of a marginally clinically
important reduction in pain after steroid injection. Restrictingthe
data to those from the placebo-controlled trials (thus excluding
data from Kriss 2003 and McMillan 2012) showed no benefit
from steroid injection in the medium-term (MD -2.34, 95% -
7.76 to 3.08; 297 participants; I² = 55%; analysisnot shown).
21Injected corticosteroidsfor treating plantar heel pain in adults (Review)
Copyright © 2017 The Cochrane Collaboration. Published by John W iley & Sons, Ltd.
Cortoicoide: otras versiones
Whittaker GA, Munteanu SE, Menz HB, Bonanno DR, Gerrard JM, Landorf KB. Corticosteroid injection for plantar heel pain: a
systematic review and meta-analysis. BMC Musculoskelet Disord. 2019 Aug 17;20(1):378.
Toxina vs corticoide
Díaz-Llopis IV, Rodríguez-Ruíz CM, Mulet-Perry S, Mondéjar-Gómez FJ, Climent-Barberá JM, Cholbi-Llobel F. Randomized controlled study of the efficacy of
the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months. Clin Rehabil. 2012 Jul;26(7):594-606.
Toxina seguimiento a 1 año
Díaz-Llopis IV, Gómez-Gallego D, Mondéjar-Gómez FJ, López-García A, Climent-Barberá JM, Rodríguez-Ruiz CM. Botulinum toxin
type A in chronic plantar fasciitis: clinical effects one year after injection. Clin Rehabil. 2013 Aug;27(8):681-5.
Proloterapia vs fisiológico/lidocaína
21
Table 2: Comparison of the clinical data of the groups
Control Prolotherapy pc Effect
size
Mean difference
(95% CI)
VAS-A
Median
(IQR)
Pre-
treatment
9 (8-10) 10 (9-10) 0.06
Week 7 5 (4-7) 1 (0-3) <0.001 2.41 -4.5(-5.4/-3.5)
Week 15 6 (4-8) 0 (0-2) <0.001 2.94 -5.4(-6.3/-4.4)
pa <0.001 (1>2=3) <0.001 (1>2=3)
VAS-R
Median
(IQR)
Pre-
treatment
7 (6-7) 7 (6-8) 0,47
Week 7 3 (2-4) 0 (0-1) <0.001 1.66 -2.6(-3.4/-1.8)
Week 15 3 (2-5) 0 (0-1) <0.001 2.11 -3.2(-4.0/-2.4)
pa <0.001 (1>2=3) <0.001 (1>2=3)
Control Prolotherapy pd Effect
size
Mean difference
(95% CI)
FFI -pain
Mean ± SD
(min-max)
Pre-
treatment
87.7 ± 17.1 (36-
100)
88.7 ± 10.9 (70-100) 0.78
Week 7 52.2 ± 24.3 (12-88) 11.4 ± 14.5 (0-56) <0.001 2.09 -41.8(-52.1/-31.4)
Week 15 54.5 ± 22.2 (25-89) 8.2 ± 12.3 (0-46) <0.001 2.48 -47.2(-57.0/-37.4)
pb <0.001 (1>2=3) <0.001 (1>2>3)
FFI -disability
Mean ± SD
(min-max)
Pre-
treatment
81.7 ± 16.3 (55-
100)
88.2 ± 11.1 (56-100) 0.08
Week 7 52.1 ± 23.8 (12-84) 7.4 ± 12.9 (0-45) <0.001 2.91 -51.1(-60.1/-42.0)
Week 15 53.1 ± 22.8 (14-90) 5.6 ± 10.2 (0-36) <0.001 3.09 -53.9(-63.0/-44.9)
pb <0.001 (1>2=3) <0.001 (1>2>3)
FFI -activity
Mean ± SD
Pre-
treatment
23.3 ± 11.3 (2-46) 28.0 ± 14.5 (2-60) 0.17
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
ACCEPTED
Mansiz-Kaplan B, Nacir B, Pervane-Vural S, Duyur-Cakit B, Genc H. Effect of Dextrose Prolotherapy on Pain Intensity, Disability and Plantar
Fascia Thickness in Unilateral Plantar Fasciitis: A Randomized, Controlled, Double-Blind Study. Am J Phys Med Rehabil. 2019 Oct 18.
PRP vs Proloterapia
Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar
fasciitis. PM R. 2014 Feb;6(2):152-8.
Resultados semejantes
PRP a largo plazo
Shetty SH, Dhond A, Arora M, Deore S. Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo
for Chronic Plantar Fasciitis: Randomized Control Trial. J Foot Ankle Surg. 2019 Jan;58(1):42-46.
Hialuronato
Kumai T, Samoto N, Hasegawa A, Noguchi H, Shiranita A, Shiraishi M, Ikeda S, Sugimoto K, Tanaka Y, Takakura Y. Short-term efficacy and
safety of hyaluronic acid injection for plantar fasciopathy. Knee Surg Sports Traumatol Arthrosc. 2018 Mar;26(3):903-911.
Otras
ORIGINAL PAPER
Effectiveness of polydeoxyr ibonucleotide injection versus normalsaline injection for treatment of chronic plantar fasciitis:a prospective randomised clinical tr ial
Jae Kwang Kim1&Jae Yoon Chung1
Received: 8 January 2015 /Accepted: 22 March 2015# SICOT aisbl 2015
Abstract
Purpose Polydeoxyribonucleotide(PDRN) hasbeen used for
the treatment of chronic tendinosis. This prospective
randomised study was conducted to evaluate the efficacy
and complicationsof PDRN injection for treatment of plantar
fasciitis.
Methods Forty patients with a clinical diagnosis of plantar
fasciitis were randomly allocated to PDRN injection (PDRN
group, n=20) or normal saline injection (placebo group, n=
20). Injections wereperformed weekly for threeweeks. Clin-
ical evaluations were doneat baselineand four and 12 weeks
after treatment began using the visual analogue scale (VAS)
for foot pain and Manchester-Oxford Foot Questionnaire
(MOXFQ). We also monitored the complications in both
groups at one, two, four and 12 weeks after initial treatment.
Results ThePDRN groupachievedasignificant improvement
in VASand MOXFQ scoresat four weeksafter treatment, and
this improvement continued until 12 weeks after treatment.
On theother hand, theplacebo group did not achieveasignif-
icant improvement in the VAS or MOXFQ scores at four or
12 weeks. The initial VAS and MOXFQ scores of the PDRN
group werenot significantly different from thoseof theplace-
bo group. At four weeks after treatment, the VAS and
MOXFQ scores of the PDRN group were better than those
of the placebo group, but the difference was not statistically
significant. At 12 weeks after treatment, the VAS and
MOXFQ scores of the PDRN group weresignificantly better
than those of the placebo group. We noticed no injection-
related complications, such as itching, urticaria, redness or
infection signs around the injection site in either group.
Conclusions PDRN injection is an effective and safe treat-
ment option and may beconsidered for plantar fasciitis.
Keywords Plantar fasciitis . Polydeoxyribonucleotide
Introduction
Plantar fasciitis is themost commonly reported cause of infe-
rior heel pain [1]. It is a frequent problem among peoplewho
practice sports regularly; however, it also has a high preva-
lence in the general population (3.6–10 % in the USA) [2].
The diagnosis of plantar fasciitis can be madeon the basis of
clinical assessment alone. Thepain ischaracteristically worse
during thefirst stepsupon getting up from bed in themorning
or after periods of inactivity [3]. It is also exacerbated by
prolonged standing, walking or sports. Although this condi-
tion iscommonly described asbenign and self-limiting, it can
lead to significant pain and disability for monthsor even years
[3, 4].
Conservative treatment is the mainstay of treatment of
plantar fasciitis, and a variety of conservative management
strategieshavebeen proposed for treatment of plantar fasciitis
[4]. Commonly usedconservativetreatment methodsfor plan-
tar fasciitis are nonsteroidal anti-inflammatory drugs, ortho-
ses/insoles, physical therapy, night splints and walking casts
[4, 5]. Any of these methods can be used alone, but multiple
methodscan beand areused ascombination therapy, and this
is a reason that comparison of results is difficult in the treat-
ment of plantar fasciitis [5]. These conservative management
methods are usually successful for the treatment of plantar
fasciitis. However, persistent or recurrent symptoms may
* JaeKwang Kim
kimjk@ewha.ac.kr
1 Department of Orthopedic Surgery, EwhaWomans University
School of Medicine, 911-1, Mok-5-dong, Yangcheon-gu, Seoul 158-
710, South Korea
International Orthopaedics (SICOT)
DOI 10.1007/s00264-015-2772-0
ORIGINAL ARTICLE
Autologous whole blood versus corticosteroid local injectionin treatment of plantar fasciitis: A randomized, controlledmulticenter clinical tr ial
Afshin kar imzadeh1&Seyed Ahmad Raeissadat 2
&Saleh Erfani Fam3&
Leyla Sedighipour 3&Arash Babaei-Ghazani 4
Received: 13 April 2016 /Revised: 8 October 2016 /Accepted: 11 November 2016# International League of Associations for Rheumatology (ILAR) 2016
Abstract Plantar fasciitis is the most common cause of
heel pain. Local injection modalities are among treatment
options in patients with resistant pain. The aim of the
present study was to evaluate the effect of local autolo-
gous whole blood compared with corticosteroid local in-
jection in treatment of plantar fasciitis. In this randomized
controlled multicenter study, 36 patients with chronic plan-
tar fasciitis were recruited. Patients were allocated random-
ly into three treatment groups: local autologous blood,
local corticosteroid injection, and control groups receiving
no injection. Patients were assessed with visual analog
scale (VAS), pressure pain threshold (PPT), and plantar
fasciitis pain/disability scale (PFPS) before treatment, as
well as 4 and 12 weeks post therapy. Variables of pain
and function improved significantly in both corticosteroid
and autologous blood groups compared to control group.
At 4 weeks following treatment, patients in corticosteroid
group had significantly lower levels of pain than patients
in autologous blood and control groups (higher PPT level,
lower PFPS, and VAS). After 12 weeks of treatment, both
corticosteroid and autologous blood groups had lower av-
erage levels of pain than control group. The corticosteroid
group showed an early sharp and then more gradual im-
provement in pain scores, but autologous blood group had
a steady gradual drop in pain. Autologous whole blood
and corticosteroid local injection can both be considered
as effective methods in the treatment of chronic plantar
fasciitis. These treatments decrease pain and significantly
improve function compared to no treatment.
Keywords Autologouswholeblood .Corticosteriod .Plantar
fasciitis
Introduction
Plantar fasciitis (PF) is the most common cause of heel pain
[1, 2]. Thiscondition ischaracterized by pain at thecalcaneal
origin of the plantar fascia, exacerbated by weight bearing,
also the initial stage of active dorsiflexion and hallux exten-
sion after prolonged periods of rest [3, 4].
A conservativemanagement isusually preferred in theinitial
treatment of PF [1–4]. Common conservative treatment modal-
ities includemodification in daily activities, applying orthoses,
stretching exercises, taping, and non-steroidal anti-inflammato-
ry drugs (NSAID) [5, 6]. Other conservative strategies include
physical agent modalities such as extra corporeal shockwave
therapy [7], low-level laser therapy [6, 8], myofascial release[6,
9] acupuncture [10], and dry needling [5].
PF is a disabling disease in its chronic form [11, 12]. It is
widely believed that plantar fasciitis is a degenerative tissue
condition of the plantar fascia rather than an inflammation [4],
which ischaracterized by microtearsand necrosisof theplantar
fascial ligament and intrinsic flexor muscles of the foot at their
* Seyed Ahmad Raeissadat
a_raeissadat@sbmu.ac.ir
1 Department of Physical Medicineand Rehabilitation, Imam Hossein
Educational Hospital, School of medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran
2 Shahid Modarres Hospital, Physical Medicine and Rehabilitation
Research Center, School of medicine, Shahid Beheshti University of
Medical Sciences, Tehran, Iran
3 Physical Medicineand Rehabilitation Research Center, School of
medicine, Shahid Beheshti University of Medical Sciences,
Tehran, Iran
4 Rasoul-e-Akram Hospital, School of medicine, Iran University of
Medical Sciences, Tehran, Iran
Clin Rheumatol
DOI 10.1007/s10067-016-3484-6
https://doi.org/10.1177/1071100718788549
Foot & Ankle International ®
2018, Vol. 39(10) 1151 –1161
© The Author(s) 2018
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/1071100718788549
journals.sagepub.com/home/fai
Article
Inflammation of the plantar fascia, or plantar fasciitis, is a
common condition. In the United States, approximately 1
million outpatient visits are made annually for plantar fasci-
itis.16 Plantar fasciitis is characterized by classic signs of
inflammation, including pain, swelling, and loss of func-
tion. It frequently presents as heel pain that is most severe
during the first few steps after prolonged inactivity or is
exacerbated by increased activity. A diagnosis of plantar
fasciitis is generally based on patient-reported symptoms,
history, and physical examination.
Historically, plantar fasciitis was believed to be a chronic
inflammatory condition. However, recent histopathologic
788549FAIXXX10.1177/1071 100718788549 Foot & Ankle International Cazz ell et alresear ch-article 2018
1Limb Preservation Platform, Inc, Fresno, CA, USA2Timonium Foot & Ankle Center, Timonium, MD, USA3Coastal Podiatry Center, Virginia Beach, VA, USA4Union Memorial Hospital, Baltimore, MD, USA5Southern Arizona VA Health Care System, Tuscon, AZ, USA6Baylor / Scott & White Podiatry Center, Temple, TX, USA7Center for Clinical Research, Inc, Castro Valley, CA, USA8MedStar Union Memorial Hospital, Baltimore, MD, USA
Corresponding Author:
Stuart D. Miller, MD, MedStar Union Memorial Hospital, 3333 North
Calvert Street, Johnson Professional Building, Suite 400, Baltimore,
MD 21218, USA.
Email: stubonedoc@aol.com
Randomized Controlled Trial of Micronized Dehydrated Human Amnion/Chorion Membrane (dHACM) Injection Compared to Placebo for the Treatment of Plantar Fasciitis
Shawn Cazzell, DPM 1, Jordan Stewart, DPM 2, Patrick S. Agnew, DPM 3, John Senatore, DPM4, Jodi W alters, DPM 5, Douglas Murdoch, DPM 6, Alex Reyzelman, DPM 7, and Stuart D. Miller, MD 8
Abstract
Background: Failure of conservative management to reduce/eliminate symptoms of plantar fasciitis (PF) may indicate
need for advanced treatments. This study reports Level 1 evidence supporting 3-month safety and efficacy of micronized
dehydrated human amnion/chorion membrane (dHACM) injection as a treatment for PF.
Methods: A prospective, single-blind, randomized controlled trial was conducted at 14 sites in the United States. Subjects
were randomized to receive 1 injection, in the affected area, of micronized dHACM (n=73) or 0.9% sodium chloride
placebo (n=72). Safety/efficacy assessments were conducted at 4 weeks, 8 weeks, 3 months, 6 months, and 12 months
postinjection, using visual analog scale (VAS) for pain, Foot Function Index–Revised (FFI-R) score, and presence/absence of
adverse events. Primary outcome was mean change in VAS score between baseline and 3 months expressed as difference
in means for treatment versus control subjects. Secondary outcome was mean change in FFI-R score between baseline and
3 months expressed as difference in means for treatment versus control subjects.
Results: Baseline VAS scores were similar between groups. At the 3-month follow-up, mean VAS scores in the treatment
group were 76% lower compared with a 45% reduction for controls (P < .0001), FFI-R scores for treatment subjects had
mean reduction of 60% versus baseline, whereas control subjects had mean reduction of 40% versus baseline (P = .0004).
Of 4 serious adverse events, none were related to study procedures.
Conclusion: Pain reduction and functional improvement outcomes were statistically significant and clinically relevant,
supporting use of micronized dHACM injection as a safe and effective treatment for PF.
Level of Evidence: Level I, prospective randomized trial.
Keywords: dehydrated human amnion/chorion membrane, chronic pain, plantar fasciitis
Otras
¿Qué
tratamiento es
mejor?
Yang WY, Han YH, Cao XW, Pan JK, Zeng LF, Lin JT, Liu J. Platelet-rich plasma as a treatment for plantar fasciitis: A
meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017 Nov;96(44):e8475.
¿Qué tratamiento es mejor?
Whittaker GA, Munteanu SE, Menz HB, Bonanno DR, Gerrard JM, Landorf KB. Corticosteroid injection for plantar heel pain: a
systematic review and meta-analysis. BMC Musculoskelet Disord. 2019 Aug 17;20(1):378.
Network metanálisis
SUCRA: Surface under acumulative curve. 0-100. Más cerca de 100, mejor tratamiento
Network metanalysis
Tsikopoulos K, Vasiliadis HS, Mavridis D. Injection therapies for plantar fasciopathy ('plantar fasciitis'): a systematic review and
network meta-analysis of 22 randomised controlled trials. Br J Sports Med. 2016 Nov;50(22):1367-1375. doi: 10.1136/bjsports-2015-095437.
El efecto temporal
0
1
2
3
4
5
6
7
8
Previo 1 mes 3 mes 6 mes 12 meses
24 m 36 m
O Choque (n = 39)
Corticoide (n = 40)
PRP (n = 39)
Proloterapia (n = 40
3 inyecciones (o sesiones) de cada modalidad
Uğurlar M, Sönmez MM, Uğurlar ÖY, Adıyeke L, Yıldırım H, Eren OT. Effectiveness of Four Different Treatment Modalities in the Treatment of
Chronic Plantar Fasciitis During a 36-Month Follow-Up Period: A Randomized Controlled Trial. J Foot Ankle Surg. 2018 Sep - Oct;57(5):913-918.
Punto de inyección
Gurcay E, Kara M, Karaahmet OZ, Ata AM, Onat ŞŞ, Özçakar L. Shall We Inject Superficial or Deep to the Plantar Fascia? An
Ultrasound Study of the Treatment of Chronic Plantar Fasciitis. J Foot Ankle Surg. 2017 Jul - Aug;56(4):783-787.
VAS
Combinación de tratamientos
Celik D, Kuş G, Sırma SÖ. Joint Mobilization and Stretching Exercise vs Steroid Injection in the Treatment of
Plantar Fasciitis: A Randomized Controlled Study. Foot Ankle Int. 2016 Feb;37(2):150-6.
Mejor ecoguiado
Li Z, Xia C, Yu A, Qi B. Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis.
PLoS One. 2014 Mar 21;9(3):e92671.
Mejor ecoguiado
Li Z, Xia C, Yu A, Qi B. Ultrasound- versus palpation-guided injection of corticosteroid for plantar fasciitis: a meta-analysis.
PLoS One. 2014 Mar 21;9(3):e92671.
Procedimientos sin fármacos
Punción seca: músculos diana
Cotchett MP, Munteanu SE, Landorf KB. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Phys
Ther. 2014 Aug;94(8):1083-94
30 % de efectos
adversos:
• Hematomas
• Repuntes de dolor
Punción seca
ORIGINAL PAPER
Comparison of dry needling and steroid injection in thetreatmentof plantar fasciitis: a single-blind randomized clinical tr ial
Shirvan Rastegar 1,2&Sadegh Baradaran Mahdavi 3,4,5
&Babak Hoseinzadeh1,2,5&
Sajad Badiei 1,5
Received: 17 February 2017 /Accepted: 27 October 2017# SICOT aisbl 2017
Abstract
Introduction Plantar fasciitis isacommon causeof heel pain.
Considering different interventions which are applied for pa-
tientswith plantar fasciitis, dry needling isproposed asanew
modality of treatment recently. The aim of this study is to
evaluatetheeffectivenessof dry needling versussteroid injec-
tion for plantar fasciitis.
Methods Sixty-six patients were recruited to this single-
blind clinical trial study. Participants were randomly al-
located to receive 1 ml (40 mg) of Depo-Medrol (meth-
ylprednisolone acetate) or dry needling. They were
followed up for 12 months and monitored for total per-
ception of pain using the visual analogue scale (VAS),
with data obtained in baseline and at three weeks, six
weeks, three months, six months and one year after
treatment.
Results Mean VAS score before treatment was 6.96 ±
0.87 for the steroid group and 6.41 ± 0.83 for the
dry-needling group (P value = 0.54). Steroid injection
reduced VAS scores rapidly until three weeks after treat-
ment compared with dry needling (0.32 ± 0.71 and 3.47
± 1.32, respectively; P value < 0.001). However, pa-
tients who were underwent dry needling reported lower
VAS scores at the end of follow-up compared with the
steroid group (0.69 ± 0.93 and 2.09 ± 1.58, respective-
ly; P value = 0.004). Over the long term, 82.3% and
17.6% of changes in pain were contributed to time since
treatment and treatment method, respectively (P values
< 0.001).
Conclusions Steroid injection can palliate plantar heel pain
rapidly but dry needling can providemoresatisfactory results
for patients with plantar fasciitis in the long term.
Keywords Dry needling .Steroidinjection .Plantar fasciitis .
Plantar heel pain
Abbreviations
FHSQ Foot Health Status Questionnaire
MSN Miniscalpelneedle
MTrP Myofascial trigger points
VAS Visual analoguescale
Introduction
Plantar fasciitis (plantar heel pain) as a common cause
of plantar pain has been associated with lower quality
* Babak Hoseinzadeh
Babak.med85@gmail.com
Shirvan Rastegar
shirvani295@gmail.com
Sadegh Baradaran Mahdavi
Sadegh.b.mahdavi@gmail.com
Sajad Badiei
sajad.badiei.md@gmail.com; s_badiei@edc.mui.ac.ir
1 Department of Orthopaedics, School of Medicine, Isfahan University
of Medical Sciences, Isfahan, Iran
2 Department of Orthopaedic Surgery, Al-ZahraTeaching Hospital,
Sofeh St, Isfahan, Iran
3 Department of Physical Medicine and Rehabilitation, School of
Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Physical Medicine and Rehabilitation, Al-Zahra
Teaching Hospital, Sofeh St, Isfahan, Iran
5 StudentsResearch Committee, Isfahan University of Medical
Sciences, Isfahan, Iran
International Orthopaedics (SICOT)
https://doi.org/10.1007/s00264-017-3681-1
Radiofrecuencia pulsada
Li X, Zhang L, Gu S, Sun J, Qin Z, Yue J, Zhong Y, Ding N, Gao R. omparativeeffectiveness of extracorporeal shock wave, ultrasound, low-level laser therapy, noninvasive interactive
neurostimulation, and pulsed radiofrequency treatment for treating plantar fasciitis: A systematic review and network meta-analysis. Medicine (Baltimore). 2018 Oct;97(43):e12819.
Resultados pobres
Radiofrecuencia del nervio tibial posterior
Wu YT, Chang CY, Chou YC, Yeh CC, Li TY, Chu HY, Chen LC. Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial
Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis. Arch Phys Med Rehabil. 2017 May;98(5):964-970.
• PRF stimulation
was applied for 120
seconds at 2Hz,
with a 30-
• 0.5mL of 2%
lidocaine was
injected around the
PTN
EPI
Fernández-Rodríguez T, Fernández-Rolle Á, Truyols-Domínguez S,Benítez-Martínez JC, Casaña-Granell J. Prospective
Randomized Trial of Electrolysis for Chronic Plantar Heel Pain. Foot Ankle Int. 2018 Sep;39(9):1039-1046.
Cómo cambia la evidencia...
Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of
diagnosis and therapy. Am Fam Physician. 2005 Dec 1;72(11):2237-42. Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019 Jun
15;99(12):744-750.
Técnicas de inyección
Dianas terapéuticas
Dianas terapéuticas
Fasciales
Miofasciales
Nervios
Ligamentos
Fascia vía posterior
Fascia vía medial
Miofascial: flexor digitorum
brevis y fascia media
FDB
Fascia
Miofascial: gastrocnemius medialis
Miofascial: soleus
Miofascial:Abductor hallucis
Miofascial: quadratus plantae
Nervio Tibial posterior y ramas
Nervio tibial posterior: bloqueo
Nervio: ramas tibial posterior
Nervio: rama calcánea
inferior (Baxter)
Ligamentos: Calcáneo escafoideo (Spring)
Astrágalo STalli
Esc
TTP
Spring
Para recordar, intervencionismo en fascitis:
Hay evidencia de eficacia:
Corto plazo: Corticoide
Largo plazo: Toxina, PRP
Otras alternativas en estudio
Probablemente los tratamientos multimodales sean más
eficaces
Cada paciente presenta dianas terapéuticas alternativas
que pueden ayudar a resolver casos refractarios
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